310111_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

S
U Division of Water Resources '
ry Facility Number - �'j (� Division of Soil and Water Conservation
Other Agency
Type of Visit: 577ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: fuaG Arrival Time: Departure Time: County:
Farm Name: Ce ;A, j 0+ Owner Email:
Owner Name: et'— ttnb� Phone:
Mailing Address:
Physical Address: Facility Contact: _ cad( gwwk � Title:
Onsite Representative:
Certified Operator: ,G 6'et, � (I oy-
Back-up Operator:
Location of Farm:
Phone:
Regionl.2
Integrator: IJ--c #Vj"/ At
Certification Number: qs?R`st
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
Wean to Feeder S a ll () w
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Design Current
Dry Poultry Canacitv Pori.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
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
-,�
,-D
I" �"o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
E]*�NA
❑ NE
b. Did the discharge reach waters of the k96&REN �wW�R)
O Yes
[:]No
[✓ 1NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste mana�iel srs (If yes, notify DWR)
❑ Yes
❑ No
[7�NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or pot en "MIN to the waters
❑ Yes
&No
❑ NA
❑ NE
of the State other than from a discharge? Wilmington -'Regional Office
Page I of 3
21412015 Continued

Facili Number: 7 1- Date of Inspection:
Waste Collection & Treatment
4 is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [j'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑-1�A ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑moo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[] o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[3"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?,
❑ Yes
[9No
❑ 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
❑fio
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[eNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[D 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): U , FS C v-te-
13. Soil Type(s): to tr,i c2 ILi.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[r]'b'lo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q-No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
QIo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C3 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design [—]Maps [:]Lease Agreements
❑ Yes E]"No ❑ NA ❑ NE
❑ Yes [] No ❑ 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes El"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

IFaciUty Number: _ Date of Inspection: Rfjyti G
4 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [-r]'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [3-_�o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
o
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
[]
❑ 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
[C[I'go
❑ 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
[2 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
L]No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
V]�No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Vf�40
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[D/No
❑ NA
❑ NE
Comments (refer to question #). KXp12in;any YES answers and/or any additional reconunendations or any other comments.
a
Use drawings offacilityto better.explain situations (use additionala'pages a U.,,-. drawin ty s;;_uecessary):
c2 - 3- �� P� •
1
Reviewer/Inspector Name: - `'D 0
Reviewer/Inspector Signature: /441)
Page 3 of 3
Phone:To- 3V r ,J--'
Date: 1__V .�.{
21412015

!vision of Water Resources"
Faglity Number - i O Division of Soil and Water"Conservation
O Other Agency
Type of Visit: -Q-Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 'Routine O Complaint O Follow-up O Referral O Emergency O Other
O Denied Access
Date of Visit: IOIY116 1 Arrival Time: Departure Time: County: �u / Region: Lim
Farm Name: CeCAr Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: (.C.lj �,3 �����/� % Integrator:
Certified Operator: Certification Number: I S l-6
Back-up Operator: Certification Number:
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
Discharges and Stream Imnacts
Latitude: Longitude:
Design Current
Wet Poultry Capacity Pop. F
La er
Non -La er
Design: Current
ffNon-Lulletsurkey
Other
Puults
Design 'Current'
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes ZNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
ff No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
ZNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[:]Yes
&No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
ElYesgoNo
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

FaciliNumber: JDate of Inspection:
Waste Collection & Treatment
4. Is storfge capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes M-No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes_,ffNo
❑ 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 Q 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 -ga'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes El -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 J:]-�No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L2'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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 -0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �" o ❑ 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?
Reauired Records & Documents
❑ Yes ;:�-No ❑ NA ❑ NE
❑ Yes [31�o ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes -LQ'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [-]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑Ko
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes-fl"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: Ci if
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 01 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑NA ❑NE
DNA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes _VNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ,,ffNo [] NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes -E] 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 [�TNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ,fNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes VNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ,j No
❑ NA
❑ NE
Comments (refer to question #) Explain any_YES=answers and/or-,anyadditional�recommendations�or any otizer comments a.,
le.se drawings of.facrllty�to'betterrexp!atn:situati6hs (use additianal,pages`,as:necessary).-,,
�—/ •-L Ir{ fJ ` S t rT O /C G' G Or
Reviewer/Inspector Name:
Reviewer/Inspector Signature: , �J
Page 3 of 3
10
Phone: 1?b ���� 2-3
Date: 0
214a01 S

Division of Water Resources
' Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: O Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Q Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: � Arrival Time: eparture Time: County:
Farm Name: � r �� �l� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: fyA 6ar7, &_le —
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Swine
Phone:
Lw&_ Region.
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop. Layer er
3 GOI INon-Layer 1 4=1
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Pullets
Other
Poults
Design Current
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �"No ❑ NA ❑ NE
❑ Yes �ffNo
❑ Yes )'No
❑ Yes Z No
❑ Yes K,�fNo
o
El Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M-,-j No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes if No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):JA
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 2] No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
[2 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
j2rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ETNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑Yes
9,No
❑ NA
❑ NE
maintenance or improvement?
Waste ADDlication
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 JZ 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 ;a -No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r]�No
❑ NA
❑ NE
acres determination?
TT
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
pa'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:2-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q 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
❑ 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 Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
Y4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L2'No ❑ NA ❑ NE
25, is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ff3No ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes J:2-No ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes .,[allo ❑ NA ❑ NE
❑ Yes ,❑ No ❑ NA ❑ NE
❑ Yes 12 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes allo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes E�J'No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes _Q/No ❑ NA ❑ NE
Comments {refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
v,U� N
6 T/O //,�_ / , -2— T— 4
a 7 Z;7-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
J
Phone:
Date: 3
21412014

Division of Water Quality
Facility Number - �� Division of Soil and Water Conservation
Q Other Agency
type of Visit: (;Kompliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
treason for Visit: �) Routine 0 Complaint O Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: L L-d � l Arrival Time: ', arj Departure Time: _ 3S ail j County: l;r�
Farm Name: CRQ{ )YhoT 63nin Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:,pC�+�,r��y
Back-up Operator:
Title:
Phone:
Phone:
Region: "/RD
Integrator: G
Certification Number: q q p a
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
Nan -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 ;2!rNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
WTNo
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes gfNo
❑ 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 ZfNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes YfNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes [ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facif Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;D-No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
,RNo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P6No
❑ 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
ZfNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[—]Yes
P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
PNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 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
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;6No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
OK
17. Does the facility lack adequate acreage for land application?
❑ Yes
;27No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VT'�4o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ WE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑ WUP [I Checklists [—]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
PNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - 1' Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;3'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VTNo ❑ 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 4 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [�fNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes [ TNo ❑ NA ❑ NE
and report mortality rates that were higher than normal? T
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?
❑ Yes KNo
❑ Yes VfNo
❑ Yes tffNo
❑ Yes FT, No
❑ Yes VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Name: 3ui.. �,_ Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 V412014

` sd Division of Water Quality
Facility Number - M171 0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit: $0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: 12rftoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: C 'f Owner Email: '4
Owner Name: 1A T G-(''t QPhone:
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
Other
Other
Latitude:
Phone:
Region: W
Integrator:
Certification Number:
Qa �bt-"V
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
1[41 er
Non -Layer
Design Current
Dry Poultry Capacity Pon.
La ers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Design Current I
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daia Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ;?fNo ❑ NA ❑ NE
[]Yes []No
[:]Yes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [:]No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ;ZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ;a -No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

iracili'dumber: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;�J'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed? [-]Yes ONo ❑ 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
VTNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
;To
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P-No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or.wet stacks) ,.
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�f`No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
JZ
❑ 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
R_No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r� o
❑ NA
❑ NE
acres determination?
TT
17. Does the facility lack adequate acreage for land application?
❑ Yes
g'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Vr No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�fNo
❑ NA
❑ WE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZTNo
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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 Z No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes rNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

'aciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes VNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes J!J'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 VrNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes ff No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes A No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 2r—No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes RIM ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes m No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question 9): 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:
21412011

U Division of Water Quality
Facility Number ©- L r i' ,J 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 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: Departure Time: County: DUPL�I Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 5e N ATE A -a 4YZ.ALArl, Integrator:
Certified Operator: Certification Number: O
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
pJ7
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
Design Current
Non-L,
Pullets
Other
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ICI ❑ NA ❑ NE
[:]Yes [No ❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciliNumber: - 1 Date of Inspection:
Waite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1
Identifier: L146164
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any inunediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes Y/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 environinent,11threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ 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 u lvo ❑ 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6o
❑ YesVN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ WE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes r
❑ 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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
o
❑ Yes�FNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
C] Waste Transfers
❑ Weather Code
Sludge Survey
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspecti;/No
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes io
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - Date of Inspection: c)
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ 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 C31N90 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 610 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[—]Yes Ko
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ENo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 2 No
❑ NA
❑ NE
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes FNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes ❑ NA ❑ NE
Comments (refer to question 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). ;*
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 1 'l✓
2/4/20H

0 Division of Water Quality
Uicility Number i -_J - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Com lance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 35 Departure Time: County: ' { i Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: j )OUATHAO M ICE — L Integrator:
Certified Operator: Certification Number:
Sack -up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
3� 0
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.
La er
Non -La er
Design
Current
Dry Poultry
Caaacity
Pon.
Layers
Non -Layers
Pullets
Turkeys
.Turkey Poults
Other
Longitude:
Design Current-
Cattle Capacity Pop.
Dairy Cow
Dai 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)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes
&
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
lac
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility N mber: - Date of Inspection: t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes lin/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 [If No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes LNo ❑ 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 2/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?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility ail to have all components of the CAWMP readily available? If yes, check
the appropriate ox.
WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
E�
❑ NA
❑ NE
❑ YesrNo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
ny o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Ys
❑ No
❑ NA
❑ NE
Yes
❑ No
❑ 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 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
WNO
❑ NA
[] NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: Q
24. Bid 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 Zycs ❑ 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 1 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)
❑ Yes El"No ❑ NA ❑ NE
[:)Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
E� No
❑ NA
❑ NE
No
❑ NA
❑ NE
�❑
No
NA
❑ NA
❑ NE
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations, or any othercomn
Use drawings of facility to better explain situations (use additional pages as necessary).
/y) #EW otEa_ Gar NCO
A16 To2�-
=;15, n/F k/ P,,A wi-tjq AJ6I!J 0;vk Z.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 76 —70
Date: q 1 1
21412011

Facii y Number
Division of Water,Quality. .
O Division of Soil and Water Conservation
Q Other Agency "
Type of Visit
Crpliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
0 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: $ Departure Time: County: DLAI'� _ _ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �v�ATl�h}� ��LL6iZ
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o ❑ , „ Longitude: = o = , = 11
Design Current Design Current
Swine' Capacity Population Wet"Poultry Capacity Population ' Cattle
❑ Wean to Finish
❑ Wean to Feeder
3 8YU
gab
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ GiRs.
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry . _ ..
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
-
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design 'Current
Capacity ;Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Humber of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[]Yes
[]No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El Yes
VNo
❑ NA
❑ NE
❑ Yes
04
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: j — 111 Date of Inspection
Waste Co)Fection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I AC at.-O
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3;.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes ZNo ❑ 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 environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? [IYes No ❑ NA ❑ NE
8. Do any of the stuctures tack adequate markers as required by the permit? ❑ Yes 91No ❑ 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 El Yes LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes dNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 04 ❑ 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)
I4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes WNO
o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ZNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes LXNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes EXNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any; recommendations or ahy other comments
Use drawings of facility to.better explain situations: (use additional,pages as necessaryj..
Reviewer/Inspector Name I `j a H a4u C{:i; Phone: 80
Reviewer/Inspector Signature: Date: q I I (,
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection b
Required kecords & 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 ❑Maps El Other
❑ Yes 7No
❑ NA [I NE
El Yes ❑ 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 V
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
; No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[]"N( o
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Ej'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
WN o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LEI 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
[:I/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
El Yes
��
[2No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�_,,
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,/(
El
ElNA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[IYes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
i
r
Page 3 of 3 12128104

Factlity.Nttmbe
_ere vision of Water Quality
O Division of Sod and Water Conservation
0. Other Agency
Type of Visitpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit tRoutine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Mp Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ►{ ,,, n Title:
Onsite Representative: U�+jj1 jw ry tX--L--K
Certified Operator:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: = e = f =dg Longitude: [= o = 4 = f1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
5ZFeeder Finish
3 S 44,
-kc"T-ITO
❑ 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
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood CoL
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes . [ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

acility Number: — Date of Inspection 7 6
iVVaste 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
Cl NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LAGr'M6-'J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): IjL
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 environmental t}yeat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes r1J No ❑ NA ❑JNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O 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 EI/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement? �
11. is there evidence of incorrect application? If yes, check the appropriate box below. ElYes C No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2fNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes
[dNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo ❑ NA
❑ NE
.. �. ~�A. � ��.�:-.?•
Comments (refer to,question #): Explain' any YES answers and/or any recommendations or any■other comments��_
ea
Use drawings of facilio to.better explaiii,situations (use additional pages as jnecessary) '
Reviewer/Inspector Name
Phone:
Date:
Reviewer/Inspector Signature:
7
12128104 Continued

Facility Number: 31 — Date of Inspection 7 z o
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes d/No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 El Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E No ❑ NA ❑ NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V_No
❑ NA
❑ NE
❑ Yes
L,l(
El NA
El NE
El Yes
,No
lL�No
El NA
[I NE
El Yes
dNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ENo
❑ Yes 2(No
❑ Yes dN 0
❑ Yes ONo
El Yes [�o
❑ Yes No
❑NA El NE
❑ NA ❑ NE
El NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
El NA ❑NE
12128104

Facility=Number. 111 OBnt
tOil
ision of.Water Quality
ision ofSoil and Water Conservation
Type of Visit 7coompliance 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: 7 Arrival Time: 1 Departure Time: County: '00000 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative:=�—
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
l
Phone:
Phone No.
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I Longitude: C
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
3 ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
o = e = u
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures: E]
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes ❑ NN
El Yes L"J N
ElNA
❑ NE
ElYes . o
❑ NA
❑ NE
12128104 Continued

P.
Facility Number: 3 ( — Date of Inspection 0 7 v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier• C.w 6-M
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _3Z'
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 9/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 IJ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes PNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��,,��
10. 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 9<0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[-]PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
t2. Crop type(s)
t3. 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
[�1Go
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
I=J 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
N0
❑ NA
❑ NE
Ue0ATLTA -
rT9
DEsr'6rJATCO
SErvo =rJ WIM
Reviewer/Inspector Name r A 1�%C�LL Phone: Z0
Reviewer/Inspector Signature: Date: 7

r�a
Facility Number: Date of Inspection a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CJ No ❑ NA ❑ NE
the appropirate box. ❑ W ❑ Ch kl' ❑ ❑ M ❑ Oth
ec UP rats Design aps er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
2/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
�
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
7No
❑ NA.
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[!(N
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
&Yes
El No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ffNo
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffN/o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
�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
1 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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
P/'Vo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
C No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
kacility Number 3 f 0 Division of Soil and Water Conservation
0 Other Agency i/
Type of Visit
CoyYtpliance 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: 1/%1 j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: v mw.An
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: = a = i Longitude: = o ❑ 6 = fl
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I❑ Layer
LI Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes O<o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes O ❑ NA ElNE
ElYes 21 o ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection 6 1
:r
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
Cl NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:���
Spillway?:
Designed Freeboard (in):
n If
Observed Freeboard (in): r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes diN,
❑ NA
❑ NE
Oe/ 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 t at, notify DWQ
7. 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? ❑ yes7No
❑ NA El 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❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
El Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
N El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N ElNA
Cl NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�r!J Cal y aE d 1 - K'(-W j.
D6 ga plq i f d,4 QuD G E Sv /C-
Reviewer/Inspector Name Phone{ %I 3
Reviewer/Inspector Signature: Date:
1uLoivw l.Oniin"Cu

Facility Number: — Date of inspection / m
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Qlf o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes _13No ❑ NA ❑ NE
the appropirate box. ❑ VJTJp ❑ Checklists ❑ Design [I Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[2 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4�(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
��To
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
rNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
VYess
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ICJ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
040 ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ 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
,,��,,/
L,d'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
,��
LS No ❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ejl El NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
1=1 No ❑ NA
❑ NE
Comments and/or
12128104

Facility Number
i
Division of Water Quality
1101
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit P<ompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit pRoutine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /77 Departure Time: County: 'r Region:
Farm Name: S Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Gilts
Other
❑ Other
Phone:
Phone No:
Integrator: ZZ
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = t = Longitude: = ° = I =
gg
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
�I ❑Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pultets
❑ Turkeys
❑ Turkey Poults
❑ Other - ---
i --
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

t
i
Facility Number: — 7 Date of Inspection
,1
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
Struc re I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 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) �y
13. Soil type(s) �� T
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):
r rt vi- lecor 1el"CT-
Reviewer/Inspector Name �� Phone:
Reviewer/Inspector Signature: Date: I4
page 2 0j-3 12/28104 Continued

Fa' ility Number: 31 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate bolow. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste AnalysiSoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24Iid the facility fail to calibrate waste application equipment as required by the permit?
ElYes
❑ No
ElNA
ElNE
o25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ No
❑ NA
El 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 burs and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments and/or Drawings:
40'� recz�/ lPve/
Jell-e CG,y�C�f� /?PGc� �IGCG SGl/
t/
6 V
,61,g Vey
Page 3 of 3 12128104

facility NumberU0VK_�
-
(Division of Water Quality
Q Division of Soil and Water Conservation f
Q Other Agency 1�1(
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit ( Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 212t 105' 1 Arrival Time: 4'-� s Departure Time: S �tS' County: C1QPd '-1 Region:
Farm Name: CuAs:-4-;-S t;V►>3fC FP%O—W. Owner Email:
Owner Name: -.,,
?`railing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone No:
Onsite Representative: G er jb to NoJGo y Integrator: J cl 40 AXD
Certified Operator: CHaz.�ks IwaTl62
Back-up Operator:
Location of Farm:
Operator Certification Number -
Back -up Certification Number:
Latitude: = o = , „ Longitude: = o [� ,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder SSE40
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify 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 [INo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
El NA
❑ NE
[IL7 Yes
,�,/No
No
❑ NA
❑ NE
12128104 Continued

4
Facility Number: 31 — III
Date of Inspection 1 14 z . T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El 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: LACsoaN i
Spillway?:
Designed Freeboard (in): I q"
Observed Freeboard (in): Q,co
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
E No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
LI No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Cj'No ❑ NA ❑ NE
maintenance or improvement?
Waste ARplication
10. 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) F6sWE (6) GWS
13. Soil type(s) FoA
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U,f No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
1 o
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[]
Yes
LJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
12� o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1 No
❑ NA
❑ NE
t4.) i'L-r�rr�r ?_OD CaC 06(-_0_S -rb 6r, tjZtH 6ZCC or��S,
rA R 1�r L as lc,S CY-00 .
Reviewer/inspector Name Phone: qoo 395-- 3q6- v Lo3
Reviewer/Inspector Signature: Date: oS
12128104 Continued

Facility Number: 31 — III Date of inspection
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
2l . Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ZNo ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
all Comments and/or Drawings:
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
❑ No
dNA
❑ NE
❑ Yes
❑ No
E' NA
❑ NE
❑ Yes
fNo
❑ NA
❑ NE
❑ Yes ❑ No E�NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
❑ Yes El"No ❑ NA ❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
El2 Yes
No
❑ NA
❑ NE
12128104

Facility Number
f
Date of Visit: � Time: t
i
10 Not Operational 0 Below Threshold
Permitted }Certified D Conditionallly Certified 0 Registered Date Last Operated o Above Threshold:
Farm Name: CA!f1.16 #t4_1t+Ar._ County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: kmei ak Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude �' �6 u
Design Current
JWme
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feedei
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ La er I I IQ Dairy I
❑ Non -La er I I on -Dairy
❑ Other
Total Design Capacity--�
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
- --
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management S stem
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 gat/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 b
Identifier: f
Freeboard (inches): Z �0
05103101 Continued

Facility Number: 7 -- 11 Date of Inspection ZL
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?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anolication
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive P//onding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type GY/5 i FescAte f i�t7�k m
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes El
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ief 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 facilit- 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?
(iet discharge. freeboard problems, over application) ❑ Yes ❑ No
23, Did Reviewer/Inspector fail to discuss review•iinspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
LD No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments { to que ©ia ft Eiplaitt any-,,YES`ansWeif an�dinr. nay recommendations or A *-+other ooiftments
_
Use drawings of facility to better explain sito> lions. (use additional pages as necessary)-'�:Q Field Copv ❑ Final Notes-
/pt d— �1Gt Dr/�s lO0 G�O��•
Reviewer/Inspector Name S-• -�" �` _"' . _ -, Q. �.
Reviewer/Inspector Signature: Date: rj
05103101 or ; Conttnued

'4:
Facility Number. 3r-111 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30, IXere 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.)
1. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
05103101

s:
e Division of Water'Qualtty ,.n
Q Division of Sail and Water Conservatiou
O.Otlter Agency
Type of Visit a Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit f5,Routine O Complaint O Follow up O Emergency Notification O Other El Denied Access
Facility Number 3 / Date of Visit: 'rime:
IQ Not Operational 0 Below Threshold
® Permitted 0 Certified 13 Conditionally Certified [3 Registered Date Last Operated �o/r� Above Threshold:
Fk
Farm Name: L-�6r1 �5 l7fik�� dm County
Owner Name:
Mailing Address:
Phone No:
Facility Contact: ��jj Q Title: /JPhon/e No:
Onsite Representative: Amo ke-i Phiy __ __ Integrator: L 41!�/%E�f �i`/tdEr•G[
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 " Longitude ' 6 0 u
Design Current Design Current Design Current
Swine Capacity Population Poultry CapacjtV Population Cattle Capacitv Population
Wean to Feeder 10 Layer I I ❑ Dai
❑ Feeder to Finish 1 10 Non -Layer I I ❑ Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons f ' J ❑ Subsurface Drains Present 1101,agoonAres 10 Spray Field Area
Holding Ponds / Solid Traps jo No Li uid Waste Management System
Discharges & Stream lm acts
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Freeboard (inches): 3 `t
05103101
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes R No
❑ Yes ERNo
❑ Yes MNo
Structure 6
Continued

FacilityNumber: '31 — f Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ® No
❑ Yes ® No
ror
UW Yes No
❑ Yes No
❑ Yes CANo
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes MNo
11. Is there evidence of over application? ❑ Excessive Ponding ,�❑ PAN ❑ hydraulic Overload ❑ Yes CRNo
12. Crop type �LX/f�� ��e� 5—V / a AoGo 2
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15.
Does the receiving crop need improvement?
® Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
5INo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
10 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
[I Yes
R1 No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONo
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5a No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
R] No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
9 No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
91 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Ej No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ERNo
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_[.C]'.Yl #Z.4 ' -.Ga::-'', h .'t
Comments' refer"to question #} ExpWn•any YE nswers and/or aoy recammendatinns or a�oyFother eomments t ;.
r, _
Use drawings facthty tobetter egplam situations (use additional
of pages as necessary) ❑ Field Copy El Final Notes
/ f
�7 �$Odlt I�eC�S `� aC G�eQ4�CGi DU7L� s�/Y�riL� f7/777� �L�r
/� �ScliC hPC/ls - fib /JK 1'XihP�. �lcs sr/j`O,t� fi.� �GSf` A,
t hk4 hr} hee/h k'Afle-&�O�e
/ L2# W A 611r IlS o--
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Jr U
Continued

I Facility Number: 31 — /// Date of Inspection � 28�Oz_
Oder Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
El Yes B No
El Yes 14 No
El Yes ER No
El Yes B No
❑ Yes n No
❑ Yes KNo
❑ Yes El No
05103101

Plan Amendment to Include S&WCC Chronic Rainfall Practices and Standards through March 31, 2000
L If this facility can comply with its existingprmitand CAWMP it must do so. - - - " --
2. Temporary Addition of New Sprayfields (*) (Check appropriate boxes.)
[] A acres of cropland List crop types used:
[] B. acres of hardwood woodland @ 100 lbs PAN / acre added
0 C. acres of pine woodland added @ 60 lbs PAN / acre added
3. Summer Perennial Grass (Check appropriate box)
[] A Application window extended for acres of perennial grass until first killing frost.
0 B. An additional 50 kbs of PAN applied to acres of perennial grass prior to killing frost.
4. P Application Increased for Small Grains & Winter Grasses to be harvested. (Check appropriate box.)
A PAN application increased up to 200 lbs per acre for /�cres of small grains or winter grasses to be harvested
[] B. PAN application increased up to 150 lbs per acre for acres of overseeded summer perennial included in 3. B.
5. Waste Analysis (Check appropriate boa-)
0 A. Prior to December I", 1999 the calculation of PAN will be based on a 35% reduction of the last analysis taken '
prior to the first 25 year 24 hour storm event (Current waste analysis must be used after Dec. 1" .)
0 B. Use current waste analysis to determine PAN.
6. Required - Maximum Nitrogen Utilization Measures for Small Grains and Winter Grasses.
A Use of higher seeding rates,
B. Timely harvest of forage to increase yield, and
C. Irrigating during periods of warmer weather-
7. Re�tred -Irrigation Management Techniques to Reduce Runoff and Ponding PotentiaL
A- Making frequent, light irrigation applications, and
B. Not irrigating immediately before predicted rainfall.
8. The owner / manager is required to manage the movement of animals to and from the facility to minimize environmental
impacts, ensure compliance with the facility's permit and, amended CAWMP, and avoid discharge to surface waters.
9. Authorization to use the additional practices included in this amendment expires if a facility discharges to surface waters.
Any discharge is a violation and may result in an enforcement action.
10. The owner / operator is required to keep records of ail waste applications.
11. This revision must include a map or sketch of new land application areas.
Facility Number 3 / - /
a 4 A, /.
Facility Owner / Manager Name (PRINT)
acdity Owner I Manag Signature
Date1
144Z.4- A-Z,
Facility Name
� rpu nib Lam'/C `yn�7 J V " _
Specialist Name (PRINT)
Techni& Sf3ecialist Signature
Date_ 4,2
This document must be filed at the SWCD office and be attached to the facilities CAWMP
and be available for inspection at the facility.
(*) New temporary sprayfields. must meet applicable buffer and setback requirements. Waste must not be applied to wetlands.

Type of Visit ACompliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 ��—� Date of Visit: Time:
__ __j Q Not Operational Q Below Threshold
Oerinitted [3 Cerrdfiied'- `3 Conditionally Certified r] Registered Date Last Operated or Above Threshold: ...
FarmName: ........ `'.."..... e ....in`-.......... .......................................... County: L.............. ............ ..... ..... .............. ....
Owner Name:
PhoneNo: ........................................................ . . . ..... . ....
Facility Contact: ............................................................................... Title:................................................................ Phone No: ........... ..... ..............
_ .
MailingAddress: ..................................................................................................................... .................................................... ...................... ............. .........
Onsite Representative: ............................................................ Integrator:....... W_.......�
Certified Operator: ................................................... ............................................................. Operator Certification Number:....................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �9 66 Longitude • 4 0"
Design Current
e SVnne .. Canacity Ponulation
Wean to Feeder
t7
-0 Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
Flo Farrow to Finish
Gilts
Boars
Design . Current ... Design'.:
Poultry Capadty Population Cattle Capackk `Po 'ulatioa='_
❑ Layer ❑ Dairy
❑ Non -Layer I 1 ❑ Non -Dairy
❑ Other
Total Design Capacity -
Total SSLW
' Number of Lagoons , ❑ Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
Holding Ponds /.Soled Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
gNo
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
ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
JKNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:........................................................................................................................... ........
Freeboard (inches): 9^y)
5100
Continued
on buck

+Facility
Number: Date of Inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
9No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
;`No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
XYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
t"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
VNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
kslo
11. Is there e(vidence of over applicat' n? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑YesNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JqNo
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
ONo
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?
V Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
14No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
)3fNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
M No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
f $Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
8fNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
C'f No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
JM No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
( No
24, Does facility require a follow-up visit by same agency?
❑ Yes
Z No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Z,No
1[P.**.'.gliitioils;or deficiencie ' -*'re hot 4 i 0ftig this:visit; Yop wiil iecQiye o Fui-th�r
eorresnotid6ie: a�wtit this Vislta
Comnseats (refer to gnestzoni #):'Explain anyYES answers and/or'any recommendation or Many other eomtnenty,
Use dra�►tugs of.facility to:lietter explain sittuation& {use additional pages as necessa►iy}. w
Reviewer/Inspector NameSZGI►-�(�
Reviewer/Inspector Signature: Date: at 5/00

. ..
Facility Number: ''3— Date of Inspection G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes VNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes �No
❑ Yes Wo
❑ Yes 19No
❑ Yes ®No
❑ Yes IRNo
0 Yes gNo
Additional omments and/or-
rawings: = T - -
15 f'CnL'-- +
b I.. 6,
�scs�e -A-u s
s
( LIr
5100

Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ;Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
1 ... —.--] Facility Number
llate of Visit: 3—a� Time: GO Printed on: 7/21/2000
3
Q Not Operational Q Below Threshold
© Permitted Wertified `❑ Conditionally Certified © Registered Date Last Operated or Above Threshold : ........................
Farm Name: ....w1p3....ln� ........... County....t't...................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:
Bailing Address: ................................r t�
Onsite Representative:. ;C� --., ! „ ... Integrator:.. .
t".....................................................................................
Certified Operator: ..................................................................................... Operator Certification Number:...............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� �� Longitude �• �� �t.
Design Current
Swine CaDacity Ponulation
Wean to Feeder
-2p
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area JE1 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?
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. ll'discharge is observed. what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier: ........................................................................................................................................
Freeboard (inches): ag
5100
❑ Yes
))-�No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
[-]Yes No
❑ Yes bKNo
❑ Yes XNo
Structure 5 Structure 6
Continued on back

F ca ility umber:Date of Inspection �� Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑YesNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Cl Yes K'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 MNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes WNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over applicakn? , ❑ Excessive Ponding PAN ❑ Hydraulic Overload Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes gNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes gNNo
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 hj�.No
16. Is there a lack of adequate waste application equipment? ❑ Yes j(No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes 6(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 KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes j�(No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes N(No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONO
24. Does facility require a follow-up visit by same agency? ❑ Yes b�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes gNo
.; .id-vWatigns;or deficiencies were n6fed- during this'AsIC- Yoi� VH1-teceiye do further,
' : * icorieso oridence' about: this visit.: ' : ' : ' : ' : ' : ' : : ' : '
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of faeility to better explain situations. (use additional pages as necessary):
A.
►� s�� Lj ��_ t,� �.w-� , � Cyr 11 A
�� � �e. e.�o i �-,� 1,.,e2. � �e� s r5 h � Q ice►-w,%t- a�+-z v-2�C;
Reviewer/Inspector Name 1q10 —3 S ^J13G0 1 _2D
Reviewer/Inspector Signature: Date: 10 --3 — oa 5/00

E'acilft9 Number: 31 — l L Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
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 )o 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 WNo
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 VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes j(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes j�No
Additional Comments andor rawtngs:
siaa

- : 13 Division of Soil and Water-Consei-Oation - Operation Review t
' i 0 Division of Soil and.Water- -onsery anon ;Compliance.Inspectioa
Division of Water- Quahty Conigliaiice Inspection _ x
. OOther-Agency- Opeea& Review a
14yRoutine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection F 7 ---3 --9
-11
Time of Inspection 24 hr. (hh:mm)
0 Permitted )0 Certified [3 Conditionally Certified © Registered 113 Not O erational Date Last Operated,
Farm Name: ...... C(.IQar.it,%.:s... .4u4e �County:..... up 1-11................................................... ....
Owner Name: ..... pl'I.GS....l#Z.i�l......................•.-............................-...... Phone No:.19....9...............................
Facility Contact: ...... .%nC1Q....9-ci 1%. d.y..............:...... Title:............... .................... ...--- Phone No:
Mailing Address: ...30..... '*'Y!{JI.aO! .............. �....P.J.c........ 3 jr.... ..........................
Onsite Representative: Integrator: LJr l4..............................................
Certified Operator: .......... . .....................................................
Operator Certification Number:,,-,,.,,.,,
Location of Farm:
Latitude 0 9 .4 Longitude 0 ° 11
Design Current ':-
Swine Capacity Population
0 Wean to Feeder
8
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
iNumber of Lagoons Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area -
Holding+P,oiids / Solid Traps -. ❑ No Liquid Waste Management System
Discharges & Stream Impacts
Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ❑ 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?
[:]Yes hq No
❑ Yes ONo
❑ Yes 42rNo
❑ Yes No
❑ Yes [allo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Q'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):..........2.1......................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes qNo
seepage, etc.)
3/23/99 Continued on back

FA,cility Npmber: 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 N'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 UNo
$. Does any pan of the waste management system other than waste structures require maintenarice/improvement? ❑ Yes 18 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes N�No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes OONO
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 (No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 034o
b) Does the facility need a wettable acre determination? ❑ Yes 2 'No
c) This facility is pended for a wettable acre determination? ❑ Yes 2KNo
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
19. 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 reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: K.6M6hW6ris:or• McWh6b9 •were noted• dit-f Frig tthis:visit. - YoWwill-receive iio fui-thgr ;
corresp&idei�ce: a�auf this visit_ - ::: :
Comments-(iWer'to,qu&ii6n #):' Explain any YES answers and/or any recommendations or:any other commenu:
Use,drawings of facility to Vettef explain situations (W&additional•pages as necessary) -
Ovase'u ;ng +S - n� dace. eurrr�l��►r
Cron. mue. worK an �esct�e. e e^cseccl' hart rncs�.
❑ Yes 5No
❑ Yes Iff No
❑ Yes §�No
❑ Yes N(No
❑ Yes [5�No
Cl Yes I�KNo
❑ Yes ERNo
❑ Yes RNo
❑ Yes [QVo
❑ Yes O1No
❑ Yes RNo
3/23/99

Facility Number: J? � — � � Date of Inspection
Odor Issues
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below--&Y-o 1
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes KNo
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 MNo
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 gNo
I 31. Do the animals feed storage bins fail to have appropriate cover? El Yes W No
�! &V Do the Bush tanks lack a submerged fill pipe or a permanent/temporary cover? 1,
[AdditionaU Commmts and/or rawings -
r
3/23/99

Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
19 Routine O Complaint O Follow-un of DWO inspection O Follow-up of DSWC review O Other 1
Facilit�, �� Date of Inspection 3 qY
y Number r��l�
Time of Inspection U 0 24 hr. (hh:rnm)
© Registered 0 Certified [3 Applied for Permit © Permitted [3 Not Operational Date Last Operated:
FarmName: .. s......'�....................................... county:......... .....................................................
Owner Name: -�'"�� 1 1"� � Phone No: Q ��-�4 "3�,;l.l......................
FacilityContact:.........cl.................................................................. Title ................. .....----..............._....`...b.............. Phone No:......jj---....................------......--.----.--
Mailing Address: ..24.U.......................
Cz.,
1......... ..........................
Onsite Representative: ow.te ...! 2 k- ............................ Integrator:...! Q,.... ..............
CertifiedOperator:............................................................................................................... Operator Certification Number..........................................
!ecatiXn ofjarip: lit Kr
...�............. ..........s...... ............................... �....... ........... .. . . ... . .................... ..
Latitude 0 1 46 Longitude 0• 6 44
General
1.
Are there any buffers that need maintenance/improvement?
Yes
❑ No
2.
Is any discharge observed from any part of the operation?
❑ Yes
XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
VNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
;q No
c. If discharge is observed, what is the estimated flow in gal/min?
NA
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
❑ Yes
Wo
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
W No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
X No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
M No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ENo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0 No
7/25/97

W_
Facility Number: I — t t t
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (LagoonsMoldine Ponds. Flush Pits etc.)
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: A_
Freeboard(ft): ........... .L1.............................................................-............................................................................................
....................................
10.
Is seepage observed from any of the structures?
❑ Yes
0 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
P9 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
15 No
Waste Application
14. Is there physical evidence of over application? ❑ Yes W No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
�r 1
15. Crop type Q... �!'' T�........................................................................................ ................ ----
f ...... ..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[3• No.violations-ar" deficiencies eire-nated-during th_is.visit - Yoin4ill receive•i�o-f&ilier
:�:•correspa�deitcetitiout>~hxs:vi�it�.•: ;�.::-�.�:-.: .�::�� : .�:�:�� .:-:�:: �.�. . .. ;.. .:, �: ��
❑ Yes J[ No
❑ Yes ,9 No
9Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes M No
❑ Yes to No
❑ Yes No
❑ Yes] No
❑ Yes 0 No
•�} Be sw�e � t� tea Wit- b�?�•� �-�� �l� `�--- � �� �� c�-e_
°k ems- e�
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: > C A l Date:

F - %
[] Division of Soil and Water Conservation ❑ Other Agency
fil Division of Water Quality
8 Routine 0 Cont laint 0 Follom-u of DW ins eetion 0 Follow-u of DSWC review 0 Other
Date of Inspection
Facility Number j }
Time of Inspection 24 hr. (hh:mm)
[) Registered ® Certified E3 Applied for Permit © Permitted [3 Not Operational I Date Last Operated:
Farm Name: Count ,
Owner Name: .............. :.Lz4....... ........................... Phone No: ..�.°�.3..Q�..�9.g..r.. �q.��.......................
Facility Contact: ................................................................... p.... Title p Phone No p
Mailing Address: 2...(, �..,c�.!�+'1.A.ira.�l.......A� �. tz1. - ..... ................................�,,. .....5� ...
Onsite Representative:....t-a ac..� R �...... .a�....•,�.1perator
tegrator:.... I1.krA....................................................
. j� r
Certified O erator.. ;/.' ! � ............. Certification Number,..- - ... ..................
Location of Farm:
_fJa...... r. e a .c...s; .d,.a, ..... .. ... .... •
a ....7...1....�-.--..a....�?.x.�1.:�..,.�n.ir... .....ks.ti.�... ..sss.a:t...
p ..
......... WAI....yt... .......----................................................................................................................... -
LatitudeLongitude ©• ®' ®"
Desigp Current, qk 'Design Current. Design Current
Swine ;<, Capacity Population r Poultry. Capacity 1'npulat�on Catt_ie Capacity Population r F
,, :
Wean to Feeder
$ ❑ Layer ❑ Dairy
❑ Feeder to Finish
❑No -Layer ` ❑Non -Dairy
❑ Farrow to Wean
-, a
A El to Feeder
5 ❑Other F ,
❑ Farrow to Finish
V,
Total Design Capacity„
❑ Celts
❑Boars
T©ta 20
,'
Number of Lagoons i HoldingaPondS' ® Subsurface Drains Present © Lagoon Area 19 Spray Field Area
�: f3.
.. ... .. ......... . ...... .. ... ........... ... ......
s E ❑ No Liquid Waste Management System
r
General
1. Are there any buffers that need maintenance/improvement? ® Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes Ef 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 Surface Water? (If yes. notify DWQ) ❑ Yes 0 No
c. If discharge is observed, what is the estimated flow in-alUmin?
A. 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 RNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes (.No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes M_No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes t4 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes lR No
7/25/97 Continued on back

Facility Number: 3j — I 11
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes KNo
Structures fLagoons.Holding Ponds, Flush Pits, etc.}
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes &No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z_., Z-
Freeboard (ft):.............................................................
10. Is seepage observed from any of the structures? ❑ Yes J-No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes XNo
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 JR No
Waste Application
14. Is there physical evidence of over application? ❑ Yes �R_No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .... .�............&A AAMO.............1n7.ts.df........................ .... rcLl.c vA....................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ®Yes ❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
IEio
18.
Does the receiving crop need improvement?
12 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
1R No
21.
Did. Reviewer/Inspector fail to discuss reviewrnspection with on -site representative?
❑ Yes
10 No
22.
Does record keeping need improvement?
10 Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
allo
O-No.violations,or deficiencies.were-noted.during this', visit. You.will i&e' ive-no•i:urther ;
6rr6pondence A out this'visit'.- :
y.w
lb. Ll.s �-p r c-0,rr1 �^ a ►-F.r f 's C L( lZ-L4- -A r A c Lu
lw yr o E a try . -3 a pro S S t� q '-0. :> ¢ o + t s a C I v� c a rp 0 Yu .` rL i' ��-o �`i.� C.2, fi
Ea • (QB,. c .� , +rav �' � c a -tL a � � e � r•..2- , e)Lk #-z-
.
L r_ mccteq
Is. o YLt " r-0 -c* rlj� o
N e� b c. E L
I 7/25/97
Reviewer/Inspector Name ,-
Reviewer/Inspector Signature: 0_ _I , 0 , , r J'j . pda_v,�..._ - o �, Date:

Site Requires Immediate Attention:
Facility No. 3 il ti lti t
DIVISION OF ENVIRONTMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 10 3 , 1995
Time: (1 O Z)
Farm Name/Owner: �_" C2 L tE S 1__t 0 r-Yry—a
Mailing Address:
County: 7 v -P L, t `
Integrator:
H C- V tta F-r—
Phone:
On Site Representative: _ _ Phone: Z`t'g
Physical Address/Location: W, S t C S R VI IS I NV3 a {�
tw'4-(-s V_' Ck ki —�
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 34 1 a' Oo Lon--itude: � � 4 t � � b „ Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
. (approximately 1 Foot + 7 inch ( Yes No Actual Freeboard: '3 Ft. Inches
Was any seepage observed from t aQoon(s)? Yes or Wa.k anv erns_cn observed? Yes oi(
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: 9C-- gr A
Does the facility meet SCS 1141inimum setback criteria? 200 Feet from DwPllina_Z7 es oI No
100 Feet from Neils? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or�
Is animal waste land applied or spray irrigated within 25 Feet of a cCS liap Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, cv
similar man-rhade devices? Yes oa) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
cis.
_ - -
Inspector Name
S i-nature
cc: Facility Assessment Unit
Use Attachments if Needed.