310194_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

..-
'Type of Visit: UCom lance Inspection U Operation Review V Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint 0 Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Lt1.4.L Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: V O ommd W�_� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I ot/ I s
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
C>attle
Dairy Cow
Design Current
Capacity Pop.
li
Wean to Feeder
I
INon-Layer
I
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D ,A P0oul
Layers
Design
Current
D Cow
airy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I jBeefBroodCow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?!
-
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
2VNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: �/, - Date of Inspection: '
Waste Collection & Treatment
4. Is si rage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CNo ❑ NA ❑ NE
r
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: (G-66
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes n 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 ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ 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 [,l" No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
7.jn
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
�0o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FIN o
❑ NA
❑ NE
the appropriate box
❑WUP ❑Checklists ❑Design ❑Maps ❑LeaseAgreements ❑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 [ o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes u1 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes
25. Is She 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:
❑NA ❑NE
No ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
La"No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
0o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3"No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
bNo
❑ NA
❑ NE
Comments (refer to question #):. Explain,any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon�: Q —TM
M d
Date: Q
2141206

Type of Visit: Q Cofnpliance Inspection U Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: V1 ( ) I Ij I Arrival Time: ° p Departure Time: 2 ') County: tf' [ZLO Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: J u.IrCTWfJ M1.4_ (ESiL_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
e
Wean to Finish
Wean to Feeder
Design CurrentMDesign
Capacity Pop.
Wet
La er
Non -La er
pacity
Current
Pop.
Design Current
Csttle Capacity Pop.
DairyCow
Da' Calf
Feeder to Finish
<
Da Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) . P,oul" .
Layers
Design
Ca sci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
El
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [; No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes j—j No
❑ Yes o
❑ Yes WNO
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: Date of Inspection:
lc -
Waste Collection & Treatment
4 t,, storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Structure, 1 Structure 2 Structure 3 Structure 4
Identifier: l4 we
-
Spillway?:
Designed Freeboard (in):
❑ Yes
. No
❑ No
❑ NA ❑ NE
❑NA ❑NE
Structure 5 Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
dYes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
40
❑ 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 do ❑ 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 IX No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
YNo
❑ NA
❑ NE
acres determination?
1
17. Does the facility lack adequate acreage for land application?
❑ Yes
I ' I [yo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
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 Q 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 F_VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 214/2014 Continued

Facili Number: Date of Ins ection: �-0 IJ
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25. Athe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes CZ"No ❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes VNo ❑ 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 Ef/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[)No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[�/Nlc
❑ 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
No
❑ NA
❑ NE
Comments (refer to question #)::Explain any. YES answers and/or any additional recommendations or any other comments.
-
Use drawings of facility to better explain situations (use additional pages as necessary).
sIJ l*E khUL-
Reviewer/Inspector Name:
Phonk - io-7`r6--
Reviewer/Inspector Signature:
Date: C !/ , -o I Is
-
Page 3 of 3 1
21412015

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: [� Departure Time: pl,� County: Region:
Farm Name: ' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: JCOPV AMAW 9 Y 2CU i-'(L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: I 0 og ,s
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
11
Non -La er
Dai Calf
Feeder to Finish
3So 0
nIGOD
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
tc 'C acit + P,o .
D Cow
Non-Dai
Beef Stocker
Gilts
Fers,
Beef Feeder
Boars
113eef Brood Cow
Other
01 Other
Turke s
Turke Poults
Other
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No
[:]Yes ❑ No
❑ Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes O ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facili - ,_{Qumber. Dale of Ins ection:
Woie Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNO
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier: (N/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
[DNA ❑ NE
❑ NA ❑ NE
Structure 2 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 ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment/al threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ICJ ❑ 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 P-No ❑ NA ❑ NE
maintenance or improvement? TT
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 Y ❑ 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
'❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
40
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Io
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [—]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EeNo ❑ 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 0 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 F[:] NA ❑ NE
Page 2 of 3 21412014 Continued

Faciti Number: _ Date of Ins ection: 1
24. Ijid the facility fail to calibrate waste application equipment as required by the permit. ❑Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes J�jo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report mortality rates that were higher than normal?
ZN0o
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑Yes
�o
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature,
Page 3 of 3
Phone: l
Date:

(Type of Visit: Q Coptpliance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: Gj Q 3 Arrival Timer Departure Time: County: l RCZ:PJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: `�OrtTl rw I r =j A k Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: 1 ? 0 9 S
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
C•ucrent
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Curre
Cattle CpacityaP op.nt
Da' Cow
Wean to Feeder
Non -La er
Da Calf
X
Feeder to Finish
',.j Z.o�
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
Beef Brood Cow
Other
El Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page l of 3 21412011 Continued

Facili Number: - Date of Ins ection: l0..
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier. L'K&6 d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
7 No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [*No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E2/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 E2eNo
❑ 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?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [3eNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [;V<o
❑ 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 E No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rainfall InspectiokNo
❑ 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 3 21412011 Continued

Facility Number: _ _-5 l_ - rV-A7 I Date of Inspection: I Ick 111'7j
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ea " ❑ NA ❑ NE
i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[ 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
❑ fo
❑ 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 file drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Q'X ❑ NA ❑ NE
❑ Yes �❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the ReviewerAnspector 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
Ej No ❑ NA ❑ NE
Ioo M NA ❑ NE
0 DNA ❑NE
Comments (refer to question t): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
E
Phone: (9ta) 776 V 73
Date:24 =- -
21412011

Type of Visit: (0 Co fiance Inspection U Operation Review (� Structure Evaluation p Technical Assistance I
Reason for Visit: Routine 0 Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: .-T tjy:)rrAA J I v m, I_E(L
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 18 69S
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
iLayer
Design
Capacity
I
Current
P)p.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean [o Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
6
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
.. P, ... , Ca aci + Po ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pallets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [,No ❑ NA ❑ NE
[-]Yes [-]No
[—]Yes ❑ No
❑ Yes Ej
❑ Yes No
❑ Yes 0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Faciti 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 strucI freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (.A&,=d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2frNo
❑ NA
❑ NE
(i.e., large frees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
Ea No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment gt/hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo
❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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?
❑Yes VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes _Vo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes gNoo
❑ 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3- Date of Ins ection:&0Z/ 1�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 040 ❑ 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 Io ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
._
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NNA
g
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ YesNo
❑ NA
❑ NE
Comments (refer to question #): Explain, any YES answers and/or any additional recommendations, or,any other!comments
Use drawines of facilitv to better explain situations (use additional paves as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonet w /
Date: /
21412011

for Visit: dRoutine 0 Complaint Q Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: I Arrival Time: m Departure Time: County: WF ZI s Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 11•. ••,,11 - Title:
Onsite Representative: V J N AT �Hi�7 rn�LL 1x2
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Finish
Design Current
Capacity Pop.
W,et Poultry
Layer
Design
Capacity
Current
P,op.
Design Current
Cattle Capacity Pop.
DairyCow
Feeder
rFFarrow
Von -Layer
Da' Calf
o Finish
j ?�
I) . + P,oultr +
Layers
Design
Ga aci_ +
Current
P,o ,
Da Heifer
o Wean
o Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
O[her
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
[—]Yes F No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility -Number: _ - 19 y Date of Ins ection:
Waste Collection & Treatment �-�( /'T_
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �I No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZZ
❑ NA ❑ NE
❑NA ❑NE
Structure 2 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?
i
[:]Yes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environments hreat, 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 I I/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 7
9. Does any part of the waste management system other than the waste structures require ❑Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes;No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes dNo
❑ NA
❑ NE
No
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Q
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes <0
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
�
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes L�J N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 2/No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [-]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
1
22. Did the facilityfail to install and maintain a rain gauge? ❑ Yes L ❑ 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

Facili �kVtrmber: - Date of Inspection. q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑NA ❑NE
❑ NA ❑ NE
❑ 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
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ NA
❑ NE
Otherissues
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
Ej No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
No, ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑. NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations
Use drawings of facility to better explain situations (use additional pages as necessary)."
or any other comments ;p as
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ( 1V —
Date: 97,
2/4/2 11

(Type of Visit Q Cop[ ❑ pliance 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: u
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: DllPL=Q Region:
Owner Email:
Facility Contact: Title:
Onsite Representative: �, J � N A-rM/ WLC k"L.
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: = o = ,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes U No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 2No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

f acilityNumber: 3� —wj� Date of Inspection ID
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?
St'ructure\\I Structure 2 Structure 3 Structure 4
Identifier: LACT�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 01
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 eNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0 No Cl NA ❑ NE
❑ Yes 2�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 GI No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [PNo ❑ 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 VN ❑ NA ❑ NE
maintenance or improvement?
Waste Application �f/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement? ,�,/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes
15. Does the receiving crop and/or land application site need improvement? 13 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
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
0/No ❑ NA ❑ NE
ErTjo ❑ NA ❑ NE
0 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any otherm coments x
w w
Use drawings of facility to better explain situations. (use additionahpages as necessary):m
IReviewer/Inspector Name I . '"`Sj'3 ( -, ,�% Phone: (970t 3 Y'f I
Reviewer/Inspector Signature: ,`7,1M J Date: 9 ht..Ab
12/28104

Racility Number: 3 — Date of Inspection
r
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
�f/
2 /N9,
❑ NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
� O
❑ NA
❑ NE
the appropriate box. ❑ W UP ❑ Checklists ❑ Design El Maps El Other
/
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ElYes
L2 oo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Weather Code
Rain Inspection�No
22.
Did the facility fail to install and maintain a rain gauge?
❑Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
O NNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ON
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
1/J No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,.,//
I"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
EffNo
❑ 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
Ulo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
N
:No/`,//
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional'Comrtients and/or Drawings:
Page 3 of 3 12128104

Type of Visit ,CQ9mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Yl Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 91 22/65 I Arrival Time: -to—o-61 Departure Time: County: LUPL�#✓ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:ydagtl� " f� Integrator: -
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = ,
Design C•ureent
Design C*urrent
Design Current
ultry Capacity Popul1111
city Popn
to Finish
❑ La er
❑ Dai Cow
n to Feeder
❑ Non -La er
❑ Dai Calf
er to Finish
❑ Dai Heifer
w to Wean
l❑
D Cow
❑ Non-Dairyw
w to Feeder
FGitts
to Finish
❑ ers
Beef Stocker
N -L❑
Non-ts ers
❑ Beef Feeder
s
Pullets
Brood Cow❑
Turke s
❑ TurkPets
Number of Structures:
❑Other
r
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
CZ/No
❑ NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�
[I NA
El NE
[:3Yes
V
❑ NA
❑ NE
12128104 Continued

Facility Number: 3— Date of Inspection
i Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structurg 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: uai
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[n 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
dNo
❑ NA
❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require
❑ Yes
2(No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[!] No
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LJ 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?
El Yes
No
El ElNA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
7No
❑ NA
❑ NE
Comments (refer to question #) . Explain any YES answers and/or ahy recomm ndatora any other comments
iM
Use diawings of facilityto better explainsituations (use additional pages as neeessan) § ��
IReviewer/InspectorName I TZ'NzI xj Phone:"TD 7U-73F1 I
Reviewer/Inspector Signature: Y, Date: U
f

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E(No ❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Elyes No ❑ NA ❑ NE
the appropirate box. ❑ 1171 P ❑ Ch kl' ❑ D ❑ M ❑ Oth
ec tsts estgn aps er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
,_,//
L' No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
3No
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D o
❑ 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
B<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
—BNo
Ek<o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
D'No
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
CI 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
EKo
❑ 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
ONo
❑ 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
[3 N
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Lf
Type of Visit Cornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency p Other J ❑1 Denied Access
Date of Visit: Q a� Arrival Time: [O6(1 Departure Time: County: D09(Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: YO0YATPPQ J MLL_ 4fL, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o ='
Longitude: = ° =' = 11
Design
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
ID Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
® Feeder to Finish
35 to
3Lur7
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Laers
El Beef Stocker
Non-LayersEl
❑ Gilts
❑Beef Feeder
❑ Boars
El pullers
❑ Beef Brood Co
El Turkeys
Other
❑ Other
❑ TurkeyPoults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? _
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection X
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: iA61-a61J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `{
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltZhr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ 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 L9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application �
10. Are there any required buffers, setbacks, or compliance alternatives that need ElO Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1,1<0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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?
18. Is there a lack of properly operating waste application equipment?
Reviewer/Inspector Name
❑ Yes
❑ Yes
ONNo ❑ NA
[���Q NNo ❑ NA
❑ NA
❑ NA
No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature:
D--- 7 -f 7
Date:

Facility Number: 1 — 19 Date of Inspection 41
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YesET/No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [:]Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections �❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J'
No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes E No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ mo ❑ NA ❑ NE
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 EJNo ❑ NA ❑ NE
❑ Yes
E3No
❑ NA
❑ NE
❑ Yes
L'] No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
ElYes
CEN/0
❑ NA
❑ NE
❑ Yes
ZNcNo
❑ NA
❑ NE
❑ Yes
IJ No
❑ NA
❑ NE
Page 3 of 3 12128104

a Division of Water Quality
Facility Number 3 I r'] y O Division of Soil and Water Conservation
O Other Agency ✓ `
Type of Visit 6 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Sd Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: !p Ld 07 Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: ' Title:
Onsite Representative: l—►4AIATNAIJ / i �/� = l AA, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
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
❑ La er
- I ❑ Non -Layer
i
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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
❑ Yes
g: ❑ NA
❑ NE
r
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Z No ❑ NA ❑ NE
12128104 Continued

Racility Number: —
Date of Inspection /o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): !'9,
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes EINo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? /No
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ElNA ❑NE
ElExcessive Ponding ❑Hydraulic Overload ❑ Frozen Ground ElHeavy 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?
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
RrNo ❑ NA
7 ElNA
❑ NA
LY o ❑ NA
1; o El NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ 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):
�� UPDA-j� s�bucrf/G
-
8f
Reviewer/Inspector Name Phone: =,a
Reviewer/Inspector Signature: Date:
1 12128104 Continued

Facility Number: 'j — Date of Inspection
Required
19.
Records & Documents
Did facility fail have Certificate Coverage & Permit
/
6WNo
the to of readily available?
❑ Yes
o
El NA
❑ NE
20.
Does the facility fail to have all components of the CAW MP readily available? If yes, check
❑Yes
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Applicati ❑ 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?
❑ YesJ`-
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
-No
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,L�
E)4
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[(i NNo
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues
�
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
No
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,�L�J
L7 o-
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 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
X
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
No
❑ NA
❑ NE
Comments and/or
12128104

.'~� 0 Division of Water Quality
Facility Number 3 �� 19 �{ Division of Soil and Water Conservation
Other Agency
V
Type of Visit d,lC.,ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Z OS Arrival Time: I130 Departure Time: 1Z3v County: 009i,rtd
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OusiteRepresentative: GF.,.lo
Certified Operator: 2A�V 4 I -A tMe W
Back-up Operator:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = ' = Longitude: = o = ,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder JEJ Non -Layer
N Feeder to Finish 136-z 174010
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [' No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[--]Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑No
❑ Yes
1
LI No
❑ NA
❑ NE
❑ Yes MNo ❑ NA ❑ NE
12128104 Continued

Facility Number: ( — Date of Inspection o S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes
(/
No
❑ NA
❑ NE
�2
a. If yes, is waste level into the structural freeboard?
❑ Yes
R No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA(oarJ t
Spillway?:
Designed Freeboard (in): IQ
Observed Freeboard (in): a3
5. Are there any immediate threats to the integrity of any of the structures observed?
Ell9 Yes
�/
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
L1J 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? dyes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement? ,//
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes LJ 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 Drill ❑ Application Outside of Area
12. Croptype(s) CS(J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ef No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0
El NA
El NE
%❑ 16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinationYes
,d],
U No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
zNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
'1•) GttAAss coJ6rL arrl pz—k,z- ylpw t4EEAS fib G( ©or. e_ 1?L0, E :1;4fa111 ovo wtito
WaALK NAS (3tL`� pale Sld t146 Cor�cr3� �EA�
te.) CC Arlo Pc,rtev-sY nf��os ri BE tiZYtt 2&(rrWS_ (r���
Zt ) L0.vP iSbt fl p)E br�3 Ya �F perSE ANNV(AL. 6,k LP. ArJ'O S_roo,,t/jt" LoP+( LrS.'fti '!<t3PQi� +
Reviewer/inspectorName �cNt/ R; Phone: iID 3WS�3r� x,zv3
Reviewer/Inspector Signature: Date: t 6 $
12128104 Continued

,Facility Number: 31 — r q Date of Inspection ¢. o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? LEI Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other ,_,/
21. Does record keeping need improvement? if yes, check the appropriate box below. U Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑Annual Certification
❑ Rainfall [Stocking Crop Yield ❑ 126 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes E! (?N ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ,❑, NNE
❑ Yes ❑ No ❑ ErNE
NE
❑ Yes CINo ❑ NA ❑ NE
❑ Yes [J No ❑ NA ❑ NE
❑ Yes If No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes [ 'No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
12128104

Type of Visit lZi-Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit jQlRoutine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: z y B Time:
refry Not O erational Below Threshold
S Permitted LCeerrtified 0/ ConditionallyCeCertified [3Registered Date Lastop ,e[r/tj� or�Above Threshold:
Farm Name: 06/.d C.4h i ¢� /!�✓.re Count '��!!V't
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: GCi►J e&,te L® z
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑Horse Latitude =' 0` =- Longitude =- =1 =_
+DesignEurrent
Swine. Ca v achy P,o ulation
- I)e ign Current Design Curreot
Poultry Ca aci P,o ulation Cattle Ca achy P,o ulation
❑ Wean to Feeder
❑ La er
❑ Da
® Feeder to Finish
JLJ
Non -Layer I❑Non-Dai
31111p`'Kl.
❑ Other
Total Design Capacity
Total SSLW
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Aolding Ponds /Solid Traps
❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
❑ No Li uid 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 ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ?i i
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13.
Do the receiving crops differ with those desigrrted in the Certified Animal Waste Management Plan (CAR'MP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑Yes
❑ No
b) Does the facility need a wettable acre determination?
El Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
. `. 18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
-
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard waste analysis & soil sample reports)
❑Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
El yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ier discharge, freeboard problems. over application)
❑ Yes
❑ No
23.
Did Reviewenllnspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
IO No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commea4 refei to iiesd6 ' .
q ::Eiplam any.- S answers andlorany,mommendatmns or atry otheccommenta. h� ''� ^•--
_
Use drawtags of facilrty to better erphun sdna6ous. (use adrltnoaal pages ss necessary) -� : E1 Fie Couv ❑ Final Notes
-�a—+e..o�---•--e-.A—.'---��....a..._
Nee A/l
r i �e IKA;tt �rt ; K &V e," oft /g1eoK wall, �'`L.'.,/I t. e revf e %a ek
r/�jt
5ttde, iniv btfoon.
Reviewer/Inspector Name
- C.> u�:^v—�—'S'.W..CrTF _e as_GztlA'•- >Aac.J�^?
Reviewer/Inspector Signature: Date:
051031VI - - Condnued

Facility Number: 3 — Date of Inspection f
Odor Issues -
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters. etc. )
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
05103101

Facility Number — Date of Visit: �Time:
Not Operational 0 Below Threshold
O Permitted 0 CeeDrtified D Con/ditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: tf'/�At County: _�ut✓r/th
Owner Name:
Mailing Address:
Facility Contact: e Title:
Onsite Representative: elmf 6 twee(/ /
Phone No:
Phone No:
Integrator:
77GF�sK'
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Caftle ❑ Horse Latitude =' =' = u Longitude =' 0° = u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Freeboard (inches): g/)
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑Yes
KINo
❑ Yes
�gNo
❑ Yes
KNo
Structure 6
Continued

-191f
Facility Number: 3 —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aoolication
❑ Yes ® No
❑ Yes 09-No
❑ Yes ® No
❑ Yes 0 No
❑ Yes �3 No
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
® No
11.
Is there evidence of over application? ElExcessive Ponding ❑ PAN ElHydraulic Overload
❑ Yes
[Z No
12.
Crop type ,&2raA #' ew S , _C,46
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
M No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
V) No
b) Does the facility need a wettable acre determination?
❑ Yes
P No
c) This facility is pended for a wettable acre determination?
❑ Yes
® No
15.
Does the receiving crop need improvement?
❑ Yes
P No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
P No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
RNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
A No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KI No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JS No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
�s No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
b,No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9[No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments)(refer to question IF):• Explain any;YES answers and/or anykrecommendations or aoy other comments. �i»`» ,.
Use drawings of facility to tietter ei;plamA°situations (use additional -
as necessary) i
pa"g'es ❑ Field Copy ❑ Final Notes
y,
��L ti J
r iK�tO/ Ll�D !.t Q l
/vole " weeAI'6 Ap move loee-S e7`i' OT O Gt'
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z
05103101 ;.1 Continued

Facility Number: V — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 05No
❑ Yes Sa No
❑ Yes 5d.No
❑ Yes F-1 No
❑ Yes 93 No x
❑ Yes 6 No
05103101

(Type of Visit Xcompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit \Routine O Complaint, O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit:
'',S `i
X,Permitted 0 Certified 1p— Conditionally Certified [I Registered
Farm Name: _..._M " .`.... ` 1.......................................................
Owner Name:
Facility Contact:
Title:
—U Time: a S
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: ......... _.
County:....�............................ .... _.
Phone No:
Phone No:
MailingAddress: ............... . .........................................5...........................................................................................N......................_ ........
Onsite Representative: ..//......... �i`................................................ Integrator:....._`...:�h ................._
L7e.....Q ......................................................._..........._..
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =" Longitude =• =' =-
Design. Current Design :Current _ Design Current
Capacity Population Poultry Capsci Population ` Cattle Capacity Po nlatiou
❑ Wean to Feeder I[] Layer ❑Dairy
Feeder to Finish 1,3Sap ❑ Non -Layer I ILI Non -Dairy I'
Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish ..
Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of pone ❑ Subsurface Drains Present ❑ Lag ❑ Spray Field Ares
.. � oon Area ..
Holding Ponds /Solid Traps E= 10 No Liquid Waste Management System
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 part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes R-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes '[Jf No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): 31
5/00 Continued on back

Facility Number: 3 t — H L( I Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
f(No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
((No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
kNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
MNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
XNo
elevation markings?
❑
Waste Application
10.
Are there any buffers that need maintenancelimprovement?
❑ Yes
90
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12.
Crop type W T44
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
OZNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
9No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
Z No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
A No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
dNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
O No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
OrNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
C$No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Iy No
Ed
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
&No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
J4 No
fV¢•Yiola;itifis;ee ft. fjcpencies -w$re jlof. dorifig thjs;visit; -You ivttl-sect iye fiti fuj th$r.: ;
coriesnorideitce:aboutthis visit :::::::::::::::::::::::::::::.:.:.:.:.:.:.
rj> ���—ct. Q�Q�W\�fA t\ram V—dt.� �sP��'WA� -Cot
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: ` /— \1—k-/ l 5100

Facility Number: — Date of luspection • M G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Vyes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes );(No
❑ Yes )� No
❑ Yes ONO
❑ Yes No
❑ Yes RNo
❑ Yes $(No
Uo ^. omments an orDrawings:--
5100
5100

ODivision of Water Quality .
Q Division of Soil and Water Conservation
0 Other Agency -
(Type of Visit ,Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number q Date (jr visit: �--�✓-GO Time: �300 Printed on: 7/21/2000
�—_
Not O erational Q Below Threshold
Permitted 13 Certii-r led 0 C/on'ditionally Certified n Registered Date Last Operated or Above Threshold: ........................
Farm Name:"'1 . `�"'7e� County ,,,,�,���
.................................................................................................................................................................................
OwnerName:........................................................................................... Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ................................................................................................................................................................................ ..........................
(•,. Onsite Representative: ..-��,-w....... .......................................... Integrator. kk
......................................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F____j- =, =`. Longitude =• 0' 0.1
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Sao ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
[]Gilts
❑ Boars Total SSLW
I Number of Lagoons JE1 Subsurface Drains Present 110 Lag•llm Area 10 Spray Field Area I
Holding Ponds / Solid Traps E:= ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
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 part of the operation?
❑ Yes
&No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
NNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches): aS
5100
Continued
on back

'Facility Number:31 —
Date of Inspection Printed on: 7/21/2000
-
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion,
[]Yes
XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
b(No
closure plan?
❑ Yes
(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
Wo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
(XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�Oo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
P(No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
ONO
12. Crop type G W
I S�,f
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
NrNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Jallo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
Q<No
16. Is there a lack of adequate waste application equipment?
❑ Yes
K No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
gNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
b(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [(No
24. Does facility require a follow-up visit by same agency? ❑ Yes ,N No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
. . . . •Vl. . . .l. .O. (tt't�IC1e. . . . �. . . . . . . ftlli. . t�i1S, VISIt. . .0. . It. . . .1Vt. i. . t�. . . . C. , .
. : corresnotideilce: about. this :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):
L5
t`o+2. hk t 51`��.7^t( 1v2 cc wu(�-d j�tiS t t �Q 1 l ice` (�G-�
1� �TtQ\Ct.S L.�tlQ�- G3l.T lt�vlc�.
r
Reviewer/Inspector Name
Reviewer/Inspector Signature:
-375'-3gC0 X-2a6-
Date: IQ-3— co 5100

Facikty Number: — lq Date of Lnspcction 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
KYes
❑ 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
R No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[gNo
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
P(No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
t
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
EX(No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
WNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
(INo
5100

-
. y � '�•_" =:.._- -:' `. �Divtsion of Soil and Water Conservahon- O eralion'Review
P _
:Division of Soil ag}Znd WatecCortservation CompGance'Inspection -
.�Division of Watetiality Compliance Inspection = -
^., : Q,Other Agency-' Operatiom;'Revtew �_ - -t • r'�` '-'"'
JO Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection
Time of Inspection E�= 24 hr. (hh:mm)
10 Permitted 0 Certified [3 Conditionally Certified Q Registered
Not O erational^�Date Last Operated: .......,_...,,_,,,,_,,,
Farm Name: ........rtaJ.pk...hG6lI.IGI�.._ .. CLGC �...................................
County:........D.v?�.)-e-).....................................................
�jI.
Owner Name:........I)aJP .... LP�......1,..........................................................
Phone No:..........1..I ...'!Z..[.g..-..y23�
%
Facility Contact: ...��//1/2�:tip...... R.C..1111 .......... ...........n.. Title: ................................p...�.............................
.}
Phone No: Z5Z.:n 6L'?-Z&4.
/
Mailing Address: Q.Utll.lDlalLj....... LS.d...
f1.�0.11.f.!'�e...... N anC?..l...A.....
..Q..kx.Q...... .................................
.(l)
OnsiteRepresentative: .............................../...........................................................................
Integrator: ...... lV..C..11_!LQ..C.l...................................................
Certified Operator: .............. .'I....hW...GI/...........................................................
Operator Certification Number:..........................................
Location of Farm:
Latitude =• =1 =•1 Longitude =• =1 =11
Swtne -
Design CurrenC` '
Capacity Population Poulti
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Current. - Design Current
Population -Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
-Total ssiw
-.- Number of Lagoons - �J :.I❑ Subsurface Drains Present III Lagoon Area �❑ Spray Field Area
-
HoldrngYonds L Solid Traps ; - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes b�No
Discharge originated ac []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes WNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 16 No
c. If discharge is observed. what is the estimated Flow in gal/min? �11/4
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes (VNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes pd No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes W No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [)(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: p
Freeboard(inches): ................I.Q .......................................................................................................................................................................................,,,............//.
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Dg Yes No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 j - Al Date of Inspection /Z -3-y
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes VNo
(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 9No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [VNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level,
elevation markings? - ❑ Yes 0 No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
&No
11.
Is there evidence application? ❑ Excessive Pending ❑ PAN
El Yes
VNo
12.
rof�over
Crop type i CSr?n Si-
oe- U rQ_ Corn 1Wa 1 46V
13.
,
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14.
a) Does the facility lack adequate acreage for land application? -
❑ Yes
10 No
b) Does the facility need a wettable acre determination?
❑ Yes
O No
c) This facility is pended for a wettable acre determination?
❑ Yes
O�No
15.
Does the receiving crop need improvement?
❑ Yes
VNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[ tNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
E�Io
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
..,,
6M
(ie/ WUP, checklists, design, maps, etc.)
El
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
(a1Vo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
OkNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
QTIo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
RNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
5tNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
j$No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
J No
����llll
iVci yi91'atidiis;o deficiencies *� re h4ed� diWiitg this;visit; - Yop will-teceiye tie; further • ; •' •
... comes ondeitce: abbe f this visit:' ::.....::.......::.... .
Comments (refer to question #): Explain any YES answers and/or'any recommendations or anp'other comments
Use drawings of facility -to better explain situations. `(use additional -pages as necessary):
_a
YjDOQ '140fro cA 4 -fee 00-r a_ S" S ( t 19 irtc It e > •
Mir. kwue(llv� Sr uror adds or l A4AJ (z001b) due, Ito hVr//l:vk,SeW17
rilw9 '
t�cno �,tn�dy N9r,: $cf✓ic{S rll bc. d wncok &A 10 OUP
Reviewer/Inspector Name k e
Reviewer/Inspector Signature:
Date: / Z - 3 -
3/23/99

FaciliWNumber: 3 f — C� Date of Inspection / T?
Odor Issues
NIP'26-EG)es 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 �j No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes $ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes t17 No
alPg2lDo the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes tNo
3/23/99

JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION ioo9
Facility Number
Farm Name:_ p Opera Son is flagged for a wettable
On -Site Represent Zee: r acre determination due to failure of
Part 11 eligibility item(s) F1 F2 F3 F4
Inspector/Reviewer's Name:
Opera Son not required to secure WA -
Date of site visit: 64, determination at this time based on
exemption E1 E2 E3 E4
Date of most recent WUp: pZ
_1,� Operation pended for wettable a
Annual farm -PAN deficit 7aUpounds determination based on P1
—�
Irrigation System(s) - circle# 1. hard h
ard-hose..center- iv
Dt 4. stationary sprinkler system w pe aonery sprinklre 3' Lnear--moves a6. stationaSystem w/portable pipe;system;
stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART'-- o; ; ; etermination Exemptions (Eligibility failure, Part Il, overrides Part I exem
ption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D21D3' irrigation operating parameter
depicting wettable acres, is Complete sheets, including map
p and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, !s complete and sici by a WUp.
=4 75°o rule exemption as verified in Part Ill. (NOTE.-_7b % e
applied to farms that fail the eligibility the xsm. Dri cannot be
Checklist Part II - F1 F2 F3, before com laki:st in Part 11. Complete eligibility
p eting computational -table in Part 111).
PART II.7s% Rule -Eligibility_CheckiistandDocumentation of WA Determination
Requirements. _ WA Determination required because.operanon iai!s-Dne Of the eligibility
requirements I!sted�elow:
__ r2
F4
Lack.o;�greag�y�icim�sutieddnaver�ppiicanon�fanrastavvate,=(PAN) onspray
Held(s)�ccorriingio�arm-
'sjastiwo:yeas,n
af7rnn=r ,,.. _L
Unclearrilleg!ble,zr lack of infDm ation/maD.-
uu„�,rsemBaCK�CiHa g. nr251°�eldsJes-jha ddeiriin">ddnsCAWMRjiibiudes==`
small,-irreguiarlymhapedields ire!ds_lessihan��csVe!e�rJ=ssihan
2 acres-TTor
WA determinationTequired because a CAWMP-
Of 75% Of the respective field's total acres creditsTreld(s)'s acreage in excess:.
g_ as noted in table in Part III.

Facility Number-- I I
Part III. Field by Field Determination of 75% Ex
TRACT FIELD TYPE OF TOTAL
NUMBER FIELD
NUMBER IRRIGATION ACRES
ram- SYSTEM
RtVsed April 20, i 999
rtion Rule for WA Determination
CAWMP FIELD COMMENT53
ACRES
-.c - nyo,-aMpull,zone; orportrt number may be used in face
and type 7 irricaiionays+em- l oulls,-etC- Cresslnore-than one neld,.insp ctorire no Id numbers beoe
calcufaL= nding on CAWMP
7b n ld byfieid determinarionior= s vi_wer will have to combine7felds to
FL.LDNUM$EF''2_ x_mprion;atherwise onerauon will be subje� to WA Jere
Tnust el switrjeariy-delineatednnmap, rminauon.
CDMMTTs3--back-lip 7r�ds.with CAWMP_B'-7 aoem=.ding 75% of imtntalacresand Navin re_e
onsannual .PANzs�or-urnentedmiire_;arm°spr'aviousiwp_Years'(1997&1998)mtmuanonoecords cannotse
sole i)asisio;7equi�gaWADeterm 9 -mnnotstrran 50%'
by irrigation h2b"n�aCk-uD "e'ds-TnL'sti)emoL-d in fne � rv_e s the
sYsiem.- omment�eCiionandmustbe axessible
Part IV. PendingWA-Determirations
1 Plan Jackslollowinginfonnauon:
— ( ram i�iamadisiomnay.satisiy�5%-rule ';ased.on�deauate ove
/ adiusiingallfieldacreagejObelow.75% us=rate raII.PAN dencitandby
3 Other Oe/in pracess of i stalling new irricaiion system): pwS i !'
i��S-•'��cyt.

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
Date of inspection \L \C31c18
Facility Number
Time of Inspection ® 24 hr. (hh:mm)
13 Registered 13 Certified E3 Applied for Permit APermitted 113 Not Operational Date Last Operated:......_ ..................
Farm Name:.....`1�. r? l� f_�-''... �'.:.�1................................................... County:........... '11........................................................
`�o-ads-� 3
a
OwnerName: ...... �......... . �2...✓................................................................... Phone No:....................................................................................
Facility Contact:
Title:
Mailing Address:.... U.:.y`/'.'.'....1.�14'a�c�Y... _..1�...................1C
Onsite Representative:...k.2e? .te3.-A,',,j...............................................
Phone No:
Certified Operator................................................................................................................ Operator Certification Number;
Locatipy of F
. G.h ............:.........r`..G.:a...........................!'.:.`.:(...........,... �"......... ........ '� .. .. ... 1.........................................
...............
11
�....0......................� 1. .k. ._ C �.�e....4 ...............................................
Latitude ='=c=ae Longitude =• =' =«
Subsurface Drains Present jj❑ Lagoon Area M Spray Field Area
No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
2. Is any discharge observed from any part.of the operation?
❑ Yes
D& No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
R(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?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
rd el No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
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
P(No
maintenance/improvement?
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
O No
7/25/97

7ray Number:3 1 — '
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
V[No
Structures (Lapoons.11oldinE Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
;4 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: •••,•....._...A. ............. ................................................................................................................................................................................
Freeboard(ft):..........ez :.................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
W No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
gYes
❑ No
12.
Do any of the structures need maintenance/improvement?
%Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
ONO
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess o WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type _VA..f......Gc �1.,T1 f�...........................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
• ❑ Yes
P No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
V No
18.
Does the receiving crop need improvement?
Yes
❑ No
19. Is there a lack of available waste application equipment? ❑ Yes V!,No
20. Does facility require a follow-up visit by same agency? ❑ Yes I(No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 04 No
22. Does record keeping need improvement? ❑ Yes ONO
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ONO
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes M No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes No
O_No.viulatioiii�ordeficiencies.werenotedduring this:visit. You:will receive n&ftirfher:
correspolideilce atiout this:visit.
CommentsreferYto question #j Explam any YES answers andlo ny rernmmendatxons orY
an c
( other orirments
s �. mac, �
sedra�nngsoffacibte}beterexptw°'sr dd�tonalpagn�ueeessuri}�
7/25/97

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
1® Routine 0 Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other 1
Date of Inspection h 6 9-
Facility Number
Time of Inspection = t{ 24 hr. (hh:mm)
E3 Registered ® Certified 0 Applied for Permit 0 Permitted [] Not Operational I Date Last Operated: ,__'......,,,,_,..__^...
Farm Nam .... ...d..A..1:1....... _(k-!n:.i.P/..:r... .D ............................. County:.au.p..L.t'.................................. W t_..... ,l.
Owner Name: ................ 1 4 �..P_h ......... .... L.0—x�.%. 5r.i....�T.................. Phone No:..� `11..I .,..Z`�.�...`{ zc. .. ....................
FacilityContact: .............................................................................. Title:................................................................ Phone' No:...................................................
Mailing Address:.... ..�1.�....... ..^. k _^ �d:W..^...... ..:......................... — ? V..LA.-NaJ...:R rt...11J..� ................. .�8. �.�..�.
Onsite Representative: .... K,.a.4.^:o:.:�rhc...)....l.a.,.•.-.i.4e...(�9..rro..1.k
Certified Operator:..T.-Lc YW .....:. J.I ..............................
Location of Farm:
,.
Certification Number:..1.0.55..............
Design;;; , Current. _ _ Design �,;',Current _ Des n Current
Swme;'4 _Capactty;Populatiou Poattry CapacrtyPopalatton .Cattle A Capac�Gy 1?opulationk,.
❑Wean to Feeder 10 Dairy -"
Feeder to Finish ❑ Non -Layer ❑Non -Dairy '
❑ Farrow to Wean �..�._ ,_v2; , �-z-V
z�
=- ❑Farrow to Feeder ❑ Other _
❑ Farrow to Finish e Total Design Capacity.;, 3 Q
❑ Gilts
[I Boars
Total SSM'. 5 ZO t
Nnmheti of Lagoons / Holding' 'it =� ❑Subsurface Drains Present ❑Lagoon Area 10Spray Field Area :;g
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4., Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes CTNo
❑ Yes ® No
❑Yes
NNo
❑ Yes
0 No
=1 � �—
❑ Yes
® No
❑ Yes
IgNo
❑ Yes ® No
JKYes ❑No
❑ Yes -W No
❑ Yes RNo
Continued on back
i%

y 31 —�
Facilit Number.
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.tioldine Ponds. Flush Pits. ete.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: I. 9
.......................................................................................................................................
Freeboard(ft):.............................................................................................................................
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
iallo
Structure 5 Structure
................................................................
6
.................................................................
❑ Yes
9No
21 Yes
❑ No
RYes
❑ No
❑ Yes
HNo
❑ Yes
Ip,N0
15. Crop type....L.v..1r.................... .....__4R.r..xv........... lnl.%� x: ...................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 0 No
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.violitions or deficiencies.werenotedduring this.visiL You.ceiv will reeito further
.........................:........ ................. .....
Orrespoudetice about this:visit.
❑ Yes KNo
.KYes ❑ No;
❑ Yes RNo
❑ Yes 19 No
❑ Yes iR No
[I Yes ($No
❑ Yes IR No
❑ Yes i5No
NOMEM.
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7/25/97

Site Requires Immediate Attention: /`'y
Facility No. 1-1
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: (j, 1995
Time: t ) : �d
Farm Name/Owner: RA4P// 1_9,AxiPK
Mailing Address: 5�j D C,�
County: D�07
Integrator. _/t/ e I G�A�t w S Phone:
On Site Representative: Phone:
Physical Address/Location: LAY °-y" " Jam^
V� KA1059 NC 1 I I � kz, o^-
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: 3 S' d U Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 5"V ' Longitude: -=g ( 3 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot = 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) for No Actual Freeboard: a Fr. O Inches
Was any seepage observed from the laeoon(s)? Yes or I)Was any erosion observed? Yes ordg)
Is adequate land available for spray? (XPor No Is the cover crop adequate?(fD� or No
Crop(s) being utilized: GP) (-t
Does the facility meet SCS minimum setback craeria? 200 Feet from Dwellings? )Ce �br No
100 Feet from Wells? te> No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated «6thin 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the
tt�he state by man-made ditch, flushing system, or other
ice'
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
CX16511- / �., " t' w- t
Inspector Name
cc: Facility Assessment Unit
t�
Signature
Use Attachments if Needed.