310193_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
W)

type or visit: t omptiance inspection u uperanon tceview u btructure evamation u tecnmcat Assistance
Reason for Visit: ,Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ')j 't j(�tF1 rj Arrival Time: Departure Time:
Farm Name: _Dki �jlay A ��i Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: j 0yNa,(, rtin
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
County: I(/) Region: Vf l
Phone:
Integrator:
Certification Number: 16 0 3 90k
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design
Capacity
'2a
Current
Pop.
ZZ6U
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult ,
Layers
Design
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
jBeef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 IX I No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No ❑ NA ❑ NE
[—]Yes [—]No
❑ Yes No
❑ Yes ANo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jDate 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: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats totheintegrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes X No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes t-- No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) A
9. Does any part of the waste management system other than the waste structures require ❑ Yes *o ❑ NA ❑ NE
maintenance or improvement?
Waste Application y�
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ �t11 Yes I No ❑ NA ❑ NE
maintenance or improvement?
7`''�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes *o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ®I No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 21. Does record keeping need improvement? If yes, check the appropriate box below. El�q Yes I /V No ❑ NA ❑ NE
❑ WasteApplication ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Traanss`fers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ I20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I J,y No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: _ Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
a No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
0 NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
A 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
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 �0No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes [ q No ❑ NA ❑ NE
❑ Yes VVNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES. answers and/or any additional recommendations or any other comments. I
Use drawines of facilitvto better explain situations (use additional vaees as necessary).' ' -
_ Sta baK an 5 [ 0M / ems.
4'�w vvtl� _f�w , 't(T.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
2/4/20 5

Reason for Visit�0-koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time: Departure Time: County: 1xPixil) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: t.J00A-TNwJ ffty� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I I p o Q 3
Certification Number:
Longitude:
Swine
Wean to FinishI
Design Current
Capacity Pop.
Wet Poultry
11-ayer
jNon-Layer
Design
Capacity
IDai
I
Current
Pop.
Design Current
Cattle Capacity P.
Cow
Dairy Calf
X
Wean to Feeder 3 a1
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) . P,oult ,
Layers
Design
Ca a_ ci +
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
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 dNNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
[2�No
❑ NA
❑ NE
Page I of 21412015Continued

Facili Number: Date of Inspection: O a
Waste Collection & Treatment
4. 1 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El ,dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1\l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �r"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 12No ❑ 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 ['J No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [�fNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes EJ/No ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
d o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
E� o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ej7No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 5/No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [�rjNo ❑ NA ❑ NE
25.(ls the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes rfNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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
No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
I NA ❑ NE
10 ❑ NA ❑ NE
�No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use.drawm¢s of facility to better explain situations (use additionalpages as necessary)..
Reviewer/InspectorName: [;�R/JC-( ,
Reviewer/Inspector Signature:
Page 3 of 3
Phon�-Jl jy fib " IJ bb
Date:` to
214120A

(Type of Visit: aCo�tHance Inspection O Operation Review U Structure Evaluation U "technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up Q Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: /I / Q//,� I Arrival Time: Departure Time: /® County: 4M� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
,TOnsite Representative: N) /��LlC
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number: / 6 U1
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
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 0o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes VNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: - Date of Ins ection: `'
*iste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes M/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
LA
❑ 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 ZJ/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes 7VNo
❑ 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 dNo ❑ 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 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yesg'Ngd
❑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 ErNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ONo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and 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 2No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: -I Q< Date of Inspection.
24,Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25y Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
❑ Yes
11i
1 J No
CjNo
LJ No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [JNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes []"No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes dNo ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments...
Use drawings of facility to:betterexolain situations (use additional pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonek , D
Date: IK
15

'Type of Visit: tg Cptnpliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: V1>,R_ outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 0 Arrival Timer Departure Time:® County: JUP Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: LJ O IJ'q'i -f4 ?J � � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: I I 1 U 1 )
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
O.P.P
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
'LQ
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult.�CB
Layers
Design
8CI�1;0_acIt7
Current
.
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
NJ Other
Turkeys
TurkeyPouets
Other
0
Discharges and Stream Imoactsand Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes Zo ❑ NA ❑ NE
[:]Yes WNo ❑ NA ❑ NE
Page I of 21412011 Continued

\ Facility Number: - Date of inspection: jo
`; Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure_I Structure 2 Structure 3
Identifier: L'� lwl"
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [—]Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA [:3 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes FNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
W1,❑
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesVNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the a to riate box
PP P
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑YesVX0
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

�1 Facility Number: j i - 431 1 Date of Inspection: 10 12-9
`' 4. Did the facility fail to calibrates waste application equipment as required by the permit? ❑ Yes � ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ YesWN,'o ❑ NA ❑ NF
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 o ❑ 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 ZNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIAP? ❑ Yes zXC ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VN0o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better exulain situations (use additional ogees as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 11 t Arrival Timer Departure Time: 'FO County: __%;Up Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
i
OnsiteRepresentative: L)pM/ All 1U-EILI
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: I)bfi�
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Da' Cow
}(
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oultr. Ca aci P,o ,
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
94d
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [/No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes o
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: IffDate of Ins ection: it p3
Waste Collection & Treatment
4. ds storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O/No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure lStructure 2
Identifier: LAGtr1W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 11-
❑NA ONE
❑ 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 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmeutl threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [�J/No ❑ NA ❑ NE
maintenance or improvement? .
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [� /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ff, o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ 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 dNo
❑ 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 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall InspectiVNo
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❑ NA ❑ NE
Page 2 of 21412011 Continued

Facili Number: Date of Inspection. lt(q 1
24. Did [he facility fail to calibrate waste application equipment as required by the permit. [:]Yes [YN
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q 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:
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.
❑ Yes [TNNo
❑ Yes 0<0
❑ Yes El"No
❑ Yes No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes
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
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
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
No ❑ NA ❑ NE
�No ❑ NA ❑ NE
L__J No ❑ 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 paces as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( �b -m
Date: U
2 /2011

Type of Visit: U C pliance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: f n Z Arrival Time: $ 30 Departure Time: �j j�o County: bk)P(/-DJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: .Jodmyitaro 0:rk r.(L- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: l yo zo /
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
ILayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
3
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
D . P,oulti.
ILayers
Design
Ca aci
I
Current
P,o ,
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
I
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
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 2fNo ❑ NA ❑ NE
❑ .Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ZIN ❑ NA ❑ NE
[-]Yes VNoNo ❑ NA ❑ NE
Page of 21412011 Continued

Facili Number: Date of Ins ection: It 7 'L
Waste Collection & Treatment
4. Is forage 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
t A (2-16�
W
❑ 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 El
No ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmegtal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [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 EdNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes C;�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
F2 Yes
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
n I�Jo
�Q/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LZ/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N
❑ 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 E7No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ NNoo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

fail to secure a phosphorus loss assessments (PLAT) certification?
❑Yes
No ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑Yes
� ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑Yes
No ❑ NA
❑ NE
Facili Number: 19 Date of -Inspection. it 7-- �//
24. Lid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I t'j Noj ❑ NA ❑ NE
25. Is be facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes =�'N/o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: pppp 26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0 IN, ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes O N ❑ NA ❑ NE
27. Did the facility
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
K❑NA ❑NE
V N ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #):Explain any YES answers and/or any additional recommendations or any other comments.f
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
)-w IgRrje 1,
Phone:( 1 /d L ` / J
Date: 11 '7 Z/
2/4/201

(Type of Visit: CD Coy(tpliance Inspection U Operation Review tJ Structure Evaluation U Technical Assistance I
Reason for Visit: C1J Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ki ; tit ArrivalTimed $3o Departure Time: County: DUpL�pJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
i M��� � ��
Onsite Representative: (,dN Rr{ Al-i Irt-�ld.R/1...
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: 19064
Certification Number:
Longitude:
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity PopFinish
Dai CowFeeder
Non -La er
Dai Calf
Finish
rkWeantoFinish
Da' Heifer
o Wean
o Feeder
o Finish
D . 7 Poulf .
La ers
Design
C_a acit
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
11 Other
Other
Turke s
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 U/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes TjFb ❑ NA ❑ NE
ElYes ❑ NA ❑ NE
❑ Yes Ef No ❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: - Date of Inspection: It 3
I
Waste Collection & Treatment
fills storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure 11 Structure 2 Structure 3 Structure 4
Identifier: (-M r
Spillway?:
Designed Freeboard (in):
❑ Yes
ZNo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 5 Structure 6
Observed Freeboard (in): Vq
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
V No
❑ NA
❑ NE
waste management or closure plan?
TT
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmen 1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
V�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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P6 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[,7�Yes
❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[NNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L3'No
❑ NA
❑ NE
Required Records & Documents
1
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections/ ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes !'J ❑ 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

kkFacility Number: - 9 Date of Inspection: tt
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25�. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E2*No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
[—]Yes Z(No ❑ NA ❑ NE
❑ Yes [I/No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes � ❑ 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
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments A,
Use drawings of facility to better explain situations (use additional pages as necessary).
I) tmm4E 1JEEt D Auo 24J LEVELS ACC C"36 To LlmxT LEVEL
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (QI 0% —151p
Date: 11
2/ !/2om

�P
Division of Water Quality
Faeility�Numbet -
3 O Division of Soil and Water Consenatton
�'�
O Other Agency
(Type of Visit (Ef Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit I 1 9 ID Arrival Time: / (J Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: 06WA7NA>J YVA�IkfL
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [� e = = « Longitude:
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 L_J/ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
[I No
❑ Yes
ONNo
❑ NA
❑ NE
❑ Yes
EINo
❑ NA
❑ NE
Page I of 12128104 Continued

rFicilityNumber:
Date of Inspection bi S 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I, Q 606W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 ti
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 ICJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes EdNo ❑ 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 [jZ"S'o ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�/
9. Does any part of the waste management system other than the waste structures require ❑ yes l� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El,.
Yes 1� No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes rJ No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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
15. Does the receiving crop and/or land application site need improvement?
Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
17. Does the facility lack adequate acreage for land application?
❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Q No ❑ NA ❑ NE
R,/No ❑ NA ❑ NE
E2,KNo ❑ NA ❑ NE
L✓ryL ❑ NA ❑ NE
L"J No ❑ NA ❑ NE
Comments (refer, to question #)i Explain anyYES answers and/or'any recommendations or any other comments
Use drawings,of facrhty,to better explain situations..(pse,additional_'pages as -necessary): w
_,
74
ReviewerQnspectorName r _ f� J • p /E(j _- Phone: (710 %¢4-1391
Reviewer/Inspector Signature: AZ kV Date: d
Page 2 of 3 12128104 Continued

hacility Number: — Date of Inspection
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ yes
E3'No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2"T o
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
,.
IJ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Cl i�jo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑Yes
[;NNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
_id
O
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
�/
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O 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
E 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?
El Yes
LI No
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
D No
❑ NA
❑ NE
AdditionalCommentsapd/or,Drawings, „ N
Page 3 of 3 12128104

.-t 3
Type of Visit Cptnpliance Inspection O Operation Review O Structure Evaluation Technical Assistance
Reason for Visit ®,t�Routine O Complaint O Follow up O Referral O Emergency Other ❑ Denied Access
Date of Visit: Arrival Time: 34ca Departure Time: u County: OvOUt-2.J Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =U =' =" Longitude: =o =. =„
Design Current
Design C•unrent
Design
ne CapacitPopulation
Wet Poultry Capacity Population
C•atlle Capacity Populati
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ Da' Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
IN
❑ Farrow to Finish
❑ Layers
❑Non -La Non -Layers
❑ Beef Stocker
❑Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ TurkeyPoults
❑Other
Number of Structures:
❑ 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?
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 LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ElNA
ElNE
❑ Yes
vlo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

1'
Facility Number:31 Date of Inspection It
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?
❑ Yes RI No
❑ Yes 00
❑ NA ❑ NE
[I NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: GACr�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): l'�e 5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1 � No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [d 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 'NNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ElNA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ^^ No [I NA El NE
15. Does the receiving crop and/or land application site need improvement? El Yes C?<O ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes CyNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Eg'No
❑ Yes P'No
El NA ❑NE
El NA [I NE
rComments (refer to question #)c Explain any YES answers and/or any recommeudatioos'or any other comments I
IUse drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I n�] 61 n q; I Phone: `f/b i &
Reviewer/Inspector Signature: lhY1. 1, pqy\46 Date: I ki hto All
Continued

1
Facility Number: 3 — Gj Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes
❑ No
❑ NA
E
❑ Yes
El No
[I NA
ZE
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
❑ No
❑ NA
26NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
WINE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
[Q NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
['IE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
1 `NNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
E2 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
E N/E
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
EVINE
30.
and report the mortality rates that were higher than normal?
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
�
ONE
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
2rNE
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
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[INo
[IINN NA
E
12128104

acility Numbe.
Type of Visit ,C.,00mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit CJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: d (/ Arrival Time: ® Departure Time: County: 0U1P _'dJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Joel P'CHYi0 i Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude:
a
Design
Current
Design Current
Design
Current
Swine Capacity
Population
Wet Poultry
Capacity Population
Cattle C•apa�ity
Population
❑ Wean to Finish
❑ Laver
❑Dai Cow
Wean to Feeder 1.0
Z Ob
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑Non-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Be Feeder
El Pullets
ef
❑ Boars
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ 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?
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 EJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ NN9
❑ Yes
L NN
❑ NA
❑ NE
❑ Yes
LJ No
❑ NA
❑ NE
Page I of 3 12128104 Continued

/ Facility Number: 3 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
S1 Structure 2 Structure 3 Structure 4
Identifier: LAtructo
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1-6
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes EJN/o El NA El NE
❑ Yes I� No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes '[1� o ❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No [I NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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 dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �o El 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes c ElNA ❑ NE
❑ Yes No ❑ NA ❑ NE
om(refer to queiton #) Explamtany YES answers and/or any recommendations or�anyfother comments
',Co
,lie dra air s,of facthty;to bettez explato situations (use`addrtidnal pages "as decessary) ; wa ,,,, �, w n, -�.. .
_..
fwoGE &vbt,. C-H, cevk Ar ApilcW4t _,
6 N4eoE� aA/
Reviewer/Inspector Name - v'- .p �/.,7
Phone. 9/ / —/ ? ep
Reviewer[Inspector Signature:
Date: /'i Li. 6
12128104 tontinued

Y
r
Facility Number: —
Date of Inspection
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes �'No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 I^JjNc❑ NAElNE
�❑ Yes�� ❑ NA El
❑ Yes L,j'No ❑ NA ❑ NE
❑ Yes L�d/Ny ❑ NA El NE
❑Yes �yN ❑NA El NE
❑ Yes No ❑ NA ❑ NE
❑Yes L3hNNo�o ❑NA ❑NE
El Yes Ld'A10 ❑ NA ❑ NE
❑ Yes OKoo ❑ NA ❑ NE
❑ Yes EKo ❑ NA ❑ NE
❑ Yes :NoElNA ElNE
❑Yes ❑ NA ❑ NE
f�71iI1
❑Yes L3hNNo�o ❑NA ❑NE
El Yes Ld'A10 ❑ NA ❑ NE
❑ Yes OKoo ❑ NA ❑ NE
❑ Yes EKo ❑ NA ❑ NE
❑ Yes :NoElNA ElNE
❑Yes ❑ NA ❑ NE
f�71iI1
f�71iI1

Type of Visit Co liance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q101the�r -r�❑ Denied Access
Date of Visit: /6 a Arrival Time: ® Departure Time: County: VWt�N Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: T� Title:
Onsite Representative: , /°d/! zgPL) V Lru(l,
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' Longitude:
Design Current
Design Current
Design
Swine Capacity Population
Wet Poultry Capacity Population
,jjCurrent
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
® Wean to Feeder
20 3cov
10 Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ ers
El Beef Stocker
❑ Gilts
N
❑ Non -La ers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
El Turkeys
Other
❑ Turk— Poults
❑Other
Number of Structures:
❑ 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?
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 CNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑ N ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

F9cility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E3No
❑ 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):
2
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
lr 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
n 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 thSeat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes �/J1 o ❑ NA ❑ N
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ J No ❑ NA ❑ N
(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 Q&o ❑ NA ❑ N
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes N ❑ NA El
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ N
❑ 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
E
E
E
E
E
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
Coimments (refer to quespon #) +Ezplam anyYES,answers and/or any,recommeudaho 'soKany other corn a is
Use drawings ofdtacthty4o.better eaplaI sI(use addthonal pages as necess''
Reviewer/Inspector Name Phone: f `— 8
Reviewer/Inspector Signature: Date: 0'b 6 Df
D000 7 of 7 1212RI04 Continued

Facility Number: — 9,} Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ 'in in ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes 7No
K ElNA ❑ NE
❑ Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspection,.s.,.(/❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
CJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ K.
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�Ivo
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,_,{/No
K� No
❑ NA
❑ NE
Other issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E3 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
LJ 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
O o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�,�
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
U4o
❑ NA
❑ NE
Page 3 of 3 12128104

90 Division of Water Quality /
Facility Number 3 O Division of Soil and Water Conservation tl//
0 Other Agency
Type of Visit ,C[9_�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 07 Arrival Time: ! O Departure Time: County: I� UPL?N% Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: .f.0 Ja
Owner Email:
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o =' = Longitude: Q ° =' =
Swine
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
36-2.0 131,a6 I ❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LJ 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: 31 — t9
Date of Inspection I�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: J.QCscylJ I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 y
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 E4 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 2NNo ❑ NA ❑ NE
❑ Yes ENo ❑ 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? El Yes dNNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes E No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any par of the waste management system other than the waste structures require ❑ Yes 20 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C"No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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. Soiltype(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes u No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
Z Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
El No
El NA
ONE
eJNo
ElNA
❑ NE
E 'NNo
❑ NA
❑ NE
R<O
❑ 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):
L0kJ ,FAJ oN FdEcA / Foa POLkS l w 2 AI o i0 �l(. qvG, 2Z Fi-y OVM D
&TCTv0l!EG Pvc— Z qs OLP otif Pact At u S TgoaEteL- r NEW P41L-->gt*1,,
ALI- fra-w .91&A0 ;✓E6' ZroN.1 of (--rm , d0p"fr Auo sr,4ptEk6Crtr' % SOIL
U) AwP NAI lao /6 ov(A_SeEv As AN ep zpN. Aarg rdTAt_ �'A�,/ JNous/✓c � Zt C4n/m1/
8E An/ OPTS) AI ?tom Ad E CWA,J",
q os P IqC &A AMD r6vt u A S
Reviewer/Inspector Name Llo t✓ Phone: ( WV 74L - 73W
Reviewer/Inspector Signature: Qe Date:
VU
12128104 Continued

,
. Facility Number: ,31 — Date of Inspection
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have components of the CAWMP readily available? If yes, check [yes ❑ No ❑ NA ❑ NE
the appropirate box. V3WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EKO
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ 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
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,_�/o/
L No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
///NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,[[[�([iii
2 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
Cl Yes
[2,wo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[__1 No
QA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
J!'] No
❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ErNo
❑ 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
CK
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
�
31.
Did the facility fail to notify the regional office of emergency situations as required by
El�,
Yes
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?
El Yes
11 N
El NA El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA ❑ NE
Comments and/or
12128104

�� vision of Water Quality
Facidlity Number 0 Division of Soil and Water Conservation
— —
Q Other Agency
Type of Visit -O Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance �.
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: %.'i O' Arrival Time: Departure Time: Xounty: /%mil Region' W /
Farm Name: i , < Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �� Title:
Onsite Representative: Mtn � .j tpvk
Certified Operator: 1AA0 S
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
n°
Latitude:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
I —n ❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Longitude: =0 = ` M "
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =
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 J3'�o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
LNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

Facility Npmber: — Date of Inspection%
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: T
Spillway?: TT
Designed Freeboard (in):
Observed Freeboard (in): -
❑ Yes UNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes] No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ErNo ❑ 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 ZI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
,aYes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question t/): 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):
Awl S,errey /FlftW 214
aC�' a,ei 'Z'� d -r/ !/P�Y�zCrlGi� Q'1't
IReviewer/Inspector Name I A, e Lj I Phone: d/lO'- 2 1/ I
Reviewer/Inspector Signature: Z� Date: .'Z
Pane 2 of 1 92R/04 Cantinued

Facility Number: — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [:]No ❑ NA ❑ NE
the appropirate box. ❑ W JP ❑ Checklists ❑ DesiElElgn Maps Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a min gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments and/or
�r,spe c�oj/ I n (e s r r1 S e -ice -0y-OVP/-) , j'f�I/Ct) fom V I a i vt
(%
yo W-eii' (,vC� s S P(C�q ( r3 i t1'�? c.w eoc, s .
A4 4�YY\o C'- t v'S6`C4-1C YN rn o s + G -(- 4�
9 e X c e;��' 1 ct,J1 eCr S.
ry✓e� Sorni�6cx�A ;'Y�Q� }lave �fc1Zc-0
Treesl .hd-U5h i!>\-e 1 �J�� n0
ova S i u ( f LAY\4-� W C-s
Q'4- (� \ V� S�' C L✓>� .
1'tPca,e U-e 6,_fe 4-o Sf rc(l w I",I tips bttf4r5,
12128104

(Type of Visit 0 Co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ty S Departure Time: County: ICU T Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: \JONATHO J,) N1.Ll A, EYL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =' =" Longitude: =o=, =„
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
3520� sseo �� Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
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)?
Number of Structures:
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 Ld No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
El NA
El NE
El Yes
❑N
El Yes
Noo
ElNA
❑ NE
ElYes
7
Ld'No
❑ NA
❑ NE
12128104 Continued

Filsility Number: 3 1 — 3 Date of Inspection 11 Z oS
:1 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: [ AF o d ^J
Spillway?:
Designed Freeboard (in): S
Observed Freeboard (in): i q
5. Are there any immediate threats to the integrity of any of the structures observed?
/
ElYes 2 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 ET/N�o ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes Q o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2< ❑ 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 Z No ❑ NA ❑ NE
maintenance/improvement?
11: Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[3 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
es
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
EfNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
No
❑ NA
❑ NE
15',-) /06 ss61Js 4" S6-6 PLAWrCn Wx�rN IvW'6 APPsCA'�Lol/t, 56tiO ?it„oa w/ /oA
]9') !t/d 1�E�M WFTR �6WVCOJ
w✓�s7E An1Al,Ysi-sF62 71�o`vr~9�iG/n5� vPDATE C2dP1'rELtl�
.fNsSrAL ]d6 htizx/ �rIS�EG7Yon/� W"T14CP_ Gd10C Fa I3C DrrJ(� 11 R/ki//FAtl,"lp,) dew V✓P OsnlE — A6RsmcejT JoLiZu-S T6 QE� /�EGNlteoHAsKnl l�t2Eb to
Reviewer/Inspector Name - - ,' . °.;{.z a .c*'.# `"E Phone:( 7YI9 776 0S
Reviewer/Inspector Signature:�,ytfl Date: /�s-8 oaf-"
FfiX (1/0 30-

Facility Number: 4,— ..3 Date of Inspection 1 2$
.' Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
EIVes
❑ No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�No
❑ NA
❑ NE
the appropirate box. ❑ WIJP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, chec a appropriate box below.
,_,(/
IJ Yes
❑ No
❑ NA
❑ NE
Waste Analysis ❑ S,o�il(�jnalysis [:]Waste Transfers
❑ Waste Application ❑Wee Freeboard,,
El Annual
Certification
//
❑ Rainfall ❑ Stocking Crop Yield I2'120 Minute Inspections .CJ Monthly and I"
Rain Inspections
I�J'Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Zo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
-dNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
F-1 No
3NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E3 No
❑1NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
�/I NA
❑ NE
Other Issues
--//
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
u No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
do
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
��
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
-No
❑ NA
❑ NE
12128104

Type of Visit Of C—o[�pliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Cl 0utine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date or Visit: /6 0 Tune:
O Not rational O Below Threshold
0 Permitted 0 Ce�rtified 0Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
Farm Name: __.J/fiVLs _BLR W1D fiiia YV I County: bdIV
Owner Name:
Mailing Address:
Phone No:
Facility Contact: __ p Title:. �. Phone No: _—
Onsite Representative: __$�:��0� __—� Integrator.
Certified Operator:—_ _ .�—_.. _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F__10 =' =" Longitude =• =' =11
Discharges & Stream,Immacts,
1. Is any discharge observed from any part of the operation? ❑ Yes allo
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance [turn -trade?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
C. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: __ I ____ _ —__ —..
Freeboard (inches): 36
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑!No
❑ Yes
— !o
❑ Yes
2NNo
❑ Yes
ONo
Structure 6
12112103 Continued

Facility Number: 3 — IU Date of Inspection f /pJ g/py f
5.
Are there any immediate threats to the integrity of any of the structures observed? (die/ trees, severe erosion,
❑ Yes
� /
QNo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
��
240
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenancelimprovement?
❑ Yes
❑ >�
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?❑
Yes
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
20
8'No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenanceltmprovement?
❑ Yes
❑<o
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
a o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type REtt vH (9) SGO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a)Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yes
16. Is there a lack of adequate waste application equipment?
❑ Yes
Odor Issues
INo
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
J'
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hour;?
❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
9TO
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
ONo
Air Quality representative immediately.
reeommendahoas or outer comments.
Use',drawmgs of fan"Gty�to�6e� r explain �toatioas�{fie addiho�"pages asryT y ❑Field Copy ❑Final Notes �
aNEE,t�
E�.etAs t�twt�, [RGQ 2•'LTo�,�
•
21,) ►JEGfl ?� NAJE MOST (2EGCuV �C PAJ A-," t Tr WST44 ]tEG440s, tjEW
o7l/E.S Cctv4LUl� �°i�r
lJ�c/ GNU® NEE*S TA 036 COA/E ASAP. WE?7A+3C AclrkS Da►JE R✓T
It%EW A c . A tyloUt r S 4o R.T. C6 . S /t, Io fo OGrtES.�
a3 ,) W A S� - A N A �` KTJ Goo rD F'ort.. !tea OA V5 & C FoQE pT� 9 A FTEdL SArnR C
-rAkeW
Reviewer/Inspector NameELI
Reviewer/Inspector Signature: Date: 16 S' 6
12t12/03 i Continued

Facility Number: 3 _ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
G311es
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
Yys
❑ No
23. Does record keeping need improvement?es, check the appropriate box below.
es
❑ No
❑ Waste Application ❑Freeboard C I Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Q N9,
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑TTo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27. Did Reviewer/Inspector fail to discuss reviewlntspection with on -site representative?
❑ Yes
28. Does facility require a follow-up visit by same agency?
dYes
Ng/
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
—❑ N/o
NPDES Permitted Facilities
/
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ NNo
31. If selected, did the facility fail to install and maintain minbreakers 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 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
No violations or deficiencies were noted daring this visit You will receive no further correspondence about this visit.
^> tmal Comm /or`iwtngs_ _ k
12112103

-- ,
Division of Water Qua►ity, ..
n
if
0 Dtvtsion of Soil and K'ater Cottsert atton
a ¢
O Other Agency
y
tM1
Type of Visit compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine
O Complaint O Follow up O Emergency Notification O Other
❑ Denied Access
I Facility Number . Dateof Visit: [
I /
PPermitted 0 Certified `❑ Conditionally Certified 17 Registered
Farm Name: ...�,rpJ.Ivz�. ........RQiir7��J�.._......_ .�..i1...............
Owner Name:...�i.1.X..Z............f. x-!'!/.�Q............................ ......................
Facility Contact:
Title:
Time: � Printed on: 7/21/2000
Date Last Opera
te/d �or Above Threshold: ..
County:.....K G/PG7-.�....................
Phone No:
Phone No:
MailingAddress: _................. .. .........................................................n.._......a.....................................................------------
..
OnsifeRepresentative:.. _...._GC ..._.........`---...._......................_ Integrator.,... ...---��GS
Certified Operator: ................................................... ........................
. ................................ Operator Certification Number:..........................................
Location of Farm:
U(Swlne ❑ Poultry ❑ Cattle []Horse Latitude =• 0` 0.< Longitude =• =, 0..
Design_ Current - Design Current Design_
Capacity_Po ulation Poultry Capacity PCattle (a-poulation ;_. Wean to Feeder ❑ Layer I I I[] Dairy
Feeder to Finish ❑ Non -Layer I I ID Non -Dairy
Farrow to Wean
Farrow to Feeder - ❑ Other
Farrow to Finish Total Design Capacity C
Gilts
Boars Total SSLW F—
Drains Present JJ❑ Lagoon Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made"? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State" (If yes, notify DWQ) _ ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) - ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes PNo
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 F40'No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................................................................................................
Freeboard (inches):
5100 Continued on back

t
Facility Number:3/ — / Date of Inspection / O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancetimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over
12. Crop type
Excessive Ponding ❑ PAN ❑ Hydraulic
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination!
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
P.
!-YiorAtiolis O Oorleen*$ -**re )1oced- 00609 thj"Wit; • YOO ivirj •i eegiye 46 fur•tW • :
: 6firisbo dence:abbot:this' isit::::::::::: '.::::: ....::::::
/�� (dFT7FlBG� /fC/QES //,
It/
�i��I�.�F,� .G.✓ �e
�a4(2lJa Gr%�h S MIfWi55,17,-1,,)
e7- ! �F9 L�F n/CE �V
,?OAF LR,V0ie�
�115 P9,e wGrff A� e)
❑ Yes PNo
❑ Yes XNo
❑ Yes U(No
❑ Yes 0 No
❑ Yes (VNo
❑ Yes JdNo
❑ Yes ;dNo
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No.
❑ Yes P140
❑ Yes ONO
❑ Yes PNo
❑ Yes 011
❑ Yes VJNo
❑ Yes IA No
❑ Yes �INo
❑ Yes �No
❑ Yes (�No
❑ Yes XJ No
❑ Yes. /F(No
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: / 5/00

Facility Number: — Date of Inspection / / D 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 �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 INu
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, El Yes /VNo
toads, building structure, and/or public property) TT
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
Additional"Comments and/orDrawings:
/9 �STF NirGYSZS NEED 5 /o U� ���l�,t% //102E
(/4) �NfFLSZS,
- /l%�DS /d L F �
�A�D,� �TfYO S��A��ZEL D S lri0/; FJ Li��D.
3d7�
5100

IFacility Number 1 cj I
0 Permitted PCe%rtifed E3 Conditio
Farm Name: ..........,1.... ...............................
Owner Name: ,,,,.,, G%✓i__
Facility Contact: ...taxi/........
Mailing Address: .......
ddress:.......
Onsite Representative`(,,,,
Certified Operator: .................
Location of Farm:
Latitude
Certified 13 Registered
Design _ 'Current
Swine - -Capacity Population
Wean to Feeder
�Z
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
of DS W C review
Date of Inspection
Time of Inspection
County:
Phone No:
Title:...... . ..................... Phone No:
24 hr. (hh:mm)
Operated: .............. ...
24t.-.1 . .....................
................................................................................. ..........................
Integrator:..............s ................................
Operator Certification Number: ..........................................
Longitude =• =' =11
Design Current _ Design Current
Poultry Capacity Population Cattle - Capacity ... Population
❑ Layer
JE1Dairy I-
❑ Non Layer I I ILI Non -Dairy I_
❑ Other
Total Deslgn,Capactty:_.
Subsurface Drains Present 11❑ Lagoon Area I❑ Spray
No Liquid Waste Manaeement System V.
vJxuai¢cn a osnu...upAcu
1. Is any discharge observed from any part of the operation? []Yes bNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes 'E(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes. J!�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �Io
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: N / //
Freeboard(inches): ........ .r/...........................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes (Io
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection O O — U 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 i_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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancchmprovement'?
11. Is there evidence of over application? ❑ Excessive Ponding []PAN []Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0 NO VIOiat10lIS,Ot,(tCticlen,tkk*WCCE` O'k.ed, d*&, iMitbii'.vlSlt.-Yj*4, Wltl*I'eC2iV'0 iio, fUt'thQt,,
ctirrespotidence:aboutthIs:visit_ :: .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes q No
❑ Yes RN
❑Yes &,1Vo
❑ Yes VNo
❑ Yes );zNo
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
ElYes
❑ Yes
❑ Yes
M
I
Cf �l✓ 0 kONI� vj, sk (/ i L`Z `� . {� lam- Yes; -
Reviewer/Inspector Name
Reviewer/Inspector Signature:

r Facility Number: Date of inspection /p n
J
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 4No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? - ❑ Yes 0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes INo
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 64'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 j No
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes &0
ttiona =, omments an or rawmgs:.
TiOrv,
way,

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Facility Number Date of Inspection t � I F +v
Time of Inspection 0 24 hr.(hh:mm)
0 Registered Certified 0 Applied for Permit 0 Permitted 0 Not Operational Date Last Operated:
r �� ..........................
FarmName: .... ......... 4&5 ...... 1.1wi ....... ......................................................... County:....�n u�ji,..............................................................
OwnerName :........................ b1:'.:Y.SA........... ..... xm`..................:................................ Phone No: ...... LZLoi.....................................
FacilityContact: .................. _ ......................................................... Title:................................................................ Phone No:...................................................
MailingAddress: ....... LDA ...... < ..... n!:G.....la!y.....a�.................................. ............. AAAyd.4,..NL..................................... ..L85iS..........
` t
OnSite Representative: ................ �M;� .......... alknj ................................................... Integrator: ................ ca"0.11.5 ..............................................
Certified Operator................................................................................................................ Operator Certification Number:.........................................
Location of Farm:
Lafitude 0• ®` ®" Longitude —7-1 • ®` 01
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
(,� No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
( No
c. If discharge is observed, what is the estimated flow in gaUmin?
�T
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
iTNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
,,--®No
pA+_ No
mai ntenanceli mpro vement?
6. Is facility n6t in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
iP No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

Fat ty Number: ) —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures(Laeoons.Holdine Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier:
Freeboard(ft):.......... ;.!..................
10. Is seepage observed from any of the structures?
❑ Yes RNo
❑Yes 03No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering watersofthe State, notify DWQ)
15. Crop type ................. !]ermuUa.............. ......... SrYvl .l....[ Mir.\ .......................... ............................................................
.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations or deficiencies. were noted during this.visit. You.will r&6e•no further
correspbodeitce about this:visit.
❑ Yes ® No
❑ Yes 0 No
❑ Yes ®No
❑ Yes ,i1UNo
❑ Yes P No
❑ Yes P No
'RYes ❑ No
❑Yes ®No
❑ Yes ®No
❑ Yes 1;3 No
IP Yes ❑ No
❑ Yes (� No
❑ Yes (bNo
❑ Yes [P No
1$". 1iQ,rritllpp,
to rye�� � i /Cx�T-loll �3 Sllot,lt) bt
trh�YU Jtp '(J P1f��k t�9.
C.Dn�U,CI �15�1"IC� JJi�
�
�I oV' suvic'e,
4V
22gu °u ( oh Q�Qw ir\sc t 10dor cav`i -01
r or�c�j�i{� CkLck1)3�5�
m Cer it �ScA%a�
1 1'n(Y'\`gw.�DY\ b�ICIC1 �-T Cfn��OnS �
t�0.i4�YYt,�'WS -
6W
SI.oJ�t] �
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Tr Cam»` `"tG�roS. t�u� o`[' "il-OI$ sr„t,tl,ruir SQtA,I
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1f2.1 Cav t *k b. Fx+.
y v'-VVt 1 O c- n403
7121197
IReviewer/Inspector Name REA<tl _ r .lwirc_: MN
Reviewer/Inspector Signature: A4z—/_ �j —�' Date: I1)/i7AV

_ - Division of Soil and Water Conservation -'Operation Review. • - _ -
j- 0 Division of Soil and WaterConseryaton Compliance Inspection -
J bivision of Water -Quality Compliarice Inspection
OtherAgency - Operation Review
Routine O Com laint Q Follow-up of DWQ inspection O Follow-u of DSWC review Q Other
Facility Number 3 Date of Inspection
Time of Inspection s 24 hr. (hh:mm)
0 PermittedorCertified E3 Conditionally Certified 0 Registered Not O erational Date Last Operated:
c
Farm Name: .............. �-�..V.:�..r�......t3..�!�.^ii%...... ............... .......................................... (.ounty:......_D.SJ:�-:' �.......:........................................
OwnerName:---..........................._..............................._.._..._................----.._.__._._..._.._ Phone No: ..........._.....___......................................
...-----------
Facility Contact:
Title:
Phone No:
MailingAddress: . ...........................................(..�........................................................................ ..................................................................................... .........................
Onsite Representative: �L L.-oNy....A[. ,.T E -.S.hl................................. Integrator:..... GAR2 1 C-. rr......................................
Certified Operator: ................................................... ......................................................
,,,,._ Operator Certification Number..,.,_.,.,,,,,,,,_,,,,,,,,,,,,,,,,,,,,,,,
Location of Farm:
Latitude =9=, =•' Longitude =• =' ="
Design- CurrentDesign Current Design Current _-�-
Swine..:-_ -__._ Capacity Po ulation Poultry -Ca acity Population Cattle -'-- Capacity Population
can to Feeder SS ❑ Layer ❑ Dairy
❑ Feeder to Finish.;.': ❑Non -Layer ❑ Non -Dairy
-,- ❑ Farrow to Wean
❑Farrow to Feeder ❑ Other _
❑ Farrow to Finish
Total Design Capacity
❑ Gilts,
`:.. ..: _.:,..
❑ Boars Total SSLW
© Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
�1Viimber of Lagoons _ .,, ❑ g p
HoldirigT nds / Solid Traps _ ][]No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes 40
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes dNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? - ❑ Yes J��- (/N��p�
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )No
Waste Collection & Treatment 1
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway ❑ Yes d No
Structme 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: y
2.6
Freeboard(inches)................................................................................................................................................................................. ..............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.)
3/23/99 Continued on back

�e _
Facility Number: 31 —f 4 3 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? - - ❑ Yes I 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 fZ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes VINO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application '
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Pawling ❑ PAN
12. Crop type �•;,, Q�_�µV p S-, 6�%�
❑ Yes
❑ Yes
❑ Yes
[d"No
D40
ZNo
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
ONO
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
91NO
b) Does the facility need a wettable acre determination?
❑ Yes
2�o
c) This facility is pended for a wettable acre determination?
El Yes
m No
15.
Does the receiving crop need improvement?
❑ Yes
ONo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
0 No
Required Records & Documents
N
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
W UP, design,
❑ Yes
00
(ie/ checklists, maps, etc.)
19.
Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports)
Pr es
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
v❑ Yes�i'No
/
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
J' No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
fie/ discharge, freeboard problems, over application) ❑ Yes 4eNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONO
24. Does facility require a follow-up visit by same agency? ❑ Yes ,❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? []Yes
.. d.. •violatit.. o'r ilef►c...... •were .... • ..... t.... s. - You :will . e.... t.. further - . -
correspondence: shout this
9 9J1= Ai�� �� arAST� s-PA�g..,.E f3- iva�C.avNQ' (-v2. A;tVt%cA-T; w,�S MYJ�C_ P4 JU+'y,
t.AS� SAMPt_>— r.J APk-'L 9`t -
N� ovrE Aff u%.o f o A c,o- t-E etc F�E�Dj 84 CESS Td� A Pw�ir� /J anf O/f
N1 Z. Pf T- ae_ a ✓V SAY D - r,AJ£ 00X r IJ SEcT A.JO M 02TAL TY CAU• _iC'(A'SiS
Caw I0LE7EO
)s� fJt�£ Ta /rtva f }tAly 1=.�t� ToA'St><Gb C-,F—r MakE rAr�£ Aff�,�,c
a,aco rMeS� Et-ps A�9 A DECE�J�CAor t/'ft D
tar: e-a 9m ) 3fS-
Reviewer/Inspector Name
ReviewerQnspector Signature:
Date:
3/23/99

Facility Number:
Odor Issues
Date of Inspection
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? - ❑ Yes�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ?No
roads, building structure, and/or public property) TT
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ;Z"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 6No
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 P<0
3/23/99

Fl�
❑ Division of Soil and Water Conservation ❑ Other Agency t ��
Rj Division of Water Quality
JQk Routine O Com taint 0 Follow-u of DW ins ection O Follow-up of DSWC review Q Other
Facility Number Date of Inspection q �
3 43
Time of Inspection 1 Z! Iv 24 hr. (hh:mm)
13 Registered ® Certified 13 Applied for Permit [3 Permitted E3 Not Operational Date Last Operated: ..........................
Farm N'ame:...... �AAS....R6L..fT:;--<....................................................................... county: .....��..V.p.Un....................................... .......................
OwnerName: ........ b al.(.5.........BlGrad.......................................................................... Phone No: ... .R1.A.. �.�i..'_ ...........................................
17nfc Q�Pr•d
Facility Contact: ..... .. ... ............. Title: ...... QV.h.,kr....................................... Phone No: ...q1.Q�.2:9.(e.-...��..7.3..........
Mailing Address: ........... I.77.�I.....t1%n.'../1.1%............................................. ...pC!II1ifn.... ..N.(l....................................... . 2 R.4.50 .......
Onsite Representative:........ V't's.S.....P Wj............................................................... Integrator:...... CGCtd.1b.........................................................
Certified Operator: ..................................................
Location of Farm:
Operator Certification Number. ..... ..-5 ,11 1
...................
Latitude =• =, =" Longitude =• =' ="
Design,n-Current,-e �. Design Carcent ": Destgo Current
Swine; Capa©ty:=Population Poultry Capacity;Population `Cattle Capacity_Population„.1
�._r.
(X Wean to Feeder jssz ❑Layer a' ❑Dairy
°_. ❑ Feeder to Finish ,,' ❑ Non -Layer 1 ❑ Non -Dairy
❑ Farrow to Wean ...."' "-
❑ Other - r
❑ Farrow to Feeder sF r- !- _
a. []Farrow to Finish ` �' _ .
Total DesigricCapaeity S Z U
's ❑Gilts
❑ Boars Total SSLW ' lot
' Number'of aoris t HoldingPonds' ". ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
Lag
®
N. ❑ No Liquid Waste Management System .„
:...,.
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge ori=inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
❑ Yes
® No
b. If discharge is observed, did it reach Surface Water? (if yes. notify DWQ)
❑ Yes
® No
c. If discharge is observed, what is the estimated Flow in gamin?
N Ilk
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
JA No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
R No
mai ntenanceli mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
0 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
19 No
7/25/97
Continued on back

• - Lr
Facility Number: 3 `— 193
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons,tloldirw Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ...........n................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes ® No
❑ Yes ® No
Structure 5 Structure 6
❑ Yes
® No
❑ Yes
I[Z No
(� Yes
❑ No
❑ Yes
ELNo
❑ Yes
69 No
15. Crop type ...........ktxYraud.G ....................................... .............. ......................
5i"A... IVAL'.........................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 Nwviolationsor deficiencieswere noted during this.visit. You.wifl receive no further.
correspotidence ah"out this visit
❑ Yes 03 No
❑ Yes LRNo
64Yes ❑ No
❑ Yes ® No
® Yes ❑ No
❑ Yes No
R Yes ❑ No
® Yes ❑ No
[]Yes [KNo
❑ Yes ® No
lz- i..lt} li,-r Akould
be e.xwta
Aiyu,.,- rtilt
la caul
I& st�wlt isM4-- thodd
1k rtJr OL6 a"i) bevAldc.
itoTti 60 ;'M1Vvvej
2Z.Sptp,nl tuoraa sLvula
6e. V4?t by
dull nutnhar­
+ Atli YLV*bo;, (�liltcSCCtt 1A4(nce Siwvl�
��aPk� maniin�y
tls;rt� IRl~ L
%rm. (nlGs{c 5oi1 canp� &Vxa��-eS ts.4 larrr,
1b1e
t3e%Iq In should be_ in GeV'F�4W ?lost•.
L3 Cer 1t'ca l" wAz met &Uvti�o.�rls ai fi^^�
of ,ASV gun. Plan s(rr��IJ be Ilap�
ava%610 < ion 4rn- sik.
7/25/97
Reviewer/InspectorName V".J
Reviewer/Inspector Signature: '%'S/_' _ �_ ,%� Date: