310180_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

Itype or visit: Cl-oyrpuance inspection V uperanon Keview U Structure Evaluation U Technical Assistance I
Reason for, Vissii_t::__J Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Q / kkZ] Arrival Time: O l-/ Departure Time:® County: Region:
Farm Name: `�'�-�'-'� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 150Q ^ St M P S4 n
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 17 Z-70
Certification Number:
Longitude:
Swine
"an to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
s Z
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
P.oul
Layers
Non -Layers
Pullets
Design
Ca aci
Current
P,o P.
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
101 Other
Other
Turkeys
TurkeyPouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE'
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑Yes ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

jFacility Number: �( - �- p j Date of Inspection:
Waste Collection & Treatment
d Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
,--,
[2-Ko U NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2. 6
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
01<0 ❑ 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
eat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes D<0 1—:1 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
Ef No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
'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
No NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
2: o ❑ NA
❑ NE
the appropriate box.
❑ WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [; 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

Facility Number: 31 jDate of Inspection:
?4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No - NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesgNo ❑ 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 noncompliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes OCo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ErNA ❑ 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
01<�01__] 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
�❑ 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
ONo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
IIJ lq6 ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[�-ido �❑ NA
❑ NE
...................Y...,............ - . V. . nvu... -1 - , , W
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

rco
Type of Visit: d Cayfipliance Inspection U Operation Review Q Structure Evaluation U Technical Assistance v
Reason for Visit: C1> Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ?) Departure Time: County: bUQU-PJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: scriW 9'_'Q2S6'j Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 172 {0
Certification Number:
Longitude:
Swine
Design Current
gapachy1op.y
=Qpa�cit,y
Design
Gurrent
Pop.
Design HE
Cattle Capacity Pop.
Wean to Finish
Layer
IDairy
Cow
Wean to Feeder
'3s
Non -La er
IDai
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I)n+ P�oultgy Ca acit + P,o .
La ers
D Cow
Non-Dai
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ o
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412015 Continued

Facili Number: ^ - Dale of Inspection: /, Qa�
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: A�
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
2No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment
'threat, notify DWR
7. Do any of the structures need maintenance or improvement?
El
71N
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Yo
❑ 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 Oo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ 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
[21 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ 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
[;KNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
c
❑ 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 o ❑ 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? ElYes N - ❑ 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 Ins ection: Q
24. Q?id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El�'o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E(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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 [✓�No ❑ NA ❑ NE
❑ Yes 7No
. ❑ NA ❑ NE
❑Yes ❑ NA ❑ NE
❑ Yes 2f No ❑ NA ❑ NE
ElYes 0 c
❑ Yes o
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
(Comments (refer totquestion:#):Explain any YES answers and/oranyadditional -recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatin
Page 3 of 3
Phone: / /
Date: 1
2/4/2 15

(Type of Visit: ® Couipliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: TR�outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 4a ( S/IS I Arrival Time: 1 Departure Time: 6,S' County: I y Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: S GAtJ S"y11QSo) i Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 0 Z13o
Certification Number:
Longitude:
Design current
Swine Capacity Pop.
Wet Poultry
Design
capacity
Current
Pop.
Design current
No
Cattle Capacity Pop.
Wean to Finish
La er
Da Cow
)(
Wean to Feeder
S
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
I) . P,oul . •
Layers
Design
Cap aci_
current
P,o ,
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
lBecfBroodCow
Boars
lather
Other
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes MNo ❑ NA ❑ NE
[-]Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
❑ YesVNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facili Number: Date of Ins ection: $ S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes MNo ❑ 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: (y4��
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 I LNO ❑ NA ❑ NE
waste management or closure plan? ttt���
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 —dNo ❑ 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)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑/ ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ffNo, ❑ 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
[210 ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
N
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
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes LYI I:] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 21412014 Continued

Faciti Number: -ISO jDate of Inspection: '- /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I _I o ❑ NA ❑ NE
21. 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 PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [%�No ❑ NA ❑ NE
[—]Yes WNNo ❑ NA ❑ NE
❑ Yes ZJ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [.(No
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or other commenU. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Date:

Reason for Visit: J0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:, O T. Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: SEA#0 :�� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: 1 % 0A 9 0
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
GO
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Dr. P,oultr.
Layers
Design
Ca aci
�l
Current
P,o ,
DairyHeifer
Cow
Non-Daity
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
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?
[:]Yes 2/No ❑ NA ❑ NE
❑ Yes ❑ No
[-]Yes [—]No
[:]Yes ❑ No
[—]Yes
❑ Yes VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Pagel of 21412011 Continued

Facility Number: Date of Inspection: )
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Struct�urelI Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAl�Op1V
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ 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 environmto
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [—]Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
uu1 0
❑ 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
Wo
❑ 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 E3No ❑ 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 L; N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes rNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey , ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes CZNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes [ Io DNA ❑ NE
❑ Yes O N ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o ❑ NA ❑ NE
DNo ❑ NA ❑ NE
F21No ❑ NA ❑ NE
(comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional paves as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone(/ o 4 —
Date: i
'21414011

Reason for Visit:
Date of Visit: Ls
Farm Name:
-
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Referral
Technical Assistance
Other 0 Denied Access
Arrival Time: Departure Time: 'I 12cl County: IWPIZO Region:
Onsite Representative: S A0 LIEME500
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Title:
Phone:
Integrator:
Certification Number: .1: A J 6
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pap.
Design Current
Cattle Capacity P.
Dai Cow
Wean to Feeder
Non -La er
Dai Calf.
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oultr.
Layers
Design
Ca aci
Current
P,o
Cow
on -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
El Boars
Pullets
lBeefBroodCow
Other
NJ Other
Turke s
TurkeyPoults
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 WNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes
I_ I ❑ NA
❑ ❑ NE
Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: 110 1 Date of Ins ection: "
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
[:]No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo❑NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? �/
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes I d No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.•)"
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes.
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ YesWo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
[�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Wo
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 o ❑ 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 min gauge? ❑ Yes Inspections
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection:
24. Ilid the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes �o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
[2f No
❑ NA
❑ NE
❑ Yes
EX<o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ Vo
❑ NA
❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
❑ 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
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
rjeNo ❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( 3
Date: 7 5
2/4 of

r
Reason for Visit: C/ Ro fine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [y1q1L Arrival Timer Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: &—'-A W sbyq;�6k)
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: 1 290
Certification Number:
Longitude:
Design Current
ne Capacity Pop.
n to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
n to Feeder
6
Non -La er
Dai Calf
erto Finish
Dai Heifer
r
ow to Wean
ow to Feeder
to Finish
Dr, P P.Tudit
La ers
Design
Ga aci
Current
P,o
D Cow
Non-Dairyow
Beef Stocker
Non -La ers
Beef Feeder
s
Pullets
Beef Brood Cow
er
r
Turke
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?
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 6 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[—]No
❑ NA
❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[:]Yes &No ❑ NA ❑ NE
Page I of 3
21412011 Continued

Facility Number:
- Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EJ'No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: .o CIO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ L
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
,�,/
I f No ❑ NA
❑ NE
waste management or closure plan?
777""'
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 U N ❑ 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 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes WNNo ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land 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 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
[__,144o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
do
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
or
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Io
❑ 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
❑'llo
❑ 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
E�rNoo
❑ 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 Ins ection: 01
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25JIs 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:
V❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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
aN
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
IDYes
No
❑ NA
❑ NE
ElYes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
V❑ NA ❑ NE
N❑ NA ❑ NE
o ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.-.'=)
Use:drawines of facility to better exDlain situations (use additional nasesas necessarv). `
Reviewer/Inspector Name:
L'_
Reviewer/Inspector Signature:
Page 3 of 3
- i�

Type of Visit: Q Co lance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: (p i $ Arrival Time: 9 OQ Departure Time: ® Coonly: t Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
�+� tl1N11 Title: Phone:
JScr MP540 Integrator:
Certification Number:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
3SS2
Non -La er
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,oult .
Layers
Design
-a aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
lBeefBroodCow
Other
Other
Turke s
TurkeyPoults
Other
El
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 EZ/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes [—]No ❑ NA ❑ NE
❑ Yes L ❑ NA ❑ NE
[-]Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

17a cility Number: 1 0 Date of Ins ection: (o (, t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
( AW
S_
❑NA ❑NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[—]Yes No ❑ NA ❑ NE
[:]Yes dNo ❑ 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 do ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes F2/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ 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 M No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
V
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
INo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
jo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑Yes
o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number:31 PRO Dateo(Inspection,
24:tDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 14 ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes WNo ❑ NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
M/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
/No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
LJ 1q
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ENo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments: R
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: J014?j Pi(u)Fl
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�nj(U��
Date: 1 J 1
21412011

0
Type of Visit GKCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
'b I L I C
Arrival Time: 9 0f1
Departure Time: County: Douw
Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
OnsiteRepresentative: SEAd SirlPSot% Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [�o = =„ Longitude: =o=,
r
Design
,Current -Design
Current �- Dstgnrret t
USwine adz » Gapac�ty
,
P°1!°lah °° `• et Poultry Pactty :Populatton ` Batt :v w P ty. Population
7' Wean to Finish
»
❑ Layer
- ❑ Dairy Cow
Wean to Feeder
$
19100
; ❑ Non -Layer
I
, ❑ Dairy Calf
❑ Feeder to Finish
Dairy Heifer
`a ❑ Farrow to Wean
Dry Poultry
` ❑ D Cow
El Farrow to Feeder .�
""" ❑Non-Dai
�. ❑Farrow to Finish
❑ Laers
_. ❑Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
' El Pallets
❑Beef Brood Co
ElTurke s
. ❑Turke Poults
�,.�
❑ Other;
ate:
❑Other
Number"of Structures"r_
y.`^
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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
Page I of 12128104 Continued

Fficility Dumber: 31 — 18o Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:lACrab✓
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ti3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ yes
dNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[Z�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
Id No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LI No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes LI 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 L3 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
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Comments (refer to"question #): ,Explain any -YES answers and/or any recommendatrons or any other commeVnts
—'axc-+-b.flnv 6.y1i4 �'
Use drawings of facilityto better explain situations. (use addrtional'pages as'necessary):
Reviewer/Inspec[orName F JoN� Phone: QfO 79L-7S g
Reviewer/Inspector Signature: Date: 11
1 ,.r a 12128104 Continued

Facility Number: 3) — I $0 Date of Inspection
Required Records & Documents �/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ 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
[2rNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EjNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
(]'NO
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�N o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
6 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q4o
❑ 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
L7 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
L"J No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
1
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
IJ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E�/No
❑ NA
❑ NE
'Additional Comments and/or Drawings:
Page 3 of 3 12128104

100
Type of Visit pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit gRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (.o Z- 1 Arrival Time: 9 w Departure Time: County: DLPL=j Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 3r=A'1 S3'"PSo.J
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
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
10 Layer I
❑ Dairy Cow
❑X Wean to Feeder
3s'91,
J❑ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Non -Dairy
ElElN
Farrow to Finish
Layers
❑ Beef Stocker
❑ Gilts
ElNon-Layers
❑ Pullets
❑ Turkeys
El Bee Feeder
❑ Beef Brood Cow
❑ Boars
Other
❑ Turkey Poults
Number of Structures:
❑ Other.'
❑ Other
Discharges & Stream Im acts
I. 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 C No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
[I NE
❑ NA
❑ NE
❑ Yes E] Nn
❑ Yes L90
ElNA
❑ NE
ElYes LJ No
❑ NA
❑ NE
Page I of 3 12128104 Continued

`II
Facility Number: $ ( — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t Aa boo ^)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '�3
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M No
❑ NA
❑ NE
(i / large trees, severe erosion, seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[XNo
❑ NA
❑ NE
through a waste management or closure plan?
If any
of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat,
notify DWQ
7.
Do any of the structures need maintenance or improvement?
❑ Yes
ld No
❑ NA
❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[Z/No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require
❑ Yes
2(No
❑ NA
❑ NE
maintenance or improvement?
WasteApplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No ❑ NA ❑ NE
maintenance/improvement? �//
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes td 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
m 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
�eJ
2 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
1N�o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r-/No
❑ NA
❑ NE
K*" CL,-dAILZ 1/FED i= "t A Sort. 5AA4eLC IDAIC.
Reviewer/inspector Name pRNCt� Phone:(_ I — - 15
Reviewer/Inspector Reviewer/Inspector Signature: Date: G��69
Page 2 of 3 12128104 Continued

n,
Facility Number: 3 — Date of Inspection L a o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes I;Io ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check El Yes •L�-,JG/No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
,_,(/
l�l No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
YJ J�'o
❑ NA
El 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
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1No
JAI No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q o
ElNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
iNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2No
❑ 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
,�,t//
LNo
❑ 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
� o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
lAdditional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality V
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit '0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Fg I t Arrival Time: F9 Departure Time: County: L1 y Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 1?AUII] POUS70W
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ='
= Longitude: = ° = I E__1 u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
3s!jQ 1'39W I ILI Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkevs
❑ 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 ..I
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 W No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
V9 No
❑ NA
❑ NE
12128104 Continued

Facility Nptober: 3 J — f8O Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0Q 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: LA400d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LO
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [A 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 [1041 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? X Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes K 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 N]No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [X No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 101bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ 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
M 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
JONo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
90 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):
�. b%KC wAi L 70p IVF.EDS A (IrrLE 70�So1� v GitASS
�. NEED eA[ ►�i[AT1oN 7(L,> -To con\y<X,-16 w Swlb CoPIG5 T-G*b�i IN 308ayS
95, N60-h SLkocG Slx"SLS ktrN: ArnANDA Comes
/VCDEivQ DwcA ow FAk910-3511-;)(10
lad CA2bINK7
Reviewer/Inspector Name Am OF) C AIAIr 73IL-MIN6TCyV-*A/C Phone: ,�p
Reviewer/Inspector Signature: Date: _Q119/09
12128104 Continued

Facility Number: -?7( — �Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .0 No ❑ NA ❑ NE
the appropirate box. ❑ WIIP ❑ Checklists ❑ Design ElMaps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
W No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
50 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
0 Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
hm Yes❑tt
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,t►dri,,
171 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
r%h
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9No
❑ 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?
ElE/ 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
[I 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
4No
❑ NA
❑ NE
Comments and/or
12128104

00 Division of Water Quality w
Facility Number ,3 Division of Soil and. Water Conservation
— Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Yf Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
' /
G/i�G7„JRegion:
Date of Visit: �L{f/��'.� � Arrival Time:.),�� parture Time: fy:
Farm Name: Owner Email:
Owner Name: a/ :,a��590� Phone:
i Mailing Address: / /(//,D) z��
Physical Address:
Facility Contact: Title:/
OnsiteRepresentative: i)✓2!� Ot/570"
Certified Operator: 4�-A)J>-6 'U ILLZZC,-�f9^%
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [70 M, [7„ Longitude: Mo M, 71u
Design Current
Design. Current
Design Current,,
Swine - Capacity Population
Wet Poultry Capacity Population
Cattle Capacityk Population .i
❑ Wean to Finish
❑ Layer
I
1
❑ Dairy Cow?
Wean to Feeder
O
❑Non -La er
❑ DairyCalf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
DtyPoultry ...
El D Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
El Farrow to Finish
❑ Beef Stocker r;
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
I
4 ❑ Beef Brood Co
- - —
❑ Turkeys
- -
Other
0 Turkey Pouets
❑ 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 I/J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ Yes ,�❑t, No El NA ❑ NE
❑ Yes J�,,,,((((I No ❑ NA El NE
El Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes ICI No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes /❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [2(No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes F(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? ,,,���ttt
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes lL1 No El NA ❑ NE
El Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground El 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 Winn 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 XNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? El yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes /[21 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes lEf 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):
25) Gt� �/}X (OPt� Cf%f ii'F�u65 7 %2 ��lm PTzos✓ �2�n✓� %��r/i✓v
54uO6'_4 S�2'��y �P 28� ��i9T/!)Ei✓f ��� lGfjS�f/ O
ZF, '1 e7l5.
Reviewer/Inspector Name f / f �/ �� q Phone: 1'2) —7_Z'Z -7
Reviewer/Inspector Signature:
Page 2 of 3
Date:

Facility Number: / Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �PrNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other ,,,���(((
21. Does record keeping need improvement? If yes, check the appropriate box below. ElI/J Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers/ ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
CVNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes )zNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ;�'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes �dNo
NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes El�I No
,-❑.
NA
❑ NE
Other Issues
G
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
�y
❑ Yes ,�I No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �dNo
❑ 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 m No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes F(No
[INA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments and/or Drawings:
AV5
JC�,g,✓ �ilmp ���,���a/ SDP �Gln'I/� G���>L /-/�o.�
Page 3 of 3 12128104

Division of Water Quality
Facility Number � �8o O Division of Soil and Water Conservation
O Other Agency
Type of Visit fiD Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: .� Departure Time: % r County:
Farm Name: Owner Email:
Owner Name: zj Ta^l Phone: _
Mailing Address:
Physical Address:
Region:
Facility Contact: Title. Phone No:
Onsite Representative: D/li Integrator: ' b'V'L)
Certified Operator: - Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: = o = ,
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 I of 3
❑ Yes/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection / O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier: U
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
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
❑ Yes ❑ No
Structure 5
❑NA ❑NE
❑ NA ❑ NE
Structure 6
❑ Yes /No ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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 F(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No El NA El NE
maintenance or improvement? /VJ
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. ❑ YesNo ❑ 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 Area
12. Crop type(s)
13. Soil type(s) _A16
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ,,,,,((( o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes JCS No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 25No ❑ NA [:1 NE
17. Does the facility lack adequate acreage for land application? ❑ Yes/ RfNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes .y] 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):
20) k4V A6 646V w+c to F�6CT /rc�5?ar�}c ' Orr /ton 0,*44n/5r
Reviewer/Inspector Name I /
Reviewer/Inspector Signature:
Phone:
Date:
Page 2 of 3

Facility Number: / — Q Date of Inspection
Reunited Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ���fffNo ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes yJ No [I NA El NE
the appropriate box. El WEl❑ Design El El UP Checklists l ,�(
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes }J No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes VJ No [I NA ElNE
El Yes !❑ No 27NA ❑ NE
❑ Yes �No El NA ❑ NE
El Yes v�,,,///No [INA ❑ NE
❑ Yes ICI No ❑ NA El NE
❑ Yes /❑ No /NA ❑ NE
❑ Yes yJ No
❑ Yes /� No
❑ Yes No
❑ Yes ( No
❑ Yes /I(J o
❑ Yes No
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
AdditionalComments and/or Drawings:
�! -
'
Page 3 of 3 12128104

Type of Visit OrCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access �,) Q/J
Date of Visit: J! A� Q$ Arrival Time: /�.G� Departure Time: .� County: 41v��✓ Region: �0
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: //�� Tilte:
OnsiteRepresentative: J/0d?,0 LGfrf,/1�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator: I 'n i g&0/— !i
Operator Certification Number:
Back-up Certification Number:
Latitude: = U = ' = Longitude: = o O
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 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 Lam[/J
Waste Collection & Treatment �(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
StFu re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier
Spillway?:
Designed Freeboard (in):
y�
Observed Freeboard (in): �7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZI No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes J] No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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. El Yes VJ No El NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) T
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of ?04111)
ptable Croo iindow [:]Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s) , lA/i/", �yB�f�/✓S
13. Soil type(s)l1,�G%&
14. Do the receiving crops differ from those designated in the CA WMP? ❑ Yes oNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes VNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ yes dNo []NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
t l &111P f1&,,05 lO 6A— %(kdLSF/> /c �, N tJ Al
J s©yeF_aNs �o BE 1PK7,o coRn). -Sjc
-n/��fEo`70 Al�-4P C'�lq/P�1
VJ,E Jffll/' /D akc
Reviewer/Inspector Name
Reviewer/inspector Signature:
❑ Yes r� No El NA ❑ NE
El Yes m No ❑ NA ❑ NE
/F�CHC�Z�Ac. ��zd}r:z57
Phone:-L11
Date: ,j
12128104
=3ia9 r 7-76
Continued

t
• Facility Number: / Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes TTTT,--yNo El NA ❑ NE
ElEl❑ Design El ❑Other
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 ❑ 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
I/ No
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,
d No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�dNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E/No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
10 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
rrrririri
y� 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?
El Yes
���///
Lq No
[I NA
[I 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
0No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
ZNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

(Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit x Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: D Time:
O Not Operational O Below Threshold
,AfPermittelACertified 0^ConditiioonaRy Certified 0 Registered Date Last Operated or Abov Threshold: .............
Farm Name: ..... ....... fn. ._..._.... ._.— ....... County: __.✓U_QL ___...._.___.__
Owner Name:
Name:
!flailing Address:
Phone No:
Facilitv Contact: .._.__._...._.__..._._.__.__...._.......__._._._.__ Title:.._ ................. ... .................... _..... _.... Phone No: _ ... — ......
__....._...._-•---_—.-..
Onsite Representative:..bdtJ j 3a . .__._...._. _ Integrator:.._.... 1{Z { �_S
Certified Operator:
Location of Farm:
Operator Certification Number: .—................................
[]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' 0" Longitude =• 0' ="
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes LE;rNo
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 gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ........ _._.L.... ........... ... ............. ........ --- ... ............ _..... ......... ...............................
Freeboard (inches): _3 q _
12112103
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes ❑/No
❑ Yes M.NNo
❑ Yes 9No
❑ Yes No
Structure 6
Continued

Facility Number. 3) — Q Date of Inspection 5. Are there any immediate threats to the integrity of any of the structures observed? (die/ trees, severe erosion, ❑ Yes U N/
o
seepage, etc.) �_�
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes QNo
closure plan?
(If any of questions 46 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 [Zj N
8. Does any part of the waste management system other than waste structures require maintenan�mprovement? ❑ Yes ;NCO
9. Do any smctures 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
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 G51t/
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
&N
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
[�Nq
b) Does the facility need a wettable acre determination?
❑ Yes
I;
c) This facility is pended for a wettable acre determination?
[I Yes
NN
15.
16.
Does the receiving crop need improvement?
Is lack
❑ Yes
Yes
p o
there a of adequate waste application equipment?
❑
B o
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
UNo
liquid level of lagoon or storage pond with no agitation?
/
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
N
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[ o
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
o
Air Quality representative immediately.
Comments (refer to question #) Exphun any YES a�wers aadlor any recommendations or any other comments
Use.drawtngs,of facdtt` y to�better explain sitnagons (use addttionsl pages as necessary) ❑ Field Copy ❑ Final Notes
- - �- -_ -
Reviewer/Inspector Name = '
_
Reviewer/Inspector Signature: Date: 3
12112103 1 Continued

Ij Facility Number: ?, _ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes E Noo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [,a'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 BNo�
25. Did the facility fail to have a actively certified operator in charge? [I Yes [a IVo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes o�
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes (o
28. Does facility require a follow-up visit by same agency? ❑ Yes ; o
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)
❑ Yes
o
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 1D Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit t6 Routine O Complaint Q Follow up O Emergency Notification
,,,...,,,/// Facility Number Date of Visit:
{q Permitted Certified OConditionally Certified 13Registered
/Farm Name: k.0
Owner Name: 011510/1
Mailing Address:
O Other ❑ Denied Access
Time:
Date Last Operate or Above Threshold: ,. l�
County: 1 4z1V [�!/.' 9
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: 26/Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle [1Horse Latitude I ]o r--]` � Longitude =a =, 0`
to Wean
Farrow
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): �-
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes i No
❑ Yes )Z(No
❑ Yes '1ZNo
Structure 6
05103101
Continued

Facility Number: — Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observeed�?'(-ic// trees, severe erosion,
❑ Yes
No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0 No
9.
Do any strictures 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
A.,,(No
11.
Is there evidence of over application? El Excessive Ponding ❑ PAN [I Hydraulic Overload
El Yes
ILJ No
12.
Crop type -�
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
,..fNo
V1J No
b) Does the facility need a wettable acre determination?
❑ Yes
7V1 I� No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15.
Does the receiving crop need improvement?
❑ Yes
m No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
;�'No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
XNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
)ZNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(VNo
(ic/ discharge, freeboard problems, over application)
❑ Yes
RfNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
rLi No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
%No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�ZNo
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
•,. 6' y cygm • ua. tux auu�uoua� pascam ura,osaary ;�.
rsr;. r.._ Field Copy Final Notes
�irlNF2 �'FFi�Zi✓G- /�/� �� i".f ��9�i1E���A-L /�-/17Z1���
Reviewer/Inspector Name
Signature:
05103101
Date:
Continued

Facility Number: — Date of Inspection I G/7�jIQ7J, 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 I,Q No
liquid level of lagoon or storage pond with no agitation? /111
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 LYivo
roads, building structure, and/or public property) T1
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �J 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 I ,f No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ YesXT No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ' ❑ No
Additional omments and/orDrawings: - - - -
5100

Facility Number Q Date of Visit: 16 �G I I Time:
Q Not Operational Q Below Threshold
Permitted 0 �C(ert1ifiie'dd 0 Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
FarmName:....J...`..`T.i�._................................................................................................. County:...,Ll�^v�1.lr�............................ _..._ ....._.,
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: ......................_�....................................... .......................... `....................... ..........................
Onsite Representative:.. ._ ... 5!_..._....._........._....._._.___....... Integrator• ...j........................--..._......_.__
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry []Cattle ❑ Horse Latitude =• =, =" Longitude =• =, 0"
Design r Current Design Current - Desigtt Carrot
Swine. — Capacity Population Poultry Capacity Po ulation Cattle Capacity Po' dlatiort
Wean to Feeder a ❑Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
❑Farrow to Feeder ❑ Other -
s ❑ Farrow to Finish Total Design Capacity
Gilts
10 Boars -Total SSLW ;
Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Ngmber.of Lagoons ; . ❑ m
Holding Ponds%Solid Traps. ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VfNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes &No
Structure 5 Structure 6
Identifier: .......................
Freeboard (inches): G
5100
Continued on back

Facility Number: — g Date of Inspection O ,
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
WNo
8.
Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
0 No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Oyes
❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
gNo
11.
Is there evidence of over a plication ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
® No
/
f z
12.
Crop type CGv' 1 J (5; t^ S
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
JXNo
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
WNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
1'9No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
VR'Ro
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
XNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
[I Yes
KNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
WNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
��} No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
WNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
14 No
Y: NQ -VorP{ipt(s Ar. ilgtjci hOm •wire P9(.e# Stl�B Ns;visic • You wi(i-i ec$iye 00 fu4 tiler
• correspo deiki about this visit: • . :: ..................................
56�
\�� � b�''� 1�Fu1 � �t'lW �1�+ �w. � 15�c� 1'C ►-•o� �vv(;�
Reviewer/Inspector Name - .` e.J ,"�"'_. =r
Reviewer/Inspector Signature: Z::=. �=a: Date: c 'aI -Oi 5100

i
Facility Number: Date of Inspection T�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
��� ppp
®No
liquid level of lagoon or storage pond with no agitation?
(\
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
t No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
L
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
XNo
Additional Comments andfor-Drawings:,
Uv2 � -k-- -�cc�-�s V-. at-t-A
5100

30 Division of Water Quality ` ( I 0
. Division of Soil and Water Conservation V
Q Other Agency
(Type of Visit ,'6C(ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit p Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
�j Facility Number Date of Visit: 8 On "rime: QS Printed on: 7/21/2000
3 1 / i
11 Q Not Operational Q Below Threshold
13 Permitted oCertified 0 Conditionally Certified 13Registered Date Last Operated or Above Threshold: .......................
Farm Name: .r" D Fgrw1S County: ..J�?,.
.............................................1...................................................................... .U�r...L....................................................
Owner Name:...........' oh No(.l-f�°i'.......................................... Phone No:
Facility Contact:
Title:
Phone No:
MailingAddress: ..................................................................................................................... .
Onsite Representative: etV,iC�.........N0.u::SL0l'................................................. Integrator: dfl is
....................
Certified Operator: ................................................... ......................................................... .... Operator Certification Number:
Location of Farm:
I�
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° �•° Longitude �• �' O"
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca aci Po ulation
Wean to Feeder 355-L 41SO JE1 Layer I ❑ Dairy
❑ Feeder to Finish JE1 Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
I Number of Lagoons [[]Subsurface Drains Present ❑ Lagg�im Area 10 Spray Field Area]I
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Im actc
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made''
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/rnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............... t.................. .................................... ................................... .................................... .............................
Freeboard (inches): 40
5100
❑ Yes JffNo
❑ Yes ONO
❑ Yes [gNo
h 1A
❑ Yes T9`No
❑ Yes W No
❑ Yes 'TZrNo
[]Yes �E] No
Structure 6
Continued on back

4i
FacilityAmber: 3 1 — gb Date of Inspection 2$ 0 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 �Z 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 tyNo
(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 stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
P No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
P No
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
1P No
12.
Crop type GdrV1tW�,,4'0 4�Ga1✓t!
13.
Do the receiving crops differ with those designa ed in the Certified Animal Waste Management Plan (CAWMP)•?
❑ Yes
R'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
O No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
C�rNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
)gNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ie/ WUP, checklists, design, maps, etc.)
XYes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�C,j No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes figNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'! ❑ Yes $ No
24. Does facility require a follow-up visit by same agency? ❑ Yes g No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
El' {Vd viblafit}tis:or- &ficiencieS were it6ted ditritig this:visit, Yoit will -receive li. further
curies orideitce:ahoutthisvisit:::::::::::::::::::::::::::::::::::::
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):
/4. FnC4;4� iS perldcd -%r w q6)e otLre de�er�:i?N�tto✓1. %lase p�e�errni�q��atl
dohe 4 �5_etw( GOpieS 0-f t,ieN4ybje Acre doc,v.-.�er-..�tq�,'c.� wtap S�tow�^9 Spray
are4s, 6 InJotl�e pl4n fo �ta1r1, cre><la61 e Qcre d� fie"^,; taf �r� �o �+e 67
fo 12r1 (,-A 4;na� D FXi
l$• GawtPlt•1'e 1t7iEG7,n�0rlotnd YYior4cd;lt Gor4yal
re c0.4
J , /
l,i. eecvw. eh0 _-rower best;^ l�ee�;n9 weekly J-e)_-6oejed -eeo.-de.
Reviewer/InspectorName 57,oplavoiIl 47q4 { )5
Reviewer/InspectorSignature: ,ram/ Date: Q LS 19d 5100

.r�
r
Facilityumber: 31 —1 Q Date of Inspection H-5rop 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 Wor below []Yes 'ONo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
P 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
(FNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
0No
5100

0 Division of Soil and Water_ Conservation -'Operation - Review:
- ' ► = �+, '0 Division of Soil and Water Conservation -:Compliance, inspection
E2 Division of Water.Quality ;Compliance Inspection -
0 Other Agency - Qperation Revtew ; = y'
itine 0 Complaint 0 Follow-up of DWQ
Facility Number
0 Permitted Certified 0 Conditionally Certified 0 Registered
Farm Name: ... 1..."..'.... ................ jr .' ............ -- ......
----------------
Owner Name:
Facility Contact:
Mailing Address:......... _(_7. �......../.�L/.UY(N�.
Onsite Representative: .... /*'._l-
Certified Operator:,l/o_...u:t fzJr
...........
Location of Farm:
w-up of DSWC review 0 Other
Date of Inspection (TL3�
Time of Inspection 0 24 hr. (hh:mm)
0 Not O erational Date Last Operated: ..............
County.
Co.
. 1 04/- 4/z zk
........................... /Phone No:......._`I/A..................................................................
........ a �!VA. ��................................ Phone No:...................................................
.w .............I...��_.............I.......-aS57z,
./.T..................... Integrator: .... CAS/5............................................................
.....
...N.k y+.-� Operator Certification Number: ...............................__,.,__
..............
Latitude =•=' =11 Longitude =• 0' =-
Design
Swine Ca acit
Wean to Feeder iS1/
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
rl Boars
Current' I Design
To
Design Capacity
Total SSLW
Design Curr
Subsurface Drains Present ❑ La oon Area ❑ S ra Field Area
Number of Lagoons - - 0 ,- ❑ g P Y
- Holding_Ponds / Solid Traps E ❑ No Liquid Waste Management System - -
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes K No
Discharge originated at: [ILagoon ElSpray Field ElOther
a. If discharge is observed, was the conveyance man-made'? ❑ Yes (dNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes/?'4
No
aIf discharge is observed. what is the estimated flow in gal/min? J✓
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Ye7 ip No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Ed No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes PrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes A No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ......_................................................................ ................................................................................................................................. . .....���---fff
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �p No
seepage, etc.) / `
3/23/99 Continued on back

Facility Number: 31 — 'D I Date of Inspection
6. rAre there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
gNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
I L. Is there evidence of over application? ❑ Excessive Ponding [IPAN
❑ Yes
No
12. Crop type CAjj
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
b�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?
Z[Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ,Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) (�AfFYes KNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes gNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes PCNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes )4'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 6No
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 ANo
dVd yiolafititis:o. deficiencies were it.. .. ing this:visit; You wif....iv . t.. fu;ther •:
comes orideitce:aboutithisvistt_ ::::::::.. .
Comments (refer to question#): -Explain any YES_answ.ers and/or -any -recommendations.or.any_otlier-commeufs , Use drawings of facility to better explain situations. (use addrtionatpages as necessary):
fyb, ��o+td -ir✓,- Wc•�labl� rc�e I�la,v.
�8) ifs �lor Ce,4y&10 tctlaas -h (tcoralS
Reviewer/Inspector Name
Reviewer/Inspector Signai
MWO 910- IM'34oO
Date:
3/23/99

Facility Number: 31 — Date of Inspection
Off. Isstks
R
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes $No
liquid level of lagoon or storage pond with no agitation? ,
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes /�'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes -I�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 _KN o
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 XNb
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes MO
32. Do the flush tanks lack a submerged fill pipe or a pennanent/terriporary cover? ❑ Yes ,UNo
3/23/99

J
❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
J%Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other
Date of Inspection I1
Facility Number -
,�aW�eiv��.111101�.,����,,, Time of Inspection 24 hr. (hh:mm)
❑ Registered GICertified M Applied for Permit 0 Permitted [3 Not Operational I Date Last Operated: ..........................
FarmName: I-A..g...1? .................................................................................................... County: .... Dvt- i.�+......................................W.L..��i
Owner Name: ........... .a...1.!^,......... .....tTU..u.l..itA_!ti................................... Phone No:... ..b.
FacilityContact: .............................................................................. Title:................................................................ /Phoney No:...................................................
htailittgAddress: .. .%r_`.........:a..t.tr...1f✓\.:N:......R....1A-.-................................. ... .i_ t. ...}:t._..l.I.....nl_C..�................. _L.fS.s.7L
Onsite Representative: .....-.,I.J..,c:- ...... !TA.V..S..' _..................................... Integrator: ...... C...0.xx:II...LL5............................................
LL
Certified Operator**.L..�..tQ(4...... .....I QI45........................................ Operator Certification Number;..�.. .. ..........
Location of Farm:
Latitude �• ®' ®" Longitude ®•'"
Wean to Feeder
U Layer
Feeder to Finish
"
❑ Non -Layer
Farrow to Wean
="
Farrow to Feeder
❑Other
Farrow to Finish
Gilts
Boars
`Number of Lagoonss t Holdrug Ponds I I I ,I❑ Subsurface Drains Present 110 Lagoon Area ID Spray Field Area V
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes JS.No
2. Is any discharge observed from any part of the operation? ❑ Yes IR No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Q No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Y\es R(No
c. If discharge is observed, what is the estimated flow in gaVmin? JA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes KNO
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 12fNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require []Yes R 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 M No
7/25/97 Continued art back
A

j;i
:I
Facility Number: 31 -1 0
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes tO No
Structures (Lagomts.}Ioldinc Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Ed No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..._.Z ...................................................................................................................................................................................................
Freeboard(fty........................................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes 19 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ 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 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ... ............... ..................g.al.w..+.¢.vsn-f.........drn.v..rv.a................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
tgNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
IM No
18.
Does the receiving crop need improvement?
❑ Yes
gNo
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
Q No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
(R 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
C9 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ZNo
25.
Were any additional problems noted which cause noncompliance of the Permit? -
❑ Yes
Cd No
No.vioWioitsor deficient:ies.were noted during this.visit. You.win receive no further.
correspoudenceahoutthis:visit.:..::. :.._. �...�:. ...:...: ... :.:.:.:.....:: :
Z.Plve,e.t si4_ O ^t VCLr^- SPafc of Io-no0v wall.
r Z 1 A a [JR s u t dt0 L i i t- i ra t't "k e K J wL I" F�
ttA., V- S P r 9-A
c-o Nd • - IS 0 t A 8 a- w�.-e -S k-o VO f �-y tv r viol ol t-t t
t�ov [n.v 4e - �ltlur f,AAA, v �J
7/25/97
Reviewer/Inspector Fame A
Reviewer/Inspector Signature: rn _._..iw , . .+11 t6 U_Z— x_r. Date:

Ate
Site Requires Immediate Attention:
DIVISION OF ENVIRONMENTAL MANAGEMENTiry No. 1 — 1 Pia
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: 11
Farm
Mails
Count
Integr
On Si
Physic
Type of Operation: Swine JL,-� Poultry Cattle
Design Capacity: 1760 Number of Animals on Site:
DEM Certification Number: ACE DEM, ICertification Number: ACNEW
Latitude: 3 (�00 Longitude: 19 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 dual Freeboard: _S t Inch
Was any seepage observed from the lagoon(s)? Ye_s No Was any erosion observed? Yes No
Is adequate land available for spray? Yes or No s e cover crop adequate? Yes or No
Crop(s) being utilized: '>
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling_s?G or No
100 Feet from Wells?(IYO oo
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or I
Is animal waste discharged into waters of the the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orj�Vd If Yes, Please Explain.
Does the facility maintain adequate wastemanagementmanagement records (volumes of manure, land applied,
spray irrigated on specific acreage with
Additional Comments:
'ooU19 oc
J' tm �)vPS
Inspector Name
crop)? Yes or No
i k7_ a:..
,I.
cc: Facility Assessment Unit
Use Attachments if Needed.