310176_INSPECTIONS_20171231

NO H CAR OLIN
Department of Environmental Quai

(Type of Visit: (,JCory¢Hance Inspection O Operation Review Q Structure Evaluation ()Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: pup Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
v /
OnsiteRepresentative: Jpr/4-
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: j —7 3 1 2--
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
We[ Poultry
I 11-ayer
Design
Capacity
I
Current
Pop.
Design Current
@attle Capacity P,op.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
DO
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) P,oultry
Design
C•_a aci[
Current
P,o ,
I
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke 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?
[]Yes No
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
�o
❑ Yes o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412015 Continued

Fircili Number: jDate of Inspection: oZl
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: ci(>,oDN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
o
TTTTTT"''''
❑ 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
ZN i
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
/
9. Does any part of the waste management system other than the waste structures require
❑ Yes
I__I No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
InNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
�o
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground . ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
W(y es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
D_<O�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ 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 D<0 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I]"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑,No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of Inspection.
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
W
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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?
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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
El"No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
P,No ❑ NA ❑ NE
❑ Yes to
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 04 ❑ NA ❑ NE
❑ Yes ,0No ❑ NA ❑ NE
❑ Yes t❑ No
❑ Yes No�
❑ Yes > o
❑ NA
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any othercomments. ,. .
Use drawings of facility to better explain situations (use additional pages as necessary).
151) r �rVtE �EC�E�, I{E E�' roc K ET
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�H t�1 �k 62►J C l,i..
Phone:
Date: I d-1 U
21412015

�L
Reason for Visit: Ja'Roufrne O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: [ r J M / I �j Arrival Time: ® Departure Time: ® County: (a f Region:
Farm Name: �� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: _YWAT A 1 y {. _L_,E& Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: ' -73' 1-1
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
!Mayer
Design
Capacity
Current
Pop.
Desigu Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
er
DairyCalf
Feeder to Finish
Z
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . � l;pul , Ca aci M Iio .
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
L
JBeef Brood Cow
Other
Other
Turke s
Turke Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[-]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4as storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[:)Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LK y6�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmenta hreat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
Sd "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
E24o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
I XNo
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
AIo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
, �/
I ,—Vrvo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑'IQ-o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
vo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L3 o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E31No ❑ 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 ❑1No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ra �Io ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

_11,23115-
Facili Number: ell, Date of Inspection,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ffNS
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑NA ❑NE
❑NA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes bQ"" ❑ NA ❑ NE
Other Issues 28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [�--�� o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Io ❑ NA ❑ NE
❑ Yes [>hf ❑ NA ❑ NE
❑ Yes ❑-?,r6 ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No
[] No
❑NA ❑NE
❑NA ❑NE
❑NA ONE
(Comments (refer to question 4):. Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of 3
Date:
ri

Reason for Visit: _O Routine 0 Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: (( q I Arrival Time:
Departure Time: County: Cxpcyo Region:
Farm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 11414 fr Cthl l
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
I ILayer
Design Current
C>apacity Pap.
I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow [o Feeder
Farrow to Finish
D . P,oult .
La ers
Design Current
Ca aci Pao P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turke s
Turke Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ YesVNo
� ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EdNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 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
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
CZ(/No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes I yNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 777777
9. Does any part of the waste management system other than the waste structures require ❑ Yes �A o ❑ NA ❑ NE
maintenance or improvement?
Waste Application �����,,,,,/////
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
Alp
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
,�r
I �1 No
❑ NA
❑ NE
Required
Records & Documents
TTT
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes &No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Fac lity Number: - Date of Inspection:
24i Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N/5 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L� oo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ /No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E5 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 do ❑ 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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes to
❑ Yes Zf No
[—]Yes do
❑ Yes [Z�10
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone Ifb)j t
Date:
2/4 14

(Type of Visit: Q'Con iliance Inspection p Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: $ S Arrival Time: Departure Time: County: Region:
TO
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Jon4"-ra Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 12 3 1
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Weanto Finish
Design Current
Wet Poultry Capacity Pop.
Des' gu Current
Cattle Capacity Pop.
Dairy Cow
Wean [o Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oult . Ca sci P,o P.
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [/�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes yo
❑ Yeso
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) -less than adequate? ❑ Yes Io
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Identifier: LACtj
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment
hreat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Vo ❑ 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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2rxelo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes Eallo ❑ NA ❑ NE
❑ Yes bo_._ ❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
❑ Yes No
❑ Yes �Nc
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes UN ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ W kly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection.,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo❑ NA ❑ NE
21. 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 to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes OAIO*� ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application) .
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes C; "o ❑ NA ❑ NE
❑ Yes E;I-<o ❑ NA ❑ NE
❑ Yes 04o ❑ NA ❑ NE
❑ Yes CNtt ❑ NA ❑ NE
❑ Yes � ❑ NA ❑ NE
❑ Yes JZNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. 1
Use drawings of facility to better explain situations (use additional pages as necessary). I
21) uWAT(-,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
CRAW Le ` ('CV,
Phone:

Type bf Visit: U C�o/mpHance inspection U Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visitoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I q L i I I I Arrival Time: ® Departure Time: , � County: NIP Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
i
Onsite Representative: J dNAT}j A i I t - IL A-f—ft, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: 19 9 ?se
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Dairy Calf
Wean to Feeder
[Non -Layer
Feeder to Finish
6d
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,ouh � Ca acit P,o
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
NJ JBcef`BroodCow
Other
NJ Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No
❑ Yes [—]No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes LQ No ❑ NA ❑ NE
❑ Yes Ei ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: MDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA (,,y4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 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 en ' nmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes Eo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes _CJ/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 ❑ N ❑ 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
Q No
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes$Zo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
—�o
I VNO
❑ NA
❑ NA
❑ NE
❑ NE
Required Records & Documents
777
,
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No/
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
—
Vo
❑ 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 E3No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections /❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ ICJ N Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 21412011 Continued

[Facility Number: Date of Inspection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. Is [he facility out of compliance with permit conditions related to sludge? If yes, check [3 Yes UNo ❑ NA ❑ NE
tht 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
21. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes/ ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesFNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or -any otheucomrrents;�', 'r'
Use drawings of facility to better explain situations (use additional pages as necessary):
7) DXIC6 VVA c� OL6jo Ctbt�rJ Vf OF 011EA4-n1,_1W
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ( qW72
' 11
Date: V
214 011

Type of visit: U Coliance inspection V Operation Review Q) Structure Evaluation Q) Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: "� County: alf Lai Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 0 G 0 ATPALLL(.C,i[ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
to Finish I I , La er
to Feeder —[Nnn-t aver
Phone:
Certification Number: 19 993
3
Certification Number:
Longitude:
nair ralf
Feeder to Finish 114do I lffQ Dai Heifer
01 Farrow to Wean I i Dry Cow
narrow to teener
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?
Beef Stocker
Beef Brood Cow
❑ Yes 0No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: -2 1 - I (Date of Inspection: -21 , a,l I
Waste Collection & Treatment
4. Is Storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t r y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes WNo ❑ 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 e) o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
. (not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [Vo ❑ 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 ONo ❑ 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
[�prO ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
i N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
EKO ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections [:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: q 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1" I NNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes B<c ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues �--�� /
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0,<0 ❑ 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 2<0 ❑ 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 CfNo ❑ 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 [^+ ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
�o
❑ Yes Egl< ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes L4410 ❑ 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-necessaryj.,
CNEC L 56 r,7LE[.D sN swpCe T�_Rd wm" 7Z .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

for Visit: 0 Routine
Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
s
Arrival Time:
Departure Time: County: D ct, k) Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J ouAr1lW iv) T t 1 A_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
❑ Yes Q 0 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes n ❑ NA ❑ NE
❑ Yes uq 0 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: 31 - Date of Ins ection: I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C!�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CA&�s
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3,7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 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
N
7. Do any of the structures need maintenance or improvement? ❑Yes ❑
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ENo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes O/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?
No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Q
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does land
es
�ly
[Z /No
YN
❑ NA
❑ NE
the receiving crop and/or application site need improvement?
es
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ No
❑ NA
❑ NE
acres determination?
1/
17. Does the facility lack adequate acreage for land application?
❑ Yes
C NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
I YNo
❑ 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
❑ 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
,�4 ❑ 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 CJ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes No ❑ NA ❑ NE
Page 2 of 3 214,12011 Continued

Facility Number: Date of Inspection, III
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes No ❑ NA ❑ NE
25. ff 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
N
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
El Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
B<0
❑ 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
En� 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
MZNo
❑ 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
�
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility follow-up by
❑ Yes
�
❑ NA
❑ NE
require a visit the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments;
Use drawings of facility to better explain situations (use additional pages as necessary). -- r,,,„.„x
("a t dYw 6 F�16L17f SEN/) Cep a� R�GT
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
Phone: D 3
Date: Z7 )
21412011

- ��Jllrvision of WatWQuality'
1
Facility -Number 'J ( I� :0 Dtyision of Soil and Water Conservation ✓ry y
Other Agency
Type of Visit Copipliance 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: Q 3 D Departure Time: County: 01*tzo Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ,j1.IJAjjP j3 M
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [�o [7]' E71„ Longitude: I _ Io n n
Destgp,'
Current'" '^ �� Design
"Current iw'",� ,"„ Design, Cu„frrent
^Swine _=Capacity
Population „r Wet Poultry Capacity
Population Cattle Capacity rPo "ulahon
.sue, P . ,
;.
❑ Wean to Finish
10 Layer
I
Dairy Cow
`,
❑ Wean to Feeder
1,, ❑ Non Layer
I
III III
❑ Dairy Calf
-
Feeder to Finish a0
Farrow to Wean
` "., $ '
a "" `" �- M
Dry Poultry
„❑ Dairy Heifer
<, ❑ D Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
Layers
' ❑Beef Stocker
❑ Gilts-
El Non -La ers
❑ Beef Feeder
"❑
Boars
._ ❑ Pullers
❑ Turkeys
CEO]Beef Brood Co
`Other
_
El Other
w
El Turkey Poults
,t ElOther A.:" Numberbf Stntctuie»�
Dischar¢es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 Co ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ,1/J No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,_,(/
U 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: LQGcmd
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 2
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
1
u 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
E- No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
Ed 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
El Yes
�//
I� No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,,(/
IJ 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? ��s �No [INA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑�J o El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes _LI No El NA El NE
17. Does the facility lack adequate acreage for land application? ❑ Yes EYo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes P!(No ❑ NA ❑ NE
Comments (refer to question #) Explain anyYES answers and%or any recommendattoii's or any other comme t
Use drawings of facility to better explain situations. (use addthonal,pages as necessary)' h
i5.) IJE6o LA*"6 a j FZ2Z C,bS
IReviewer/Inspector Name Phone:
ReviewertInspector Signature: Date:
r2

F&,-ility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,L�2-N/_o El NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check El Yes LJ {No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Ej o
❑ NA
❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather
Code
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
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,[,I
Li'[/�Vo
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
2 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,Q-�40
vo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2 o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�
9? o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
❑'>`
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CTNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

I M I%
Type of Visit CornpHance 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,' 1 ❑ Denied Access
Date of Visit: Arrival Time: I( OD Departure Time: County: Df/Pl% Region:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: =n = Q« Longitude: [�o
Design Current
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
10 Layer I ❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
❑ Dairy Calf
Feeder to Finish
34ao Z 1eo
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
ElNon-Layers
❑ Beef Stocker
❑Gilts
❑ Beef Feeder
El Boars
El
El Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes !J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Id No
❑ NA
❑ NE
❑ Yes
21 No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3 I — Date of Inspection 9 6
4 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes RKo ❑ 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: LACs00'i-)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
E3 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
dNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th'eat, notify DWQ
J❑
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? ❑Yes
7No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
,.,//
E2 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. El Yes
,.,{/
CJ 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
0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
[I NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
,,,��d,,,///No
❑ NA
El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
IS,) rak-w5 N&b9
2e) r4E6b UPAA"-
Lztml�'
LEASE A ClR C MEn/T rZ-AW nF 24"8
Reviewer/Inspector Name /A Phone:
Reviewer/Inspector Signature: , 'Uj Date: IO
12128100 Confinued

Facility Number: — 'i6 Date of Inspection
l� Required Records & Documents 6661
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0<0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Q'Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design [I Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E I, 0
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ITNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ETNP
❑ NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�I No
❑ 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?
Comments
❑ Yes
E�No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
IM No
❑ NA
❑ NE
ElI( Yes
No
❑ NA
❑ NE
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
12128104

Type of Visit Co fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: / 2da Departure Time: County: 1�1/ Z Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Jo0Vrrr l4skj �c U_g Q- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =' =" Longitude: =o =, ="
Design Current
Design Current
Design Current
Swine Capacity Population
We[ Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er I
❑ Dairy Cow
❑ Wean to Feeder
JLJ Non -Layer I
❑ Dairy Calf
® Feeder to Finish
-&V
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Laers
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes O'No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
[--]No ❑ NA
❑ NE
0
❑ o ❑ NA
❑ NE
❑ Yes
❑ Yes
LI No ❑ NA
❑ NE
❑ Yes
LJ tvo ❑ NA
❑ NE
12128104 Continued

w
7
rcility NumDate of Inspection
Waste Collection & Treatment //
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0<o ❑ 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: COOV(�lj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
C I 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? [I Yes
I0�J N/o
NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
b 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
ffNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
04/0
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IJ
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
V
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
�
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
V
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reviewer/Inspector Name a } ]A J A Phone: q(O - 7 0
Reviewer/Inspector Signature: �yL, Date: * it
Page 2 of 3 12128104 Continued

acility Number: — to Date of Inspection 6 a
Ifeauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Desi ❑ p Ma s gn ❑ Other
❑ Yes Lf No ❑ NA ❑ NE
❑ Yes P'io ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain InspectionsWeather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
,❑
El'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[DNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
WNNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
P! No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNoo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
I 0_
❑ 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
5�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
3 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
—/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
N�
[I NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[L7
J Zo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Facility Number r3 -7
ft) Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
IType of Visit 0 Co(npliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance '
Reason for Visit Q/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access I
Date of Visit: I I
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: ® Departure Time: County: r l R TU Region:
Title:
Owner Email:
Phone:
Onsite Representative: J"N^ rro 4 Al /'f+L I E IL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
o = ' = Longitude: = o = , M
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
3 6
Z 60
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischar¢es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑
o ❑ NA
[I NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection r/
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 Structure 2 Structure 3 Structure 4
Identifier: ljcm
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,fNo El NA El NE
El Yes E No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1� No ❑ NA ❑ NE
8. Do any of the stucmres lack adequate markers as required by the permit? ❑ Yes ffNo ❑ 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 l.,d No ❑ NA ❑ NE
maintenance or improvement?
Waste Application --//
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes MNo ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre deternination?❑ Yes ,['No
17. Does the facility lack adequate acreage for land application? ❑ Yes ,E1 o
18. Is there a lack of properly operating waste application equipment? El Yes 0� 0
❑ NA ❑ NE
❑NA ❑NE
❑NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name &R Phon :
Reviewer/Inspector Signature: Date: / r p
r' 12128104 Continued

Facility Number: g — %� Date of Inspection t c
Required Records & Documents
19. Did the facility fail to have 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 ff No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U<o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
CWO ❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
iJ� NNoo ❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ly"��NoEl NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
0 4o'� ❑❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L_i-rvo O NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Eligo"
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[IYes
Ekmo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,�
[I NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
7No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

`'� }Division of Water Quality J /
Facility NuMber 3 O Division of Soil and Water Conservation l/
0 Other Agency
Type of Visit ttompliance 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:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: 3 - GU Departure Time: County:
Facility Contact: Titl
/e:
Onsite Representative: t/ .l
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator: Z�
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = = ' =„ Longitude: = c = , = „
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made? i
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waiste 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?
Struc re 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): 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):
!Vo JluayP sU/d GVIM on sl/e fGcords - �lcsc
eon/e >� '5l�e�
910- as-0 - goo /
IReviewer/Inspector Name 1 IUA 944J14L44 I I Phone: O-b(( d y I
Reviewer/Inspector Signature: AL, Date:
n..7rx 12/28/04 Continued

IType of Visit QJCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z O Arrival Time: : ?O Departure Time: 17.0 County:
Farm Name: S_ Owner Email:
Owner Name: /6C&E4 1641 2VIV Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: &f4- S�fd
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
i
Integrator'e4&14 OL S
Operator Certification Number:
Back-up Certification Number:
Region: a -)-ley
Latitude: =n E__1' E__1„ Longitude: [�° [�' [�„
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La et
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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 00 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ///X No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 10 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?: Ab
Designed Freeboard (in): 4 9.5
Observed Freeboard (in): 3j
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? A Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) -
9. Does any part of the waste management system other than the waste structures require ❑ Yes VrNo ❑ 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 VNo ❑ 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 Q 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'0No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination![-] Yes
JoNo
PfNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ONo
[INA
[INE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
Z No
❑ NA
❑ NE
'�-.UKR�/`rf'LNGS 'rion rr
-cry Nf40g
_ SQm?r eQOOF.tJT
`tOfees 5 lJ /O 4,2b k"W7
-Fifo ,6rA)CC /f2.0amo
147 �DRi4z� v6A��
IReviewer/inspectorName y Phone: -'yYfXJ 22Q
Reviewer/Inspector Signature: Date: Date: 2 OS I

Facility Number: —% Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? VYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesNo ❑ NA ❑ NE
ElEl❑ Design ❑Maps El the appropirate box. WUP Checklists '
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 0 Crop Yield X 120 Minute Inspections rwnthly and V
.10
Rain Inspections 9weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CdNo
❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA IEJ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
I/J No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
FJ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
!0)/�dJ CO Gd�>� EC'p�eGZS, f}d�. oP� 6 fzQmT
21)4w' 7-7L/ �Ef,OEO 1p[ ��L17/1�zi✓Gl7fi �PFC72d�✓
411M� A,1,5iy NFroAo.
- eR vP AF_ 4e Aco2Os /I%Eo
` An1i�wRc L1F�»izCfFT'a�N FpeM 1V'6 03
✓IC /% 6Q61 z24 Zdo� CF
z"�'0,5 A��
N�
12,128104

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
Facility Number I Date of Visit: S 1 0 Time:
I O Not Operational O Below Threshold
p'Permitted jdCertified 0 Conditionay Certified 0 Registered Date Last Operated or Above Threshold:...__....__._.__..
Farm Name:.._.....L.. ........... County:.... .... _._.................._.. .
Owner Name:
Mailing Address:
Facility Contact:
Title:
Phone No:
Onsite Representative:.._._. SE� l.. �+.�Q!J..__...._. .. Integrator:
Certified Operator: ...................................
Location of Farm:
Phone No:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =1 =11
Design .=Current Devgn 4.;Current +<7 -Design Co rent =
Smne Ca acr .:Po elation':` Pouiltryaci Po"YnlaAon Cable : - _ : Ca aci _ Po'ultition .
❑ Wean to Feeder -! ❑Layer Dairy
eeder to Finish
3WO
_
❑ Non -Layer
I
_
❑Non -Dairy
Farrow to Wean
-
❑ Other r '
Farrow to Feeder
r
Design Capacity-'
Farrow to Finish
-
Gilts
a m
5
;Number of Lagoons
l _-
f
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ........... _.1.... _............ ... _............... _..... .... ... .................... ......... ....... ................... ... ...
Freeboard (inches): 27
❑ Yes do
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [I No
❑ Yes QINNt
❑ Yes ( o
❑ Yes UNO
Structure 6
12112103 Continued

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 el No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenan�mprovement? ❑ Yes Noo
9. Do any stuctures lack adequate, gauged markets with required maximum and minimum liquid level ❑ Yo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes o,
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [�'No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &R WISA L ) SGD WtSI,LEf
le-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
Comments (iefer to gaeshon #)-F.aplam any°YES answers and/oi• any recommendat,oas:or nny, otheur comments. � -
U� drawtttgs of facility to better explain sttnations: (use addr6onal pages as necessary) ❑Field Copy ❑Final Notes `, :�
__-
e. HAW 6t9 PAoA E IOumSc-& a ADbaAS5
W/ z4c"-s (mosr P'6(ENT)
21) I #0-j) To KkEP Cot Ate 1(c—fZMST
Kip coP r dF M�RrAtiT
35) SWW Su2JEq NFCAS-S6'L-A"r=wJ
oB,r+=rJ coPY of Faoly\ A��nsu
UPDATE CRAt' Yi6LD Foe-M.
23.) MAkE SufLfc ro NA✓E APALYS,£S L6RRESPoN'SA1(�Y� r'✓Y✓tPZAJG F✓GAITS.
60 pA'? S Qtts62 A►., 9 PqS-'
�tKR--I F0(ZtAS OA(/6 Ito Msa✓TC
FA�-M 2ra C�o9 o2D60Z
Reviewer/Inspector Name
Reviewer/InspectorSignature: Date: i$ o
12112103 1 Continued

Facility Number: — 7 (o Date of Inspection ~J 1 O
N.
Required Records & Documents �
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 2Yes ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Y o
23. Does record keeping need improvement? If s, check the appropriate box below. Yes ❑ No
❑ Waste Application ❑ Freeboard Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit? "(/
(ie/ discharge, freeboard problems, over application) ❑ Yes u_ o
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 0
28. Does facility require a follow-up visit by same agency? ❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) eYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CA'N0_
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes L920
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes o
34. Did the facility fail to calib waste application equipment? —❑/Yes 04_0
35. Doe record keeping fo DES required forms need improvement? If yes, check the appropriate box below. [Yes ❑ No
St
king Form Crop Yield Form []Rainfall []Inspection After 1" Rain
120 Minute Inspections ❑ Annual Certification Form
12/72103

Type of Visit F C mpliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
/Permitted Q Ce ' red [3 Condi£onally Certified Q Registered
Farm Name:
Owner Name: ......... .....
_ _. rr..1 X._......... U.... ....... ............. ....
Mailing Address:
Time: EZ��:]
iperational O Below
Date Last Operate r Above Threshold: .�
County: (
....................
Phone No:
Facility Contact : ................ _._ __ .. Title: ........................................a .................... ne No:.........................
Onsite Representative: ..._Z��,-.K� _ %.7...P.N Integrator:..........
Certified Operator:
Location of Farm:
Operator Certification Number:
/Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =` =" Longitude =• =` ="
Wean to F
Feeder to
Farrow to
Subsurface Drair
No liquid Waste
Discharees & Stream Impacts -
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon Cj Spray Field ❑ Other
a. If discharge is observed, was.the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any. adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .... .................. .._...... ...... .............. ..............._.........._._...._.._..._.....__..._.................__.._ �_.....
Freeboard(inches): ...........52 ............. ........... ..... _._........... .................................... ................................... ._................................
❑ Yes XNo
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Q" No
Yes XNo
❑ Yes /No
Structure 6

FaciliR' Number. —� Date of Inspection 5. / Are there any immediate threats to the integrity of any of the structues observed? (ie/ trees, severe erosion, El Yes [�'No
seepage. etc.) TTT
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or %
closure plan? El Yes �j No
(If anof questions 4-6was answered yes, and the situation poses an /
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenanceriimprovement? /Yes [] No
8. Does any part of the waste management system other than waste structures require maintenancehmprovement? ❑ Yes [INo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes INo
Waste Application
10. Are there am, br$ers. that need mamtenancelrmprovement? ❑Yes; No
11. Ls there evidence of over applicati ? ❑ Excessive Ponding ❑ PAN Hydraulic verload ❑ Yes XNo
12. Crop type s — f/IS D 1 aA
13. Do the receiving crops differ with those desiated in the Certified Animal Waste Managem an (CA )? I❑ 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? 1,] Yes gNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit es other Permit readily available? ❑ Yes i•7� o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? I"
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) /Yes No
20. Is facilitynot in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? P ❑ Yes /No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, nuboard problems, over application) 0 Yes No
23. Did ReviewerRnspeetor fail to discuss reviewfmspection with on -site representative? ❑ Yes No
24. Does facilityrequire a follow-up visit by same agency? ❑Yes A No
25. Were any additional problems noted which causenoncompliance of the Certified AWMP? . ❑ Yes P1 No
0 No v�olahons ordeficienciesweremoted durmg.this visit. You will receive no further.rorrespondence.about thisvisit.
e�'�??et'�;mn�';7aaff�Ss�anstvecs,andiae�rseommendaiiomcnt�.au rrtherxommen�s ''=fr'
9�o[vile.�mfn�y�'-t'sn`FHF¢�a;6roi>7nr ,- z ` �jEgC��li......i�...» <.ne�23.gar�r�- _ k _ ,. ."'"'• z ' `",tom t£
Field Copy FinalNotes
3 ^t+'',i .K« io zi zxz3 ?t iF<` ii a- xE. i :� t- ❑
• ��(' �T�Q �� BGZ A') �FiJ �jr .
Reviewer/inspector Name
: Reviewerauspector Signature: Dat ()Z

Z
Facility Number: — Date of Inspection /
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
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 blad (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
ElYes ojIpo
[I Yes //(ZJ No
❑ Yes ,,y___,,�(((No
❑ Yes /yam No
El Yes �No
❑ Yes ❑ No
�� 40116/tj15 ,
cleRpcf/5 Fv�D F_,J7 /� < 44A,;�i0&G-r 1;P15S
Pr r z•s1j
-- /]%END
raw, �. ,fGL
Eo F�E,ey AJ c 4��s,� �.✓ O,P�o�,e
05103101

ytsron of Water Quality
�` Divrsron of Sod and• Water Conservation
0 Other Agency - -
Type of Visit R,,Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason !or Visit pSlRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: 3CiG Printed on: 7/21/2000
ii 10 Not Operational Q Below Threshold
Permitted ❑ Certified( ❑. Conditionally Certified .[. Registered Date Last Opera d or Above Threshold: .......................
Farm Name: .......... ` Counh
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: ..................................................................................................................... .
Onsite Representative: „ .....................................................................
.... Integrator:._ s
......................................................................
Certified Operator:
Location of Farm:
Operator Certification Number: .............. ...........................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =, 0.. Longitude =• =, =4
a
Design Current
Design Current Design Current
Ca ci population
Poultry
Capacity Population CatNe Capaiat , Population
_- Wean to Feeder
❑ Layer
❑Dairy
W Feeder to Finish
(Q O
❑ Non -Layer
❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
CEO
Farrow to Finish
Total Design Capacity
.,' Gilts
Boars
Total SSLW
Area JU Spray Field Area
Waste
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes *rNo
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 �fNo
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 *0
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): 39
5100 Continued on back

Facility Number: I I Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion,
❑ Yes
P(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures reed maintenance/improvement?
,'Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
J<No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
('Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
VNo
It. Is there evide cc of over application? ❑�Excessive Pointing ❑ PAN ❑ Hydraulic Overload
❑ Yes
gNo
12. Crop typer`w(Y-�e1e�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
O'No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination? -
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
b(No
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? -
❑ Yes
bKfNo
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
XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
DrNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VINO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
A 'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes KNo
24. Does facility require a follow-up visit by same agency? ❑ Yes WNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes $No
..1..Qi....t.......e ...Aver..0e. duffingthis;visit; Yo�t;wi11-receivetitifuith$r•; ;
::....siwridence ............:: :
1 "l1 ��--� ���( �14 �7t'C �^t'� Yam �l ��� �"'�r�y, �✓- `1l^c"`j� � c'� C1Q-�i9 �
+' (.•2_"mod ri'C>�.,ra l Y
Reviewer/Inspector Name \
Reviewer/Inspector Signature: LA h! ` Date: 5-1•b_-<j1 5/00

Facility Number:- — n4fl 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 �r(No
liquid level of lagoon or storage pond with no agitation? J�
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
``/ �No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
�'No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
s/00

Facility Number I f Date of Inspection O
Il Time of Inspection 24 hr. (hh:mm)
Permitted 0 Certified 0 Conditionally Certified 0 Registered Not O erational Date Last Operated:
FarmName: .........?..r.....1:,................�%C�!v.H!`.......................................... ......... County: ................ M. .�......................
OwnerName: ...... ..L.:.1.1.f,16-. ................. ..... .11:................................ Phone No:....................................................................................
Facility Contact: ...:..( —11-.�\ .... Title:...... .- ................... Phone No:...................................................
MailingAddress: ............................................................................................................. ........
Onsite Representative:..... ,;6� ..... J `•.'L"1'iF`;,-:................................. Integrator: , ✓ ✓ I� I S
0 .............................................................................
Certified Operator: ................................................. ; . ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =•=' =" Longitude =• =` =11
.. ' Design _
gn , Curren['. Design - Current :Design' Current
-Swine Ca acity- Population ulation Poultry CapactyPo laCattle --CapacityPopulation
❑ Wean to Feeder ❑Layer ❑ Dairy _
e Feeder to Finish (poO 10 Non -Layer 10 Non -Dairy
`:. ❑ Farrow to Wean :. ... -
❑ Other
❑ Farrow to Feeder - -
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSL-W':,
_ Number of Lagoons 1 (. j❑ Subsurface Drains Present �J❑ Lagoon Area I❑ Spray Field Area -.;?
Holding Ponds /Solid Traps' �_ ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes RJNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes RNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes J�1-1`0
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 RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J�kNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Freeboard(inches): ........ 7 ...........................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes jlqNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: — '% Date of Inspection
6. Are there structures on -site which arc not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? -
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over
12. Crop type t(
1T Do the receiving
❑ Excessive Pending ❑ PAN
differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
U. lVd violatiotis:oi:8eficien'db'9 •Mere noted, d(trifi, this:visit; • Yoit Wiftebeive iio: further •
correspondence: ab6t t this :visit:
❑ Yes RNo
❑ Yes Fv�No
❑ Yes HsZlo
❑ Yes $No
El Yes ENo
❑ Yes wl o
❑ Yes 12:Z4o
❑ Yes 6jr—No
❑ Yes Q�No
❑ Yes KNo
❑ Yes PdNo
❑ Yes [XNo
❑ Yes J<No
❑ Yes �Io
❑ Yes 9INo
❑ Yes E2,No
❑ Yes qNo
❑ Yes 5kNo
❑ Yes 4'No
❑ Yes S&
TQ_ -Z iC w.,j7
�ie(ai
0,
Yecv✓ e�et- ,.i+v I✓�ev��LtS�.
d
ri,sey✓iC1 S YC✓i p� ��� w*-6t "0A
wX 011 Ire a n f D vrlrVl\1 Af'X � X` S .m 212—J-1 '
Reviewer/Inspector Name
Reviewer/Inspector Signature: A, `_�6 // Q/ Date:
3/23/99

Facility Number: — Date of Inspection
( "
Odor Issues
26.
Does the discharge pipe from the confinement building to the. storage pond or lagoon fail to discharge actor below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
////........,,,,����
N
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
/,tom
/IQ 130
roads, building structure, and/or public property)
1����''
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
ion No '
[/
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
/VrNo
31.
Do the animals feed storage bins fail to have appropriate cover? -
❑ Yes
DkNo
32.
Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover?
❑ Yes
�(No
3/23/99

0 Division of Soil and WaterConservation-'Operation Review. -
- 13 Division of Soil and Water -Conservation Compliance Inspection
ODivision of Water Quality`'- Compliance inspection
Other Agency -_Operation Review
LOS Routine 0 Comnlaint 0 Follow-on of DWO inspection 0 Follow-up of DSWC review 0 Other
I Facility Number '7 Date of Inspection C�lL\
Time of Inspection a 24 hr. (htt:mm)
43'Permitted Ocertified ❑ Conditionally Certified E3 Registered 0 Nut Operational I Date Last Operated:
..........................
ES
.�
FarmName: .............. L.S...L....... ............ ....................................................... ................ Countv:......,�?.u.P......
Owner Name: ---------...__..--- ........... -----...........__......................................... ------.__ Phone No: ....................................................... .......
__........._....__..
Facility Contact:
Title:
Phone No:
MailingAddress: ..................................................................................................................... ................................................................................... ..........................
O / /
Onsite Representative: ....lc_.'.S.!S.%....� ......�.V.".!.`.... ,�...lzT.—R..!`�.................... Integrator:.........'..P �cL:...................................
Certified Operator:
Location of Farm:
Operator Certification Number:
Latitude =• =° =-1 Longitude =• =' =11
Design
--Swine _ - _ Capacity
°' ❑ Wean to Feeder
L2Teedcr to Finish 3G op
-; ❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
Design Current ,
Poultry _` Capacity Population Cattle
❑ Other
Total Design Capacity
Total'.SSLW
Design- Current
Number of:Lagoons ❑Subsurface Drains Present ❑ Lagoon Area [ISpray Field Area
Holdtng:Ponds Solid,Traps , ❑ No Liquid Waste Management System,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Dischargc originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONO
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 9fNo
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 Zf No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 71No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El Yes VNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes INo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Z5
Freeboard(inches): .................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? fie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
3/23/99 Continued on back

Facility Number: •3 — �' 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
INo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
No
8.
Does any pan of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any sluctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
-
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
JYNo
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN
❑ Yes
XNo
12.
Crop type C. BCX_A•J-t�.A S'.G- T. 4- W 4AI)✓A(, S
13.
Do the receiving crops differ wit those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
ONo
c) This facility is pended for a wettable acre determination?
❑ Yes
PrNo
15.
Does the receiving crop need improvement?
❑ Yes
;2rNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
PrNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ZNo
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 _�2'No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes L2'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes EfNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes RrNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes .0440
o•viol'atidiis:ordefcie'ncies-werenoted-dtwihii4bis:visit;.Y:ou:will.t&e ive'nitifurthgr•: ;
. : cori•es on.eitce: al>outi this :
"Comments (refer to_question #):-.Eiplain any,'YES
and/or anyrecommendations or any other comments , - -
Use drawings of facility to better explain situahons (use additional'pages as,necessary) x'
17) '?f4e4` TTVW hi`wu Iy?J Gel— COPY dL lEAM: r `fo k-Eif J�i� ?-£viaDS
IS) w--rt4 tFF.>9JcS T'o tasrp5i s/d C��D covc�g6� of
22 G ErJrt y JFZcGGcn r-- «✓vk -
c!,'1010 91V )375-
Reviewer/Inspector Name r�Q/.Sj.r--"=�f�•"1;,f4T, 9w191.."S7J ({,�7(i7
Reviewer/InspectorSignature /� r— ,J ,,,,,,�-- Date:
3/23/99

Facility Number: j ( — %7 Date of Inspection t(�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes OfNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'VNo
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 ,E�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) - ❑ Yes //No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes `No
32. Do the flush tanks lack a submerged fill pipe or a petmanent/temporary cover? ❑ Yes P—rINo

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspection 2 q
Facility Number 11 Time of Inspection 0 24 hr. (hh:mm)
Registered FICertified 0 Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated:
........................
Farm Name: ..........�1..L.... �-4.. S.......................
.......................................................................... County: ....... Du?lila...................................... .......................
Owner Name: .........................jcKt Sv..!.IfA1................................. Phone No: ..C�lto.�_i4L-.�9.�?................ :............................ ...
Facility Contact:
Title:
Phone No:
Mailing Address: .........B.S..]....... ta&t..... bvLVDc .....�'btp................................. 4t1,.,wSzL...... t..f .fir......................... ... .!.-MAg.......
OnsiteRepresentative:...............( t.{....... SuSl9h................................................... Integrator: ........ C vram........................................................
Certified Operator ............. ........24 :...........�.Vfio.n....................................... Operator Certification Number....17SH .........................
Location of Farm:
Latitude 3S • ltl , ®" Longitude E—JI-10 ®' =«
"
Design Current'
Design Current , '
Design Current
Swine
Capacity Population. - Poultry
Capacity Population -Cattle" `y
Capacity Populahon;
❑ Wean to Feeder
❑Layer
-" [I Dairy
Feeder to Finish
Gp0
p
�:
❑Non -Layer
I
I
J'_LqNon-Dairyj
Farrow to Wean
_
;;
❑ Others
❑ Farrow to Feeder
Total Design Capacity
s
❑Farrow to Finish
❑ Gilts
-,.El
-
Total SSLW
Boars
, .Number of Lag ns'! Holding Ponds -�''. ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
❑ No Liquid Waste Management System,
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 17J No
2. Is any discharge observed from any part of the operation? ❑ Yes ®No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes �9 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes [P No
c. If discharge is observed, what is the estimated Flow in gaUmin? PIA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yews ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes i) No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require 1§1 Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
7/25/97

r
Facility Number: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons.Holdine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Identifier:
...................................
Freeboard(ft): ... __..........................
❑ Yes IANo
❑ Yes I@ No
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes No
❑ Yes ® 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
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
IA No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15.
Crop type ............. :j..th1JL............ KStL............... sumaw........ a iwwaA........._..W.A.r..4aatwJ...................................
..........................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
53 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
IN No
18.
Does the receiving crop need improvement?
EP 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
P No
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
7O No
22. Does record keeping need improvement? ®Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes No
E3•No.violati6nsordeficiencies.viereiikidduringthis:visiL You:win i-tcdve vafiirfhei :.
cor 00fidehoc ahoitt this:visit:: ::......:.. .
s'r5< t< ,reAu1 aF (pa1L 5c io\6 sivrtr`LhJclr O,-ain&y csrca WW,_, wash,v) aLh- t, heus,S.
L. oJTw aIV..R_ wa`V. oVII oo� Smoot/ br "wed,�. Fcscve. n Ffq(() Ih JsHou�t� Na srb�1 oar , y\o W �n iA of f'i`cIl']L11-11131•
:2- Porno e�1J rw'c st,«l� Le fadxlt () o� slihr y taco �s �t o�tl�cf. Use. ctWrc��
:�raauQ �n~ WUp �er %'c�C� Z�1 i—GS1.
7/25/97
Reviewer/Inspector Name
Reviewer/InspectorSignature: %�� Y 1 ,/j Date:

❑ DSWC Animal Feedlot Operation Review
IIJs .1(9 DWQ Animal Feedlot Operation Site Inspection
II® Routine O Conmlaint O Folloe-uo of DIVO inspection O Follow-up of DSWC review O Other 1
IFacility Number' I76
Date of Inspection
Time of Inspection 1 11=30 24 hr. (hh:tnm)
❑ Registered 10 Certified 0 Applied for Permit 0 Permitted JE3 Not Operational I Date Last Operated:
FarmName: ......... K±.........TGri..................................................................................... County; ..... lAt�ll.l.............:....................................................
Owner Name:.... n`}5 ...._`i ..R Jm.......!S /4fCC\............. ..................................... Phone No:..C91G 19ia�.aft.l................................... .......
...
.
Facility Contact: In i„_�„ ` ' "Y1
.L . ...G c'Title:..........Q.hZhe No:. tl......r.............................. Phon�Q�_?R.6.-QiJ�............
Mailing Address:....W4.4... Br�r1�...Rd.................................................... 1�1u+r�5.v.11�[.I..LN.(I........................................ ...283!fi......
Onsite Representative:- .. Integrator: Q�L5 ........................................................_....V1y�.......................
Certified Operator:............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
... P.-4......14 .... 993...Avgn k....... m..... Sv:l. ....Ttrrt?..... K..k..t&,...6....�..(517,.....t.urn...�r .+.... ax.. .... Si&..l360.... I ..... �
{%I�r..._�Y.....oa...�3....._.:�SIa....Faarm....fs.... Q,_.....tt•_5......ttr,....narih....s.......CLe.Ff.%.l.�ehi. .....1�1._'f X._Fay!t......
Latitude ©•®,®6, Longitude ©•EZV,71®11
Swine Capacity Population Poultry Capacity Population Cattle Capacity
❑ Wean to Feeder I0 Layer ❑ Dairy
Feeder to Finish j p0 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ID Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts I7 Roars Total SSLW
Number of Lagoons / Holding Ponds
Subsurface Drains Present IIU Lagoon Area
Current
Population _
Field Area
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
Q No
2. Is any discharge observed from any part of the operation?
❑ Yes
12 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
C9 No
b. If discharge is observed, did it reach Surface Water? (if yes. notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated Flow in gal/min?
-
i
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
KNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
[gNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
91 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[R No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
I'(No
7/25/97
Continued on back

---------------
Facility Number: — 1-I
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures(Lagoons,Itoldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft):........4.......................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes 9No
❑ Yes i2No
Structure 5 Structure 6
15. Crop type ....... C,........ P:a........................................o,ti-d d............................. m4v.e.........................
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 ReviewerAnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ No.violatioits or deficiencies were noted during this,visit..You,will receive no further.
....... ........ . ...... . ...... . ...... . ...... . ...
correspondence about this,visit: _
'4- eslu is PI1ln.4 ;m kelp t)e5ijjJ-a 1Utctnuud6 WL`.
I I. Fescue- Anp 1 ytermuk c is SkwiO J6 tKfyuyep. / p / '
Z.Z. (rri A:Vjo� rctads-ixool) 1be.- (t %V 6 t rVA t1uKW. and d1� 4d Yxum6er.
skouO ne ih wask uf� i A om P�a.1. �✓'i�iG^ tNrntssion 4o Sn er
b•, cv\ �Iarn- t
2►(- S�*�e� on T(�sl l;eldt��- lv.+ FreIJ trot des�9t��e� ;^ Ala..
❑ Yes allo
❑ Yes 1d No
❑ Yes QlNo
❑ Yes 0 No
❑ Yes Ij�No
KYes ❑ No
❑ Yes R1 No
td Yes ❑ No
❑ Yes KNo
R Yes ❑ No
❑ Yes ® No
0 Yes ❑ No
❑ Yes No
(jYes If No
❑ Yes l'No
Tract" 46-1 Add *4
6.e3 I.,d SItodJ
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: / 4, A - Date:

i'
•
•
Site Requires Immediate Attentio
Facility No.tp
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS STTE vISTTATION RECORD
DATE: 1995
Time:
Farm Name/Owner: � YI h �/
Mailing Address: 13(IF WZ�
�(�r��o
County:
Integrator. Q. ff Phone:
On Site Representative: Vi vi . Lc Phone:' / fl
Physical Address/Location: /t%rn r� 1+ C7 �' %� /;5 J V O p'k,
Type of Operation: Swine Poultry Cattle 7`c 0 �SLI t ✓I
Design Capacity: u1.D Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:' •�' Longitude: 7' �' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with. cover crop)? Yes or No n
Additional Comments: --a ( ra eo A. t (<e i J `'1 0 S S C1 v� � vri -�� I� Y —
cc: Facility Assessment Unit
Use Attachments if Needed.

.'i
•
Farm
Mailu
•
Site Requires Immediate An n
Facility No. / — //77 0
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. 3 1995
County: 1� i
Integrator.
On Site Representative:
Physical Address/Locat
Time: / 9 3y
-- ? ' C6157
Type of Operation: Swine t, Poultry Cattle (K
Design Capacity: Q_ �( t� /5 Number of Animals on Site: Nfry.
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 26—* ( b7 " Longitude: 77 * _��7' 023 " Elevation: Feet
Circle Yes or No `
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) & or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or6 Was any erosion observed? Uor No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized3(?D 03fCOL A f�X —
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(9s or No
100 Feet from Wells? & or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 6
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or o�
Is animal waste discharged into waters ofthestate by man-made ditch, flushing system, or other
w similar man-made devices? Yes gCNd 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 o No
Inspector Name Signature
vy
e ry
S
cc: Facility Assessment Unit Use Attachments if Needed.

•
Site Requires Immediate Attention: �}
' Facility No. I - I (o
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE.. - f5/a 7- 1995
., Time: �
Farm Name/Owner:
Mailing Address:
County: 0
Integrator: LcnolI t—
On Site Representative:
Physical Address/Location:
19
Phone: (9/0) c394- 197 d
Phone:
S_j;f_ I s 1 - i-o
Type of Operation: Swine Poultry Cattle
Design Capacity: '3(-2 0'tZ) Number of Animals on Site:
DEM Certification Number: ACE IDEM Certification Number: ACNEW
Latitude: 3 S" O 1 ' S-q.a8 Longitude: _T-_� ' S ' E1jj' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) I
es or No Actual Freeboard: �1 Ft. Inches
Was any seepage observed from the goon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: I I- %v G L A t-) AC k� Le - Coo,.4<.,P - SL, OOA-C-
Does the facility meet SCS minimum setback criteria'? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters oe state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (0e or No n -
Additional Comments: 'PCM�I� _w Amn. r' c, O � c �, Cc,%P-
• Inspector Name Signa��
cc: Facility Assessment Unit Use Attachments if Needed.