310249_INSPECTIONS_20171231

NUH I H CAROLIN
Department of Environmental Qual
W)

(Type of Visit: O Co ance 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 O Denied Access
Date of Visit: 1 Arrival Time: 9 D Departure Time: / ?— County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: c. Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity op.
DairyCow
ean to Feeder
]Non -Layer
DairyCalf
Feeder to Finish 0S
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. + P,oult . + Ca aci + P,o P.
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turke s
Turke Points
Other
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 Ef No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes mo❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

r
Facility Number: - 2 Date of Inspection: f
Waste Collection & Treatment
4. Isstorage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑'No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑4o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment reat, notify DW R
7. Do any of the structures need maintenance or improvement? ❑Yes ] ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 04011—❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q N ❑ 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
—
I ,YNO ❑ NA
❑ NE
acres determination?
777
17. Does the facility lack adequate acreage for land application?
❑ Yes
E 'x ❑ 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 N9 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA P readily available? If yes, check Yes �° ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists esign ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ij No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

U
Facility Number: -7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑-Ilro�❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E >� NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
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
EJAX6_�[_] NA
❑ NE
❑ Yes
to ^❑ NA
❑ NE
❑ Yes
EJ-5-o ❑ NA
❑ NE
❑ Yes Dlq_o_�❑ NA ❑ NE
❑ Yes ❑'%o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
4,0
ZJ - t-Vao/X IA-e5;1#\ ' ��c9Tds,f-
631'(Y tj n�- J&•dL-e k/"• o Scnd Cnri hobo-/E
Reviewer/Inspector Name: a , e'l Phone: ,fl o %Q U-6Y
Reviewer/Inspector Signature: �* �.. Date: ft Irrk
Page 3 of 3 2/4/2015

Visit: O'Compliance Inspection U Operation Review U Structure Evaluation V Technical Assistance
for Visit: -CrRoutine O Comolaint O Follow-up O Referral O Emergency O Other O Denied Access'
Date of Visit: /�I a ��G Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: p / / Title:
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: 12774
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
I
INon-Layer
I
Da' Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oul
La ers
Design
Ca aci +
Current
P,o .
Da Heifer
D Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J
I A No
777""
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes9No
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Ye
❑ 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
16 No
❑ NA
❑ NE
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 gNo
No ❑ NA ❑ NE
Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: i/ - V dI I Date of Inspection: /,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes %f No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 7No ❑ NA ❑ NE
S I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): oG (l
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ili 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
lii No
❑ NA
❑ NE
waste management or closure plan?
j"
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
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?
ev
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement? 11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 4 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
1� No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
En No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [—]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [Af No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: p c
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I nl 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 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?
r0 A
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[—]Yes V No
❑ I ,I Yes No
❑ Yes Tj /I ,,,I���,/// No
❑ Yes No
❑ Yes W No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes V No ❑ NA ❑ NE
❑ Yes
[ANo
❑ NA
❑ NE
YesNo
gNo
❑ NA
❑ NE
Yes
❑ NA
❑ NE
ons or any othercottimentsi`
f �irn� IleWfyJ_ Ak6�rcioO/C
Phone: ,&Z
Date:
21412015

Type of Visit: jQeCo7pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 9 Ifoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /oA//ti'I Arrival Time: Departure Time: County: a , j tyt Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: ��� Integrator: M ��
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
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?
Certification Number:
Certification Number:
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?
Longitude:
❑ Yes �o
❑ NA
❑ NE
❑ Yes EfNo
❑ NA
❑ NE
❑ Yes ,ETNo
❑ NA
❑ NE
❑ Yes �o
❑ Yes jj�No
❑ Yes 0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4 Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
❑ Yes
Ea'No ❑ NA ❑ NE
Ej`No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Z 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 EfNo
❑ 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 J2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes L�'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
❑ NA
❑ NE
maintenance or improvement?
JE2'No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes -ffNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes La'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) ,
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes J�rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �ffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes �ETNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2,N'o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes EgrWo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes P No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes _[M
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J[24110 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes,, ] No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes .,d No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: 3 1.- Date of Inspection: �}
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [aoNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [fNo ❑ 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?
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?
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes Iallo ❑ NA ❑ NE
[—]Yes [;7 No ❑ NA ❑ NE
❑ Yes [;2-No ❑ NA ❑ NE
[-]Yes
Wo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
FNo
❑ NA
❑ NE
Comments (refer to question ff): 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).
I P:arrr, k- re- LarJS
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
S
tzoV. C�)QC)G
11 car
Phone:
Date: /d
21412014

Type of Visit: Q-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Z Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I 161;ZVIIVJ
/Arrrival Time: /U. Q/i Departure Time: County: �/ Region: LJ%/Z
,t Farm Name: Lr /(f - 7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: "a4 4 , Integrator:
o �
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine CapacityWet
Wean to Finish
Poultry
]Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
I) , P,oult .
Layers
Design
Ca aci +
Current
P,o P.
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullers
Beef Brood Cow
Other
01 Other I I
—TurkeyPoults
Turkeys
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other.
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page I of 21412014 Continued

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

Facili Number: 7 1p1 Date of Inspection: of
24. Did the facility fail to calibrate waste application equipment as required by the permi . [—]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 to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�(I
�/bo1/��
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9JQ/ ff 732
Date: //0 zq
1412014

Type of Visit: S
Reason for Visit:
Date of Visit: LL
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
O Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
Arrival Time:Departure Time: County: Region: _L.&A67
/rr, /l — -/ Owner Email:
Onsite Representative:����
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: f�/Q
Certification Number:
Certification Number:
Longitude:
Design Gu
Swine Capacity Pop.
Wean to Finish
Wet Wall ry
11 iLayer
I INon-Layer
=Design
Capacity
I I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)r.'+ P,aultr.
Layers
Design
Ca aci_
Current
P,o ,
I
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [:]NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili -Number. Date of [ns ection:
Waste Collection & Treatment
4. Isstorage 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
Struu ture 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
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 ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
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 ❑ No
❑ Yes [-]No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili •-Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the perm/ ? ❑ 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 to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Otherlssues
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
❑ 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
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better
explain
�— expllainsituations (use additionalpages
as necessary).
Uussar, `-Ltb e dla" a
- l2 r/ / 3 71 ate - a J CIA
C2 113112 O y
GZ re CG�oP-S IGd�C �oa�
i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 6
Date: /
21411201111

IType of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 1/U//O//1-1 Arrival Time:
Farm Name: K/M T /A//yLi /t_
Owner Name:
Mailing Address:
Physical Address:
Departure Time: County:
Facility Contact: Title:
Onsite Representative:�&&�i1
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:_
Operator Certification Number:
Back-up Certification Number:
Region: 4.k'
Location of Farm: Latitude: =n =, =" Longitude: =o =, ="
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes fil'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 D WQ)
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 4No ❑ NA ❑ NE
❑ Yes ,b No ❑ NA ❑ NE
❑ Yes O'No []NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes . `No ❑ NA ❑ NE
Page 1 of 3 12/2&04 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
dNo
❑ NA
❑ NE
Struchye 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
in 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
ONo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
I �l No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
r
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Aoplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes )�fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes JE!fNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yesf No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes y I No ❑ NA ❑ NE
acres determination? /�
17. Does the facility lack adequate acreage for land application?
❑ Yes DlNo
❑ 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 ,,,r----,,,,!!!!
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes J2'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes eNo
❑ NA
❑ NE
Page 2 of
21412011 Condnued

�Facilitsy Number: Date of Inspection:
z4. Did the facility fail to calibrate waste application equipment as required by the permi 7 ❑ Yes 9-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)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NA ❑ NE
❑NA ❑NE
❑ YesoffNo
❑ NA
❑ NE
❑ Yes /ETNo
❑ NA
❑ NE
❑ Yes ;21No
❑ NA
❑ NE
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes�No ❑ NA ❑ NE
❑ Yes �2' ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V I N o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes /— N ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
p• G D r J a^ �7 Me,
046 cxr'flr'�
l� S�
Phone:
Date:
21412011

Type of Visit: �bmpfancc Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: . e Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:
Departure Time: County
Farm Name: lwe­ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: yyt
Az
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
wine Capacity Pop:
h
Wet Poultry
La er
Design
Capacity,
Curren[
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
rHFK7arr0wtoFeedcr
er
Non -La er
Da' Calf
sh
Da Heifer
an
der
Farrow to Finish
-
D , P, - it .
Layers
Design
Ca aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turke Points
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ErNo
❑ Yes [—]No
[-]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ,❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Z No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �' o ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number:
Date of Inspection:
Waste'Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VT ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �!r`No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q
Observed Freeboard (in): `J6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo
❑ 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 do
❑ 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 �rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
❑ NA
❑ NE
/21'No
maintenance or improvement?
Waste Application �/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I iI No
❑ NA
❑ NE
maintenance or improvement? !`"'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes N o
❑ 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 needimprovement?
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?
Reunited Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
[:]Yes C No ❑ NA ❑ NE
❑ Yes%No ❑ NA ❑ NE
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes �No
❑ Yes ,No
❑ Yes No
❑ Yes �ErNo
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yeseoo&
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dN
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �N
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

rl?aciliNumber: Date of Inspection, 6VeW
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JfNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes KNo
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?
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)
El Yes 0No
❑ Yes No
❑ Yes /No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes 0No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
7777"'������
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
I/y///
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or,any other comments. -
Use drawings of facility to better explain situations (use additional pages as necessary).
��/j/ d . l7 • /�—-�c.,.� �;�r-l-pcs l h j �.(� 2�l � c--�l� r.2
71--1 Of /1 Gti43% a/r/y'(/S
le sceca -46 coo Abe Euwe::�
-(�c ao Ll
TiFron, (- ,re-ccrds look 50001
.
ReviewerQnspector Name: I d /,J Phone:
Reviewer/Inspector Signature: Date: &I-_;f111
Page 3 of 3 12142011

s .Mtvtston of Water Quality.
Facility-Number;O;Dtvtston of Soil and Water Conservation
. q Other Agency_
Type of Visit 7C701mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: — Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 1-3"d,4 Integrator: rn0�
Certified Operator: (_j Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = , a Longitude: = o = ,
Resign - Current
y;
Design
,Current „ -Design Curr o
- Swme • ^ •- , - Capacity -Population `
Wet -Poultry-
Capacity
Population "Cattle `_' ._ � Capactty_ Populati'o
'-
❑ Wean to Finish:
❑ Laver
I ❑ Dairy Cow
El Wean to Feeder
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
-;
Z. , • z El Dairy Heifer
r;Y ❑ Farrow to Wean
K
Dry Poultry
El Dry Cow
El Farrow to Feeder
"`
` ❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
` El Beef Stocker
Gilts
- ElNon-Layers
ElBeef Feeder
❑Boars
El Pallets
❑ Beef Brood Cow
❑ Turkeys
Ot_.her .❑Turke Points
.
...
1 ❑ Other
�• ❑Other
;""Numbei of,Structurea::
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 qNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes XNo
❑ Yes �No
❑ NA
❑ NE
❑ Yes � No
❑ NA
❑ NE
Page I of 3
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 PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes p 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 U"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
[I NA El NE
8.
Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
TrNo
�No
[INA ❑ 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
VfNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
R�No
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
VNo
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes'p No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes [�No
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes /VNo
❑ 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 [;lo
❑ 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):, a
Reviewer/Inspector Name.
Phone: � —
Reviewer/Inspector Signature:
Date:El
Page 2 of 3 121628104 Continued

•Facility Number. —,2 Date of Inspection ZA-yv
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
J3 No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis PrSoil 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
PNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
id the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
ElNA
❑ NE
@'Didthe facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
F(No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes PNo
❑ Yes 'P"No
❑ Yes ZNo
❑ Yes XNo
❑ Yes t p No
El NA El NE
❑ NA ❑ NE
❑NA El NE
❑NA El NE
❑ NA ❑ NE
Page 3 of 3 12128104

J
(Type of Visit Wompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit 0❑ Routine O Complaint O Follow up O Referral Q Emergency 0 Other Denied Access
Date of Visit: L.N�-I Arrival Time: / y Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title':
Onsite Representative: ,`J ) L _ L%-1 'AQkAS 7U / v
Certified Operator: 1`LZA L(A I�A)
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: L7O�` F7„ Longitude: n o n n
Design Current
Design Current
Design Current
Swine Capacity Popula_tio_n
Wet Poultt Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑ Non -La er I I
Dai Calf
(,Feeder to Finish
_4(ob
❑ Dai Heifer
❑ Farrow to Wean
Poultry
D Cow
❑ Farrow to Feederers
❑ Farrow to Finish
-La ersets❑Beef
TO
Feeder
❑ Gilts
❑ Boars
❑ Beef Brood Coe
s
Other
❑ Other
Number of Structures:
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 O.No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 0,No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — y 9 Date of Inspection S 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?
Structure I Structure 2 Structure 3 Structure 4
Identifier: L AGoCwN
Spillway?:
Designed Freeboard (in): 19. S
Observed Freeboard (in): �) q-
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 oNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
J4 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 X No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes i�t No ❑ NA El NE
maintenance/improvement? ,
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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
A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
K No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
M No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
A No
❑ NA
❑ NE
Reviewer/Inspector Name 1 Phone: `'t Q " a`i(r -I S of -{
Reviewer/InspectorSignature: , Date: S!I �D�Q�
Page 2 of 3 12128104 Continued

lre � •.
Facility Number: Date of Inspection iD 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 19No ❑ 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 ❑ Desig
n [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes No
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,��
ILF No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
���ttt
E No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q�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
WNo
❑ 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
CSNo
❑ NA
❑ NE
Page 3 of 3 12128104

j Facility Number: % — Date of Inspection
Waste Collection && Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes }`'' No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes VfNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ETNo ❑ 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 ❑'Flo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo ❑ 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 )�TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ElNA [INE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PFNo ❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes /ffNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
QNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
PrNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
EiNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
R!fNo
❑ NA
❑ NE
IComments (refer to question #): 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):
7 ,64 _
lid %H YoGe Jeco.� S�G�
�•-, �2�-ice% = -
Reviewer/Inspector Name /C al1/11 / ice /� �� Phone: 71cf— fX,T
Reviewer/Inspector Signature: L/ ��7 �' Date:
121.

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Z�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 9Yes ❑ No ❑ NA ❑ NE
❑ Waste Application fjWeekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections PlMonthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a min gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
94 or
12128104

Type of Visit Od'ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit
> . utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access y�
Date of Visit: /� /;7Q/(J/n� Arrival Time: !Q. Departure Time: County: �%L Region:
Farm Name: ;ArGt /i'YI Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 2 yn /1 / %?G Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Back-up Certification Number:
Latitude: El0 0 [7 Longitude: [----]0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
d
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
I
❑ Dairy Heifer
-
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes OI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
ZN0
❑ NA
❑ NE
12128104 Continued

1
Facility Number: —,2 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: l
Spillway?:
Designed Freeboard (in): �—
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Q-No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,EFNo ❑ 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 10-No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes -E"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
,O"No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
.eNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[-] Yes
,o No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
jEfNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
IReviewer/Inspector Name �, ^ 1f,,111,og fG ✓� _ Phone:
Reviewer/Inspector Signature: ��. .fZ_ ` Date: / , D 06
12/2 04 Continued

Facility Number: Date of Inspection
Rego„ired,Ri!cords & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? E]Yesl,,g No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check _aYes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists�Design ❑ Maps ❑ 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 ❑ 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 ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes []NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes �TNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes e ElNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes B'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ffNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes PIo
❑ 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 P�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 0-No
El NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
^�..,_o
[It-`V Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes qNo
❑ NA
❑ NE
jMctitioriaLComm- ents and/or,Drawings:
aoJ CA C_Gf� ©-(!2 [GL.My-1 deslSh 5UMYk(gC j
5} t - o o vx- s0 � �-e coied S
- 77ov►skr lee1 c/ "e'-ecolcOs
12128104

of Visit CyCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (i'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: g g O rime:
O Not Operational Q Below Threshold
Pfeirmitte!,,�rtified [3Conditionally CertifieeddJ 13Registered Nate Last Operated or Above Threshold: - —
FarmName: --� .� _-_- County:1�
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: ------ Phone No:
Onsite Representative: Integrator
Certified Operator. Operator Certification Num r:
Location of Farm:
[Swine Poultry ❑ Cattle ❑ Horse Latitude =• =` =- Longitude =• =' =-
m to Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes '.UIQb
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Jallo
❑ Yes E314o
❑ Yes -014o
Structure 6
12112103 Continued

Fecility Number: . a Date of Inspection O D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
- seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
�B'go
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes C�No
8. Does any part of the waste management system other than waste structures requiremaintenance/improvement?
❑ Yes _01(to
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes . 3to
elevation markings?
Waste Application
10. Are there any buffers that need maintenanceltmprovement?
❑ Yes -0fio
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes r I No
7
❑ Excessive ❑ PAN H/yd/r%atilic Overload ❑Frozen Ground ❑l Copper and/or Zinc
:onding
,❑,
12. Crop type �er�'f��CltL��
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes AZrNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes [3-Ao
b) Does the facility need a wettable acre determination?
❑ Yes ,01Qo
c) This facility is pended for a wettable acre determination?
❑ Yes - Ro
15. Does the receiving crop need improvement?
❑ Yes 014o
16. Is there a lack of adequate waste application equipment?
❑ Yes E jto
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below
[]yes krgo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes 0-No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes `01Vo
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
❑ YesLj5No
Air Quality representative immediately.
COID!lpeat5 ([ugaeshonEt4tam,�atry 9IId/Or aoyr871tOOS.0I8Not)a_!
U�_drawtngs a[fsaltty��'� �;to betteratpiam�s,toataons. (ose addtbonal,pagcs as ne�ry)_ ❑Field Copy ❑Final Notes �,
A.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number:
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Ye'10o
❑ Yes J:3-Ko
❑ Yes �o
❑ Yes '�C3Qo
❑ Yes �3Qo
,2�les ❑ No
❑ Yes 2'14o
❑ Yes 9214o
❑ Yes 0'ko
❑ Yes ,0'go
❑ Yes .0-110
0 No violations or deficiencies were noted during this visit You will receive uo further correspondence about this visit.
AddiddnidiCdhiniffiW i�= _- — ry
'_�:a—...s z,..._. ,,..�..-—=,.r
A.
� T
Kr7 ( 1.0 T
if /S/ e- P 7-
/CO 7-
!� ! 7
�l Qs2 lime- c��ca l
12112103

Of
Type of Visit 95 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 95 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit:
Permitted E3 Certified [3 Conditionally Certified 0 Registered
Farm Name: K2 E49M5 �— nT
Owner Name: i G( Pi-=(_% la —
Mailing Address:
Facility Contact: Title:
/l.��
Onsite Representative: mil_ ) to DD�
Certified Operator:
Location of Farm:
'rime:
Date Last Operat or Above Threshold: _
County: Z
Phone No:
/�P`h�o�ne No:
Integrator: r � w1�P1�t� .
Operator Certification Number:
Swine ❑ Poultry
❑ Cattle ❑ Horse Latitude =*
=,
0- Longitude =' 01 =11
Design Current
Design
Current Design Current
Swine
Capacity Po ulation Poultry
Capacity
Po ulation Cattle Ca achy Po ulation
❑ Wean to Feeder
❑ Layer
❑ Dai
Feeder to Finish
❑ Non -Layer I
I JLJ Non -Dairy
Farrow to Wean
❑ Other
❑ Farrow to Feeder
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
rl n,.-
Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Discharges & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Stmcmre 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
El,_f
Yes VJ No
Structure 6
Continued

Facility Number: Date of Inspection I T/ 1.51 E711
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?
El Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
1/J No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic verload
❑ Yes
VNo
12.
Crop type F rN I , R AY _ rl1 RLL d-Ar+2-d �t/ r21i5Fr'
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management P n (CAWMP)?
❑ Yes
;eNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
XYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
IS.
Does the receiving crop need improvement?
❑ Yes
ZNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Ld No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
ElYes
/
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[A/No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
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 fail to discuss review/inspection with on -site representative?
❑ Yes
o
24.
Does facility require a follow-up visit by same agency?
❑ Yes
TTT�No
IIIIIX�����
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
'Comments refer toques *on � eEaplain any YES answers and/or any reco`uamei dations or any other comments: ri-.k -' '
Use drawl of facility to be'tt ezplarn�sitoa ons (use additional pages as necessary): ❑
l• q:. Field Copy Final Notes
i
12_AWRfkr U,+, S S 4�FE BEzNC�_ G-a4�2-eD,
6
TTa
14b)rATQ�E AES OF_-76Ry-zNN-r_rO) tr ►vF_-D%O
�1}�tC*A�NSoF
NeeSio WPve,-e Ur-tg21TADN PLAN DtJ IT , .70 R ems
A
QSE43 Otj .TIQRsRouat� MAP 5 (0U>zNc.- %E LDC&70_pri OF i/y
Aoo FZR-Lp C W)AS rDtI '5 DF U
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date:
05103101 T Continued
l

Facility Number: — Date of Inspection i Yf/___tom 5� pLl
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
❑ Yes ❑ No
❑ Yes I[J No
❑Yes LdNo
El Yes / No
❑ Yes No
El Yes No
❑ Yes ❑ No
:Additional Comments and/or Drawings: I k " a, I
17) C P,"oj
Fro 5 7o- 8e ` owe&
No ° �UERV Tlf�W� EI-5E Ynl�f(CFILF_nJ
6 Ft'-?, rr �(p P- FZ E-,D 5. / Uc/ 17 L- /N� ��/f—S��i✓5
05103101

Division of Water Quality-
0 Division of Soil and Water Conservation \
0 Other Agency
Type of Visit gCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit XRoutine O Complaint O Follow up O Emergency Notification O Other. ❑ Denied Access
Facility Number ra Date of Visit: LJ J v _J Time: Emo Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
Permitted ❑ Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ........................
Farm Name: K? �t"1�..................................................................... county:......'.1................................................
..........................................
Owner Name:
Facility Contact:
Mailing Address:
Title:
Phone No:
Phone No:
Onsite Representative:.._......................................................................... Integrator:......._.:..^"
...............................................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Current
SPoultry Capacity Population
aeiPo ulatioCattle -
Capacity Population
Wean to Feeder ❑Layer ❑ Dairy
eerier to Finish - ❑ Non -Layer ❑Non -Dairy
_YI Farrow to Wean
Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total SSLW
umber of Lagoons Subsurface Drains Present Lagonn Area ❑ Spray Field Area
Ponds / Solid Tr
aps taps. No Liquid Waste Management System
utscnarees of atream tmaact5
1. Is any discharge observed from any part of the operation? ❑ Yes jXNo
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
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes [2(No
Structure 5 Structure 6
Identifier: .......................
Freeboard (inches):
5100
Continued on back

f
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
)krNo
seepage, etc.) -
-
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
I
closure plan?
❑ Yes
lha�f No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
,KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
ONo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
elevation markings?
❑
ErNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
WNo
11. Is there eviden of over application? ❑ Excessive Ponding [I PAN [I Hydraulic Overload
❑ Yes
CYNo
12. Crop type 5-9
1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo .
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
WYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
1*0
16. Is there a lack of adequate waste application equipment?
❑ Yes
WNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
-
(ie/ WUP, checklists, design, maps, etc.)
((No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
;IZNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
PNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
5dNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
JWNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JR(No
24. Does facility require a follow-up visit by same agency?
[]Yes
W"No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes.
JKNo
IP - --,-,.". igti-.- -d$- - - —c-.- were - - --�StQiitg- - -..�- - • - - will•Se... Rio....gr-:-:
corresuorideit& about this :::::::::: :
Reviewer/Inspector Name;'" aY'+Sc a .::. „ - a.r.._.:-�.2*•.>-..
Reviewer/Inspector Signature: 4 Date: P- q \M 5100

r
Facility Number: —aG�, Date of tnspcction`yJ Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? - ❑ Yes 1KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4 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 W&O
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Ulo
5100

36 Division of Water Quality.
x
0 Division of Soil and Water Conservation'
0 Other Agency
Type of Visit J19 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 1$I Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: lI 00 'rime: (Z ' y5 Printed on: 10/26/2000
3) Z
0 Not Operational 0 Below Threshold
]� Permitted 0 Certified E3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: .. r'tr+'+-•j /�-9 ............................. County:..!14......!.!1.......................................................
............................................................................................
OwnerName :......... Z'.r..g....k'_nj......................................................................... Phone No:.......................................................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: ... tJ.. r✓1�....................................................._.. Integrator: _mv��� �'" ^'tl
..................... .........!'9..............................................
Certified Operator: ................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Twine ❑ Poultry ❑ Cattle ❑ Horse t I I I I ' ""--sl-- "` ' ' ' ' ' '
Design Current
Swine Canneity Pt nnlation
❑ Wean to Feeder
Feeder to Finish
Zgg�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps
Design Current Design Current
Poultry Capacity Po ulation Cattle Capacity Population
❑ Layer ❑Dairy
ION n-Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Area I❑ Spray Field Area
Discharges & Stream Impacati
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. li discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............�...jI................... ........... ....... ....... ........... ................................... .................. ...... ............ ........ ....... ........ ......
Freeboard (inches): 79
5100
❑ Yes 0 No
[]Yes ly No
❑ Yes $No
h /q
❑ Yes 0 No
❑ Yes 0 No
❑ Yes 26 No
[]Yes )9 No
Structure 6
Continued on back

Facility NumbeDate of Inspection /Z 0 Printed on: 10/26/2000
5.. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes JgNo
seepage, etc.
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 2�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
V1No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
UYes
❑ No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
19'No
Waste Application
10.
Are there any buffers that need maintenance/improvement? -
❑ Yes
ONo
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
JgNo
12.
Crop type ee rie-kVda qe' St-N P 6'- t • e)
13.
Do the receiving crops differ with those design ted in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
'B'No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
[]No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
:9 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
'PNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
21 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
�E] No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
X Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J�TNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Zf No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONo
24. Does facility require a follow-up visit by same agency? ❑ Yes ZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,1!1 No
M6lati6tis:oi: il¢ficie'ncles were it6fed during ibis:visit-' • You m i11-i eegiye fie: rui Cher -
. - . - corres ondeitce. altotif this :visit: - : • : • : • : • :
Comments'(refer to question #):- Explain any YES answers and/or any recommendations c r any_other comments '-.
Use drawings of facility to better explain situations.. (use additional pages as necessary):--
$. Ieerq�r _�®A�s B� 1�toGt•sC'J,
Iq, Meeal ¢o hake pas) -fevebvn�A rezerdf Use Waste
cq.1a1Ysif ota�a,4 W(a -r zsFapPl;cq-�t�Oh-iNe Sl?jE, 2'J.
Use Y+'ol�e✓ bell 't'l-) �i1N 41111t.1Itvic for` 1 w-,.ste pla^ -'>' �Pk- Z/1•
Reviewer/Inspector Name
Reviewer/Inspector Signature: 6 /J 71�/,/�, Date: /t/11/00 5100

Facility Number. '3 —Z-q Dale of Inspection IZ 1 DQ Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below )4Yes []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 ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
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 JO 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 jfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes FrNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes e3 No
lAdditional Comments and/or Drawings;
No4e= Afrl );Vvwe 44 J,5�dhs/o,c.Q o►Zq/1 f2v//SAC&O, ;h
rebrvA-1 ZDO1..
No4e' Crowe✓ ^sreo\yo -6y *Lie oW -4)e SPvIIs 4:ki �1
26 �re5� wkS�e play, shown >to}�I of I`I aces, J
-r4o 1 fd 1;e ih a eem¢vt�.
h16� e; L✓ , s4v 101Ah l ; s�s of Sel ayn6ev — MoVe►r"ber w,'n4oW
on �,ttall �fain.Ivlves};gale a yvo,re -(Icy:ble W,'VVAol,✓
beaoay 1A Vt.
5100

{
Division of Soil and Water' Conservation -'Operation Review: _
.0 Division of Soil and Water_Conservation - Compliance Inspection - - _
.-0Division of WaterQuahty =:Compliance Inspection
Other Agency - Operation Review
Routine Q Complaint O Follow-up of DWQ inspection Q Follow -tip of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection � 24 hr. (hh:mm)
Permitted EX Certified Q Conditionally Certified 0 Registered 0 N'ot O erational Date Last Operated:
FarmName: ........ .. 1 . LGi lmi............/1........t................................................ County:..............1..,, liliPl.l{�............................0.4 .........
Owner Name: ..•.,�.` Phone No:
���...a�.......................
Facility Contact: ........ .JF1't.• .....�.� ....�% !/R'...Title:...........�Y1/J��.......................... Phone No:..................................................
I% J)....�y
Mailing Address: .l.�.LL...... LC��/�l�£��..,/�/RY.... ..- �.�. ........................... ............... /k:C:� f....✓�'�(,,.,r..............--AP221el f
Onsite Representative:....4.......... l4�((............\J................................. Integrator:........./.......
Certified Operator: .................................1.......................................................................... Operator Certification Number:..........................................
Location of Farm:
Latitude Longitude =• =' =-
Design Current
,me
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
'.Design' Current
-- Capacity Population Cattle '
❑ Other
Total Design Capacity
Total-SSLW
Design _Current_
y:.
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding,Ponds / Solid Traps ❑ No Liquid Waste Management System
IS
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated ae ❑ 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/thin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Ye 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 VNo
Structure I Structure 2 Structure 3 Structure 4 Structurc'5 Structure 6
Identifier:
Freeboard(inches): ....................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Date of Inspection
"� f
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes]
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
dl No
J�
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
WO
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
3XNo
12.
Crop type � . S / � ya 7 {d
13.
Do the receiving crops fifer wit t designate n the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
� No
14.
a) Does the facility lack adequate acreage for land application? (
❑ Yes
// No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
0 No
15.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required
Records & Documents
IT
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
19.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
El
V No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
krNo
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
O'No
{Vo A6 atiocis:ok. deficiencies were nofed• ditriitg tbis:visit.- • Yop will•i'epeiye do further-
ctiriespondeitce: about this visit:
Comments (refer to�question #): -Explain any-YYES answers and/or'any.r`ecommendations or any other comments "
_. _ , _..
Use drawrn-abetter additiona'paesahece,ttssary)_..T-:-
,S�rA/! (.riAiil q'�'vSCCd /J %/I ��Jnrrn.Yy °�— ��a .I�,o�.,� iJt �7t�2�5 • �
�)I Gto°+� So-1 �tlys%s
Reviewer/Inspector Name
Reviewer/Inspector Signal
Date: zz-AG ll;
/.vl/� / C/�G� �gS . 39� •�!�d�S- 3/23/99

j Facility Number: — Date of Inspection
Odor Issues
/I
1A�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?
❑ Yes
� No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
gNo
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
iNo
Allh -. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
J],Ycs�-Aid^
3/23/99

Division of Soit and Water Conservation 40 Other Agency
Division of Water Quality sRA
Facility Number ®--- I Date of Inspection
_• Time of Inspection E= 24 hr. (hh:mm)
0 Registered 0 Certified 0 Applied for Permit APermitted 10 Not Operational Date Last Operated:
FarmName:......5-1 3....... `.....I......................................................... County:.........C. ��.\.!'_� . ....................................................
Owner Name: ... !a:��,.,,\ Phone No:.......5_«I'�` ���.' 3 613
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address:.... ......................... j\ . .
Onsite Representative:...,Sx..._`........_................................_.................... Integrator: ......1.:..1....;I.""..!�L........................................
Certified Operator:............................................................................................................... Operator Certification Number .........................................
Location of Farm:
....... ........ :.. s.,iL..}.... ........`.:.e.?-............ ........ ......... .........-......r......_�``.:`.�.5........ ......... sR ��
......................
. �...�.,e�....�c........ ,..�x a-t:�....1_s....ot-._...r..x..r�........ ....Q....1....'�...2..p�„�......................3�,........................................................... .
Latitude =•='=11 Longitude =•='="
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
2. Is any discharge observed from any part of the operation?
❑ Yes
(4 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
14 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Y`e'sA
14 No
c. If discharge is observed, what is the estimated Flow in gaUmin?
1�[i
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
(Co No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
51 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
ONo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
El Yes
�W
t No
7/25/97
(/

iz
.: Faeility Number:.3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 4 No
Structures (La2oons.HoldiniPonds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes to No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:................................................................................................................................................................................
...................................
Freeboard(n).............. .L:�................................................. ................................... ............ _...................... ....................................
... ........ I........................
10.
Is seepage observed from any of the structures?
❑ Yes
K' No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
)( No
12.
Do any of the structures need maintenancetimprovement?
❑ 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
tdNo
Waste Application
14.
Is there physical evidence of over application?
[I Yes
ry
igNo
(If in excess ofWNW, or runoff entering waters of the State, notify DWQ)
15.
Crop type ....1�.".1t.... r5........................................................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
PfNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
I(No
18. Does the receiving crop need improvement? ❑ Yes No
19. Is there a lack of available waste application equipment? ❑ Yes qNo
20. Does facility require a follow-up visit by same agency? ❑ Yes (fNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes INNo
22.
Does record keeping need improvement?
Oyes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No ap
[3.
No.vi6litions of deficiencies:werenoteddui.ing this:visit. You:win receiveitti ftiritier :
-
correspondence ..............
7/25/97

.ion Review ;
on Site Inspection
® Routine O Comnlaint O Follow-up of DWQ inspection O Follow'-uo of DSR`C review O Other
Date of Inspection 5 1
Facility Number 31 2
Time of Inspection 15 : 15 Use 24 hr. time
Farm Status a rZ t Total Time (in hours) Spent onReview
or Inspection (includes travel and processing)
Farm Name: t n ` �c� r w —__ _ County:
J
Owner tiame:.
Mailing Address: r I r -- -•— �y-•-
OnsiteRepresentative:--EuL-L +� _ _._ Integrator:
Certified Operator. �1�� —._ Operator Certification Number: _.a Z 4 ....__
Location of Farm:
Tn.V-P- Ea i + SS'i on T tN
Laver
I I =_; lu Beef I
❑ Other Type of Livestock
General
1. Are there any buffers that need maintenance/improvemeht?
2. Is any discharge observed from any part of the operation?
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 gaLlmia?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Is there evidence of past discharge from any part of the operation?
4. Was 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
rr=intenanc-- r.^.crovemenr?
❑ Yes
&No
❑ Yes
® No
❑ Yes
El No
❑ Yes
® No
IJ
A
❑ Yes
® No
❑ Yes
SNo
❑ Yes
® No
0 Yes
❑ No

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)?
❑ Yes 1$\0
❑ Yes S No
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon I Lagoon 2 Lagoon 3
3.�
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 structires lack adquate markers to identify start and stop pumping le -"es?
R'aste ADDliCation
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type k a c ktAd ... t� _
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land applicarion?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment? For Certified Facilities Onlv
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way'.
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Iaspector fail to discuss review/inspection with owner or operator in chage?
❑ Yes K-No
❑ Yes MNo
Lagoon 4
❑ Yes ®tio
9 Yes ❑tio
❑ Yes ®No
❑ Yes ® No
❑ Yes &Fo
®yes ❑tio
❑ Yes 10 No
❑ Yes 0 tio
❑ Yes ® No
® Yes ❑ No
❑ Yes 9 No
❑ Yes IRNo
CAmm tS (IC er to gnCSttonrirr) liiplam any �Y S anSR eZS 2nd/or ally Ie ommbeadanons o mil* y other co* mme-16:
Iff a diawmes offacnitdto better:e lainsittiatibns:= use additional a es as necessary v °
% r CeL f'o Le,
4
I, C.- �.J ^ 14 J C ✓� W 0. 1 1 r t�Al CO �G 2. ✓' i,J 'i ' l�, l P- C�4 \ W� v.� cyL 1 @
ZL. ""V-t SVrt Ck41 T Leh NJvnb h CVI� R�i vJ 0.S tcZ
1wi�l
(
YrIF yr 0-ye Yin Or( C1Cl �n LrreS -t-�e t0. Vi YY•°N IC
Lto
I J
rZ �oJ�d.S.
Zi °t °J� SeAdeL r�Q ^iedt k bL i C.or�ernfecl. to cwir.n�
w eA l
J •J J
ii
Reviewer/Inspector Name{D�� ' Cr -i�tt rrit'
Reviwertinspector Signature: 0\-_ r Q,... 2.� Date: Z q 1
rv,..... n..,.r.... c..,..:,,.. F. M� ' AVC'Vr;;PIIt Grier I :!I3,19b

JUL-14-1995 15:22 FROM DEM WATER. QUALITY S9'_TION TO WIR.O P.92i92
Site Requires Immediatc Attention:
• DIVISION OF ENVIRONMENTAL MANAGEMENT Facility
No.—�
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:> 1995
Time:
Farm Name/Ownt
Mailing Address:
County:
Integrator. All
On Site Representative: _
Physical AddresVLocation:
Phone:
Phone:a—
!`%�iC
Type of Operation: Swine %� Poultry ` Cattle _
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:.� t_ a oyU " Longitude: 7- 5 -' a
�" Elevation: Feet
Circle Yes or No _
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
• (approximately 1 Foot + 7 inches)o5� No Actual Freeboard: _Ft.
hes
Was any seepage observed from the lagoon(s)? Yes or Vas any erosion observeA'esr No
Is adequate land available for spray? Yes or No ! Is the cover crop adequate? Yes
Crop(s) being utilized: c-te,pr�
Does the facility meet SCS miniamm setback criteria? 200 Feet from Dwellings Yes r No
100 Feet from Wells? e. o
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ot�1O
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system,. or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied.
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: `yll'-'vuc bS;C,, ,,�
s;
ltit e
•
Inspector
cc: Facility Assessment Unit
Use Attachments if Needed.

07;;18/95 16:27 %29102962122 USDA NRCS
rfA
•
•
Site Requires Immediate Attention
Facility Number: 31q
SITE VISITATION RECORD
DATE: -7- / 3 1995
Owner: Cra:,,&—k i = - -- Fart Name:
County: ,
Agent Visiting site:. im S'u a a Phone: 2l d- Z 96 - Z t 2 (
Operator:
On Site Representative:
Physical Address: Ol
Mailing Address:
Type of Operation: Swine ,/
Design Capacity: -L8 SO
Phone:
Phone:
Poultry _ Cattle
Number of Animals on Site: gB�
Latitude: o " Longitude: o
Type of Inspection: Ground V Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot+ 7 inches es r No Actual Freeboard: 2 Feet S Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes oras there erosion of the dam?: Yes or(SD
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments- c/a /
Fax to [phone]
SignatLWd Agent