310078_INSPECTIONS_20171231

DivisiontotaterriKesourcesi,
FsCility Number _ ` 0 D is on of.Soll and Water, Canservationa�
Type of Visit: Com ' nce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Po O Departure Time: County: Region:
Farm Name: `-' Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: v �/ Integrator:
Certified Operator: Certification Number: 4 q
Back-up Operator: Certification Number:
Location of Farm:
awme- et;
Wean to Finish [Laye
n to Feeder
Non-
eeder to Finish
Farrow to Wean
._
�< :.�` •»`:;
Farrow to FeederM
Farrow to Finish
Lave:
Latitude:
jBoars ? Pullets
Turkeys
Other Turkey Poults
Other b Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cow
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes W�N
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Ej No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
dNo ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
15 No D 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 hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No, ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes D,Xo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Flo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [` No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ei/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes []�No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes l_ i" `V
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[-]Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [J"No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: q- Date of inspection: 3 3
17
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EfNo ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ es
❑ 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 [ r d ?
first
r 2 I/ -7/(6
List structure(s) and date of 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 ❑�1GA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0-<o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E],W
❑ 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
Zj 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
KO
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
`�
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F]/Ko'
❑ NA
❑ NE
0 el
!
�� f <. re.Gorls rr~-Gt �•-.+f �-QP�' �q �%r�1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:-^-{a`�[ /� T
Page 3 of 3
Phone: 7 _-) v�
Date: 3 t�
21412015

Division of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency u/
type of Visit: Cotn lianee Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Zeason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I Departure Time: O Q County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: 54--- - G
Certified Operator:
Phone:
Integrator:
Certification Number: rQ _Q 1-4 S
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Wean to Finish
WSan to Feeder
feeder to Finish
T 92r
96
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Caoacitv POD.
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes io ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[:]NE
❑ Yes [:]No
❑ Yes I
❑ Yes NNoo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facilkty Number: _ 7
jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D" No ❑ NA D 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: [j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -Z S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3-N-
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E),iQo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑`t�ro—
❑ 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
I__I No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[f No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[2-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ 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
En —No
[DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
l6. 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
ED 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
�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
ONo
❑ 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
[D-No
❑ NA
❑ NE
23. 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: -�?_
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3]1qo ❑ NA ❑ NE
0th
the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑/ "�To❑ NA ❑ NE
e 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 [a -go— [] 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 To , ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
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
I —I Ah
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?
❑ Yes
[D No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E3 No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑NA ❑NE
❑NA ❑NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
[] NA ONE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to betfer explain situation`s (use additional pages as necessary).
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
sa v t (� (/,,7`' - r- l
V0 77o zr G s--
Phone: T F 0 7Q C 73�Y
Date: 7 Ile,
21412015

Facility Number 4 -I eo
UDivision of Water Resources
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Com - ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 77"1 Arrival Time: Q n o Departure Time: Q - 0-1 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: D/ a r F 1e //
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Wean to Finish
W "to Feeder
feeder to Finish
1 Z
9 7n P
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dg Poultt Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharizes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discbarge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes V:fNo ❑ NA ❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ' NA ❑ NE
❑ q`N7
Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

jFaAity Number: - 7 Date of Inspection: z y
Waste Collection & Treatment
4'. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ED K-o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0"No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes []'—No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No NA
❑ NE
maintenance or improvement?
J 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):
l4. 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
F�_Now
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[3 o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ID 10
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ET'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements 00ther-
21. Does record keeping need improvement? if yes, check the,appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Zaste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
Rainfall 0 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes r!j No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Favili Number: 21- Date of Ins ection:
y Did the facility fail to calibrate waste application equipment as required by the permit? 0 Yes ❑ No ❑ NA ❑ NE
s the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ff 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 ❑-<o- ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [j No 0 NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ET'No
❑ NA
❑ NE
Comments (refer to,n #):-;Explain. any -YES answers and/or, any additional recommendations or any other comments
Use drawings of facE[tty,,to Better-explaln.situahons
.
_ (use.addiho.nal:pa�esas,necessary}.;„
3/ u'SS C ems,
! 1, S7 LID 2_n � `�/W ?n l s
R-e PIG c e boi r ! Arr ev—t b /-/�.
O,, ! O ✓l� w , (,wit 57� 19,
C 9i 4"+ `JQe k"-,A �- 94 w,'lk ;P-(l�23
cPMes e -OcCcI %r ki., JAG S,,,r�e� �� �� -�� ► e_
zG oT-c G�C� �i.to`�Uj62n
PI
Reviewer/]nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
`l�---'e(
Phone: 1 ! n 73 6 7 3�
Date: Zf � y 1 l y
21412015

r
Grbivision of Water Resources
Facility Number - d l O Division of Soil and Water Conservation
O Other Agency
Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Q, routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:'—=��--> � Arrival Time: Departure Time: 000 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
eederto Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Discharees and Stream Impacts
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer I +— I
Non -La er
Design Current
jury rounry
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation? ❑ Yes [?"No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes g �No ❑ NA ❑ NE
of the State other than from a discharge?
Pagel of 3 21412015 Continued
1_

Facility Number: - Date of Inspection: IMPC
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:_ �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zoo 3
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 Io ❑ 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 env' onmental 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 E(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 JJJ No C ] 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 [�IE
D 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
•E�fNE�
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
fo
❑ NA
e
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
E�NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
[�E
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[] No
❑ NA
I _I <E
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
E]"NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
[NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ 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
0E
"NNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
Page 2 of 3 21412015 Continued

r
Acili Number: 1- Date of inspection: � /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA TE
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 ❑ N NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑Yes
[:]No
❑NA
4�3E
❑ Yes
to
❑ NA
❑ NE
dNE
[:]Yes
❑ No
❑ NA
❑ Yes
❑ No
❑ NA
[3/NE
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? 's
❑No
[✓ /NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? Vyes
❑ No
❑ NA
ONE
Comments (refer .to question #) . Explain any: YES answers and/or any additional-recommendationsor anpther.comipents:
Use drawings of facility to better'explai-nsituations°(use additional pages as, necessary):._
4
(lw�' Cou (�te�0.1�, t,r}�e +S Sic �� Qle clKvc� �v,••,`sJ,'a� !�e�
A 6����,�.
nee a+ -cn+�o +Ltr L,:fre Cr4 A-q 0,,,4- [oc(. 9 r�[s1� Cat, e' ;
S7 O lS cro �,1�� , �p �IRCF soi �w+ �� rGSS G0 G".
�0 37�oP e rc5d•on 4�'���/
pw�/%r z
L," ( ( g_t eokir— 61(9,— kto
5A L.—r� 4 '/, f-' / +- ��
Reviewer/Inspector Name: �y 1 1 go _- {C
Phone
Reviewer/Inspector Signature: �(/ ''l Date:
Page 3 of 3
1(9-7
71 z /s-
21412015

(O Division of Water Quality � . ; ,
Facility Number ® 0 Division of Soil and Water .
- Division ' er Conservation
0, Other Agency
Type of Visit: 7Routinc
pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3d Departure Time: County: �U�N_ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
`- Phone:
Onsite Representative: ?PrVVxa_ 2ELX_, Integrator:
Certified Operator: Certification Number: 11164
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
I( Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop.
L_jLaXer
Non -La er
Design,' Current
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Cattle
Design ,Current...
Capacity ' Pop.:
Dairy Cow
Daiai Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1I
1. Is any discharge observed from any part of the operation?
[:]Yes
❑Ao
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
j 0
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: (Paq
Waste• Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d�
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 env' nmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ NNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
[�/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
[DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
VNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EN❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2 ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N ❑ 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 o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wo ❑ 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 o ❑ 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 [,(No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: q.
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ZN.9
NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes [] 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 C7<0 ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes ID4 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signature:
Page 3 of 3
[:]Yes �No [] NA [] NE
[] Yes 2/No NA [:] NE
Yes 0"No NA ❑ NE
Yes [3'*No ❑ NA ❑ NE
Yes
Yes
Yes
jz�No NA NE
ZINO NA NE
F2/No ❑ NA NE
Date: (a aql &
a
21412011

I/
}
Facility Number
Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency=
E
sit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
r Visit autine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / / Arrival Time: ' ep rture Time: f? ounty: Region
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: , 'C %�
Certified Operator:
Back-up Operator:
Location of Farm:
Swm" e
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Phone No:
Integrator: _ �-IR
Operator Certification Number:
Back-up Certification Number:
Latitude: � o �' = Longitude: � o =1 =
Design Current Design; ;. Current .. .Design ` ..
r
Capacity Population Wet Poultry Capacity Population Cattle ,e ` Capacity P'_
xJL Non -Layer I I
-Dry Poultry
Non-L.
Pullets
❑ TurkeyPoults
❑ Other ❑ 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?
❑ DairyCow
Division of Water Quality
Q Division of Soil and Water Conservation
O Other Agency=
E
sit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
r Visit autine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / / Arrival Time: ' ep rture Time: f? ounty: Region
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: , 'C %�
Certified Operator:
Back-up Operator:
Location of Farm:
Swm" e
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Phone No:
Integrator: _ �-IR
Operator Certification Number:
Back-up Certification Number:
Latitude: � o �' = Longitude: � o =1 =
Design Current Design; ;. Current .. .Design ` ..
r
Capacity Population Wet Poultry Capacity Population Cattle ,e ` Capacity P'_
xJL Non -Layer I I
-Dry Poultry
Non-L.
Pullets
❑ TurkeyPoults
❑ Other ❑ 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?
❑ DairyCow
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
'Numbpr.c
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 KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ Yes
JW%To
�No
❑ NA
❑ NE
❑ Yes
ON.
❑ NA
❑ NE
Page 1 of 3
12/28104 Continued

Facility Number: t- Date of inspection:
c Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 7 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes P No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[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
(2 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?
0Yes
0No
❑ 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
[!I No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
0 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes
JZ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2 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
Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box b W. ❑ Yes E No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis f ❑ loil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 6vonthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes C? -No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes `Y No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

I le
Facili Number: - �- Date of Ins ection- l
24. ad the facility fail to calibrate waste application equipment as required by the permit?
Yes
❑ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ICJ 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
[allo
❑ 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 GAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Comments (refer, to question #): Explain any YE& answers and/or any additional recommei
❑ Yes P No
❑ NA
❑ NE
❑ Yes Te3 No
❑ NA
❑ NE
❑ Yes ?] No
❑ NA
❑ NE
❑ Yes allo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
[;2'No
❑ NA
❑ NE
❑ Yes
C' No
❑ NA
❑ NE
Use drawings of facility to better explain situations (use additional pages as necessary).,,,:_ _x
co 7 vs 16 6rt
! k!* � a Berl Pl;'/Lsrcr.-v.'
F'r'M & ,fie CVr ds look- zparr
7 C4-
�l) lVa CQ//hl4-f l yXJ fo7( eqQle�2. %�/ sue , �� 1-iCr �.0
1 �
a,-Y- ass/� ors
Illce-eta pl—or- c� /� �lC .ram rffl*L k, ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/ 011

vision of Water Quality
.Facility Number � � k3 0 Division of Soil and Water- Conservation
Q.Other Agency��
Type of Visit ,f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit AMoutine O Complaint 0 Follaw up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: r Departure Time: � Q aunty:94j_Region:
Farm Name: AA�Z� — r Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ��%% Title:
Onsite Representative: Ld.,e�.r��� S%/`�j
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone
No:
Integrator: 21I/
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = 6 Longitude: = ° = ❑
Design Current.:. ," Design° Current,,'. Design' ;Current
w
Swine Capacity Population" Wet Poultry Capacity Population'.. ..Cattle Capacity Population ,
❑ Wean to Finish ❑ Layer ❑ Dairy Cow
❑ Wean to Feeder I0 Non -Layer I ❑ Dairy Calf
❑ Feeder to Finish w ' ❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder ❑ N D
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
on- ary
❑ Beef Stocker
❑ Beef Feeder
F ❑ Beef Brood Cowi
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 0<7 ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El Yes ❑No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes ONNo
❑ Yes Zo
❑ NA
❑ NE
❑ Yes 2�No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
.0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
YANIEes
ice-' 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
C'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?
[eyes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
7No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
No
- ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[-]Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ 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
;2rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
)ra-No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
�TNo
❑ 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
.0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�rNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facifi Number: - Date of inspection:
2-4. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes ZNo
❑ 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 E2-No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ;2-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 J2!� No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes � No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
[:]Yes P3No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storagc Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ZTNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes VNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comm-eats
Use drawings of facility to better explain situations (use additional pages as necessary). ,
J( ,4/* &.,)
-0y11t /.3
bn kt-C C��G a'ov+ G�IC�iI
/G4 o &W- �G a�s !^ �0rd W a�'��
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: /jam' 7AC —7r.��
Date:�j�/y�l�t
21412011

Facility:Number 3 l %
i
" vision of Water Quality
0 Division of Soft and Water Conservation:
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit1pllioutine0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: !l G U Departure Time: County: Region: 6Z4�
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:'%
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = 1 = is Longitude: 0 ° = 1 = u
DesignCurrent Design Current
awing t:apacity ropulanon
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other. _ _
s
❑ Other
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry "'
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` Currenta:>
Cattle Capacity.-Popula6in
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures,- C
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 A No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
[--]Yes
tfNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 30 116
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure S Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes )'No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes )2°No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes FZ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes P No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes�No
El NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes )2 No
❑ NA Cl NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ZNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,ENo
❑ 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 ONo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ,
[:]Yes ,Q'No
❑ NA
❑ NE
gComme.nts (refer to- uestion,#} Explain any YES answers andior any ecommendations or�any'otherFcomments
Use drawn s A facility to better explain situations: {use,,`add�honal pages as necessary)°y g
g e.r -
AL
1W
Reviewer/Inspector Name. Phone: (5-- 7e6 — %
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19_ Did the facility fail to have 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 JZNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design (3 Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.- ❑ Yes FrNo ❑ NA ElNE
ElWaste Application ElWeekly 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 oNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
RWo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F"No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
,Yes
❑ No
❑ NA
❑ NE
Oid the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ETNo
EJ
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
, D—No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PFNo
❑ 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
ONo
❑ 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
ENo
❑ 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
FTNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ZNo
❑ NA
❑ NE
Addehonal Comments andlor Drawings•
AL
J12-110 Z GJ fir. W�jje �.sl� o�
-P,,J-,,les
w«i os) 61 4 e�e�>�
da ��, Oaue_
�s crs J�
V soasl �
'�5a5- Auo A1'ef 6QZ.*, VIL,
Fr
Page 3 of 3 12128104

vtstoit of Water Quality u
Facility Numtier Q Division of Soil and Water Conservation
Q Other"Age©cy n
Type of Visit G<oompliance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visitjg�-K-outine O complaint O 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:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phones No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: o =' = Longitude: = o
R-.Design Ciirrent w Desag€
Swine _ . .
-apa.city "Populatioie Wet P©ultry =;Capacity
❑ Wean to Finish ❑ La er
❑ Wean to Feeder ❑ Non-Laye r
❑ Feeder to Finish
❑ Farrow to Wean��
Dry i'ot�lT
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
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?
❑ Yesp"No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes pNo
❑ Yes
ElNA
❑ NE
gNo
ElYesNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — 7 Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PrNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes TNo ❑ NA ❑ NE
Struc re 1 Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ 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 N �o El NA NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ((
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ;?rN o ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. [--]Yes Xo ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
7,No
❑ NA
ElNE
17. Does the facility tack adequate acreage for land application?
ElYes
No
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
. n.
Comments (refer=to question #) Explain any YES answers and/or,any recommendation o Hany other torment
Use drawings of facility to better explain situations. (use additional pages as necessary)
Reviewer/inspector Name � � � Phone: `ill% �(/�`
Reviewer/Inspector Signature: , Date:
12128104 Continued

Facility Number: — Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 9fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VfNo ❑ NA ❑ NE
the appropiate box. ❑ W­Up ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [�'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
[:]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ,ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0 No
❑ NA
❑ NE
2
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
d9Did
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
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
pNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
RNo
❑ 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
ONo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
,yp
,�I No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�?No
❑ NA
❑ NE
A�dditional},ComEnenis &nii/or Drawings:
50 10sc-c;
2/;-
co ecA- oAa� OOL
-eu e - A, C'4 44-- '=' Vt le- cj s`�
scf le. a n _-C 4c- z_
y°
,l6"'-ck o¢ l<�F dr-an /n
1.
�S,�r.f/r�
d
d l/ C / Ae ZvbZr,,- ,-/cl��S c
�s/�-'Ja/ Al- 4d
3.0
9lG - 3�d ram
Page 3 of 3 gy"Idn /(�P' O

i1. AD Division of Water Quality
I Facility Number Q Division of Soil and Water Conservation
0 Other Agency / 11
Type of Visit &fompiiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (?"Routine ()Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 102ZO Arrival Time. �Q Departure Time:
Farm Name: PC) /
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
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Region:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o= 4 Q Longitude: 0°= g 0 N
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
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 RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
ElNE
❑ Yes
❑ No
Yes
El,
tvo
❑ NA
❑ NE
❑ Yes
dNo
❑ 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
Identifier:
Structure 4
❑ Yes P'No
❑ Yes ❑ No
Structure 5
El NA El NE
El NA El NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
C)Ao
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
RfNo
❑ 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
KI 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
PFNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
RNo
❑ NA ❑ NE
maintenance/improvement?
l l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
7No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZINo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes P No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ,[_, 'No El NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes r�Ll No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 6 No ❑ NA ❑ NE
Reviewer/Inspector Name I lee u I yt I Phone: % 2
ReviewerAnspector Signature: G Date:
I Page 2 of 3 1212 810 4 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JVNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropirate box.
❑ WUF ❑Checklists ❑Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
?No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
toNo
gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
gNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PNo
❑ 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
PNo
❑ 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
PTNo
❑ 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
)dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[dNo
❑ NA
❑ NE
013/6 -7 1. s
/ • T La500V1 - �R�l �c►��
G) -a.rq +i-c-ez4mP,_A— I cj-PJ
3 v - t j4PeCQ 5 u-iv m1+ �DO
-,6 e `Su�C �` ,-L �— - /'ee✓ d r�aGS 1 a d�Crj /
Page 3 of 3 12128104

FaMity Number �( 7
AD'Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
f Type of Visit ()-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
IReason far Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Arrival Time: �` Departure Time: County:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = 0 0' = Longitude: = o [—] ' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -La et
Dry Poultry
❑ La era
❑ 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: El
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [3'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes J" No ❑ NA ❑ NE
❑ Yes /6'No ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection
F.
Waste Collection & Treatment
4. Is storage 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 [,"]-No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 19
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ,3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes J:'No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes _, No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ETNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ,ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 13-No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes -El—No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)'
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes D—No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes zallo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes J No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes d"No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ITNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
o d �5/1,3u ry tJ 9/O - 3 SO -� iA v j/
d a o 7
��PeloGa rli �Gca✓G�s 1t2��/�p' b -c osr �/<-r/� �lr'� S,
e��A-aAzlls
Reviewer/inspector Name Phone: 0—
Reviewer/Inspector Signature: Date:
u% }I• ■�Zzuivv •,wtui+Nra
/ 0 Z t—

Facility Number: c3 f —% Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
eyes
❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking VCrop Yield ❑ 120 Minute Inspections 9monthlyand V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
allo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA ONE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA �JNE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes _O'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes P14o
❑ 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
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
e&No
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ YesZ'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE '
General Permit? (ie/ discharge, freeboard problems, over application)
',,,eNo
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[]Yes ZfNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

�R O Division of Water Quality
"Faci
.'lity Number O Division of Soil and Water Conservation ;
I 0 Other Agency V
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:.
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
c
Facility Contact: / Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
eeF eder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Soars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification ber:
Back-up Certification Number:
Latitude: [ [ [= Longitude: [= o = d 0 «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
I ❑ Non -La er
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
❑ 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?
❑ Yes J�Mo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
.Q'No
❑ Yes2No
❑ NA
❑ NE
❑ Yes
LI No
❑ 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? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):37 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window �❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) QVO
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes MNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J2 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
O—No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ETNo
❑ 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):
�yoan �. r0"43
Gafoo �� a 7 �G1
Reviewer/Inspector Name ( Phone: !l0
Reviewer/Inspector Signature: Date: v'—.3 4,G
Pace 2 of 1212NI04 Continued

.Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Eallo ❑ 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 El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes . ElNo ElNA ❑ NE
❑ Waste Application ElWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25, Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ,ETNo
❑ NA
❑ NE
❑ Yes ❑1,Vo
❑ NA
❑ NE
❑ Yes ONo
❑ NA
❑ NE
❑ Yes )R No
❑ NA
❑ NE
❑ Yes J2 No
❑ NA
❑ NE
❑ Yes 9No
❑ NA
❑ NE
❑ Yes .❑ No ❑ NA ❑ NE
❑ Yes J;rNo ❑ NA ❑ NE
❑ Yes �TNo ❑ NA ❑ NE
❑ Yes fI No ❑ NA ❑ NE
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes El No ❑ NA ❑ NE
Additional Comments and/or Drawings:
17
0 ti��v,�
a� t6l-7
3.1
3— 616 3 e
_6e1 117"e" TU fp s ' CC I�"1
� �v� l � oohs
Page 3 of 3 12128104

acil- y Number
1
7
�tlAqu#
Type of Visit Q-C—ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit QA(o"utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z G rrival Time: Departure Time: County:
Farm Name: Owner Email:
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
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone:
Phone No:
Integrator•
Operator Certification N u m. er:
Back-up Certification Number:
Region 1
Latitude: = o = f = Longitude: = ° = t
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I I? ❑ Non -La et
Other
❑ Other - - - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharszes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
EFDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 eNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El Yes El No
El NA
El NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes 0No
❑ NA
❑ NE
❑ Yes P'1Qo ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection 00�_
WAte Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes O<o
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �rn
Spillway?:
Designed Freeboard (in): ? `l
Observed Freeboard (in): 36
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 AETNo
❑ 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 ,'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 2No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes AET�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes A!TNo
❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 9No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No
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 VNo
Reviewer/Inspector Name
Reviewer/inspector Signature:
Phone:
Date:
124
El NA [I NE
❑ NA ❑ NE
El NA ❑NE
El NA El NE
❑ NA ❑ NE
Continued

Facility Number: — Date of Inspection UFZ4_
Reoalred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 10No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
ZYes
❑ No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists XDesi n g El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
El NA
❑ NE
❑ Waste Application VrWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections 0 Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Wo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EgNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
19No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[?rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
El NA
El 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
PINo
❑ 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
P 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
7No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
gNo
❑ NA
❑ NE
AddEhonal Comments and/or Drawn s v �'
Mead aquiK& 1 clr3ooy\ &sibs i troern 5cji
�a �e r
kc corj F-rep 63a rod Ta t n�p,
PS�
12128104

1,livisiaii of Water amity � _ a -� -
". ` ...�°" . . � 6��� �Cii3ivisii►n of fi�,il'anit=�V9ter_Ca�cervahoa r� �,.- s "a m=�
Type of Visit j} Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit J6 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
O Not Operational O Below Threshold
fi3 Permitted O Certified E3 Conditionally Certified © Registered Date Last Operated it Above Threshold:
jam/ J--..._....�..�._--
Farm Name: GG1rfP1��ZS� ;f._.a County: .. ._�Iplxi� .......... ..
Owner Name:,&Gf!Q�+?f-�.�j �/����n7ff Phone No:
.................... ......
Mailing Address: ..................................................
FacilitvContact: ........... w............ _ ...._ Title :.................. _.............. Phone No: ....._...................------.................
4
Onsite Representative... � �r LL Integrator: �IQ�..........................................
......................................................... Int tor: .......
Certified Operator: .............................................. Operator Certification Number:..... .................
Location of Farm:
r Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * 4 " Longitude • 4 44
- -
Ilsign ;Current _.; ...1 :@arrant _
_`-':_Ca
acit ''Po elation-
❑ Wean to Feeder
Feeder to Finish
97717Z
13 Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges & Stream impacts
" ❑ Layer
❑ Non -Layer
_ ❑ Other
1. Is any discharge observed from any part of the operation? ❑ Yes )ZNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? - ❑ Spillway ❑ Yes .10No
Stlucture 1 _ S`trruc�ture 2 rwStructure 3 __. Structure 4 Structure 5 Structure 6
Identifier: ... /EI..II��C,i f=' 1• _.........
Freeboard (inches): 40
12112103 Continued

t
Facility Number: ,3 / — 7� 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 andlor 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? If yes, check the appropriate box below.
❑ Excessive Ponding ❑PAN ❑Hydraulic Overt d ❑Frozen Ground ❑Copper an�
12. Crop type �REnLQ Pz�q 6, (bOLK-F-EZ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management"
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?
Zinc
❑ Yes 0 No
❑ Yes Z No
❑ Yes 0 No
❑ Yes V1 No
❑ Yes 2fNo
❑ Yes No
❑ Yes No
(CAWMP)? ❑ Yes E 'fqo
❑ Yes 12f io
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes ONO
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 XNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )TNo
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 ❑'�to
Air Quality representative immediately_ /
ha u #I) =E plaw_a y YES;answeiis and/or atiy_ recoatmendatians.oi any other comnirats.
use grawtngs;wtcaway to patter eaptam srmaaaas. Iuse scuvaona[ pages as necessary) x ==g ❑Field Copy ❑Final Notes r$
— a-
w�
31op�2.
— �ot� T RECOm�� p �P�N� LzrnF uN�FSS JQ�ca�rr`��DFQ �iJ
= Fm FRFFf3r5ARo RECoRDs row �i•F� NoFnr�s aR l�
Fix- 200
V F Epzt3c - ��RZG_l�7 �a rJ �f COQDS Yi��s,
Reviewer/Inspector Name 21
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: _ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N TDES Permitted Facilities
❑ Yes ONO
❑ Yes JVNo
❑ Yes ❑ No
❑ Yes 0"No
❑ Yes ,En ivo
❑ Yes ,dNo
❑Yes )2No
❑ Yes XNo
❑ Yes 2rNo
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) z Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes j2 No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes P-90
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ONO
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ,eNo
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
ddtttonal_ omments-and/or Drawi.:....�. _ i - ram. _.-.-..� F: � ?:
j) �"D ( © T�, F EC3
Dri flWWD'-)F-O
iJ EC) Tn kkf�.
'�fl2N FAr (_ i-'��Out N� s HtJO -� t�EeT�vr�s
�D�rr-s
{�EeP 4 zoe��=Nt� 4_E( rF_f? rH PF-0-CA
1) F_&F-fl7
Q�DERL�.
Et:5 2N }Rol` R. pac NAY �►�
E
12112103

Swine -.;Capacity.
❑ Wean to Feeder
Feeder to Finish Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds-/ Solid Traps_
Date of Visit: Time: i iJt
Facility Number
Not Operational Below Threshold
M Permitted 19Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: �/?� �`—j► TAd�i'�SP3 ]�4/ / _ _ County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: < C Integrator -
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 u Longitude 0' 0' 0
Design "Current,Design =Curren# - De
Poultry " _ ; -Ga �a�tv �Po -ulation .:Cattle Ca
❑ Layer I I❑ Dairy
❑ Non -Layer ! ❑ Non-Dairy
❑ Subsurface Drains Present
❑ No Liquid Waste Manage
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: f 0-
Freeboard (inches): Z ��
05103101
Current .
J Sprav Field Area U
❑ Yes WNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes X No
❑ Yes CffNo
❑ Yes )1-No
Structure 6
Continued

Facility Number: 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 part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
I0. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type (2k f4 iaa i"V 7i- _;W h" 167'WAr 4ff���
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?
I5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge? —
22. hail 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 kNo
❑ Yes Q No
❑ Yes Vlwo
❑ Yes V No
❑ Yes U.No
❑ Yes ®,No
❑ Yes 59No
Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
1XNo
SNo
❑ No
❑ No
allo
[�[ No
❑ Yes [lNo
❑ Yes Q9.No
❑ Yes 51Vo
❑ Yes XNo
❑ Yes 5?�No
❑ Yes KNo
❑ Yes EgNo
❑ Yes Z[No
❑ Yes 12INo
M No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Com-mints (refer�io question #) Lpiainr" YES answers antllor aay recommendations orany othei ceinmeiits _
Use-drawiogs of faciility to better,expiain s tnattons. (use i ddstionaltpages as decessarv) A E] Field Cotiv ❑Final Notes
bcOrk rPL
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date: 2.
05103101 c /
Continued

l
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 at/or below El Yes ['No
liquid level of lagoon or storage pond with no agitation? V
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 125,No
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes $--
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 Wo
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 �;-Vo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes MNO
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover? ❑ Yes MNo
Additional Comments;andler'.Draw in -.
t
05103101

Division of"Water Quality
0 Div>tsion of Soil and Water Conservation-
,'
0 Other Agency
Type of Visit AO Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ;d Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 3 ZB 01 Time: 9 - Q Printed on: 7/21/2000
Facility Number 3 r
Not Operational 0 Below Threshold
© Permitted ❑ Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .............
�2�� r�1¢S r lujn•tL�tf Jr i 0.f� Count l
Farm Name: !1�.....,..........1. V...........................................
Owner Name:x1�..±'� r'1CShGs. t r...1.'L'� fPhone No:
... ..1-
FacilityContact: . Title: ............................................... Phone No:................................................................................................................................ .................
Mailing Address:
Onsite Representative: P'l 4V- - G k S e ............................................................ integ...................................rator .r of
Certified Operator:................................................................................................................ Operator Certification `umber:..........................................
Location "of Farm:
A
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��� Longitude �• �� �«
DesignCurrent' Desi Current Desr , gn 11� ..' Current
S.. -
Ca " ci Po ulation Poultry Capacity Po" ulation Cattle
ftliwati6n.
Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish Z ❑Non -Layer ❑Non -Dairy
Farrow to We
Farrow to Feeder ❑ Other
Farrow to Finish
Total Design Capadty_
€ ❑ Gilts
Boars Total"SSLw
y llj� of Lagoons�. ❑Subsurface Drains Present ❑ Lag�n Area ❑ spray Field Area
Holtlmg Ponds /Solid Traps ' ❑ No Liquid Waste Management System "-
t?
Discharees & Stream Impacts
1.
1. Is any discharge observed from any part of the operation?
❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes A No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes XNo
c. If discharge is observed. what is the estimated flaw in gal/min? 10 f 6(
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes IdNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �?No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Struct re I Structure, 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .... ....... I . ..... 1........Wxl .....................................................................................
Freeboard (inches): z y 20
5100 Continued on back

Facility Number: j 1 — Date of Inspection 3 Z 41 Printed on. 7/21/2000
`f Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,?No
seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �rNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ 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 Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes] No
11, Is there evidence of over application? Excessive Ponding PAN ❑ Hydraulic Overload
El Yes � No
}}❑ +❑?
12. Crop type _�_ e �''r't!<dg N0.� 7 ASj V re , Sr14
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 J No
b) Does the facility need a wettable acre determination?
❑ Yes JJ No
c) This facility is pended for a wettable acre determination?
❑ Yes 9 No
15. Does the receiving crop need improvement?
❑ Yes tffl No
16. Is there a lack of adequate waste application equipment?
❑ Yes O No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes ,El No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes -] No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes yj No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 9No
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 9 No
23. Did Reviewerlinspector fail to discuss review/inspection with on -site representative'? ❑ Yes j 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 �j No
o yiolati6hs :ot• df eWndes •wee noted. du. 0i 4his' visit - Youwil!-eeyRo further
• comes' orideiTce: aN f this visit:
,r
Comments (refer to question #); Explain any YES answers and/or any recommendations or any other comments: �
Use drawings of facility to beater explain situations. (use. additionalpages as ess nec "" " ay) !! II m W
1S•. �eSa n c �eed I p of{ec4S 16 4treo,S %q t G1re ho4 t.,., i?hi )Athd{ "►fQ�rc'&r w
Ar eate. J
0Veeodt -6,cIt } � avqa( eeC,6ra(S Aee Weil k�P�,
w
.-
Reviewer/Inspector Name 10G i.rri. �. -- ,. A� h' f s_
Reviewer/Inspector Signature: Date: ,/ Z �3 1 6 I 5/00

Facility Number: 91 — 8 Date of Inspection IaL,910 I Printed on: 7/21/2000
;)� Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge tit/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 ;gNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0 No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes $ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
5100

+Division of Water Quality
_.
0 Division. of Soil and Water Conservat_ ion
Q Other -Agency
Fof Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
n for Visit t(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: �ime: Printed on: 7/21/2000
tN�otOperational Q Below Threshold
Permitted © Ceerrhfted 0 Cjonndihonally Certified Registered Date Last Opera Above Threshold: ....I
Farm Name: 1 /-f.. J.. .1. ....
3.•.�.:....-..s....�.�ounty...... �dor
.. 1..- ...........
OwnerName:................................................................... Phone No:.......................................................................................
Facility Contact: r_UlnfrS .i�1.. ....[.�. ................ Title: ...... tl..W..j,41[,.J1rt,t�........................... PhoneNo: ...................................................
MailingAddress: ..................................................................................................................... ..........................................................r.......................... ..........................
Onsite Representative:..... { !!Lru2` - e Integrator: ,
... .......
Certified Operator:
Location'of Farm:
.. Operator Certification Number:
wine ❑ Poultry ❑ Cattle
❑ Horse Latitude
Longitude �• �� ���
_ Design
Current Design
Current Design ` Current
-
Swine Capacity
Po elation Poult ry Ca aci
.. -
Po ulation Cattle cipadty Piioktioa .
Wean to Feeder
❑ Layer I
I 1 10 Dairy
Feeder to Finish
❑Non -Layer
❑Non -Dairy
Farrow to Wean
Farrow to Feeder
❑ Other
°
"
Farrow to Finish
ToW D ogn .CapaCl y
Gilts
Boars
Tota ssLW--
Number of Lagoons 'rI� ❑ Subsurface Drains Present ❑ Lag^ n Area
Holding'Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [ISpray Field ElOther
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. I!' discharge is observed. what is the estirnatcd flow in gal/min?
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
I Spray Field Area
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 Stru •l/u,,re.2 Structure 3 Structure 4 Structure 5
Identifier: ... .....4...i........ ....................... ............ ............................... I .... ....................................
...r.�.....
Freeboard (inches): A;k /
5100
❑ Yes RNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes 1�o
Cl Yes KNo
Structure 6
Continued on back

Facility Number: — Date of Inspection Q printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[ No
l 1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
[No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[VNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
r" No
b) Does the facility need a wettable acre determination`?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
EgNo
19. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
14. 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?
�'�10-violaiigns bt- di!ficieucies -were noted• dewing this:visit. • "4 :wil1•re;b6V6 rio furthr
correspondence. a)3"f thi visit. .. .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes IQ No
❑ Yes 54 No
❑ Yes F0 No
❑ Yes No
❑ Yes N No
❑ Yes 0 No
❑ Yes K No
❑ Yes ONo
Belt 11�AAvgrises dves av�, oy-tcltz.^4-;vb &-p? +�a+�o�G�..�� . L;,ti,,c
r to,:tf — t A-s of &�X t
o`Q pt-,�4 -� t?s +`�d� S Gov i �Ls N,, Y {. c e rA& . ` tx # o of j J 101.
Free b o car Pt ,nrv.#,...c.� "L 4..-w It o4- C-ti i b 01 utr- . s s A. # A
Reviewer/Inspector Name y c � Lv 1 CL — }) Q C, IU Ci5r 3 00 e)L4 21ti
Reviewer/Inspector ,Signature: Date: t 00 5100

Faci 'ty Number: — Date of Inspection ! t I 000 Printed on: 7/21/2000
vOdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or h0ow
❑ Yes
JkN o
liquid level of lagoon or storage pond with no agitation?
27,
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
eNo
28.
is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt,
❑ Yes
Of.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
XNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
XNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
itiona : otnments an or.:Drawings:
S '-�Ot
5100

r Division of Soil and'Water Conservation .'.Operation Review
x xra. ,0 Division of Soil and:Water Conservation'=`Compliance Lvspecti6p . }
- -
O. vi on of Water Quality - Campiiauce Iitspectioii
=. D.Other-Agency, :Operation Review
10:aoutine O Complaint O Follow-up of DWO inspection O Follow -tip of DSWC review O Other
Facility Number I I
Date of Inspection 1jr_1;X/qC1
.
__ -- - -- - -- Time of Inspection QO 24 hr. (hh:mm)
Permitted [3 Certified E3 Conditionally Certified � Not Operational Date Last Operated: Registered p ated:
..............
1 ( i � Farm Name: ........ ..-' 1......D,
................................... County:......-- �..�p�, 7...................I..............................
Owner Name: ..................................... Phone No:. ----........-
Facility Contact: ...................................................................... .Title:................ ..... Phone No:
MailingAddress:................................................................................. ..........................
Onsite Representative. 'Lsn ......... Integrator: 4'r............................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of FarmL_ r , , i t ­— F i . ( n — _ %. t — \
_.)................................................................."............................".. - � .....
Latitude �•�° �•� Longitude �• �� ���
Design Current m..' Design Current_ _- Design Current
Swine - Capacity Population_: roultry Capacity Population Cattle _ Capacity' Population
❑ Wean to Feeder ❑Layer ❑ Dairy
Weeder to Finish q' ] a _ ❑ Non -Layer I Non -Dairy
❑ Farrow to Wean
_ - --- -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish = T6ta1-Design: Gapac�ty
-.
❑ i Gilts
❑Boars =:. ;. Toial'SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
HotdingPonds I Solid Traps �- ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes MNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes WNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes DNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ......... 3?..... .. ......la-5
...............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3123/99 Continued on back

1
F
Facility Numbe'r: 31 — Date of lnspection
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
XYes
❑ No
8.
Does any part of the waste management system other than waste structures require main ten ance/improvement?
❑ Yes
VNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid Ievel
elevation markings?
❑ Yes
IN No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
KNo
12.
Crop type { S
N
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ZNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
gNo
b) Does the facility need a wettable acre determination?
❑ Yes
gNo
c) This facility is pended for a wettable acre determination?
'Ryes
OrNo .
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 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
t<No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ErNo —
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
E�No
22_
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
MNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
K_,rNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
gNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N[No
yiolatiQris.. deencies were noted• during �his:visit' • Y:oir :Wiil•teeeiye do further
icorresponde...ab6' this visit. .
Cornment5:(ref er to question #) Explain -,any YES answers aat1/or4aQy recommendations or any other comments
Use-drawiiamm of fae€h to :better. ex lain=situations use addr6onal a es as necessa = Y
h'_ P .._ { _ P g._ 0)
zlL-, w e-c �-,
$/NCO 1(
r A
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: t � la- i 9 9
3/23/99

Facility Number: 'j — b' Date of Inspection
' Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes El 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 MNo
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 bRrNo
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 MNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the hush tanks lack a submerged fill pipe or a permanent temporary cover? XYes ❑ No
ttionaComments- and/orDrawings:
3/23199

Y
Division of Soil and Water Conservation ❑ Other Agency'
Division of Water Quality a�
10 Routine 0 Complaint 0 Follow-up of DWQ ins ection 0 Follow-u of DSWC review 0 Other
Date of Inspection
r_ Facility Number '
Time of Inspection O 24 hr. (hh:mm)
© Registered 0 Certified [3 Applied for Permit 0Permitted [3 Not Opera Date Last Operated:
t - r
Farm Name:....................1� .....rYie!�ri. 4...i:�..� .-- ........ ...►"frfY, county: lfxs ....................
OwnerName:.......... ......... 2:C11................................................................. Phone No:..L� ?� Z I!.-D.(........... .............. ........................
FacilityContact:..................................................................I........... Title:..-............................................................. Phone No:...................................................
MailingAddress: ...... P..0....tPA...... .7r..`.................................................................... ........l W �S. �..�. ��..f.NL..---.---.------..........------.... ..�3`f1..........
OnsiteRepresentative: ........ [ald....Lt...:............................................................I... Integrator:....... V.. ............................................................
Certified Operator:................................................................................ Operator Certification Number ................
Location of Farm:
.....5��..15.1�.;..oA... M;fai....W.C.5... QT....... tK.1.S -W. ..........................
........ .. ............................................---.............
Latitude �• �� �"
Design 'Current
Somme 16paeity , Population
❑ Wean to Feeder
® Feeder to Finish
�j14 Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons I Holding Ponds; '' ❑ Subsurface Drains Present] ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste ManageSyst ment em
-a
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes U] No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes tp No
c. If discharge is observed, what is the estimated flow in gal/min? nJ
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 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes �'No
7/25/97 Continued on back

T
Facility Number:
S. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Lagoons.11olding Yantis, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Structure 2
Identifier: .......... &i ................
.......... 1................
Freeboard (ft):............. LL .............
............... 3 . .....
10. Is seepage observed from any
of the structures?
Structure 3
Structure 4
❑ Yes M No
❑ Yes P No
Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(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. Croptype ......................
btx tnu h.o .............................tea �1..IYX,tih...................... ........... .................................................
16, Do the receiving crops differ with those designated in the Animal Waite 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?
0 No.violations or deficiencies were noted during this. visit.- .You.w'ill receive no further
correspondence about this:visit:. _
❑ Yes M No
❑ Yes [PNo
PYes ❑ No
❑ Yes [q No
❑ Yes j4No
❑ Yes No
❑ Yes 0 No
[4 Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
[O Yes ❑ No
❑ Yes No
❑ Yes [ No
❑ Yes No
eorttments (refer"to question #): Explain any YES answers and/or any recommendations or any outer comments a y
Use drawings of facility: to better explain situations, (ttse additional pages as necessarv)
.
.oreaS
S e t.�.`'j S1tiot� 6e r8 Y� Sp►a+� C�
ll. Ero<, K a k" Qn inru�r ��kc Wa�i�_ 0� $� �� 00r, Silpu�c� ion �iiit� W` RS>°t� .
(�%� (4,1. 4 9( l/}yoh _3 +11 E� rvl0041 ELM pXto-% dry [Q�eatr� �i� t 56id bt
27-. S�� yt.Coyk StAOO,d Ve 14ebl �0 t17-0,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

Feedlot
❑DSWC �in>imal OpelratloaReview
DWQ Anrmal�Feediot Operat>lon Site Inspectlon� �f
� }
��
® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 6
Farility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ORegistered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: _.`arc! 5 ....a� n ....�..`^ _..,. .._ County:....�� .�.x�..... .... _.... _..�
Land Owner Name:.._.Iy cw Phone Na: .¢61...... _..... _ ....._ ...._...
Facility Conctact:............_........._....._........._................_...................... Title: ........ Phone No:
iVlaifing Address:._? fl ... _._� r.�.L�._._..... ....._._....._..........._........ .........
.....u.t.�
Onsite Representative: l
p ..��.�-----...,�..�,.aecr t..._.....�................._............._ Integrator:... ....t,,..r.tca..�u#......._........_..........---......
Certified Operator: .. �(........ ! .....�.... .... Operator Certification' Number:7�....
Location of Farm:
Latitude �' �° cc Longitude
Type of Operation and Design Capacity
s ,u ,
�Destgn �trrent = Deli n Current Dest n Current
$wtne >;.t Fg ro
.. :..,- Ca acr u;Po ulatiott� ..Poultry Ca ac►tv:Eo ulattan Cattle .Ca aci HPo ulatton
❑ Wean to Feeder '�❑ La er ❑ D
R Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
s
A
Farrow to Wean �
Farrow to Feeder Total Design Capacity 1rrs�
Farrow to Finish
❑ W
other
E
Tatat -SSL
u Number of;agoons / Haldmg Ponds ❑ Subsurface Drains Present
❑L �u f
9
.� agoon Area � ❑Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/9 7 maintenance/improvement?
❑ Yes KNo
❑ Yes .® No
❑ Yes KNo
❑ Yes & No
❑ Yes
® No
❑ Yes
§� No
❑ Yes
ff No
Yes
❑ No
Continued
on back

Facility Number: ..,j.....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Pondss
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
Structure 4
❑ Yes
® No
❑ Yes
®'No
❑ Yes
0 No
❑ Yes
RLNo
Structure 5 Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
E'No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
gLNo
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
allo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ........ __.........—.... - ...... .._----- --------
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
®,No
17.
Does the facility have a lack of adequate acreage for Iand application?
❑ Yes
JRNo
18.
Does the receiving crop need improvement?
EL Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
29 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
E?No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
r
Cedfied Facilities
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[&No
23.
Were any additional problems noted which cause no of the Certified AWMP?
❑ Yes
&No
24.
Does record keeping need improvement?
RYes
❑ No
Comments (refer io question #� Explain any YES answers and/or any& recommendations or any other commeat s
,:
Use;drawinas.of faciIity,to betteFex)W"i'd situations: fuse additi"'Dai?es as necessarvl. : ` .. »,, . .. .'
5 T o nr o+ PL .S 4' ' `� a"r J c rp^r W a tA-vr ter ^jt, Q ru.-.(d " w A. t- r w &7S 4
SS 1 b y t h e"A cu...t E ► -V r v PLA v w I
+r v ..+-o-Y-o vv.+ t s s Q +(~�--o�S , 0 p er+a f -o r i t i r- uCsr t f i K da 11
1 V. ^ K Q�� `�l kA, L
1) • 1 12 • 0 vra �0 4-I Art/ W 4 � 1 � G 0 .p r V--t-cr �'J-0-1,
F� L S 9 { S 0 +� D
W o.. L I • �1n S p Ya lc 1✓ s; t � � o bQ CAD wN i t
Car � E W e �0.
� e t, V- d-2.w. �E 1 5 0. 4'� �a � `� °� dt-1 0 �1 Y'e "► IL �+ +
r'Ll
} � + _ Ii
Reviewer/Inspector Name :; ,
Reviewer/Inspector Signature- ��� _ s _ , ALL , _ , Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Nit 4/30/91

Site Requires Immediate Attention:
Facility No.
R -- DIVISION OF ENVIRONMENTAL MANAGEMENT
` ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: /— , 1995
Time: Q! 3
�s 5 Farm Name/Owns
Mailing Address:
County:«
Integrator:
__- -
On Site Representative:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: 1�_ Number of Animals on Site: _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude;�4 Longitude:? 7 ' 6;( ' 1" 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) 0 or No _ Actual Freeboard: :2, Ft. --& Inches
• Was any seepage observed from the lagoon(s)9 Yes or No Was any erosion observed? Yes or No r�
Is adequate land availabl�1'1r spray? t or No Is the c ver crop adequate? �or No
Crop(s) being utilized. i1(Q�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es%or No
100 Feet from Wells. or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orl Too
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No/ If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No �PA
e 0 - 7 �
•
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.

•
F, Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANDAAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: g , 1995
Time: 1 ' 00 PA
Farm Name/Owner: !�6 L L F-z�
Mailing Address:
County: QQ I t'/i
Integrator. Urh Phone:
On Site Representative: Phone:
Physical Address/Location: 903 Y—' 1 e- H can c n.
left. o,,, ISO x I ,' o,-► W4.NRP F�m
Type of Operation: Swine Poultry Cattle
Design Capacity:
DEM Certification Number: ACE
Number of Animals on Site:
DEM Certification Number: ACNEW
Latitude: It
Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 incites) (POT No Actual Freeboard; 2-- Ft. d Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes o No
Is adequate land available for spray? Yes or Not Is the cover crop adequate? es or No
Crops) being utilized: _ C --?41e , bQ'rMU C(a
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o <No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated bn specific acreage with cover crop)? Yes or No 2
Additional Comments: W on e ao 540—
L , L 5 Af�
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

` Site Requires Immediate Attention:
Facility No. 3 1 - -- 8
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: (tf
Farris Name/Owner: —iie 8 . i
Mailing Address: 0, 60 / L/ /1�✓vl �f t,i !_� � {� 'D. $ 3 V
County: Ar-
Integrator- " A 14 OLWA ., Phone:/ U -01/ 9
0
On Site Representative: _ 'fl d Y,61 "7 Phone: Q /T 22 62 �y
Physical Address/Location: ?�-- f u �l ti. �° S 1� i �3 A-�� / fa 0
r,, I i7 , �•
Type of Operation. Swine ✓ Poultry Cattle
Design .Capacity: Number of Animals on Site._L_42� lrU
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' _' G �' �`1 " Longitude: 2 6 " 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) ter No Actual Freeboard: -.,-)--Ft. �_ Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? - Yes or No
Is adequate land available for spray? Yes or No � Is the cover crop adequate? (ge or No
Crop(s) being utilized: _CO x AA
Does the facility meet SCS minimum setback criteria?, 200 Feet from Dwellings? Yes or No'
100 Feet from Wells? Yes or 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 man-made ditch, flushing system, or. other
. similar man-made devices? Yes o6 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or G
Additional Comments:
T.
Inspector Name
9-ignUiie
cc: Facility Assessment Unit
Use Attachments if Needed_

OPERRTIOHS BRANCH - 1JQ Fa.x:919-715-6048 W 4 . ?'_t l 1= ' 95 9:1C, P. 13/17
. , v •. voli.ioV LJ.ir r .C1 •r.tiz
r i
Site R..ciuir:s lrt`..Treciate A't'.entian �`_ .
xaci'�fy Nu�b�r��' �nnv
U ,.y
SITE VI,ITf1TION RE-CO't-r
LATE: _ _ z .r , 1.995
Owner: _ ,Farm Naltie' ! % MOO
_/ .
county.—.�—��
Agenr Visiting Site: _ Phone-:
Operator: _. .� . Phone: _
On Site Represerltafive-
Physical Address: '_L� I, z [ L.�-�.^�1 n-!�_ S�L /rn 0
Martina Address'
Type of Operation: Swine . Poultry Cattle
Design Capacity:--�r�,..... Number of Animals on Site:
Type of Inspection: GroundY� Aerie
Ci;cle YC�, or No
Does the Anhnal Waste Lagoon have sufa cicnt ft•eeboa.rd of I Foot f 25 ;,ear 24 hoar sLurm o,:cnt
(approximately I Foot + 7 inches) Yes or No, Actual Freeboard: Fact meths
For facilities with more than one lagoon, please address the other lagoons' freeeboard under the
cojiimit.nrs section.
Was any seepage, observed frown the lagofln(s)? Yes c 1 a Was there erosio,i of the dazit?: Yes or No
Is adequate land available for land aprHca+_on? Yes rr No Is the cover crop adc equate? Yes or No
� rJ
Y /
Additional Cornrnents:-.�.� J� _1?? a_r/ d�
Fax to (919) 7I5-3559
sl,-Maiurt Oi Acrvnt