310226_INSPECTIONS_20171231

NO_r AROLIN _
Department of Environmental Qual

II ype of visit: U t ompuance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: E; Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 Arrival Time: 3 a Departure Time: 2.G+J County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 1E!__3
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity op.
Wean to Finish
Layer
DairyCow
W to Feeder
Non -La er
DairyCalf
eeder to Finish
&J9
G 1 o q
DairyHeifer
Farrow to Wean
Destgo
Current
Dry Cow
Farrow to Feeder
D P.oul
Ca act
P,o .
Non -Dairy
Farrow to Finish
I Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I jBeefBroodCow
Turkeys
101 Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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 o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
]Yes EN; DNA ONE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

[Facility Number: jDate of Inspection:
L(
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
to ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
60 ❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E�<o ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
r--
❑ No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [] NNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑'N/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 EINo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Mo ❑ 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
P dXo
❑ 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
�o
❑ 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
Ldqm
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA [_]NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 21412015 Continued

z,14
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with pennit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑190 ❑NA ❑NE
&NNo ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [f N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [—]No ❑"NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [J�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 dNNo ❑ 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
❑ N
❑ 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
Cf 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
NNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑/N/o
❑ NA
❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
�o
❑ NA
❑ NE
Comments (refer to question #): Explain,any YES,arikwers.andlor,aoy additional recommendationstor?any other comments. s "
Use Ndrawinps�of facility to better Cxplain;siivations (use additional.. pages aSmeeessary).
Preus-e
�y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
'('.,� (-u
�/55
So
�101/� D
54C+
4 b . II Sla
fp ►i
cc G �a e, f-e
c(to�/ �nSTIV,�1�r?IL Phone:
t' Date:
214,12015

for Visit: QlRoutine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time:® Departure Time: County: Wet; d Region:
Title:
I n
Onsite Representative: 'a Ma-,( ,j Lo,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator: c
Certification Number: (♦;DS�
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
WeI Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P.
Dai Cow
can to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P,ou_It,
Layers
Design
Ca >,aci_t-lymP,o
Current
,.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
I Beef Brood Cow
Q[he_r
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ 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
E]
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: Ib
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAeOJ Z�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3s
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes Zo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Nc
❑ 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 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 XNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes E3 N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes r
❑ 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 YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ElYes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - _ Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes � ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes WNo ❑ 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 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 rl/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.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes EyNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No [DNA ❑ NE
Y❑NA ❑NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better exulain situations (use additional pages as necessary).
Reviewer/InspectorName: / �oWl:. Phonekt,
Reviewer/Inspector Signature: Date:
Page 3 of 3
'73

(Type of Visit: <1 Cgtnpliance Inspection O Operation Review p Structure Evaluation V Technical Assistance
Reason for Visit: U+J Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q Q Arrival Time: Departure Time: ® County: Dloet;rtj Region:
Farm Name:
—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: J`o n>�TNAtJ VL—,L k& . Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 9 � 6s 6 p
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Gucreut
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
azo
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oul_ .
Layers
Design
C_a aci
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes [/� No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412014 Continued

Facility Number: - Date of Ins ection:
`Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? []Yes ❑ No
Structure 1 Structure 2 9 Structure 3
Identifier: (A(,6r0 (A&cwjL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 2-9
❑ NA ❑ NE
❑ NA ❑ NE
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 VNo ❑ NA ❑ NE
❑ Yes E�'No ❑ NA ❑ NE
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 ]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [a 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 [XNo ❑ 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 0 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): i
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes d1�o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ��i /No ❑ 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 [� o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [NNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes . �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 ;o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

[Facility Number: - Date of Inspection, / /
.24: Did•[he facility fail to calibrate waste application equipment as required by the permit? ❑ Yes U O
•25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes [7o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑NA ❑NE
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L'J l"o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
(refer to.question #): Explain any YES answers and/or any additional
igs of facility to. better explain situations (use additional pages as nece!
Reviewer/Inspector Name:
[—]Yes ❑No ❑ NA ❑ NE
❑ Yes ( No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes W(No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
any
Phone:
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
....t.
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Reason for Visit: Q$ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: LU1N Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: i 10IJ AAA IJ ► r' lr l,f 9- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
•
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oulti,
Layers
Design
C_a aci
Current
P,o ,
Dry Cow
Non -Da
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ff No ❑ NA ❑ NE
❑ Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ o ❑ NA ❑ NE
ElYes Vo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: Date of [ns ection: p a
Waste Collection & Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structures I Structure 2 Structure 3
Identifier:S;IL_��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
[6 No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes [/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 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 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
WNo
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 ❑ 1N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes rNoo
❑ 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 NLI
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes ry'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ' ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes g2'No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Ilucility Number: 'Z - '��G, Date of Ins ection: a `"
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ' N
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes / No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑ NA ❑ NE
❑ Yes M 146 ❑ NA
❑ Yes No ❑ NA
❑ Yes [7No
❑ NA
❑ Yes
❑ NA
El Yes ❑ NA
❑ Yes WNo ❑ NA
❑ Yes
❑ Yes
❑ Yes
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
�❑ NA ❑ NE
1_J N
' ❑NA ❑NE
V/1 No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional oases as necessarv).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Date: A�

(Type of Visit: (Z) Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit 42 Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: I i h i Arrival Time: L Ili Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: �� /� Title:
Onsite Representative: Jotjf'T A ► y 1 t Uyk_i Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 95 4968
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
6
Dr, r P,oul
Layers
Design
Ca a_ci +
Current
P,o P.
Da' Heifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
—TurkeyPoults
Turkeys
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 [Zo ❑ NA ❑ NE
[—]Yes [:]No
[—]Yes [—]No
❑ Yes ❑ No
❑ Yes �YNo
o
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facility Nuqber: - Date of Inspection: t 4
0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA� L (A(,,J Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
E Yes
0No
❑ 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
[Z/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 environmentalthreat,
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 E�rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3 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
E] N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
[ l
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
LJ No
❑ NA
❑ NE
acres determination?
/No
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
i�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
L 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 21412011 Continued

liacifl Nuober: Date of Ins ection: -3
24. Did the facility fail to calibrate waste application equipment as required by the permit?[:]Yes dNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo
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 structures) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes C;3/No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
[:]Yes L.XNO ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes LJ ivo ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[/No ❑ NA ❑ NE
No ❑ NA ❑ NE
rNo❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: t X tS
2/ I201

-1 ype or visit: W Compliance Inspection V Operation Review O Structure Evaluation U Technical Assistance I
Reason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ET=Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: N-AIJ CV)ax,1-6fL-
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: ! (6 S 6 7{
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
yob
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D�, P,o_ult , Ca aci $o ,
Layers
Gilts
Non -Layers
Beef Feeder
lBecfBroodCow
Boars
Pullets
Other —TurkeyPoults
Other
Turkeys
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 I__I N
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes nplo ❑ NA ❑ NE
❑ Yes Q% ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: ,� - Date of Inspection: 11
J
Wasfe Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:)Yes dNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CA(,w- iJ (AGfvZ1J�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes V ❑ 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
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Lr,JS//
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Zo
N -
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N/oo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
--
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Nq�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
1Y�]�N/o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [Df4o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection, h Y
241 Did the facility fail to calibrate waste application equipment as required by the permit. ❑ YesN ❑ 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 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
o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EXNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[2 Nc
❑ 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
�f
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Lb N
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[—]Yes
❑ NA
❑ NE
Comments (refer to question #):Explain any YES answers and/or.any additional recommendations_gr,any,othercomments. . -
Use drawines of facility to betiei eaalain situatinns,(use additional paees as.nii6isarv).
_. .�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C / 0 b 0
Date: f/ '7 41 Z-,-
�1411011

(Type of Visit: Q C1opliance Inspection U Operation Review U Structure Evaluation (.) Technical Assistance
Reason for Visit: V Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 11 Arrival Time: Departure Time:© County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �TOWarN y4az Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: 2 O b5
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish =
0
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1) , P,oultcv
Layers
Design
C_a_ �aci_
Current
Pao ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes jNNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes n�Io
E.Yes /L1f o
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ENo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA(Co/J) U>(,--607-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 eNo ❑ NA ❑ NE
[—]Yes Wo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 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 VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [:3 No NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
mamtenance or unprovement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑i No NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
AIo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P/No
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�Z
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
<o
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q
❑ 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 El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E7No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes E],4(o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes b' " o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection: 1
No
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑Yes
O ❑ NA ❑ NE
25. ISthe facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
E;�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
No 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[Io ❑ 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
ENo ❑ 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
CfNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
/Nc
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
D< ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any, 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: &XL —
Date: 1 % 1
21412411

G
D�vfsion of Water Quaftty
Facility NUmber'.'_Division Sod and Water Conservation
0 Other Agency
IType of Visit Q'Com lance Inspection Operation Review Structure Evaluation Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other
s�� ❑ Denied Access
Date of Visit: I Q O Arrival Time: �/ f7 Departure Time: County: 3L VL.dNff Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: juti,fti kfNo i r_XLX_ErL
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o Longitude: [�o
Design
- - Current Design ,Current
_ DesigneryCurrent
Swtuew, , _ Capacity
`Population ;', Wet Poultry Capacity Cattle si Capae ty
p lah�on
r ❑ Wean to Finish
,Population
❑ Layer
6P
❑ Dairy Cow
El Wean to Feeder
❑Non -Layer
❑Dai Calf
Feeder to Finish l.av
(o ba '`-.-_""'�.*. '^ "
�„ ❑ Dairy Heifer
El Farrow Farrow to Wean
b
El Dry
Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
•.NE]
'" ❑ Non -Dairy
r ❑ Beef Stocker
;'
❑ Gilts
❑ Boars
ers
w ❑ Beef Feeder
❑ Beef Brood Co
^•,Other
`^ `' `:.oults
Z
"`o❑
Other
Numbe f Structu .,�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other"
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ,I N�o El NA ❑ NE
El Yes C14 ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

)Facilitk,Number: 3 Date of Inspection 11 l0
t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structu e l Structure 2 Structure 3 Structure 4
Identifier: I 1.Afi�2
Structure
5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ffNo ❑ 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 E;Wo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes vNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,(/
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes YJ No ❑ NA ❑ NE
maintenance/improvement? �(/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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
NNoo
ElNA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El,�, Yes
�" No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
QKo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KIo
❑ NA
❑ NE
Comments (refer to ques`tton #) Ezplatn any YES answers and/or any recommendations or any otherscomments .1
Use #rawingi of facility fo better explainsituations (use additional pages as necessary)
..r ..... v" t ec
Reviewer/InspectorName ONr �(� w Phone: /Q % "/ 1�`.
.:.
Reviewer/Inspector Signature: Date:
--- � r s 12128104 Continued

❑ YesCJ No ❑ NA ❑ NE
❑ Yes E3 No ❑ NA ❑ NE
Fycility Number: — Date of Inspection tt D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
.the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other ^ I-,'
ldN
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0�,
[INA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
ElI[3
�No
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,L.�,I
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�E3/NNo
NNoo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,L�J,
EKo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes L-F'No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ejq,
❑ 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
Q<o
❑ 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
R<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CJ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
' No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

n
IType of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit (!CoRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other Denied Access
Date of Visit: I 46
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Qti Departure Time: County:
Facility Contact: Title:
OnsiteRepresentative:Y'41Z.C�ft--
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = ' Longitude: = o = , = «
s
Current`^"- --
Design
'Cucretit -
Design Current
Swine Capacity Population Wet Poultry
Capacity
Population
Cattle
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
ILI Non -Layer
I
I❑Dai
Calf
Feeder to Finish
ITOT
��
��
Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La ers
El Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ffNNo ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
Page I of 3
12/2"4 Continued r--
I

Facility'Number: — 2„�,6 Date of Inspection 6 U
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA6-WZA (,A& tZoJ22
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ai C
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 Ili No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ff No ❑ NA ❑ NE
❑ Yes FJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentateat, notify DWQ
❑ 7. Do any of the structures need maintenance or improvement? Yes No ❑ NA ❑ NE
8. Do any of the strictures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ 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 LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E 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?
❑I Yes
[fNo
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
u Yes
❑l No
❑ NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[IiGo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendattonsor ny other comment-;� Z
Use drawings of facility to better explain situations. (use additional pages' as necessary)
ISJ t4AW T.jwt PA U-, (VALVAr 6 6X4 -t vO A FZO LOt ANO RQ,0 V 'ifnl04 l_-ut✓J,
5E"6 GoP'/ Td VWC�.
CAUPW 00 Am"'Mr 62"MPW vN Olck-r- r=SOS.
Reviewer/Inspector Name {A a t_ Phone:
Reviewer/Inspector Signature: / JV Date:

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I 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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
(Additional Comments and/or Drawings:
❑ Yes
ENo
ElNA
ElNE
❑ Yes
L2No
❑ NA
❑ NE
❑ Yes
[3"No
❑ NA
❑ NE
❑ Yes
f3lNo
❑ NA
❑ NE
❑ Yes
V✓ No
❑ NA
❑ NE
❑ Yes
[Io
El
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
[YNo
OQ No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
Ej'�No
❑ NA
❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes
2(No
❑ NA
❑ NE
❑ Yes
o
❑ NA
El NE
El Yes
Wo
❑ NA
❑ NE
rage 3 of 3 12/_16/04

Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Rooutine O Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / 6a Arrival Time: ® Departure Time: County: _ZWLX.1j Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: rfoto nyn/ MzLLE je Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [� o = [� Longitude: M o M
Design Current
Design Current.
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
® Feeder to Finish
M a
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
ElFarrow to Finish
❑Layers
❑Beef Stocker
❑ Gilts
❑ Non -Layers
ef
❑ BeFeeder
❑ Boars
i
❑ Pullets
❑ Turkeys
❑ Beef Brood Co
Other
❑ TurkeyPoults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
❑ NA
❑ NE
❑ Yes
L'J No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facihty-Number: — Date of Inspection
i`Waste Collection & Treatment ((( (((
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes OrNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Q,"/✓Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
LI No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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 the t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes
N ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
(Not applicable to roofed pits, dry stacks and/or wet stacks)
,..,
LJ No ❑ NA
/
❑ NE
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
EjNc ❑ 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?
YYe�es
El No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
E❑
E'es
❑ NJo
ElNA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
�J1N
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑Yes No ❑ NA ❑ NE
rs, J Fz&,Los coagrd mt°6-�6 AhlaO-r
J4 Z( Pofixece tn�o��iyiENt`
of B4/125A
CzAsF
E.fot- Sf"e To
d�Eot/C
.IIV ro
6J UP
F6 n 0Ew ,;qq/
LAMTHU_ coo6 AAly 1Z.oMU1 _fNVaq(_ NEEe 10' 3E Pratt.- OUt 4AIi
IReviewer/Inspector Name 1 4 L- Phone:
Reviewer/Inspector Signature: `�� Date:
rage < of j

Facilify Number: ' — Date of Inspection ` l 4
`-Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes E!rN, ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Ann I Certification
❑ Rainfall El Stocking El Crop Yield El120 Minute Inspections Monthly and l" 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 minbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
IQ NNo
❑ NA
❑ NE
❑ Yes
I,4N
❑ NA
❑ NE
❑ Yes
VT
❑ NA
El NE
El Yes
I o
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[I NA
[I NE
El Yes
—�/�No
L'No
❑ NA
❑ NE
❑ Yes
C3 NNo
❑ NA
❑ NE
❑ Yes
2 NNo
❑ NA
❑ NE
❑ Yes
D`N
El NA
El NE
❑ Yes
No
❑ NA
❑
NE
Page 3 of 3 12128104

Number
0 Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
IType of Visit (?'co ❑ 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: L/ Arrival Time: Departure Time: County: _&ZZ&_j - - Region: _
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �IIIAd /�� T�itlle:,/J
Onsite Representative: ��h t#&j /rL cIU64�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o =' = Longitude: =o =,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population; '�,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heife
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: _I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes C3 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑
/No
❑ Yes
CJ No
❑ NA
❑ NE
❑ Yes �o ❑ NA ❑ NE
12128104 Continued

I C�FacilityINumber: 'j I — ' Date of Inspection
1
r Wastetollection & Treatment ,�/
4.. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ [2 Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1' Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
"�
Identifier: (-�-V� -� LA
Spillway?:
Designed Freeboard (in): 7
Observed Freeboard (in): 34
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes YNo
El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the smctures lack adequate markers as required by the permit? El Yes
Io [INA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > ]0% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
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
[INA
❑ NE
,El
N.
LJ No ❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
7No
o ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AR, W/ nFU s
Reviewer/Inspector Name l , ✓ Phone W —
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: — 2Date of Inspection t0 D
I
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Applic tion El Weekly Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers El Annual Certification
El Rainfall 7tocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a min 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?
Otherlssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
❑ Yes 9 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
9-go
❑ NA
❑ NE
❑Y s
L7No
El NA
El NE
LH Yes
El No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
D No
❑ NA
❑ NE
❑ Yes
LI No
❑ NA
❑ NE
❑ Yes EK ❑ NA ❑ NE
❑ Yes El"No ❑ NA ❑ NE
❑ Yes
❑ go
ElNA
ElNE
ElYes
E3 No
❑ NA
❑ NE
12178104

(Type of Visit QlCompliance 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 El Denied Access
Date of Visit: I q
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: � o U Departure Time: County:
/ '40 ve, e—/_� Owner Email:
Facility Contact: Title:
Onsite Representative: �� 6
Certified Operator:
Back-up Operator:
Phone:
Pho a No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region: 4/1
Location of Farm: Latitude: = o = ' = Longitude: = o = , =
11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 ' Date of Inspection
;V
Waite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Stn c re 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
° Sn,Ac,) Irid, q I iCovv\ e-oa/(t5 Qimm: l 1+^Ci'` G{
Trio f
Fafwt l s '?A e4 I- s - �c c.o r d S' ncd0- i­
(0 ( Je r � 0 )
IReviewer/inspector Name ff4pvj 11 Phone: I
Reviewer/Inspector Signature: Date: Z �IZ66
Paee 2 of 12128704 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
CVa.
6 9
e-, 6
�,�G
il//b`oa V ;-C)
® 7 Z 6C
da S� kad
Sole bacic sls
�"`(I 5 i
d- �s4 q�{P�e�
^ U3dc-t t 4 0 e►'1 e-CLV
Page 3 of 3 12128104

( Type of Visit 0 Compliance Inspection O Operation Review Structure Evaluation O Technical Assistance
V I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: F5i>210 Arrival Time: t a`3 ci Departure Time: County: DoNzd Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: Caeca I(6tjN6t>y
Certified Operator: -A2.q FAmps_LA-n4
Back-up Operator:
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: F___] o [---] Longitude: � ° n n
i ?Y.. Fir.. qJ' .aYM1 •{ r^
4 i.j.'+'r I ]L 1+ t 1.YS 1 .v.�' r '+4tYE�i.S`�RY.`� Yi.:"1"'fnJiv�i'T IW Tn»
Swine
DestgnQCurrent
c
rr C�ap�aertytiOpo ulatin
Design Current - Destgm CuFient
x W .: s a + sw�E�`'e+"a 3 �, ego 1. ,i
,e_. t oultry Capacity Population Cattle Capacity Population
❑
Wean to Finish❑
L,
La er ❑ Dairy Cow
❑
Wean to Feeder
10 Non -Layer I ❑ Dairy Calf
®
Feeder to Finish lI
"" „ o El Dairy Heifer
ti - ❑ Dry Cow
❑
Farrow o Wean
. DrykP,uul_try ,
❑
Farrow to Feeder
❑Non -Dairy
❑
Farrow to Finish�i
❑.
Layers
El Beef Stocker
❑
Gilts
❑ Non -Layers ❑ Beef Feeder
ElPullets
❑Beef Brood Cow
❑
Boars
Other
Lj Turkey Poults -NMI
❑
Other
-r
.r�Nuriiber of Structures:
q; El Other AA-
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
IJ T 0
El NA
El NE
❑ Yes
[/1� No
❑ NA
❑ NE
12128104 Continued

Facility Number: ( — 2 ZS. Date of Inspection z �S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: hA60,rl I LA&0o0 2-
Spillway?:
Designed Freeboard (in): %q 19
Observed Freeboard (in): Zo 39
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 dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ENo ❑ NA ❑ NE
❑ Yes L'J No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [� No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ErNO ❑ 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 ElL1 Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [✓rNo ❑ 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 ❑ IEvidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Gr m*,t ,q ( 6- 4' ro, S 6,0
13. Soil type(s) 16IA AV
14. Do the receiving crops differ from those designated in the CAWMP?
❑(Yes
EjNo
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
E Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
ff11No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
1 S •� lj E E7 Cro,J'r'rL+6L a e6o 6o _U
yt,) C'n p yyc-.ur 06t-_03 i., riF O-A(
ReviewerQnspector Name .SoA tA Phone:l5102 3 gS — 39 p,> x L'3
Reviewer/Inspector Signature: Q Date: 24'1 t4 r7S

Facility Number: j —224 Date of Inspection s
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�No ❑ NA ❑ NE
the appropirate box. ❑ W UP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wee ly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
Wee
❑ Annual
Certification
❑ Rainfall ❑Stocking Yield [:1120 Minute Inspections ❑ Monthly and 1"
Rain Inspections E]
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[IYes
,D
L�J,1/
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
I.J�No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LJ No
❑ NA
❑_,
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
El NA
/NE
[3 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E] No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El"No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
1
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
u 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
CfNo
❑ NA
❑ NE
"
33.
Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Facility Number ( ZZ Date of Visit: 1 b Time: 0
Not O erational OBelowThreshold
ElPermitted M Certified [3Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: VLtOt- IiQK bew%.. fi-,50 County: .ViL✓Liry
Owner Name:
Mailing Address:
Facility Contact: nDpn� Title:
Onsite Representative: - AJ k1 deo b'(112- A'/- 2
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: )// 91i
I
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =' =` 0 u Longitude 0' =` =K
Design
Current - Design Current `Design Current
Swine Ga aci
Po ulan -• roultcy Ca aci Po ulanon Cattle Ca acity. Po ulation
❑ Wean to Feeder I
❑ Layer I❑Dai
Feeder to Finish I 7ZM
JEJ Non -Layer I❑Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capaeity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps
❑ Jj No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. 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?
Was Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 2
Freeboard (inches): Zo 3 0
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number. — ZL Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6..Are
there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
.
El No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9.
Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? -
❑ Yes
❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
El Yes
❑ No
. 11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CARr1viP)?
❑ 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?
El Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
. ; 18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W IUP, 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 faciliry 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?
(W discharge. freeboard problems. over application)
❑ Yes
❑ No
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
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
No violations or deficiencies were noted during this visit You will receive no further correspondence about "visit
Comments (refer to question ff): `Eiplam any,YES answers;and/or any en ins oranv other eommentsiR
Use drawings of facility to better ezplain srtnarions. (nse additional pages as necessary) ❑ Field Copv ❑ Final Notes
�lt - �pi� SRwr/l lv. G�`S `r4 L+/t i � b�j by✓esu�is G2Att li� !�/6/6 f[. �(ftt�Ta J'FaC,L
SnY)e IWIIYA/ 740 fle /CSs�i' i n y�sr rs sn,
If%ssa14 40& s- ,U.w �PiM:f c✓iiit r�U/''(S,
l% % Pi4,U ram c�dst - d�i(n.� 90 i.i>ro rro( _ �µM 40AsYe,A�/y Goh7
IReviewer/Inspector Name 'B °,,�,=:g,-a�g'`e*',` se,
Reviewer/Inspector Signature ��w ✓. _ 5-04 B -q Date: I / 7_A �AfL
05103101 Conditued

Facility Number:3 -ZZ&l Date of Inspection ( Z>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 permanentitemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
05103101

of Visit OO Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit OO Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 226� Date of Visit: 4Y252002 Time: 3:30pm
0 Not Operational 0 Below Threshold
IM Permitted ❑ Certified M Conditionally Certified Q Registered Date Last Operated or Above Threshold: .........................
FarmName: Bud.Riyenha.rkEarm................................................................................. County: D.UPUA ............................................... W. JR,Q.........
Owner Name: Bud .......................................... Biv.cubark ................................................. Phone No: 4.10-32.7. 32$5...........................................................
Mailing Address: 29.4.R..asture.Branch.Raad............................................................... Ruse.HjIL.NC ........................................................ 28458.............
FacilityContact: .............................................................................. Title:................................................................ Phone No:.................... ...............................
Onsite Representative: .Genu.l crumily............................................................................ Integrator: Brayru's.nf.CaroBna,Ltc..................................
Certified Operator:,L..R........................................... Riyknhaxk ...................................... Operator Certification Number; .20.123.............................
Location of Farm:
East of Greenevers. On North side of SR 1953 approx. 3 miles Southwest of Hwy 50.
®Swine []Poultry []Cattle []Horse Latitude =• =` =cc Longitude =• =1 =a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N 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
a 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 [9 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 IR No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................1.................................2................................................................................................................................................................
Freeboard(inches): ...............28..............................3.6............................................................................................................................................................

Facility Number: 31-226 Date of Inspection 4/25/2002
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes N No
(If any of questions 4=6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelirnprovement? ❑ Yes N No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes N No
9. Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes N No
Waste Agnlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
N No
12.
Crop type Coastal Bermuda (Hay) Coastal Bermuda (Graze) Small Grain Overseed
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
N No
b) Does the facility need a wettable acre determination?
Q 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
N No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available? -
❑ Yes
N 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.)
N Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N 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 N No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Field Copy ❑ Final Notes
15 Lime is needed for fields # 1,4 & 5 as indicated by 10/15/01 soil sample results.
18 An updated aerial photo of the farm is needed along with a plotted map which shows the irrigation design.
Rest of records and fields look good.
IReviewer/Inspector Name dale Stenberg
Reviewer/Inspector Signature Date:

O5103101,.
Continued
FacilitylNumber: 31-226 Date of Inspection 4/25/2002
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
® No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
[] Yes
® No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
© Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
Q Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan biade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No

(Type of Visit (9(Compliance 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: ® Time:
Q Not Operational Q Below Threshold
.Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ......................
Farm Name: _...._.�:"E?:.�.., ..`�........................................................... County:..._ ..1N.........................._.....
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress: ..................................................................................................................... ....................................�.............................................._.. ......__...__..__.
Onsite Representative: ei-X. Integrator. vQ
Certified Operator:
Location of Farm:
Operator Certification Number;,,,,,,,,,,,,,,,,,,_..,,__,,...........
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =a =° =11
Design, Current -
Capacity Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Current
-Design
tattle Capacity, "Population °
❑ Dairy
❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ® ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps, 0 ❑ No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. 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 Structurreet2 Structure 3 Structure 4 Structure 5
Identifier: ............1.'....\........................�....1..............................................................................................................
Freeboard (inches): /Xv 3d
5100
❑ Yes Wo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes 15(No
❑ Yes allo
Structure 6
Continued on back

[FacQty Number. _ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 13 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 A 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 EfNo
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
ONo
Waste Application
10.
Are there any buffers that need maintenancetimprovement?
❑ Yes
O(No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
ONo
12.
Crop type le✓t--t.•�c ham/ (�w tcJS olt �G] Q.QC
13.
Ir— V
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JWNo .
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
JgNo
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?
JXYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
lffNo
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes P(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 E No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes XNo
n
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes N(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes J'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes VNo
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 XNo
. iQla{igt(S:o! de£c�en0 •wgre 004 d(trittg ttjs;visit; • Yojt wii•� ecgiye tiq iu� th$r.
comes' otideike: about: this
Comments (refer to question #):'Explain any YES answers'and/or any recommendations mr any other rommetits.
Use drawings of facility:to betterexplain situations. (use additionalpages air necessair)_ =
Reviewer/Inspector Name
Reviewer/Inspector Signature: - Date:

Fycility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ 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
RNo
'�`
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ YesNo
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
tNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
NNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
ONO
ho omments...an or' ravings:-
v _
�f 1c
=3 CPc.\VS tt-a/ 3-u4fis r-
CtL���� =1 (.A Fg)
)e r;\y
�1, �� 6� tee'' ► e_CG .Q� e `k
4�ihQ
112sta--�,o
9.4
Ca`�er-
9/00 11.04 A-- Y"<LL-c2 h24 Qt- ttia�A s27,Jyvie4.

f= -
Type of Visit )WCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 / 2 (' Date of Visit: IO 20 Time: —5 30 Printed on: 7/21/2000
rO Not Operational O Below Threshold
Permitted 13 Certified 0 Conditionally Certified El Registered
Farm Name: ...... f..tJ�!A.._!`...i JCttIOS�t...P..:i................................................
Owner Name: ..... 1G?YO�._0\.� vC7..0.4.!.. .........
Facility Contact:
Mailing Address:
Title:
Date Last Operated or Above Threshold: ..
County:. (l.ir.�.....................................
PhoneNo:................................................................
Phone No:
Onsite Re resentative:&. / �' ��w/'t �7,0 J�$Q�?,e�`. .............. Integrator: ... ).no O��Q"o/�
Certified Operator:
Location of Farm:
Operator Certification Number:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =•, Longitude =• =' =..
Design Current
Lapacity ro manon
❑ Wean to Feeder
Eg Feeder to Finish 2D0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle_ Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lag,:an Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes $ZNo
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes JZ'No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DW'Q) El Yes P�No
c. if dischar_w is observed, what is the estimated flow in gal/min? '/ A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) [:]Yes 21 No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes :9 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ff No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ®'No
Structure I t vcturc Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .........6� .1......._..... �k_a'
q................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Number: ,3 — 2261 Date of Inspection 1161O 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 ❑ 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 ❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ❑ No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding /❑ PAN Hydraulic Overload �j Yes [I No
12. Crop type 6 e. r ,--% tv of 9 ce eca e .t SYti of I / /7rN I h
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21 Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'!
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.... violatioris:or defciencies were h6fed during 4his:visit; - You :will reeeiye 66 further _
correspotideitce:aboutthis vtstt.:
❑ Yes ❑ No
11�
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
AYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []No
❑ Yes ❑ No
❑ Yes []No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r�en}► 4 ,ie of Fre�bnc�rd reeo�c�l are �t ss, Se rvre 40 keep •
+^reeboek�d records Weekly•
%S. work a,q/tbe�-rdjv/lol �6e-#C r
es/o,b� sL, (�Gr�vdq- f►pirl /ir+c acaordi.,aJ �osi,l-le s%. !r
!1. Mere l Asr 6cet­ .so e �A74--, V%;c evei-lmd,'k7 (, [More 41tnh Z� &#60j j1.ms
ope'' a1Gre) 6" sowtc eVetl¢J. Do rto-} ltyk-AtI 1,6A /b ove"logo(. C"On cull-
Reviewer/inspector Name
Reviewer/Inspector Signature:
I
Date:
5100

Facility Number: �1 -Z2(o Date of Inspection d Z D p Printed on: 7/21/2000
Outno*Issues -
"-' 26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below []Yes S 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
EYNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
#No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
UrNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
O No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
JO No
T4 ,.-c r4 ✓ G h-ta rt t/ tl */ b4' e < oh Tq�rw. tl)ork 4P e8mv ✓e
Lind v} ze �� / w;A,0y4 bv.,n ;.ig.
�I
5/00

'ODivision of Soil and Water Conservation - Operation -
.a. =' E.Division of Soil and Water Conservation - Compliance Inspection
-Division of Water Quality -Compliance Inspection
Other Agency - Operation Review
Routine 0 Complaint 0 Follow-u of DWQ ins ectiyyon 0 Follow-u of DSWC review 0 Other
'. Facility lumber
Z Date of Inspection "5 2
Time of Inspection L_L.(LJ 24 hr.
R' Permitted MCertified 0 Conditionally Certified 13 Registered Not O cra[ional Date Last Operated:
Farm Name:........._$.P.� `�.- `�`1f� ......_...__ Countv: .... �iA......................................... .
.... �.t!...- a-Y.%....._kfb.�t>.-.....I............ QL. ......................
Owner Name: \ 5� Jca b...................................... Phone No:
Facility Contact: ............... Avk t......&xy. y................... Title: ................................................................ Phone No: .Cgi4�......t.'_ 8 3...............
Mailing Address: ..............
..................................................................................................... ..................................................................................... ..........................
Onsite Representative: ...... M.4.......hx..taAAtA... .(../.`2Et.o.... Va-JF................ Integrator: ...... QtVU)A'S...............................................................
Certified Operator: ............................................... ... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =•=' =" Longitude O' =' =11
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
-7Zm(t
p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons IR Subsurface Drains Present 110 Lagoon Area Spray Field Area
Holding Ponds / Solid Traps IN No Liquid Waste Management System
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation (If yes, notify DWQ)?
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 Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Structure I
Identifier: 00
Structure 2 Structure 3
at
Struc•turc 4 Structure 5
❑ Yes [PNo
❑ Yes
[ONo
❑ Yes
V No
NIN
❑ Yes
T
P No
❑ Yes Q� No
❑ Yes [A No
❑ Yes P No.
Structure 6
Freeboard (inches):
.................�1............
1/6/99 Continued on back

Facility Number: 3 ( Date of Inspection
.. Aur,there any immediate threats to the integrity of any of the structures observed? (ic/ 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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maimenance/improvement?
9. Do anysluctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markin,gs?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application'? ❑ Ponding ❑ Nitrogen
12. Crop type
3 z
❑ Yes f�) No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
0' No.vioiations oc deficiencies .were noted during .ibis visit:. Yoti wilfret:eiye no hirihe'r
eorrespondeitee_aboufthisvisit.: .'.'.'..'.'.'.....'.'.'•'•'• •'•
Comments (refei: to question #): Explain any YES answers and/or any recommendations or any other comma
UsedraivingsoEfacilityto-better-explaimsituations.(useadditional pages as, necessary):-
❑ Yes ONo
M Yes ❑ No
J9 Yes ❑ No
❑ Yes P No
❑ Yes [4 No
❑ Yes M No
.................................
❑ Yes 10 No
❑ Yes 1A No
® Yes ❑ No
❑ Yes CONo
❑ Yes ;n No
❑ Yes W No
❑ Yes ® No
❑ Yes No
❑ Yes li No
❑ Yes C9 No
❑ Yes /10 No
[]Yes 03No
77771
1. era�a woes on inm* alx-c o ll of loot- (cyo sv 3/+too- R1W a,..d rtwcdec- ion- avc&s ov-
Tnvvr 3i v t..y-ll of t 1Oyon St• ut) be, �l e.dC- . Wss or. old tort- diks. oan •shead (a.,
rro v��aai �an� Pv�L M� aJa� mute, ` &-,% sllrir�/ Svmvvu-.
G ,,J, wgt�s Sl�ovl� 6e d e_aW {o Prt`m' ero;?on. ger. sha�� bz 1po;l+ car? hydt
ao•r •raga tr Olc[a -# (. 5 `F
r.S�z.e, 9 a.r) w4I sl 1101- _POttV;t55'96- Sp6%j *�%IiS 51ir,rt�,
Reviewer/Inspector Name
Reviewer/InspectorSignature: ` fir A Date: 3/Z 1IJ I
I /6/99

0 Division of Soil and Water Conservation ❑ Other Agency
M Division of Water Quality
Date of Inspection Ig/l fqg I
Facility Number 1 22G Time of Inspection 24 hr. (hh:mm)
0 Registered ( Certified 4 Applied for Permit 13 Permitted JE3 Not Operational Date Last Operated:
Farm Name: ............... 1 p_i 0.11ta................................................. County: .......
D.s(phm.................................... ....................
:..
Owner Name: ............................ ............... ... ....................................... Phone No: .......(510...3z-1z32.W......................................
28`l —q33
Facility Contact: ........................5.�....i i,K-R ..._Y1 tfM1S kum.... �T itle:......L!?Pr G tc l........p...............1..'......... Phone No: ..L°(IQ�3? ...........
Mailing Address:...... z`.�.. .....Y..�STN4..g... Y.Arsl,k�...... rtl..x..........................................i.+p+S.C....LT?.1.1pt../.Jr,.................................... ?.—. .Si .........
Onsite Representative:........... J t......L--ytSnetw................................................... Integrator: ........ Q!TW..Y15
...................................... ......................
Certified Operator:............................................................................................................... Operator Certification Number..........................................
Location of Farm:
Latitude =*=,=" Longitude 0• 0' ="
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes 14 No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated Flow in gaVmin? n 1 jN
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑�Y'eess^A 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
I@ Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
Cl Yes
F] No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0 No
7/25/97

FacilitytNumber:
8.
Are there lagoons or storage ponds on site which need to be. properly closed?
❑ Yes
M No
Structures (Lauoons Holding Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
® Yes
❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: _z,.............................................................................................................................
..................................
...................................
Freeboard(ft):...............1...............................1'.S.
10.
Is seepage observed from any of the structures?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
91 Yes
❑ No
12.
Do any of the structures need maintenancelimprovement?
Q Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
IM No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ............ )w_rO. ,f&............sm..V...�Vtlr..................................... .........................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
t9 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
�U Yes
❑ No .
19.
Is there a lack of available waste application equipment?
❑ Yes
Q No
20.
Does facility require a follow-up visit by same agency?
1O Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss reviewfrnspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
❑ Yes
No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
J9 No
0 No.violationt or deficiencies. werenotedduring this,'visit. You:wil} receive no ftiri ei-.
corresobtidence about this:visit::::::: :
s t..o a.�-. ncwly ltarttJ �'-(j b J be- � W 3 �yr<t0j, Lt� C, ,wjd be- 46
&Hkcd
� S� �S Kf rJJ �y
Irsv( ,tiw rt4voA ih 6,K (a o.%%. L�_,00:, (,I,vek s" 6 (or *tJ i, a rcgons<Llt
1ti/I2. EroSet� areuY br jvtt,.w Qiiu 4A,11 of Lo oo,\ -#2 `oWt) 1De C ytsccyiCA.
�ns[]e Ccrnty o� �Xt LOW wtar ptre or.l �1 yinevlJ fie' rtsk.p�. 'low a�co-S or•
tr�nxr d, uall of 1plaot. •i2 51no�t1 Ioc� R, C- 1L1'4A walls. of 6fL (Ar" '_6vW Ivy
18•t�exnu)c� skonJ ba ir�tUVt�1r' aU S�ro MrloS. 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: %�ii��_ /a f _ Date:

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
(� LDateo lnspectimi i 4
j Facility Number 1 II Inspection ] 24 hr. (hh:mm)
13 Registered JaCertified O Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated:......_ ..................
�tpp r
Farm Name: ..... g �.................................................. County: .....�...tt.. ..1.f.en................................ ..'...1.- v
Owner Name: ....................gv.d,......................rld..1.111.Rn^1.:....�................. Phone No: ... CAI.
. �Z.�........... ..
FacilityContact: .............................................................................. Title:................................................................ Phone No:
p pU lfo.++t,
Mailing Address: ..... 2r..q.y......... .... {......... ...... F.-O..P..�_�1j.17... �k�..................
Onsite Representative: .... .9..q.4 .................................... . Integrator: ...... �j.i2.t.N_�n.S........................... .....zz............
Certified Operator................................................................................................................ Operator Certification Number:...�bl_Z _1...........
Location of Farm:
Latitude t 1* 1 11 . Longitude 1 *1
11 11
Design 7, Current Design .. Current ;` a Design Curient
Swine�, a a` =Capacity Population Poultry � , Capacity=Pinulatou < Cattle < .' -,.Capacity Population
❑ Wean to Feeder I0 Layer ; ❑Dairy '
❑ Feeder to Finish - ❑Non -Layer I I on -Dairy
`• ❑ Farrow to Wean:;
❑ Other
El Farrow to Feeder < '
❑ Farrow to Finish Total Design Capacity,
❑ Gilts .,
❑Soars "sr Total SSL'W, `,,
----------------
Number. of Lagoons'/ Holding Ponds �< ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Are
o LiI 11
a
,'<' s "`�`� ❑ Nquid Waste Management System. <
General
1. Are there any buffers that need maintenance/improvement?
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 ZaUmin?
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?
❑ Yes KfNo
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes t$No
❑ Yes RNo
❑ Yes JRNo
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes Callo
Continued on back

Facility Number:,7j�
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
5' No
Structures (La2oons,Holdin2 Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
EgNo
Ce11.) (. "Q"p
Structure 1 Structure _ Structure 3 Structure 4
Structure 5 Structure
6
Identifier: ....... .r..z..s......................1.....5....................................................................................
......................................................................
Freeboard(ft):.......................................................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
KN0
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
,$� No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
9 No
Waste Application -
14.
Is there physical evidence of over application?
❑ Yes
r�
V!Wo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...^...:'::.':.v..................................................................................................................................................................................:
..............
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
EINO
18.
Does the receiving crop need improvement?
14Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
19 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
&No
22.
Does record keeping need improvement?
❑ Yes
PSNo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
RYes
ONO
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0
No.violationsor deficiencies. were noted during this.visit..Y0u.wi1I receive no ftirtlier
correspondence about this:visit:::::
12.. W o � r- O h J .LLa� t'1 ✓✓,��,77 ba r..t. 0.- Y-4- s p,I V%AI t
CA Y4,Lt- S.+% e, Q,aR--0.
q* i M r Yet"
V 5 t'w-�.-i J w a i-e-r ;.. 't-h. ; s ate✓ -ea. • V
1\. Wort[ O t,nProv+r� be. yr .cLe� uVt/r. C;.(e. A4$f y r,4 t� Volu,
23. O di eL v"'t Jhoiv-t. r"Sf r`¢�rY 17 wrf4 j�wJl o+LJ•�or v d—,S k_
�p r "✓� S kv 4 ".5 Can- t-' i-p A W Q- W i I v ; �t-o , L 44GF- a.; S o o^ `S
W
FIrall Wo o. 0.it evi-S oh. Side of Uj.A-d wI..ewZ v._L.A_Lj
7/25/97
Reviewer/Inspector Name '' ` £ �,+"n :� ,�,,, " U
Reviewer/Inspector Signature q p�� _ Date: 11 1 ZG J q 1

Site Requires Immediate Attention:
Facility No. "2/- Zz.
DIVISION OF ENVIRONMENTAL MANAGEMENT
• ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: R -_23 1995
Time: 3 . 3
a
Farm Name/Owner: ".r PC t dU1 bat. L
Mailing Address: A&K2Hc t '�(1I��
County7c��a i ,h
Integrator. ��co,,ern4 Phone:
a
On Site Representative:Ri-S Qr.Jentifo .vW Phone: fs 9—3a:'r�
Physical Address/Location: ( eA --S i Z J KLeS Q l 9&` q g2p 1 h.` (? S C' >
Type of Operation: Swore J Poultry _ Cattle /h ✓)1S h i ut
Design Capacity: . D © Number of Animals on Site: 3 Q, O C7
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:Longitude: 7Z' 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) 6or No Actual Freeboard: _!E_Ft. Inches
•, Was any seepage observed from the lagoon(s)? Yes ota Was any erosion observed? G or No
Is adequate land available for spray? e or No Is the cover crop adequate? Yes o No
Crop(s) being utilized:
7 A
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Z or No
100 Feet from Wells? 6s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 6
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or4
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
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: 949004 'e40'Slay" t'C? - ( rt
Inspector Name
Qee_k
Signature
c
cc: Facility Assessment Unit Use Attachments if Needed.

Site Requires Immedlate Atrennon
C�
Facility Number: 3 ) 2 Z (v
SITE VISITATION RECORD
DATE: %-1 td , 1995
n(� <
Owner: �u�,P,c�o. KLc�2e,: Farm Name:
County: 1) ctg) ( i n
Agent Visiting Ate: ohnt f • Phone:
Operator: Phone:
On Site Representative: Phone:
Physical Address: 15'k 7A _g s_ -,5cn >L%+ 4 H G L/ .
Mailing Address:
Type of Operation:
Design Capacity: -
Swine —X_ Poultry : Cattle
Number of Animals on Site:
Latitude: C Longitude; 0 "
• Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approzimatelyIFoot+7inthes) Yes or (ED Actual Freeboard: Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments: A,
t�
Fax to [phone] Signature of Agent
t� v