310242_INSPECTIONS_20171231

r
NUH I H UAHULINA
Department of Environmental Qual

of Visit: Q Compliance
to for Visit: 0 Routine
Review
Referral
Technical Assistance
Date of Visit: ? �?_; J,�
Arrival Time:
C7."?�,
Departure Time: Caunty:; Region:
Farm Name: -/;• ,.l
.. i �•,.., ,�,._,
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ( k '`.v 1-1 " T_)1 ' i
j
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
I ry
Certification Number:
Certification Number:
Longitude:
L L
a{ ..3..,� Destgn Current
;,,.�-
., , W Destgn "Current
S wme Pacaty- PoP=u-,r
mµ:ttguCterrent�
'" R'etPov►tryst.,. ty' Popes- �`w,,;
,
Gatfle..,� °.e• Ca aacct
,Cap
'
...: k.
Wean to FtnisIt
Layer ,t
[DairyCow
-
Wean to Feeder
Non La er I_..
airyCalf
.
�{Feeder
toFinish
,, ,�
.
ff
-:,5E 3Des gn�CCM,urrent�.
- ' `p"`'
,Dty.Paultrn_ � ,Ca tact }�- o •��:
A�t
Farrow to Wean
Dry Cow
..
Farrow, to Feeder,-'`'
Non -Dairy
*4
Farrow to Finish
Lavers
Beef Stocker
Non -Lavers
Beef Feeder
7 `
Gilts
Z.
s
k3 Beef Brood Cow ••^$
R..a
Boars
wit~
Pullets
i .01_
is
i 4
Turkeys
Turkev Puuets
Other
Other
Discharges and Stream Impacts -
-
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑. NA
❑ NE
Discharge originated at: ❑ Structures ❑ 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
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation? -
.... -.
❑Yes
El No
❑ 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 - _-.
21412015 Continued

Facility Number: 'Z 1 _ 7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. [:]Yes ❑.No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q'No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first surveyindicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes p-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes © Noi ❑ 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 thefacility 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 theReviewer/Inspector fail to discuss review/inspection with an on -site representative'?
34. Does the facility require a follow-up visit by the same agency? _
tey
r
Reviewer(Tnspector'Name:
Reviewer/Inspector Signature: - /r / `----------,/
Page 3 of 3 _
i
❑ Yes ❑,No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes © No ❑ NA ❑ NE
I
❑ Yes S,No ❑ NA ❑ NE
❑ Yes ,Q No ❑.NA ❑ NE
❑ Yes ❑-No ❑ NA ❑ NE
Phone: fj��ifj j r a z'
Date:
214120151

I
Facili Number: -?, ? - :2 U � Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes
Q No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard? -
❑ Yes
Q No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
-
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '7- -
5. Are there any inrrnediate threats to the integrity of any of the structures observed?
❑ Yes
❑,No
❑ NA
❑ NE
(i.e., largetrees, severe erosion, seepage, etc.)
,
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑,No
❑ NA
❑ NE
" waste management or closure plan?
-
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑, No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q 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
Q No
❑ NA
❑ NE
maintenance or improvement?
I I. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN >:10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ .Application Outside of Approved Area
12. Crop Type(s):..:. - _ -
13. Soil Type(s):
14. Do the receiving. crops differ from those designated in the CAWMP? -
❑ Yes
❑'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
0 No
❑ NA
❑ NE
-I- acres determination') - - -- -
-
17. Does the facility Mack adequate acreage for land application? - ❑ Yes, ❑ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑. No ❑ NA Q _NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [DNo ❑ NA . ❑'NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes QzNo ❑ NA ❑ NE
�s
the appropriate box. -
. ❑NNW El Checklists ❑Design ❑Maps ❑ Lease Agreements_ -❑Other: -
t 21. Does record keeping need improvement? If yes, check the appropriate box below.. ❑ Yes .Q No', ❑ NA
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analvsis ❑ Waste Transfers ❑ Wt
j ❑ Rainfall ❑Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1" Rainfall. Inspections 7`''❑�Sludg
-
+- 22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ •N
i
.1Z 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes, ❑.No ❑'
Page 2 of 3 2/4/2014
r
e Survey,
A ❑NE '?
A ❑ NE
C atinued

Reason for Visit_: f 'Routine O Complaint O Follow-up O Referral O Emergency O Other O Deemed Access
Date of Visit: It 1� ( 3ly Arrival Time:FjI I Departure Time: County: ) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: CIM-TbIJ DL= Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I p 73�
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Da Cow
Wean to Feeder
Non -Layer
Da' Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
r
Dry Cow
Farrow to Feeder
I) . P,oultr.
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
01 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 0 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �o
❑ Yes o
❑ Yes WNo
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412014 Continued

F cili Number: Date of Ins ection: 1 ►-3 ►
Waste Collection & Treatment �--�/� i�,
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes V o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �J Z
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 environmen threat, notify DWR
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 Nc ❑ 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 im rovement?
P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (2/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?es
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
✓/�.[�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
t No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [-]Maps ❑ Lease Agreements ❑Ot er:
21. Does record keeping need improvement? If yes, check t appropriate box below. Yes ❑ No ❑ NA ❑ NE
�aste Application dWeekly 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 min gauge? ❑Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Fagility Number: 2 Z Date of Ins ection., 1 / jr3 1
24., Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25 `Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes F�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
O NNo
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes E ❑ NA ❑ NE
❑ Yes C ❑ NA ❑ NE
❑ YesVNo ❑ 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).
l (C o fLp1 ro 6L, a`OJL4 i�U nn PSN Gt � W 6 ��L& �2CG eSo irlGt D A rI J
// WAStC fiNAc-ySTS.
UC'/-9 Gc%.�t✓ NC—EDCO
p,Ja� ro �au.0I-1 L, sal fr
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
iZ.EcOfc.DS,
Phone:
Date: 11 /13
2/4/20 1

Type of Visit: inzompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Cnoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1119 -=1I Arrival Time: Departure Time: County: T Region: W/Ra
Farm Name:—Cl..' " 00z Inn Owner Email:
F'
Owner Name:
r
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Dischar¢es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Phone:
Integrator:
Certification Number: f {l )
Certification Number:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? .
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
❑ Yes po
❑ Yes ❑ No
[]Yes ❑ No
❑ Yes [—]No
❑ Yes r] No
[:]Yes E!f No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 21412011 Continued

Facility Number: jDate of Ins ection: 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes FTNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
❑ 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?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
,_,(
I/
No
❑ NA
❑ NE
waste management or closure plan?
l�
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
7 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
I/�' 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?
tZ
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �j No ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VrNo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[—]Yes
No
❑ NA
❑ NE
❑ Yes
ri{ No
❑ NA
❑ NE
[—]Yes
;2`No
T[6No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes RrNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes R/ No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;Z 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes VrNo ❑ NA ❑ NE
[:]Yes ONo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

LFacih Number: Date of Inspection: 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ ,,--yy11,,'' Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PrNo ❑ 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
Y' No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
VrNo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�/
I n No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
T
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.
T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
OONo
❑ 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
P�rNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ETNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ONo
❑ NA ❑ NE
Comments (refer to question #I): 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).
`�"'�M`+�Y 1 !' N G�� ��
Vt
U�'✓�'1/�,
v eA
Reviewer/InspectorName:
Phone:���0� dpi
` v
Reviewer/Inspector Signature: V
Date:
Page 3 of 3 <j
21412011

Facili Number: Date of Inspection: / 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JZNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z'Ro
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PGA 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?
uer to question up r xpra n any r r b answers anaior any aunt,
of facility to better explain situations (use additional Daees as
La9bm'I)-\ 9p ,
1✓�er..� Can-�-�,e�,
❑NA ❑NE
❑ NA ❑ NE
❑ Yes p No ❑ NA ❑ NE
❑ Yes O'No [—].NA ❑ NE
❑ Yes /[Z No ❑ NA ❑ NE
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes [2rNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes VI -No
❑ Yes 0 No
ons or any other
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
1
Reviewer/InspectorName: �fn`�ty N ��, Phone:id
(vim p
Reviewer/Inspector Signature: ,�,r.,_ V'&N'S,_ Date:
Page 3 of 3 < 21412011

Type of Visit: ` Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: b�,Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: p ArrivalTimed Departure Time: ® CountyA'�4LIn/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: L_C..j (�`i �A U� S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wet.P.oultry
Design
Capacity
Current
Pop.
Design Current
Ca111 ttle Capacity Pop.
La er
Dai Cow
eeder
Non -La er
Dai Calf
Finish
Dai Heifer
KWeantoFinishinish
Wean
Feeder
Finish
D . P,oultr.
La ers
Design
Ga acit
Current
P,o ,
Cow
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
TurkeyPoults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes *o ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: 31 - Date of Inspection: S
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 o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:npN
Spillway?:
Designed Freeboard (in): i Cf. S
Observed Freeboard (in): �Yl y�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 9. Does any part of the waste management system other than the waste structures require ❑ Yes X No ❑ NA ❑ NE
maintenance or improvement? �
Waste Application ��((
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes II)(I No ❑ NA ❑ NE
maintenance or improvement? N
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, et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ EvidenceofWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): FL5 Cti� `\(
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WUP ❑Checklists Q Design Q Maps ❑ Lease Agreements
❑ Yes
❑ NA
❑ NE
YesjNo
No
❑ NA
❑ NE
❑YesNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
0 Waste Application Q Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ Vste Transfers
0 Rainfall ❑ Stocking ❑ glop Yield 0120 Minute Inspections ❑ Monthly and V RainfallInspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �"'"'"No
Page 2 of
❑ NA ❑ NE
Q Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facility gumber: ) - Date of Inspection: ��....,,((
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
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)
❑ NA ❑ NE
❑ NA ❑ NE
Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes ANo
❑ Yes *No
❑ Yes
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
1
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments., I
Use drawines of facility to better explain situations (use additional pages as necessary).
u (3q_A i I6N 1,kC odd ► r3
LouG�-r c� a� 90) a 3 C, CARD .k YU:7 w oos
� E"S
Reviewer/Inspector Name:
Reviewer/Inspector Signature,
Page 3 of 3
Phone:
Date: (yl�Jj OC
21412011

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: I$ -Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival
llTiTime �^ Departure Time: County: Region:
Farm Name: C L 4- :A 7"0N 1 JH V 1 S 1— A R m
Owner Name: C(_ R- A jinn Nl U I S
Mailing Address: 1,S /U CJA(Yj(jEQ(�/C/�
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
b")AC-C-ACc- %VC '04 I-lb(o
Onsite Representative: C.LA}N101V Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design C*urcent
Capacity Pop.
I
Wet Poucity
ltry
ILayer
Desigu
Capa
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
QQ
Dairy Heifer
Farrow to can
Farrow to Feeder
Farrow to Finish
D . I P,oulh.
Layers
Design
-a aci
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113cef Brood Cow
Other
NJ Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the Scat (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 04 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: 949 jDate of Inspection. S /
/f
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:
Spillway?:
Designed Freeboard (in): 19. S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�}
17�I No
❑ NA
❑ NE
waste management or closure plan?
74
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 structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) �,[
9. Does any part of the waste management system other than the waste structures require ❑ Yes I X I No ❑ NA ❑ NE
0' maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [*o ❑ 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): '_ lrSC"( CP J S C1 V�G� l C5)
13. Soil Type(s): /VO&tC>t,IL
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
VV
7❑No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
�,t,
IX I No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
? No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP ❑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 Q Weekly Freeboard ❑ Waste Analysis Q Soil Analysis ❑ baste Transfers Q Weather Code
Q Rainfall ❑ Stocking ❑ yrop Yield ❑ 120 Minute Inspections Q Monthly and V Rainfall Inspections
{{ Q 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 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: y Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? )Ayes ❑,e, No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ pal Yes No V
NA ❑ NE
Otherissues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
1
K I No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
J�_No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments _
Use drawings of facility to better explain situations (use additional pages as necessary). {
C.� Fi U gQ-�}Tl C�'V CAE o�1J,
w•A.
6e GoPL�dF �61 CILcPai' °-ej - cKp
�JMs �*oiC Ac-noE
15. N e E.D -1C.-) SPQa� �ocz w� EDS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: n'/�—��i�o , Scrl
Date: 5 l
21412011

(Type of Visit ,3-Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit -Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /Q Arrival Time: Departure Time: County: uW Region:
Farm Name: �� AC �TOId �AVIs 1-A2f�n Owner Email: n
Owner Name: CL A"TOA/ 1, A U I S Phone: 910 — of 2-5— ytiy (i
Mailing Address:
Physical Address:
ST
Facility Contact: /+ Title:
Onsite Representative: CLAkToM 'b AL A S
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = ,
a
D,`estgn Guirent '; l)essign Current ,' Design' Current
Swine
Capacity Populahon Y Wet Poultry Capac_ iTy P,opulanon ^::Cattle „Capacity Pdpalahon
❑ Wean to Finish
. ❑ La er ❑ Dairy Cow
,70 Wean to Feeder I „ ❑ Non -Layer 1 ❑ Dairy Calf
Feeder to Finish
qyyso'"" - _ '` _ - w ❑ Dairy Heifer
❑ Farrow to Wean
4 Dry Poultry ❑ D Cow
ElFarrow to Feeder
"`" ❑Non-Dai
:� ❑ Farrow to Finish
• ❑ Layers
❑ Beef Stocker
❑ Gilts.
❑ Non -Layers
❑ Beef Feeder
❑ Boars
= ❑ Pullets f'' ❑ Beef Brood Co
Other - `" ..
❑ Turkeys
` ❑ Turkey Poults
❑ Other;
.0
❑ Other Numberof,Structures
nz
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
XNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
Page I of 3 11128104 Continued

Facility Number: 3� — �t/
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less. than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: (460Cl
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Spillway?: p
Designed Freeboard (in): 1—I .5
Observed Freeboard (in): m�' 1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes XNo ElNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /,�.,(
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes IXl No ❑ NA ❑ NE
through a waste management or closure plan? T`
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) yyy���
9. Does any part of the waste management system other than the waste structures require ❑ Yes �pJ 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? t777��yC�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes qtt 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
12. Crop type(s)
Wiinndow ❑ E(viidencee of Wind Drift ❑ Application Outside of Area
SG
13.
Soil type(s) t!'-bcS SEi6Rt, Nog_FOC-
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
IT
Does the facility lack adequate acreage for land application?
❑ Yes
�C�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 iecommendationsor any, other comments
Use drawings of facility 'to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
Phone: /1D +9&::�
Reviewer/Inspector Signature:
Date: 5fl — b
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection i C
_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. 0 WUP ❑ Checklists El Design El Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
)4No
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑>&ual Certification
Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections El Monthly and 1"
Rain Inspections 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
4 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
KNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PkNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
ElNE
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
El
El 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
[INA
❑ 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
�l t�T►can/= o0t\
e'T oq-- '/dC_WZN1N *?,AI- w�R'Coo) S -cy_D g1Ms -V
11/18104

IType of Visit 3kcompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: ""t--`fK Arrival Time: ® Departure Time: County: 1�UT Region:
Farm Name: CLiaUION DRU1S Frahm Owner Email:
Owner Name: CLf�)UTUN ictU1S Phone: qAG'DEISC&yc{
Mailing Address:
Physical Address:
Facility Contact: [fin (Z.� Title:
Onsite Representative: leg -1 AUI S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: L__J o ET
F-1 " Longitude: [= o =, [� "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes A No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
_No
❑ NA
❑ NE
12128104 Continued

facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: IAGG t
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): JQ
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 XNo
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 1A No ❑ NA ❑ NE
❑ Yes JV 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 1A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o.No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ���ttt 9. Does any part of the waste management system other than the waste structures require ❑ Yes t7tl No ❑ NA El 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.) l\
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop WindowCC❑ Evidences( �oof Wind Drift [I Application Outside of Area
12. Croptype(s) GFSCt.J ECP) G \�F(LLP')
13. Soil type(s) c noo)5G3 r-G /ttoef-clu<
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes V No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? A Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
qNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
KNo
❑ NA
❑ NE ;
18. Is there a lack of properly operating waste application equipment? ❑Yes
ANo
❑ NA
❑ NE
„�C�o���e�+(refer to+qu��tion�t#) tdEzplam any YES,�answeis and/orany recommendations or any�ther comments. '
Usejdrawmgs�ofv'� fa ihty to}better�e plamsitu lions (use`,�addrhonal pages as n .Ir.� `. �" ' , 'e
1 HE SLtADGE SuR-ue CCUL% c-llcr i; o C1au(­-D 4SY- F09- 41V E>CmPrjaV
S(
--Fauc-To �l�l(i C ao� #-eOtt-T 5'6ACP1A6 //V A t�T�2
GETc�soF'oJ9<Z�lCCa�Lv�) %'�P'4Tw) (t+ �oaDg-c�co�31I11s d
61 C' Ac71 u
1n
Reviewer/inspectorName I t1) f7F} _ Phone: g� Y7iU�3
Reviewer/InspectorSignature: Date:
Page l of 3 I2/28104 Continued

�S-
`Facility Number: —099,Ql Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2&No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes )6.No ❑ NA ❑ NE
the appropirate box. 0 WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t�gNo ❑ NA ElNE
0 Waste Application El Weekly Freeboard 0 Waste Analysis El Soil Analysis Taste Transfers JJ❑/nnual Certification
El Rainfall ❑ Stocking Elyop Yield 0 120 Minute Inspections ❑ Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �kNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 19 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
XYes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ANo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P 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
91 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
Acc..,�
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
��N��o
&No
❑ NA
❑ NE
Additional Comments and/or Drawings:
L%g9,47,n W WAS �l ifc I Al I00g
3 VLE4SE CALIRVITE a%SEARV COP 7-0.
0�•>^ Amaevcx Gpmes F- - 7o:
NCDEA?_ o a- aff , AMartoa6mAo
5 all�m �Nj /VC Q QS 5/0 3 So -DOOL4
Lod ►. 9
pcgoSS FQ.orn PUMP ►aatsE /UF�6DS To Ge MGLAaeD
d WrcE� CC /WW-OL
lF LD 6G` u SA�6/00TONAT-') N T L -aiZ U t� 9UE TO
vJ I Sw-uz� * r61SCLks,
Page 3 of 3
12128104

Division of Water Quality II
FacHi Number �'� �
ty L..� � I-i d `� of I O Division of Soil and Water Conservation
O Other Agency
Type of Visit C f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: UN Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: C LAsA (i V�iw\s
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
ine Capacity <Populatim
Wean to Finish
Wean to Feeder
,Feeder to Finish
g 160
1 a g
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
her
Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = « Longitude: C
.;Design Cur
!oultry Capacity Papal
Dry Poultry
Design --
Cattle 'Capacity, .I
Mew
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
L__1 iwrtc a -'-
❑ Turkey Poults
' ❑ Other Number of Structures: x
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
(PtNo
❑ NA
❑ NE
12128104 Continued

Facility Number:% — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ 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(SEAL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
X 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
[XNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
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
ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�INo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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
�No
❑NA
❑NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
9No
❑ NA
❑ NE
OlNo
❑ 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):
(,crlS (L IN QE2tntti0l� Flit-� - E2�t AnJ� T
M000L COWS pN-rC) LT v
Gc,o0G�L
Reviewer/Inspector Name r ( Phone: &24
Reviewer/Inspector Signature: Date: S Q
Page 2 of 12128104 Continued

Facililf 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 ElYes (No ❑ NA ❑ NE
the appropriate box. ❑ WHIP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NfNo ❑ 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
allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ATNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
5�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
ElNA
ElNE
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
rrrttl���
py No
ElNA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
n No
El NA
El NE
Page 3 of 3 12128104

Type of visit QR Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit g Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1D Arrival Time: ® Departure Time: County: UAI Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [ --- 10 I -MI, I 1 Longitude: 71 0F_1' F7
Design C•unrent
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity
Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
JLJ Non -Layer I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
ElNon-Layers
❑Beef Feeder
❑ Boars
El Pullets
El Beef Brood Co
El Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
[]No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
jMo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes bg No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I' / Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I_AG OO ry
Spillway?:
Designed Freeboard (in): JQ, S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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
W 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
'09"No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
4No
❑ 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
9 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rV(WNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
p No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
.j No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
91 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
?Vi No
❑ NA
❑ NE
Reviewer/Inspector Name I LIMAnDA) N r,,_ S ( Phone:
Reviewer/Inspector Signature: �%• a 'V� Date:
Page 2 of 3 12128104 Continued

Facility Number: I — y Date of Inspection
Required Records & Documents aa��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other ��yy��
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 ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CKNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[PfNo
❑ 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
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
4 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
19No
❑ NA
❑ NE
fi�t�71iII

, � Division of Water Quality
Facility Number i� 0 Division of Soil and Water Conservation
0 Other Agency V,
Type of Visit P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 62 Arrival Time: : FJQ Departure Time: a' unty: Region:
/
Farm Name: CiLi4'/ % On� , ILOZ5 f'A-R111"t Owner Email:
Owner Name:! G/��%A/I CJfi f%1=S Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
,[//,,Phone No:`�
Integrator: / !<h/YI - v 7_>D
�R"
Certified Operator:
I����S
Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Back-up Certification Number:
Latitude: a o = ' = Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ 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 ` tC
Cattle Capacity -Pol
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: EZI
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 l4 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 1[J No ❑ NA El NE
❑ YesyNo ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection llZt 0�1
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?
Identifier -
Spillway?:
Spillway?:
Struclur� 1
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
❑ Yes No
❑ Ye ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes gNo ❑ NA ❑ NE
(ie/large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XJ 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? El Yes Y No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No El 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 ElYes /�1
No ❑ NA ❑ NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesXNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No El NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload El Frozen Ground El 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) v&w/ wo 1 �A,q �, Sr (/. CJ�l�fi? S,V_0 _ /i,5n�, -
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? ❑ Y n1 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] Yes j//,® J�'o ❑ NA ❑ NE
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./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):
Reviewer/Inspector Name Phone
Reviewer/Inspector Signature: __ _ Date: 62Anz AQ

r ,
Facility Number: — Date of Inspection 2 O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,,,....eNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists / ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .KNo ❑ 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?
Comments and/or
❑ Yes I���[IfffNo
El Yes /ICJ No
❑ Ye41NO
No
ElYe
[IYes ❑ No
❑ Yes E�No
El NA El NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
El NA El NE
❑ NA ❑ NE
❑ Yes
No
El NA
El NE
El Yes
,,�,,(((
I,,,__J,,J(((No
El NA
El NE
El Yes
/1X
J No
❑ NA
El NE
El Yes
No
❑ NA
❑ NE
ElYes
No
❑ NA
El NE
El Yes
YJNo
❑ NA
❑ NE
—SToP "0u•,1,� Lev so. 0 4��. / 3. = ��n,,v L c vc_L.
%��Vf JJ i unt 7 C— K�F_GLA� c�7'9P
ON � —
C��
023 c
12128104

Division of Water Quality - -
Facility Number Z O Division of Soil and Water Conservation
-- O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
iReasonforVisit 9rRoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access /��-7
7J
Date of Visit: // 49 Arrival T,ime: Departure Time: unty: p Region: t !C t/
Farm Name: % r�otJ p5/✓�- Owner Email:
Owner Name: /06 �//iidZS Phone: �� Zi6 - l q
Mailing Address:
"o tf -1269,
lt 2 9,1 tad
Physical Address:
Facility Contact: Title:
Onsite Representative: 42�a! N25
Certified Operator: C%
Back-up Operator:
Location of Farm:
No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = ,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes oNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
)xNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
12128104 Continued

CJ
_y
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /ie
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes YJ 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? El Yes /I[� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /1
9. Does any part of the waste management system other than the waste structures require ❑ Yes �[f No El 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? J
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �Q No ❑ NA ❑ NE
❑ Excessive Ponding El Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside c
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
ANo
❑NA
❑NE
❑ Yes
XNo
❑ NA
❑ NE
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?
No ❑ NA ❑ NE
No ❑ NA ❑ NE
❑Yes'[ZNo ❑NA ONE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):.
q�2;�-/0�0 �oac &X-10040r
r� ,ee-.o col Z'e,
rzlvue a (%a� Q•vS�•P,g��
VL/'7 S»n�Or C�/.ic�..5L
r� GzM�/ac
IReviewer/InspectorName (_OB l Phone. /u fo Z(o -1
Reviewer/Inspector Signature: Date: O6
Continued

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 appropriate box.
❑ WUP El Checklists ❑Design El Maps [I Other
❑ Yes !" No ❑ NA ❑ NE
❑ Yes to No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections_,/ ❑ Weather Code
Ac-
22. Did the facility fail to install and maintain a rain gauge? �s No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 91INo
o ❑ ❑ NA NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? JV Yes ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? VrYes ❑ 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 XNo ❑ 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
�I 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
VfNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
2� & 2s Nf.�,U SGu�t^.� 2 ✓may �a .9�ze/lq-rzo�
4,, fio-3�o-Z
p
"
Page 3 of 3 12128104

Type of Visit Qf Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit j0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: FJ Arrival Time: : Departure Time: f / County:
Farm Name: .4 ZO/ % F m Owner Email:
Owner Name: t/%1/l%S Phone: _
Mailing Address:
Physical Address:
Facility Contact Title:
Onsite Representative: �li/¢y7�"j S r¢1 Ar_ i
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: =o =' = Longitude: =o =, ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑.Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ©,'
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any partof 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
ONO
❑ NA
❑ NE
❑ Yes
YfNo
❑ NA
❑ NE
12128104 Continued

Facility Number: -� TZ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes /No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
- //-1
Spillway?: Nd
Designed Freeboard (in): r
Observed Freeboard (in): 3 %3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes l No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
,lam
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 4No
❑ 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 ONo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes )21 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 ❑ Application Outside of Area
//rlDrill
12. Crop type(s) _�L AX M40.4 / llRi4 ZF) . /t/✓— /
/�
1
13. Soil type(s) 2dGO`�d�O �a�fO�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,rNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
,BYes ❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[--] Yes ONo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes WrNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes Z No
❑ NA ❑ NE
Zi) &/460 f/4s /Po&- v111-j/gT- foe Flscw6 /xosY i�sA�o �9�✓l� "j Zrle
= /(o00.Go�i9i✓`va/✓��os 7 BF �rs�tr�,�G /'ht;J o,✓ FiS�u•� fr�J
04%q 0g-f o Y10 5&)Z- 4 o
p zL �%r%A7h2 �Q /xy�rc�Ic 5
Reviewer/Inspector Name A:�;,.,< Phone: ld- ZIa
Reviewer/Inspector Signature: Date: &-7�0
Continued

' FacilityNymber: Date of inspection / Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes rrryyy��� No El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Id No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ 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
XNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;ZNo
❑ 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
ElNA
ElNE
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�r
�r 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
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
%oNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
5�5P&0g ,5;�xtos /t&, 1 P2o&1Girte','%)r A114o a' ,wzeo�, NFFoEa
�N FEseaf '40 '&emuo,+ 6*51-02s, 6151emull+ t�ovF�i F_
j�i4Q.5E, / ��CcQ�J �ouco �%csd Y�,eoga9l3cy �E-J�Fz> �dM
` � �ftTzoN
pleQuCs 7A�✓.✓, S��fz�✓a �Dn
T7�/li �>.O. ��/rls �LE>7�) . �2 �P> �^/ �wrt� SE�✓7 �G>.�
12128104

- Ihviston of Water Quality
( Division of SoH`and Water Conservation
of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
(Reason for Visit ()'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 4 04 Time: �
0 Not Operational 0 Below Threshold
ermittedd Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above reshold
Farm Name: ..... __.l 1.F��..-y'JA�='S.—+�a,lJ...........................
County: _..........S1Ll��
Owner Name:
Mailing Address:
Phone No:
Facility Contact:..__._.__._._._......_..._..._..__.._...__._._...._._Title:Phone No:
Onsite Representative:._... T!� ✓.I — ... .......... . Integrator:..._.__.A _.
Certified Operator: .................... . . . ................ . ........ .. .......... .... Operator Certification Number: ............................... _.....
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �•
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Ca4o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EXNlo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......... _...... I ............... _ ............................. --.. ...................... ........ ... .......................
Freeboard (inches): %S
12112103 Continued

Fac`dity Number: — Z(4 2Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
6.
seepage, etc.)
Are there structures on -site which are not addressed and/or managed through a waste management or
properly
❑ Yes
ff
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
0'No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
_UNo
pNo
elevation markings?
Waste Application
10.
11.
Are there any buffers that need maintenance/improvement?
Is If box
❑ Yes
::0 ,
there evidence of over application? yes, check the appropriate below.
❑ Yes
LyN0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type �Swe (6�) fi69 NW (6-) SGd
i
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
NNo�o
b) Does the facility need a wettable acre determination?
❑ Yes
7�
2�1 o
c) This facility is pended for a wettable acre determination?
❑ Yes
o
15.
Does the receiving crop need improvement?
❑ Yes
�!
Jallo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
0<0
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
allo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
o
Air Quality representative immediately.
Comments (refer to gnestiou #) Explam any YES answers a"ud/o� any recominendattons ortauy other comments.
Use dramrrgs of fac0rty to better explam sitnahons (a a addrhonal pages as ecessary) ❑ Field Copy ❑ Final Notes
5,c_r_rn/& Fast-M. CFFT COPY.
F�S(,,u6 NiE�-h corJrR,a� s6wIE r.�EF.9 AR -ER,
Reviewer/Inspector Name —tom
Reviewer/Inspector Signature: Date: to 1014
12112103 1 lConGnaed

Fflcility Number: 3I —2-7Z Date of Inspection
Required Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
�
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑<
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ KO
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Ell
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
;,
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
p�40
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El[ Yes
rio
28.
Does facility require a follow-up visit by same agency?
❑ Yes
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
ETYes
❑ NNo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
R1` 9
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
Two
34.
Did the facility fail to calibrate waste application equipment?
❑ Ye
[NNo
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
We
❑ No
Stocking Form ❑ Crap Yield Form []Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit O Compliance Inspection O Operation Review G<agoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
O Time:
Facility Number Date of Visit: 2 Z
10 Not Operational 0 Below Threshold
0 Permitted 0 Certified Conditionally Certified [3Registered Date Last Operated o Above Th eshold:
Farm Name: N L /� /`�( M County:
Owner Name: L `C LlJ Phone No:
Mailing Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Certified Operator:
Location of Farm:
Phone No:
Operator Certification Number:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude 0
Design
Current
Design Current Design Gurrent
Swine Ga aciri
Eo uladon Poultry
Ga aciri P,o ulation Cattle Ca actri P,o ulation
❑ W n to Feeder
❑ La er
❑Dai
eedert to Finish
❑Non -La er
❑Non-Dai
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design C►►specify
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
=10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps
❑ No
Liquid Waste Mana ement System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — Z 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? ❑ 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? El 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 Aonlication
10. Are there any buffers that need maintenance/improvement? ❑ 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 (CAR'MP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
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/ WliP, checklists, design, maps. etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie% discharge. freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fait to discuss review,5nspection 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
I0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
_. Y—m®±,a+ [ ...
Comments'(refertogoesitoa''Eiplam.any.YESanswersand/oraoyreeomm difiii r.anvother.eomments,_`.-�"
Use drawings of facility to better explain situations (use addraonal pages as neees'ssary)
_. Field Co nv
Final.
_ ..._. .
Reviewer/In ectorName
sP �:;
Reviewer/Inspector Signature l,_ _ !J �_f Date % Z9e
05103101 Continued

Type of Visit J
Reason for Visit
Compliance Inspection 0 Operation Review '0 lagoon Evaluation
(rRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted 0 Cnertified 0 Con(diittionally Certified D Registered
Farm Name: b. LAB( �%�i "� .I ��()'LS A2M.
Owner Name: � :OLJ DkLx-S
Mailing Address:
Mrlmond
Date Last Operate r Above Threshold: _
County: ywz';"4
Phone No:
Facility Contact: �t Titlle::� hone No:
Onsite Representative: �/.7F.Z P-CF_ 00 R fE Integrator: * ra =O
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =. =- Longitude =• 0' 0`
Desigp,:- ;Current Destgn-Current _ Design Current _
Swine _Ca actty Pm ulation -Poultry , .�. Ca achy=Po ulahoa-"�= Cattle , ' .Cd acih =:Po'tilatma ,
Q Wean to Feeder ID Layer I Dairy
Feeder to Finish 'L; ❑ Non -Laver ❑ Non -Dairy j
Farrow to Wean
Farrow to Feeder . El Other w =
Q Farrow to Finish = `n —.
Total DestgnCapacth
❑Gilts
s
❑ Boars Total SSL W
'Nn`mber of Lagoons =-� -cam'= ❑ Subsurface Drains Present ❑ La o0o Ares ❑ S rav'Field Area
Hofdiag'Poads'/ Solid.Traps'` '„ ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lattoon ❑ 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 pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes �6No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
2fNo
❑ Yes
VNo
❑ Yes ;eNo
Structure 6
Identifier:
Freeboard (inches): 69
05103101 Continued

Facilih Number: 3/ -2 Date of Inspection I /N//L/lJ7J
(i(ie/
5.
Are there any immediate threats to the integrity of any of the structures observed? trees, severe erosion,
❑ Yes
�f No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
ONo
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
ONo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
O No
9.
Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ko
Waste Aoolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
PTNo
11.
Is there evidence of over application? Hy ulic Overload
❑ Ex ssive Ponding ❑ P /�
or?-8:
❑ es
VNo
12.
(A, D[❑
Crop typeyERi'�tltDAt �..}P, �iE telf: G�fi2f SrnAc�
J OJE.P�FF.-D)
13.
Do the receiving crops differ with those designated in &e kertified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
Ely� Yes
r�
No
b) Does the facility need a wettable acre determination?
❑ Yes
LA No
c) This facility is pended for a wettable acre determination?
Yes
V No
15.
Does the receiving crop need improvement?
,,,....❑////;;;;
A Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
V No
Reunited Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
INo
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
VNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
gNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
�No
23"
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VfNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
P�No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�fNo
10 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
. ( _ . - -Comments (refer to:quesdon #)•,=Explain aAy YES answers and/or aay recommendanons or,anv4ther comments._
lise drawing; of fac8ity-to better eYplam sdbatons. (ose addrtional pages as necessary) ❑Field Copv _ v _ _ z., - ❑Final Notes
lb' Dn1T 1�U -, ' 0 wo(ZI< . �FRMLq)pH npPla( vc-
6r- tANop D2c.cszr7G &(V-11-
'SPRnnuOR� rN -T"�F_ l-i:!NRc, VRP'C'�R�'
S(A0UL0 4L
FF�S P �rFT �E(� m'�loR 00dtW 4C,
�'7E2
Cott —z ON e T F
Reviewer/Inspector Name Fjl--_777 -- -
Reviewer/Inspector Signature: Date:
05103101
M
Continued

i
Facility Number: —2 2 Date of Inspection �o /
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 1 No
❑ Yes VJ No
❑ Yes / No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
Additional Comments _and/or :Drawings: _
15) 2Oe2 .SozL �sc �Poc�r p�CR9P�p TF-- F-Ep
L-m F`
I�) RRfEinns
FoR lr�F �� A(ZTzrJ� PRN I�R7� FoR 7 E
10 s� (� ko kc� F r cs c Q� �tj-��/ L �s rs I (p 0 �c�.
FOR ��-5cuE.
fEUE Fi:F_L_o5 VOK (S-vo,p,
0FL
O5103101

Type of Visa oCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Dale of Visit: (Z Time: y'.3
Facility Number
Permitted 0 Certified 0 Conditionally Certified ❑ Registered
C-'a ...
p� �Qv : !"A J i'"1
FarmName: .............................................._.........................................................................
�1 /4 r
Owner Name: ......................... `..r.....,y.7Dh..._�{.V..`._J........................_................
Facility Contact:
Title:
Date Last Operated or Above Threshold: ..
County:. pj�.........`................................_..._
Phone No:
Phone No:
MailingAddress: ................................................................................................................................................P........o........i...v...A....9../...�._.�..........Y...�....t.. ......_..................
Onsite Representative: .... Cl404 DAVv.1 Integrator:
.......................................................................................... ................................. _.._....... _.. Certified Operator: ................................................... ............................................................. Operator Certification Number: ...... ............ __._
Location of Farm:
wine ❑ PouRry ❑ Cattle ❑ Horse Latitude �' �' °' Longitude �' �•
Design Current
Design Current '_ gu C#rrenf:.
Swore,._ : = Capacity Po ulation
Poultry
CapaiityPopulation Caere capacity Populationn •:
❑ Wean to Feeder
❑Layer
❑ Dairy
Feeder to Finish Z
❑ Non -Layer
Non -Dairy
❑ Farrow to Wean
Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Capacity
Gilts
;: ❑ Boars
Total SSLW
Number of L Subsurface Draient U Lagoon Area U 5
La oons suns PresSpray 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?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......... ......................................................................................................................
Freeboard (inches):
5100
❑ Yes p"No
❑ Yes P1eNo
40
❑ Yes
h
❑ Yes ONo
❑ Yes ONo
[I Yes �IJo
❑ Ye�No
Structure 6
Continued on back

Facility Nurn 3 / —2 Date of Inspection '( !� LT •
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,6No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes j 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,)eNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 7No
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? ❑ YesZfNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes AfrNo
12. Crop type F�5('treRolure,DDer~46 Pastore, frra�j��`e!^Ove--seed
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes 8'N0
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?
❑ ❑ No
�Yes
15. Does the receiving crop need improvement?
)i "es ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes ONo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes )2rNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ YesNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes EfNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes_'RfNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes prqo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ YesXNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 1l0
24. Does facility require a follow-up visit by same agency? ❑ Yes �dNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes -.no
iQ•yiglh(itjtjs;oi ilgfjcpejtsie$wgreilpfedditriitgt. is:vpsit;-yoowill•Seb¢ivei.0f1 "ht.
eorresp6 ideitce: abotif this visit: :::::::::::::::::::::::::::::::::: :
0. Explain an;
1 S. wo,- fo i,.-% re v¢ S-r4yw Of berm v4 iy berr•t vdq 1 eld S and el;ntth2le
ho716 ce tv4 �eye444,'ah• %Gl ere, ;f R Sood ceyoic Ascve i�-fllt
.tl,e se, vt.-Cie Idf .
19• -Ttterc ;s I85 ibs�Aere PAN q!lotrgMCe on zQC(-2ts (a' cesvUe)b< f
IvA-j3c il,+n kites 1(o4J G!k-tvt.5e -7t-Rle-jVJ -ID 160 .
Oire^1V.)-4nc,'01 ;s well kefI-
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ Date: /2 ® S/po

` Facility Number:, —;2qZ Date of Inspection -
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes &No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0'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.) ❑ YesXNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Ye 0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

Division of Water Quality
O ivision of Soil and Water Conservation
Q Other Agency - -
Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for VisitRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: -time: � Printed on: 7/21/2000
C Not Operational Q Below Threshold
Permitted
0 Certified
Conditionally Certified 0 Registered
Date Last Operated or Above Threshold: ..
Farm Name:
�G
County: ........ 1t
Owner Name:
Facility Contact:
Title:
Phone No:
Phone No:
MailingAddress:...........�.......{................................................................... .................................................................................................................. ..........................
Onsite Representative: 1._.l..1.r..4r.. .... ..._ L�......................... Integrator: _D6C�1.I,-a slr...................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
[]Swine []Poultry []Cattle []Horse Latitude 0• =, =.. Longitude =- =' ="
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑Layer ❑ Dairy
Feeder to Finish d 10 Non -Layer I 1[]Non-Dairyl
Farrow to Wean
❑ Farrow to Feeder Other
Farrow
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag—n Area 10 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?
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 dischargc is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Idcntifier:............................................................................................................................................................................
Freeboard (inches): elcl
1
5100
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes N�No
❑ Yes N(No
❑ Yes [(No
Structure 6
Continued on back

Facility Number: " 1 — Date of Inspection Printed on: 7/21/2000
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
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
DdNo
(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
JXNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
��,,,,
bNo
elevation markings?
❑
Waste application
10.
Are there any buffers that need maintenance/improvement'?
❑ Yes
No
11.
Is there evidenc of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12.
Crop type 12 j TG
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
XNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
((No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
VYes
❑ No
16.
Is there a lack of adequate waste application equipment?
- N'Yes
❑ No
Required Records & Document~
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
1KNo
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
4 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
NrNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
brNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes .DjrNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes IoNo
24. Does facility require a follow-up visit by same agency'? ❑ Yes VNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
0' �Vo yibl'atititis:or deficiencies were noted dirripg this:visit: You ...
i,eceive no further
correspondence: about this :visit:::....::.. .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
V25Q. 5�� Qve,-s ee�\ i (� t1,
r2 G✓"fS � ttiK. �- �L�c. c✓ t--6'�, q/ p �/ � /
Reviewer/Inspector Name (^ U— 3 (7 3 l QQ ✓�' 0�'6
Reviewer/InspectorSignature: Date: 5100

Facility NumDate of l nspection Q 0 Printed on: 7/21/2000
OdorYssues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below
KYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
I \No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
roads, building structure, and/or public property)
\\
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
P(No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
INo
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
f (No
5100

Of Soil.
of WaI
Facility Number
Date of Inspection
Time of Inspection
0 Permitted VKertified 0 Conditionally Certified [3 Registered Not O eral
Farm Name: `.41..J�.F.................................................................. County:
Owner Name:
Facility Contact:
Title:
Phone No:
L I l VO 124 hr. (hh:mm)
Date Last Operated: ..............
U
Phone No:
MailingAddress: ........................................ ............................................................................
Onsite Representative:.
................................................................................... ..........................
.
Integrator:..........
............................................................................
...t"�u
...........................................................
Certified Operator: ................................................... ................................................
m ............ Operator Certification Number:..........................................
Location of Farm:
Latitude =• =1 =1 Longitude =• =1 =11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9No
Discharge originated at: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ZNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway - ❑ Yes R(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 .Structure 6
Identifier:
Freeboard(inches): ............rJ:...l....................................................................................................................... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? fie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
3/23/99 Continued on back

M
Facility Number: —a-tl �— Date inspection
of
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
XNo
(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
[XNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
IvNo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
(kNo
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
kNo
11.
Is there evidence of ove application? ❑ Excessive Ponding ❑ PAN
❑ Yes
„(No
12.
Crop type hb id rq
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
-0No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
,N NO
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
CYes
❑ No
16.
Is there a lack of adequate waste application equipment?
9Yes
❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
TV(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.)
4 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
J�-No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
A No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
XNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
gNo
......lafitir.. . (t. . . .. . . .were....... iitgthis:visit; Yoit..11-feoeiyeIi6further•;.:.
cori•esnondence: a�oliti this
a<
� tv,V-,e 5;- f f��e� sec �e� Si�� A
Reviewer/Inspeetor Name
Reviewer/Inspector Signature:
Date:
3/23/99

Facility Number: 3 `— � i}_.
v _
Odor Issues
Date of Inspection
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoonor 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 gNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes IRNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) _ ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes '�TNo
'Additional Comments -and/or Drawings
—1x u�0.✓-�' \jYGI`+E,r— IS
a'�e
3/23/99

Division (if Soil. and Water,Conservation -Operation eview
-,r r Q Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality- Compliance Inspection
[3 Other Agency- Operation Review-
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Z Date oI' Inspection
Time of Inspection ,' Z 24 hr. (hh:mm)
13 Permitted Certified 13 Conditionally Certified ❑ Registered JE3 Not Operational Date Last Operated:
FarmName: iA'/Lt...t�...}CL...............-'ii�/..5................................................_ Coun[v:...7/J:_N...................................................
Owner Name: ........aJ...! `.. �_ Iq rz.\5....................................... 5��% ....... �t�. %...................................
q-. . ........................ ..... Phone No:.............
FacilitvContact: ...t !9.Gc3-_' 7................... AvLj.....Title:....-�.✓f1.,...A........................ Phone No:
Mailing Address:
.....J/,�....... AL... .r. ..,?..fir...�..emcf� ........... ........:........... ........,...................................
Onsite Representative: ..J.1/! !L<...L....... �Q-q......._nV
JCi�!! Integrator:II•�:.............................................................
Certified Operator:..........n.................................- Operator Certification Number:..........................................
Location of Farm:
Latitude 0.010.. - Longitude =• =' 0.1
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Feeder to Finish J❑ Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ( J❑ Subsurface Drains Present JJLJ Lagoon Area JU Spray Field Area
Holding Ponds/ Solid Traps F 7 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. 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 nun -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 gal/min?
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 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
[]Yes 0 No
❑ Yes ® No
❑ Yes [2 No
❑ Yes
Z No
❑ Yes
(KNo
❑ Yes
Q No
❑ Yes
® No
Structure 6
Freeboard (inches): .........2-A..................
1 /6/99 Continued on back

Facility Number: 3 — Zc. f 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? ❑ Yes R. 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? ARI Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes R1 No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes Q No
Waste ADolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes Fe] No
11. Is there evidence of over application'? ❑ Ponding ❑ Nitrogen {1� El Yes Q No
12. Crop type `LS...L... 5^:�-.......lgx G .......................................................... Q�....t.........................................!"I./ ...........................................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Qg No
14. Does the facility lack wettable acreage for land application? (footprint) t tJ, q
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?
No.vi0a,dons-or. deficiencies .were noted during ttiis visit:. You w.ill.receive. no further . -.
• pQrrespbtidei►ee: ab6fif this visit.......:.....:.....:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.
Eg Yes
❑ No
❑ Yes
®'No
❑ Yes
® No
❑ Yes
ifNo
❑ Yes
® No
❑ Yes
[TNo
❑ Yes
® No
❑ Yes
29 No
❑ Yes
® No
[a Yes
[I 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):;
/• (het %ATts 0?fPN.'" a" I3irr�acds
Cu..0 Llt�,....-+�.-:-1 `tom C.o.•u,, -NvvS*�5 /t,u-C Pg?,Ksr•zan'� �yrbas -�a Jic%s
ih Ft9✓w�,�uM kJ�,cc(L, .daps .:. St'o� �«t0-ry to 5'�.�•/�-1 r� 3�sP
5-esP-s" &Oilys ALc�sS � eti.�srz GaG,ovyt- wt�s �sf
� c.e,.�rnl�, w.A. �•&� cn I�.�,f�.,e, w:t,l a�•p.-�.� �• �Ly,�r.�.,•rsF��...
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 3 S/ 11/6/99

1 si ns
Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
l% Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
ate of Inspection
Facility Number a D�� Time of Inspection 24 hr. (hh:mm)
D Registered O Certified I$ Applied for Permit [3Permitted [3 Not Operational Date Last Operated:
..........................
FarmName: _ 1� ...._ t�!�t3...............:.......................................................... County:.............�'..�._�..........1....`......./ ........ .......................
Owner Name:...... YcS Phone No: ,<<! - ..5.- 1 1............
.......... ........ .....
FacilityContact: ........................�.....l...--....................................\.............. Title(:..................................................................`. Phone No:...................................................
Mailing Address:.A.`.l�.........& Ct.... �.�= \� :..........�s \ c.t..`�C.......�TL(C6..................................
.........`...'................................................................
Onsite Representative:....6:_Se............................................. Integrator:......._? ......................................
Certified Operator:............................................................................................................... Operator Certification Number:.........................................
Latitude "*",1 11 Longitude "0 1 1, "1,
' Design -=;Current; -Design `,aGarrent 'Design Curnnt
Swme, z , Capacatv(Population Poultry Capacity Population' Cattle : Capacity,Population'
❑ Wean to Feeder ID Layer I ❑ Dairy I,t,..
Feeder [o Finish y ❑Non -Layer 10Non-Dairy
❑ Farrow to Wean
❑ Other
z c
❑ Farrow to Feeder _
❑ Farrow to Finish Totai Design Capactq f,
❑ Gilts m
10Boars Total SSI W "
�t Nt tuber of Lagoons J Holdutg Ponds ❑Subsurface Drains Present ❑Lagoon Area I[] Spray Feld Area -''
�y b ❑ No Liquid Waste Management System �l
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
2. Is any discharge observed from any part of the operation?
❑ Yes
P(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
0 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
19 No
c. If discharge is observed, what is the estimated flow in gal/min?
R
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
%No
3. Is there evidence of past discharge from any part of the operation?
xYes
[1 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
allo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
(XYes
❑ No
. mai menance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
W No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
Ky No
7/25/97

Facility N4mWf:3— a
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons.Holdine Ponds. Flush Pits, etc.
❑ Yes LnLNo
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
MNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier. .............................................................................................................................................................................................
Freeboard(ft):............ 3.q............. .................................... ................................... ............................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
MNO
It.
Is erosion, or any other threats to the integrity of any of the structures observed?
X Yes
❑ No•
12.
Do any of the structures need maimenance/improvement?
N 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
XNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
%No
(If in excess q�WMP, o runoff entering waters of the State, notify DWQ)
15.
Crop type..\�V...f..�........... wd..L.................................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
ONo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
� No
18.
Does the receiving crop need improvement?
%Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
UNo
20.
Does facility require a follow-up visit by same agency?
Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
"No
22.
Does record keeping need improvement?
XYes
❑ 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
N No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RN
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
RNo
E3N.o vitilatioitsor deficiencies. were noted during this.visit. You.will receive nti ftirt6er
. . _ ..
• ;
correspQddepce abouf this:visit:::::::.: • : ; •
Vve-'ow.s - - CL l rc5T) i6-2
C__�11 'fit a1� LA:,"
,{1—�ct llt-(-��� 't s e� 't�es3 `t` f� .�`-e t�1• d e�� cs e�e.� Jet. (—
Ap L'
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: I,- Date:

^
I
JW
3
N'
Y9
M
\-

❑ Division of Soil and Water Conservation ❑ Other Agency
ELDivision of Water Quality
10rRoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other 1
Date of Inspection
Facility Number 31 2
11 [Time of Inspection 24 hr. (hh:mm)
0 Registered LICertified 13 Applied for Permit 13 Permitted [3 Not Operational I Date Last Operated: ..........................
Farm Name- ....[,.a,-6..tn.... .tl. Mu A.......r4 _C..r �-................................. County:..�.�..�.�...x�................................lAil..� 1�..
Owner Name: ........... .(✓�.�-y 9.x.._ .... .l1.nt.i............................................. Phutte No:....�..�.A.�J-12.9.,5.. y_y._y..........................
FacilityContact:.......... .................................................................... Title:................................................................ Phone No:...................................................
Mailing Address: .... .1.15...... tW. mw'. w..e... ....A..,r.........S1................................. ... P(............................ .24_16.1..
Onsite Representative:.....j�zsi-tt.1^:.......M!..L.S.............................................. Integrator:.....YB.W.a!s:..i.....................................................
Certified Operator;
Location of Farm:
0
Operator Certification Number; ......................... _..............
Latitude Q• =' =" Longitude =• 0' ="
z Design `: :Current
Design' 'Current -': Design Cn-
Swine. Capacity Population
Poultry _. Capacity _Population .Cattle .. ;,Capacity Poptilafio_n z
-
❑Layer ❑Dairy
❑ Non -Layer -' ❑ Non-Dairy
f _
❑ Other
Total Design"Capacity.;
Total SSLW
Number of Lag000ns / Holding Ponds,
0 ,!$Subsurface Drains Present ❑ Lagoon Area Spray Field Area
- r.0
it
- `, ❑ No Liquid Waste Management System Y
ta+
i
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in-aVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
® Yes ❑ No
❑Yes ®"No
❑ Yes ®No
❑ Yes
®No
❑ Yes
JR No
❑ Yes
®No
❑ Yes
KNo
❑ Yes ($ NO
❑ Yes KNO
❑ Yes p,N0
Continued on back

Facility Number:3) — Zy
8. Are there lasoons or storage ponds on site which need to be properly closed?
Structures (Lattoons.tloldine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier: 1. JQ.
Freeboard (ft):
❑ Yes 19 No
■ � r
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
KNo
91 Yes
❑ No
KLYes
❑ No
i
❑ Yes
H No
0�=Iwo
15. Crop type .... t-e.ri.c.u.:e. .............................. b.4i.?v.u.r'p........................ ..Sx!w-a-.l�........q.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 1R No
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Out G
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violtitionsor deficiencies.were doted during this.visit. You.wiU receive tto ftirther.
correspondence about this visit.,'
❑ Yes allo
® Yes ❑ No
❑Yes RNo
❑ Yes lid No
❑ Yes [KNo
-Yes ❑ No
❑ Yes 1f No
❑ Yes N No
❑Yes t8-No
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Reviewer/Inspector Signature:
Date:

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