310106_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

r - ems;,.-! I
�vrsion<af�Wate�rResonrces
Facility Number T;�M ® � '4 DiVisi6h4flS-diltand Wate r�.Consenvahon ,
.� Othr nc Agey �r .
Type of Visit: ompliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: _JE)-ftoutine O Complaint p Follow-up O Referral O Emergency O Other O Denied Access I,'
Date of Visit: } Arrival Time: { Departure Time: _ �— ' r--=—_J County: OU Region: W XO
Farm Name: ,{(iif I t� d Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: dw&a� kW,[J ,C
Certified Operator:
Back-up Operator:
Location of Farm:
o
Design Current
Swine
Capacity op_,-....., Wet`
�a
mLa�e:
}
Wean to Finish
»
INon-
Wean to Feeder
eeder to Finish
n
Farrow to WeanNr
Farrow to Feeder
." -' —,
D� �1
Farrow to Finish
"1
(Lave
Gilts
Boars
Other -r
Pullets
Latitude:
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Integrator: `
Certification Number: _f! [ / -7
3 Q l
Certification Number:
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:
y Cow
Cy alf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 61;rNo
❑ NA ❑ NE
❑ Yes[] NA ❑ NE
Page I of 3 214/20I5 Continued

[Facility Number: - Date of Inspection:le 2RR
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes
Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment rest, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No � NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes ;No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Yes
ON DNA
❑NE
❑ Yes
FT N NA
❑ NE
❑ Yes
0 No ❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
rNo ❑ NA
❑ NE
❑ Yes
��o ❑ NA
❑ NE
❑ 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 CJ�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facifi Number: - Date of Inspection. Ij
2,f 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 []'go ❑ 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 0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Ej NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 2f No ❑ NA ❑ NE
and reuort 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?
_A .
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes KNo ❑ NA ❑ NE
❑ Yes Z rNo❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
ILJI" ❑NA ❑NE
[%NP--D NA ❑ NE
No ❑ NA [] NE
AAIWA-411 (
fu Z
Phone: %9 77 6 7 30
Date: & { z q
21412015

V Division of Water Resources
Facility Number 1�p - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: =0utine
iance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: E= County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �IdAfHAII t4__nfl Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Non-L
Pullets
Other
Poults
Design Current
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
dNo
❑ 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)
E] Yes
[3NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
I__I No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 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 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: ac;zm� c6N Ti
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[:] ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes &No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 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 F2/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 ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes "N,o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Rio ❑ 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
Does the receiving crop and/or land application site need improvement?
El15. Yeso
WNN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes YNo
❑ NA
❑ NE
acres determination?
/No
17. Does the facility lack adequate acreage for land application?
❑ Yes Ld
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes gr/No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ffr/No ❑ NA ❑ NE
the appropriate box.
❑ W UP [:]Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other.
2 L 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 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to instal{ and maintain a rain gauge? ❑Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? _]Yes doVNo
❑ NA ❑ NE
25P 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 provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ?No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[:]Yes 2(NNo ❑ NA ❑ NE
❑ Yes �No [] NA ❑ NE
❑ Yes C No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [3 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? D Yes ;--N-o
'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to bette,r explain situations (use additional pages as necessary).,
Reviewer/inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
YhOne:�
Date: q 1�
214120 S

Division of Water Resourcesa
Facility Nunnber An Division of Soil and Water Conservation°`
\ - a "M 'O OthCC AgeCl
Type of Visit: Co pliance Inspection Operation Review Q Structure Evaluation Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ­G' J,Z Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
m x Design Current
Swine Capacity , Pop:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
.Other
Other
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Current'
Cattie Caps
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ 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
Z❑
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
2 N>o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Fa6ili Number: jDate of Inspection:
Waste Collection & Treatment
4'l; 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 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ° cA (m� Z,/ LAQ43
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .71 QC
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
o
[VNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑
❑ 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes jNN
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[—]Yes VNo
[—]Yes
❑NA ❑NE
❑NA ❑NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes EDNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 5/No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [2 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes io ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: -1 Mn IDate of Ins ection: 6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes ]No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes L3 NZo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[—]Yes E340 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
<N�o ❑ NA ❑ NE
gW❑ NA ❑ NE
No ❑ NA ❑ NE
(Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings`of facility to better explain situations (use additional pales as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
ad
Phone v'
Date: 11 � h
Page 3 of 3 r 2/4/201 S

I
V Division of Water Quality
Facility Number - ® O Division of Soil and Water Conservation
O Other Agency vi
Type of Visit: Co�fipliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral p Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:A.er,I Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: ���� Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish Q
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design
Current
Wet Poultry
Capacity
Pop.
4N
La er
Non -La er
Design
Current
Dry Poultry
Canacitv
Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
1139-7
Design Current
Cattle Capacity Pop..
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑-No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Page I of 3 21412011 Continued

'acili Number: IDate of Inspection: 7 34
.Waste Collection & Treatment
;.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
n No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
`
Identifier: CM,- w i LA kug3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IZNo ❑ 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 envirenmentalthreat, 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 o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes 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
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Z N
❑ 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
En/vo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EN.
❑ 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
EKo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio&"N�'
22. Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

i
Facility Number: jDateof 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
Ga"No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
allo ❑ NA
❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
C ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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 reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [/f No
❑ Yes [2r<o
❑ Yes 91
A1
6
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
[:]Yes hTo ❑ NA ❑ NE
❑ Yes L _l "'+' ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Comments '(refer to question #):•Explain any YES';answersrtsnd/or _any additional:reconnmendations or. any other comments y
Use drawings of facility to better explain situations =(use additional°pages-as-necessary).�� `
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone p 150 —73
Date: 3 j �jq
2/4 l4

! q
1
Division of Water Quality
p:.Fa6lity Number, 3 - © 0 Division of Soil and Water Conservation
h
0 Other Agency
Type of Visit: rRoutine
Hance 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: 13 Arrival Time: ldl3D Departure Time: f i a15 County: '✓lar�� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
� J
OnsiteRepresentative: MiLIQ?_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 4090 0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number: rl 2, o
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
Non-L,
Pullets
Other
Poults
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ff No 0 NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ No ❑ NA D NE
[:]Yes eNo ❑ NA ❑ NE
[:]Yes F:rNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: S ( - Date of Inspection: g 2
r5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
's
❑ 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: LAGM43 LW--$* M3
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 E f No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? dyes[:]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ff 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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [;Y&o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 911,o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMQ?
❑ Yes
(3 No
❑ 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
❑ Yes
[2"N'o
❑ 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
[;�Ko
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
01fTa
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E_. o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes e�q/o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: 31 - Date of Inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes [ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes [3"No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Ej"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E!rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes fff"No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA 0 NE
❑ Yes CJ__No
[—]Yes ❑ No
[:]Yes [fNo
❑ Yes
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Wc>U,5E t. ALLJ WAS FE(-.-, LEAK-S,
Reviewer/Inspector Name: 0a 1-4 r 't 14 a-&)( Ly
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ! �'
Date: $ a_-
2/4/2011

(_ Division of Water Quality
Facility Number _3 j�_ O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: OrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: C)Uecrjj Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Jur PTWPV Malt, o- Integrator:
Certified Operator: Certification Number: lb 5 ti 3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Design Current I Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
99M
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
Design Current
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cattle
Design Current
Capacity Pop..
Daiiy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes [Z"No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes YNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[:)Yes [No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: a I -IQ(. Date of Ins ection: 7 2G
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
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LAG EW LA&Wj3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q( Yb
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
1 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 environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E/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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
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):
l3. 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 Wo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:]Yes �o
❑ Yes �No
❑ NA ❑ NE
❑ 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 WNo ❑ 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 �j/p o❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3 - Date of Inspection: 11
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes QINC ❑ NA ❑ NE
25. Is•the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[—]Yes
[. No
❑ NA
❑ NE
[:]Yes
No ❑ NA ❑ NE
[] Yes [3] No ❑ NA ❑ NE
[:]Yes EJ/No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
[/No ❑ NA ❑ NE
[ o ❑NA ❑NE
❑ Yes [yNo ❑ NA ❑ NE
(Comments (refer to question ##): Explain any YES; answers and/or any additional; recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: aC'h I,
21412011

fr
U'Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
a 0 Other Agency ) I
Cype of Visit: Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Season for Visit: qrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I qJ, , J u Arrival Time: Departure Time: I Ci County: D
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Cn/l�t/ Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Poultry
Capacity
Pon.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ 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
N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El YesrN
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number: - u Date of Inspection: it 71
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�/No ❑ NA ❑ NE
. a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r 7 � ., " t�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 7 N910 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 environm��Yco
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 WNo ❑ 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 dNo ❑ 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?
0 Yes
E2rNo
❑ 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
❑ Yes
To
❑ NA
❑ NE
acres determination?
N
17. Does the facility lack adequate acreage for land application?
❑ Yes
[/
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
L3"N'o
❑ 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
6Z
❑ 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
10
❑ 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
C] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: -06 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
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
❑ NA ❑ NE
V�NVN�
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
CZINo ❑ 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
C2 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
C I 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
Cj No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E N ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes2Z,'o ❑ NA ❑ NE
Use drawings of facility to better explain situations (use additional pages as necessary)..'„
omments (refer to question Explain any answers and/or any additional recommendations -,or any.ot er comments
A—..='
Reviewer/Inspector Name:
l'A1J
Phone:(Yk
-1 3
Reviewer/Inspector Signature:
Page 3 of 3
Date:

�.:
0.1
Facili Division of Water Quality
Number c7� ICY 0 Division of Soil and Water Conservation "
�.
1 0 Other Agency
Type of Visit ZRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: q p Arrival Time: "b Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: p Title: Phone No:
Onsite Representative: J`A)AT_bGJ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design . Current
Swine Capacity Population
❑
Wean to Finish
El
Wean to Feeder
13
Feeder to Finish
b
Ub
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = 0 0 . Longitude: = ° = t
Design Current.
Wet Poultry.' Capacity Population
❑ Layer
❑ Non -Layer
„ Dry .Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ T..rke s
FElTurke 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 Populafioo,::'
❑
Dairy Cow
❑
Dairy Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Coyd
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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
VN
❑ NA
El NE
❑ Yes
❑ NA
❑ NE
Page, I of 3
12128104 Continued

Facility Number: 31 — j0 Date of Inspection !b
• Waste Collection & Treatment
N
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: LAG­z;,NJ I (.AG 6611l 2, LA C- CW 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo ❑ NA ❑ NE
(ief 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 environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes �/No
No ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KINo ❑ 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
70 No ❑ 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
o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L rNo ❑ NA
❑ NE
s , d
( question #): Explain any YES'answers and/or any`i commendations or:any otFter comtiients = �..
Comments refer to u -answers-an
Use drawings -of facility to.better.°explain situations: (use additional pages as necessary)
i
Reviewer/Inspector Name
_ ." n�,. Phone:
Reviewerllnspector Signature:
Date: Q
Page 2 of 3 12128104 Continued

Ftacility Number: *3 Date of Inspection 0
J Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ID Yes (� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Wwo ❑ NA ❑ NE
the appropriate box.
❑ WUF El Checklists ❑Design El Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
011, o
❑ 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 InspectioVNr4p
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
�No
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
dil
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LI N
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
To
❑ NA
❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LDS No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
B 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
[f N
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El
No
❑ NA
❑ NE
Additional Comments and/or Drawings: -
i
Page 3 of 3 12128104

d Division of; Water.Quahty x
Facilt �Nutriber.: t Q.D!vis!pn of Soil and Water Conservation
Other Agency
Type of Visit 3 Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
% o
Arrival Time: ®
Departure Time: County: QUALM&I Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
�N14' AL.t2
Onsite Representative: _
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ='
= Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
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
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coxvl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page ]of 3
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
[INE
❑ Yes
❑ Yes
{ N [INA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

r
Facility Number: � Date of Inspection 0
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
. h Structu�e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:Lwlnv N t Wirde J
Spillway?:
Designed Freeboard (in): ll ,,
Observed Freeboard (in): r Ll `?
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes 2VNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes ❑ 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 environment alt❑ eat, notify DWQ
El7. Do any of the structures need maintenance or improvement? Yes NA ❑ NE
8. Do any of the stuctures 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 E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ed/No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
VNQ
❑NA
El NA
❑NA
El NA
W❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Coennsents (refersto question'# plam�an ,,E answO.andlo y recommendations or any other comments.
Use drawtngs of facdWty to$betteryexplatn sHuafioiRV;(useTadd!tionalfpagRas necessary,}:a
3
Reviewer/Ins ector Name p c:J°N a Phone TOM -- 3
Reviewer/Inspector Signature: Date: & O
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?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
❑ Yes
jd o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ 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
o
❑ NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�'No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ll No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ej'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E
❑ NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
LJ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�/
L'J No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(2No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
e�
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes;
No
❑ NA
❑ NE
12128104

In
Division of Water Quality
E" eility .Ntimbeir } ( Q Dwision of Soil and Water Conservation
O
�" "Other Agency
Type of Visit (D CC pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i 34 oQ Arrival Time: Departure Time: County: 0WOU-1 J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 00 NY� r a ^'I IM-T u-c iz-
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ . Longitude: = o = 6 = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
W Feeder to Finish
^� a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Pou Its
HTurkey
Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[:]No
❑ Yes Zo
/❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 1 Date of Inspection l aY a
Wag' Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VrN. ❑ 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
Identif er: CA CiI t CA 6Ci1n-lL 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S y Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [Y 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 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 EKo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 3 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 L/J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[2<
❑ NA ❑ NE
maintenance/improvement?
11.
is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
IQ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
��
El NA El NE
15.
Does the receiving crop and/or land application site need improvement? El Yes
FNo
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E Rio
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
91�0
ElNA ElNE
18.
is there a lack of properly operating waste application equipment? ❑ Yes
T _ Y
❑ NA ❑ NE
Yc.T���'°"a-tea "'"A,: t�� Cr -°- -.�, -.. _ ,.,
Comments(refer�t�oquestan#) Ezrplanany�Y1ESianswers�and/or any recommendations or any other comments.
Us draw�ngsrof�factlrty to better�ex_platn ituanons (se addttronalipages as5neeess_ ary)
�sxm� s""'�
i
T
Reviewer/Inspector Name - 14 fl Phone Q �G — 13
Reviewer/]nspector Signature: Date: v
pane 2 of 3 12128104 Continued

Facility Number: — j o Date of Inspection 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ON ElNA [INE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ElYes LEI No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
W-r�o
❑ NA
ElNE
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
V
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E;
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
![J No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E3<x,,
ElNA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
; No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
Z 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
N
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number
8'Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine Q Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: j�+ (, J p'%� Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o Longitude: ❑ ° = 6 =
gs
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
I Y610
1 90
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
E3Turkey Pouits
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood 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 E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑Yes
❑No
❑ Yes
�o
[I NA
El NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ErNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure/1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: (A & 413
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r./ ,32 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ 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
ental threat, notify DWQ
envi7yes
7. Do any of the structures need maintenance or improvement?
❑ No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ENo ❑ 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
ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[]Yes
—CJ
L3No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
E?fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
(�No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
LA G �o N Z N66JS ,d VA1TVP t,14 4,L •N XVJr r p,6 . CF r A LL,_JJ19 .het/, y
V ) AnMNAL �iLT lr✓ �Io �k l+/G
E
wer/inspector Name � 6 Phone: 7' i /3wer/Inspector Signature: Date: o
e�r�o in•
•.+...vi v� tivras...wcs

I'lacility Number: ��] _ l �� 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 dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0- es ❑ N ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Annual Certification
❑ Rainfall E 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 dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNt o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Leo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ Nd' ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NN ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ElYes ❑ No ld 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
[a o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
04o
❑ 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
` io
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

��ivision of Water Quality
} Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: © Departure Time: County Region:�
Farm Name:
Owner 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
Boars
Owner Email:
Phone:
Ph he No:
Integrator
Operator Ce 'fication Number:
Back-up Certification Number:
Latitude: = e = L Longitude: 0 o = ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I 1 ❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
ElTurke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
DWaiiy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: r —]I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
❑No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: —/69 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
StuAur.9 I S cture 2 Struc re 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 57D
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
S. 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C 6`J L�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name 1 Phone: Y ' L
Reviewer/Inspector Signature: Date: Cp d
Pane 2 of 1 /28/04 Continued

Facility Number: — Date of Inspection y
Re uired 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 appropriate box. ❑ WUJP ❑ Checklists ❑ Design El 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
OC
074 y ��
C-2) f�
(J) 1�
Page 3 of 3 12,28/04

G(Division of Water Quality
►jl Facility Number 3l Ib6 0 Division of Soil and Water Conservation r
0 Other Agency t.
Type of Visitpliance Inspection 0 Operation Review Structure Evaluation Technical Assistance
Reason for Visit TRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ds Arrival Time: Departure Time: 1J�00 County: Pl Region:
Farm Name: _ _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone No:
Onsite Representative: lF�-
Certified Operator: {;,WZ-00
Back-up Operator: o
Location of Farm:
Integrator: CnUQLPR1 e
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = Longitude: 0 0 0 6 =
dl
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
91 Feeder to Finish (4c$D '40oO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Ell
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
o El NA
❑ NE
❑ Yes
❑ Yes
Vl� o ❑ NA
ElNE
ElYes
LEI No ❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — I I 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 El No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA6- J I LAGrorm7j Z c,AGo-fj 3
Spillway?:
Designed Freeboard (in): �!5 5 l rl
Observed Freeboard (in): `A,%
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.)
/No
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
❑ NA ❑ NE
through a waste management or closure plan?
t, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaTNo
7. Do any of the structures need maintenance or improvement? El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
LI No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
�`Co❑ 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
tl 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) 1 a wOA (a S6ry C-S VJ t3l-4_-5
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[I NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
ElNANE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
1Z ❑ NA
NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Z ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
�j+ILA►.ns'E� dZF� 1wp i.Acsootil t�r1Et_S Zo a:`W fa:z.rm..s, �1Tsw� l'+ 6ttk.Fl7EoL 1�?td�AL�
?�tL, l3 ComES [iw5E T. A ?000Stiao�TEQ� '?uL.t- O(L WALf PULL. TO 09F0SZ1'Cr­ Or-QfCEW
Reviewer/Inspector Name `7� q1 AazaJ�c t, Phoned 96 ) 9gS -- 3�-to�, x-- 3q x?P3
Reviewer/Inspector Signature Reviewer/Inspector Signature: Date: So -
' 12128104 Continued

Facility Number: 31 — 101; Date of Inspection l D
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
El Yes
N
El NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
V7No
❑ NA
❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Z Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soilalysis El Waste Transfers
❑ Annual
Certification
El Rainfall El Stocking El Crop Yield El120 Minute Inspections and V Rain InspectionVX01
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El YesEl
NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
7No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
2No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
'No
LZ1 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VINo
❑ 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
ZNcEl
NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N 9
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LEI No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

•yY ,.��1t�1S�lon Of Water Qaltty
R 0 Di ston.o�f So�I and Water Conservahbn
` A. Q °Other Agency
p
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit Routine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �4Vgt Time:
MPermitted ® Certified 0 Conditionally Certified [3 Registered
AAAFarm Name: AAD � <I211 t'Yt
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
Title:
Date Last Operated or Above Threshold: _
County: A91 if g I►1
Phone No:
Phone No:
Integrator• ✓
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 " Longitude '
Design Current
awtne Capacity ro utanon
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacitv Population
❑ Layer E[--]ry
Da'
❑ Non -La er Non -Dairy
❑ Other
Total Design Capacity
Total SSLW r�
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: % Z
Freeboard (inches): 3 J
05103101 Continued

Facility Number: — /0b 1 Date of Inspection /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes El No
(If anof questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement? ❑ Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate. gauped markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [:]No
Waste Application
10. Are there any buffers that need maintenanceiimprovement? ❑ Yes ❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA ArMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Docpments
17- Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail. to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP. checklists, design, maps. etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notif}> regional DWQ of emergency situations as required by General Permit?
(ie.r discharge. freeboard problems. over application) ❑ Yes ❑ No
23_ Did Reviewer,'lnspector fail to discuss review/inspection u ith on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
(p No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Coaiments.(refer to gaestion : 'Eip2M­:aay YES aaswers and/or airy recrommeudattoas ar 8nv other cammteu#s:�
Use drawings of facility to better explain situations (use add�tionai pages as ecessar) Field Copy ❑Final Notes
1414/1 o 0174 Jel�
Reviewer/Inspector Name c• �=�"_;�;;�� �,.,,,� "" ,^� ����� ,
Reviewer/Inspector Signature: Date: D
O5103101
Continued

Facility Number: — Date of inspection
dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28, is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31, Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a p'ermanent/temporary cover?
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No

-77
�-q
[] Wean to Feeder❑Laver
t..CNon-Lav
Feeder to Finish er
- Farrow to Wean`'-
�� ❑ Farrow to Feeder Other
❑ Farrow to Finish
i ❑ Gilts
-
❑ Boars
No Liquid Waste
Type of Visit OLCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
LFacilit Plumber 3{ 1p Do IV of Visit� Time: 0%
-- I LO Not O erational 0 Below Threshold
M Permitted Weerrtified 0 Conditionally Certified 0 Registered Date Last Operated r Above Threshold:
Farm Name: /Tr�D�i ��h1:fh Cs/�� T_l�iM�!_._ County
Owner Name. Phone No:
Mailing Address:
Facility Contact: // Title: Phone No:
Onsite Representative: 141rtl 4 np WV Integrator: G `
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' • 0 K Longitude * ��G
_Design • :Current Design Current<
' Sw>iite' _ Ca >+Pa tilateon Poultry ' Ca'~acrtv =Po elation -Cattle
❑
Dairy
Design . ..Current
LL^Ca add Po ulatian
s
Discharses & 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 galimin?
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 & Tre-atment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: j Z 3 _
Freeboard (inches): uli 3� Zt�
05IV3101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes FINo
❑ Yes SNo
❑ Yes �& No
Structure 6
Continued
No Liquid Waste
Type of Visit OLCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
LFacilit Plumber 3{ 1p Do IV of Visit� Time: 0%
-- I LO Not O erational 0 Below Threshold
M Permitted Weerrtified 0 Conditionally Certified 0 Registered Date Last Operated r Above Threshold:
Farm Name: /Tr�D�i ��h1:fh Cs/�� T_l�iM�!_._ County
Owner Name. Phone No:
Mailing Address:
Facility Contact: // Title: Phone No:
Onsite Representative: 141rtl 4 np WV Integrator: G `
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' • 0 K Longitude * ��G
_Design • :Current Design Current<
' Sw>iite' _ Ca >+Pa tilateon Poultry ' Ca'~acrtv =Po elation -Cattle
❑
Dairy
Design . ..Current
LL^Ca add Po ulatian
s
Discharses & 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 galimin?
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 & Tre-atment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: j Z 3 _
Freeboard (inches): uli 3� Zt�
05IV3101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes FINo
❑ Yes SNo
❑ Yes �& No
Structure 6
Continued
Continued

ram; �.�s-�-• .,-."•.emu ^
Facility Number: 3
Date of Inspection �Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion.
seepage, etc.)
6. Are there structureson-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 maintenancelimprovement?
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 fiquid level
elevation markings?
❑ Yes EZI No
❑ Yes V3 No
❑ Yes t6 No
❑ Yes [)INo
❑ Yes UNo
Waste Annlication
10. Are there any buffers that need maintenance/improvement? - ❑ Yes C,No
11. is there evidence/off over application? ❑ Excessive Pondin 1g El PAN El Hydraulic Overload ❑ Yes � No
12. Crop type L 6.�iSl [ /T�rn Ly/A 7<tr/ B 6 _
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 BNo
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
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
SNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
[9LNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
M[No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
53 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
M.No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
JffNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
_ gNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
UNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
NNo
® No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
OR
❑Field Cagy ❑ Final Notes
,4)Ate : V,(-ix lulls
Ir- 7¢ 13.
e4l-Al Ore sfz•'fln� ''K?` Gu7� Cave
Crro�
Reviewer/Inspector Name
Reviewer/inspector Signature:
Date: 2 d Z
05103101
Continued

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
❑ Yes
tj;rNo
liquid level of lagoon or storage pond with no agitation? '
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
ft
28.
is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
❑ Yes
t 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
ED No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
.
or broken fan biade(s), inoperable shutters, etc.)
❑ Yes
E.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 permanentitemporary cover?
❑ Yes
M No
05103101

Date aE Yisil: �-7 Q � Time:
Facility Number
0 Not Operational 0 Below Threshold
Permitted 13 Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: -••--
Farm Name: _.' c`>' .f' 1} t.-............................................................ County:----.....�.- ...... _...
OwnerName: ..... . ............................................ ......... .......................... ................................... Phone No: ............................. ....... ..................... .......... .... _....__..
FacilityContact: ............................................................................... Title:................................................................ Phone No:...................................................
Mailing Address: ........................................
...[..`...........
................. ...._... ..W..
Onsite Representative: L'Q'�- ...................... Integrator:.. G- `�..._...........__......
Certified Operator: ........................... . ......................
Location of Farm:
Operator Certification Number:........... _............„.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude • d Du
:Current Deli C_xi�t Design ; Current Design gn -
S�_1°e Ga ciE "Po Matron , . Poult, Y Ca .. ci Po - tilatton Cattle
Ca acr ` Pa `alatioa ,..
Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish Q ❑ Non -Dairy Q =' Non -Layer -Dairy
77. ❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish TO1ta1'DQSlgll Capacity .
❑ Gilts
❑ soars Total SSLW
Nu}nbes of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area . ❑Spray Feld Area
Hol Ponds. / Solid T
-ding . = raps:: ❑ No Ligeud Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes k�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ❑ No
c. If discharge is observed_ what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes gNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State oilier than from a discharge? ❑ Yes W40
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
[]Yes gNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ........................................................................................................... ............................................................................................................
Freeboard (inches):'
5100
Continued on back

P
Facility Number: 3 k — Date of Inspection a -
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONO
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 JgNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes 5f No
5/00

Facility Number: 3k — td Date of Inspection C�
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 maintenancefimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type If f r e1 i Sri � i J%
/ W 15a'Y
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yins ;or- dgf ciencUes' •"' 'rp' nQCec ding this -visit; - Y;oo wdl •i ecviye 40 futtit¢r. -
correspo�idence. till tizis visit: .......... .
Comments (refertti
Use drawings of faii
yQ_C_- 5 -
ins ufse add
any'recom nena
pages as nece=
'k,k'-N qv-_-C� e
�ttons oraay other ct
❑ Yes ,eNo
❑ Yes �fNo
❑ Yes b3rNo
❑ Yes ONO
❑ Yes WNo
❑ Yes K No
❑ Yes ONO
❑ Yes JKNo
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �1No'
❑ Yes ONO
❑ Yes kNo
❑ Yes XNo
❑ Yes )4No
❑ Yes XNo
❑ Yes ONO
❑ Yes $dNo
❑ Yes W'No
[:]Yes gNo
❑ Yes VNo
J, e.? �-- SPY 602�_ ).
Reviewer/Inspector Name '
Reviewer/Inspector Signature:
Date:
5100

t _ J
;'. Division of Soil and:Water. Conservation °Operation Review
w Q Dryision of Soil and;Water Conservation y_Comptiance Inspection
'- '.ram zvision of Water Quality -Compliance Lispectioa = _
Nher Agenc - O erat�o�n Revrew =�
y p
outine O Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review-0 Other
Facility Number Date of Inspection%
E2�� Time of Inspection 1— 24 hr. (hh:mm)
Permitted © Certified 13 Conditionally Certified © Registered © Not Operational Date Last Operated: .........
.................
Farm Name: ....... u.l'\....................... �- y^'A ......f 31 County:........ L!!'........................C-6.........
Owner Name: ....... ... ................. �. ......................... Phone No:
........................................................
FacilityContact: . ............... 1��..Title:...................................................•--�--....... Phone No....................................................
MailingAddress: ................................................................. .
Onsite Representative:...&..&b . Integrator:.......... IS ...................................................
Certified Operator : ........................ ........................... ............................................................ : Operator Certification Number:..........................................
Location of Farm:
�►
...... ...........................................................................................................................................................................................................................................
Latitude • 9 C� Longitude 0 ° &°
Design Current r °Design- : Current-, Design Current
Swine Ca achy Population - ,Poultry ;capacity . Population ,Cattle _C p city .Population •
❑ Wean to Feeder
Feeder to Finish
Q
Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
jNumber of Lagoons 3 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area -:
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑�Yes
�❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
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 19 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: is r'S ZS 3
Freeboard (inches): ............ . M
7
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion, ❑ Yes [ No
seepage, etc.)
3123/99 Continued on back

Facility Number: 3i —J{7, Date of Inspection
6. Are therg structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? `'`
El Yes
kdNo
(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
VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
jQf No
�\
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes]
No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
VNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
DdNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
O No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
:'(No
16. Is there a lack of adequate waste application equipment?
❑ Yes
[(No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available? ,
❑ Yes
leo
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
qNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ff�o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes VNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ANo
24. Does facility require a follow-up visit by same agency? ❑ Yes F No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? [:]Yes U(No
0: �10 •vigialriQris;o dereie'ncies •i��re noted dt�trfrig this:visit; • ;Y:oi� wiil•ree�iye nti #'urther • . •
rori'es�ondence: about: this :visit_ .. .. :
Comments (refer to question #) Explain any -YES answer§ and/or.any recommendations of any other comments: `
_
Use drawings of facility to better explain situations (use additional pages as necessary)
law/ UOhS Btrt1/'j � `-/' ,L Y
e�
Reviewer/Inspector Name
Reviewer/Inspector Signatures � j/�/%n�%. ��j,,, Date.

. 1
Facility Number: ,i — 1190 Date of lncpection
Odor Issue
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes P3�N—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 l o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes _O
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 X-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 Unto
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
3123/99

p Initial Evaluation - O Follow-up Evaluation 0 Denied Access [3 Does Facility Require a Follow-up
Facility Number 1 Q Date of Evaluatinn-/9--co
Tune of Evaluation %/ 3d 24 hr. (hh:mm)
❑ Permitted 13 Certified [] Registered ©Nance -Registered Inactive Facility Date Last Operated:
Farm Name: County:
Owner Name:.._ ,.fin __ _ _— _.__ ' .�. .......
Facility Contact: No:
Mailing Address:
Onsite Representative:
Location of Farm:
Integrator:
RLschaEzes & Strearn Imnxcts
1. I- any discharge observed from any lagoon? ❑ Yes FR(No
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 obscr d, what is the estimated flow in gal/min?
2. Is there evidence of past discharge from any lagoon?
Waste Collection & Treatment
3. Estimate Freeboard Level:
❑ SpiIlway
1
❑ Yes ❑ No
❑ Yes❑ No
/4`A-
Yes E;rNo
❑ Yes ONO
Structure I Structure 2 Structure 3 StrU;:L= 4 Structure 5 Structurc 6
Identifier:
Freeboard(inches):� __. __w.�`....�.___._.»..»......._..W_....._......._____..._....�............__w..
�.�; :�y.r:.'1 y,L 11:-_--y..:73_�'^�:�:"-':'..'TL�'s= �-��.`. T:_M^ti.__:R._�Ll'.�-T...t.. _'• f•nil,Jla_Sr.iY'.-»«:�.-.":-9.^^.^.L
Mrn_�}r z
Reviewerlbspector Namerr� 6 _�qr= = —rran area a _. - r i • _ �rL
Reviewer/Inspector Signature: Date: /
ILEF -
1112/00 1

15. Application Equipment and/or Sprayfield Not Available
16. Contact could not be made with on -site representative
uwu Nurr Jj1n',rV;Ktat BK PAGE 04/88
Inactive Lagoon Field Data Sheet
Facility Number_ -� Inactive Lagoon Number:
Latitude Longitude . ❑' kGPS ❑ Map
4. Waste Last Added (mm/yy)14Qwner ❑ Estimated
S. Estimate of lagoon surface area (acres)
6. Effective height'of embankment (feet) s Sbt
7. Distance to Blue Line or Intermittent Stream (feet)
❑ Determined From Field Measurement ❑ Map
8. Down Gradient Well
�_1 io f�S3 71 b clSr
AS
❑ < 250 ❑ 250 - 1000 ❑ > 1000
a. is there a down gradient well located within 250 feet? ❑ Yes 6&o
b. Is an intervening stream not located between any part of the lagoon and the nearest well? s ❑ No
9_ Distance to WS waters or HQW (mi.) rlj—< 5 ❑ 5 - 10 ❑ > 10
10. Does the representative ]mow of overtopping from outside waters? ❑ Yes o ❑ Unknowa
11. Appearance of Lagoon Liquid
a_ SIudge Near Surface
b. Lagoon Liquid Dark, Discolored
c_ Lagoon Liquid Clear
12. Embankment Condition
a. Poorly Built, Large Trees, Erosion, Burrows, Slumping, Seepage, Tile Drains, etc.
b_ Construction Specification Unknown But Dam Appears in Good Condition
c. Constructed and Maintained to Current NRCS Standards
13. Outside Drainage Area
a. Poorly Maintained Diversions or Large Drainage Area not Addressed in Design
b. Has Drainage Area Which is Addressed in Lagoon Design
c. No Drainage Area or Diversions Well Maintained
14. Liner Status
a. High Potential for Leaking, No Liner, S::ody Soil, Rock Outcrops Present,—
b_ No Liner, Soil Appears to Have Low Permeability
c. Meets NRCS Liner Requirements
❑ Yes N o ❑ Unknown
❑ Yes No
D
El
TUDS
1/12100 I

}� Groundwater Rating
The following questions will be incorporated into the current inspection form or answered at the
central office.
Rating Questions for Groundwater
YE
N
UNKNOW
S
N
1
Has the lagoon/sprayfield been in use for 5 years or more?
2
Is there a water supply well within 250' of the potential
pollution source (lagoon or sprayfield) with no intervening
groundwater discharge?
3
Is the predominant soil drainage classification well drained
to excessively drained?
4
Are rock outcrops present?
5
Are either of the following true?
• The lagoon was constructed before 1993 NRCS**
i standards
• There is no verification of adherence to the 1993
NRCS standards
6
Have groundwater standards been exceeded at this site
based on existing monitoring records?
7
Was groundwater encountered during construction of any
lagoon?
Depth to Groundwater (feet below land surface)
*Generally unknown, but if this data is available is should be recorded.
**Natural Resources Conservation Service
Responses to the questions will be entered into a computerized version of the scoring table on the
following page to determ-Ine the rating
.,
1
7

Water Quality Active Lagoon Ranking 4Sl
Draft fm /
Central Office Criteria
1, Was facility constructed before 1993 MRCS Standards or there is no verification of standard?
2. Plant Available Nitrogen (PAN) Deficit < 500 T per year or FI. F3 or F4 Wettable Acre Determination
Flags
F1 Lack of Acreage resulted in over application in last two yearss'
F3 Obvious field Iimitations ditches_ buffers irregular shape
F4 Application acreage in excess of 73 % of total acreage
3. Lagoon Capacity greater than 1,000,000 cubic feet
4. Was there a discharge from waste system in last five years? X-kV
Central Office Criteria available after new verified GIS data is gathered from field GPS Units
3. Distance from Lagoon to Water of the State (WOS) > 300'?
6. Is lagoon in 100 year flood plain? N6
Field Inspector Criteria
7. Modify Question m4 from current inspection_ add choice boa:: Is high freeboard due to storm water or
management? � � � 2-1 >�v i L�5de
3
S. Modify Question 3 from current inspection form (take immediate out) and define inform instructions -
Current quest7a
Are there immediate threats to the integrity of any of the structures observed? (trees,
erosion)
9. Add question on effective embankment Height > 10"
kS
2/3100

01/18/2886 12:55 , •9L9T715-6648 DWO NON DISCHARGE BR
Site Sketch Showing All Active and Inactive Lagoons
PAGE 83/08.
rs
•
5�
MEF
l/12/00 2

[3 Division: of Soil and,Water Conservation Operation Review
�. Division of SiAl and Water Conservation Compliance Inspection-
-Z
11miision of Water Qrtahty - Comphance Inspection z w
Other Agency Operation,Revtew r�
ICWRoutine Q Complaint Q Follow-up of DWQ ins ection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of inspection f : 40 24 hr. (hh:mm)
Permitted 0 Certified 13 Conditionally Certified [3 RegisteredLE3 Not O erational Date Last Operated:
FarmName: ............... N'C' ro ........... . !-..........Rlryx ............................................... County: ........ . ............................
Owner Name:........................N61.Y.4h......_.........51Mt r........................... Phone No: �'�i-f�L�..'� '. .;� �..-......................... .
Facility Contact: ............ ... Title: ................................................................ Phone No: .................._.._... .........................
................................`-...............................
Flailing Address: ......3{?S�L../..�.. iU.�...t'�w.`�.....tAA.... ...1M............................. ........l��b. o!�.�....lJ.t�................................. ....Z�`�?�%......
Onsite Representative: �.......� ,�yh �................................................. Integrator: ........ 1_1':Y f.{.G ........................................................
CertifiedOperator: .................................. : ................ ............................................................. Operator Certification Number:..........................................
Location of Farm:
r..........................................................................................................................................................................................................................................................................i
Latitude Longitude �• �� ���
°m - Design Current..:
Design
: -Current
Design Current 4
Swine _ -_ -Capacity Population
Poultry. .. . _Ca acity_Population_
. Cattle
Capacity Po ulation =;
❑ Wean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
p `�Q
O�
❑ Non -Layer
JE1 Non -Dairy
I-_
❑ Farrow to Wean
•
❑ Farrow to Feeder
„ ❑ Other
-
❑ Farrow to Finish
T6CAL DfSlgta Capacity.
tS�D
❑ Gilts
- -
❑Boars
-..
Total SSLW
E � .
Number of Lagoons Subsurface Drains Present ❑Lagoon Area ' Spray Feld Area
Holding Pon . Sohd Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the 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 t Structure 2 Structure 3 Structure 4
Identifier: PsS i A S2 A U
Freeboard (inches): ..........................................
❑ Yes PNo
❑ Yes M No
❑ Yes E�d No
❑ Yes No
❑ Yes [j?No
❑ Yes [R No
❑ Yes RNo
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3123/99
❑ Yes [,9 No
Continued on back

e Facility Number. 3t— �(o Date of Inspection $
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �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
S. 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? El Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'P No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes C3)No
12. Crop type i'JP.vmtJOG r 4 / AwSPUr--C' %Wwi I 1 avat iY' C&i--/ 1JL ' I / -.eAe
13. Do the receiving crops differ with th&e designated in the Certified Animal Waste Management Plan�(CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
56Yes
❑ 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
P No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
O No
t8.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
0 No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
Q1 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[�VNo
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
E121No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0' No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[PNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[PNo
yWh Loris :ot- &ficie ps were noted• dix°>trig phis: visit; • Y:oit will •reed*i6 ii6 ]Further -
correspoiideitce. aboiit this visit.... . . . . . . . . . . . . . . • . ' . . .
Comments (refer to`.question #) Explain -any YES.answ_e__ and/or any recoinmendatioi5s`or dny other.co menu =
Use:drawings of facility to better explain situafions `' (use additional pages as_necessary) '-
t _ -_
T Q�rc ^4ire�s on atl 41r tie Ooks Yn 6e- rt_VkyjAW. E+ Si0^ OCU_
0 r 6 c1'%e-•r � ; �C� w c i 1 a � I Q car l �S 1 s �.o u! r1 b � trlo n i �!`e {� {�a t�s ui�- tn.e -�u•-'�'�.�.r�
� c dye- • a-Vt" ne `L t? 5j
g, ;►� a.r�-�� i� S�� �tel�s s�ouli� be. r+novec� "b
tt{Pr �,a Luz ia¢sw ��otc� der wX c�� lt�rrnJta��^
germUa L il/n_ ►e�� i#- {b c5ismLAU �- z vGt�
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: jr/qq
3/23/99

i
Facihty Number: 31— 8L
Date of Inspection �q
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
1;9 No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
[:]Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
[A 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
qNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
[P No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
AdditionalL Comments and/or... Dra 4-
g11-10A

MEM
�❑ Division of Soil and Water Conservation 0 Other AgencyUsk
yF
D�s�on of Water ryQuality
Routine Q Complaint Follow-u g of DWQ inspection O Follow-up of DSWC review Q Other
Date of InspL ction to/Z
Facility Nurnber �o�_ Time of Inspection 24 hr. (hh:rrtm)
[3 Registered InCertified [3 Applied for Permit ®Permitted 113 Not Operational Date Last Operated:
AA � GG
Farm Name: 1 4 ....... 7tr�. ir• A tQot� ...................... County: ......... Dk,. 6............................................................
OwnerName: ................ •.................... :.........snnti.............................................. Phone No:.... ��a-:Y,..z2........................................
Facility Contact: ..................................: .. Title: .... Phone No:
Mailing Address: .'t........N ...... ......f..i ....9 ....IJ...:................:.... ASi � Y n.}..N-...................................I... . Z ........
Ortsite Representative:......... Integrator: ......... .................
Certified Operator...V:}Ulc-w..... I.J:!�N ............... Operator Certification Number ....... fl(.5.f ..............
Location of Farm: '
.E�.:�t...... :.........1. .....1.S1..� ..,... :......tail i lac .....tniar.. .....4.:.....St..�l.:................................................... .........................................
........................................................................................................................................................ R
Latitude �•.®' 25 " Longitude
Design V Current
Swine Capacity Population
❑ Wean to Feeder
[,Feeder to Finish
G Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
.....Design. Current
Toultry `, Capacity: Population Cattle:.;
Layer ❑ Dair
❑ Non -Layer I 1 ❑ Non
❑ Other
_ Total:Design Capa
,- -Total SSI
Subsurface Drains Present ❑ Lago
❑ No Liquid Waste Management Systi
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 hypass 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?
.Design Current
Capacity. Population.
)airy
ity °> o
W S o 00
n Area IQ Spray Field Area
5. Does any part of the waste management system (other than lagoonstholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes l$ No
❑ Yes No
❑ Yes [N No
❑ Yes q No
❑ Yes No
❑ Yes No
❑ Yes [j No
[Ayes ❑ No
❑ Yes V No
❑ Yes �d No
Continued on back

1FacilityNumber: --�
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Lagoons,llolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure ? Structure 3
Identifier: f Z 3
Freeboard (ft): ........ 4:.Tr. 3• A. ............ ..
Structure 4 Structure 5
.....................................................
10. Is seepage observed from any of the structures'?
11. is erosion, or any other threats to the integrity of any of the structures observed'?
Cl Yes y*No
❑ Yes 10 No
Structure 6
...........................................................................................
❑ Yes DdNo
❑ Yes [g No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste :Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ) _
l5. Crop type ......., l C-..............St(k�ta��....�zat.�.t!1.....................-.....l��.Y..V4..........L� ._....-...tCi�6,,A-.........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?.
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site represeniative?
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 deficiencie's.were- notedduring' this:visit.-.You.will receive no ftirtlier
: correspondence ii out this'. visit:: ' ::
W Yes ❑ No
❑ Yes N No
❑ Yes P,No
❑ Yes
64 No
❑ Yes
P9 No
Yes
❑ No
❑ Yes
f& No
® Yes
❑ No
❑ Yes
N No
El Yes
No
❑ Yes NJ No
❑ Yes P No
❑ Yes 0 No
Cortiments (refer'to question #)..,Explain any .Y 1 S answers andlor sty recommendations or any other comments...
Use drawings of facility"to better explain situations. (u`se adtiitionaipages as necessary).
-
s•G�SszJ.�.v t�y,;r. �e[pd, �-4 s�o�i� 1pe ir.�r��d �� pon ��{`us-. ru�o�-F a�a...�
`
tZ • go�c at-cc�s or. 1' i nwur rs}; kc craft off- tarncoti s]- ool� be revue
lg• �etrmvUo.. i r\ Sn i�elU(� 5�na��� �e imltsVtU. '
7/25197
Alftlov Reviewer/Inspector Name
lkeviewer/lnspector Signature: Date:

w', ❑ DSWC Animal Feedlot Operation Review_
DWQ Animal Feedlot Operation Site Inspection
JQ,Routine• O Complaint O Follow-up of DIVQ inspection O Follow-up of DSWC review_ O Other j
Date of Inspection ']
Facility Number
Time of Inspection $: D 24 hr. (hh:mm)
D Registered 1$ Certified © Applied for -Permit U Permitted [3Not O erational Date Last Operated: ------
Farm Name:
` County blr i.n...................
Owner Name: hsaxov--,.�.......Srxi,�^ ...... ......................................................... Phone No:.��!(1> ���-..�v�7................-..................
Facility Contact: .-... Q,......Srq!:................ ... Title:..... aw.r144r................................. Phone No: ��- G)..5-61-36A 7......
Mailing Address: ...... IGSD........ lN.Cr.t wl....i.l.�.. `i ..9�?3. �... ��Qlr��cs�L. _N � ...f....:. Z��?�{ .......
Onsite Representative :....... ..[�L+.y-:0(.�-----�Ikt�Sc,....................................................... Integrator :....--�.1�Yvl[-5.........................................................
Certified Operator,—.. ... ...................... ............ ............ Operator Certification Number, ...... I..k
f ............
Location of Farm:
1.M4...`10agar L........... V.11U.t...F.aX-m.....ss-..-.�tr .....saves +A.11nar .......A.,.1...Mn .U.2..-..r>�f-w-...�t......... --, -.
-.......!�J4- ..i�._ ................ -------------------------- ...............................................
Latitude a 1 " Longitude • 4 4.
Design Current
Nwme Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design;.- Current
Poultry Capacity Population Cattle Capacity Population ,
❑ Layer ❑ Dairy
❑ Non -Layer 1 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds !IQ Subsurface Drains Present ❑ Lagoon Area PWSpray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need raintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Dischar?e 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 Surface Water`' (If yes. notify DWQ) ❑Yes J9 No
c. If discharge is observed, what is the estimated flow in 4-aUmin? M k
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 Pj�No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes Rl No
5. Does any part of the waste management system (other than lagoons/holding ponds) require [Yes No
Y maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
T Did the facility fail to have a certified operator in responsible charge? ❑ Yes kNo
7/25/97 Continued on back

a
Facility Number:
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (Lattoons,flolding Ponds, Flush Pits, etc.1 ,
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: �.. �.....
.............. # Z
Freeboard. (ft): ..... :........... ................. ............... 11........... 4-
....................................
M.
Is seepage observed from any of the structures?
❑ Yes
9 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
C9 No
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
19No
Waste Applicatiott
14,
Is there physical evidence of over application?
❑ Yes
allo
(If in excess of WMP, oir runoff entering waters of the State. notify DWQ)
15.
Crop type ........CCaS......%)tVjrn.J6........... .................... 620.x................... ---------- - ...........................
.
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
KIN
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
"No
18.
Does the receiving crop need improvement?
❑ Yes
�(No
19.
Is there a lack of available waste application equipment?
❑ Yes
j$No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[5rNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
15kNo
22.
Does record keeping need improvement?
5(Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EffNo
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
[KNo
No.violations or deficiencies.were noted du' ring this.visit..You:vvill re'ceive-'no further
correspondence about this:visit:
s,�...
Cotttmeh6 {refer to question #}:,;Explain any YES answers and/or aityi&6mniendatiops or any other comments
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7/25/97
Reviewer/Inspector Name1K �QV) Iran
au,: �> €
Reviewer/Inspector Signature: Date: q

Site Requires Immediate Attention:
Facility No_
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
. DATE: '� �� , 1995
Time:
•
Farm Nz
Mailing
County:
Inte gratt
On Site Representative: al ran 's vn �' � Phone: 3 G. 7
Physical Address/Location: c-s
Type of Operation: V ' Swine �� Poultry Cattle ` `'' `s ` 0t6
Design Capacity: .�CLB . D Number of Animals on Site: ` ; O&Q
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:& ' 06' -3&' " Longitude--7-7 ° 411 —3Y 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) (Pr No Actual Freeboard: ---'( Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o No)was any erosion observed? es r No
Is adequate land availablefor spray?�or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet
Is the animal waste stockpiled within 100 Feet of USGS,Blue Line Stream? Yes o o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line?
Yes orb
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 06 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, Iand applied,
spray irrigated on specific acreage with cover crop)? Yes or No v S__ v
Additional Comments:
w1 ..� �+ w-� riff t z zu [S
Inspector ame
cc: Facility Assessment Unit
Signature
Use Attachments if Needed.