310253_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

[Type of Visit: QfCom . nce 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: 'I ') Arrival Time: Departure Time: County:
Farm Name: r (:�K Q-o'v Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone:
Onsite Representative: 4!^ f l0 R&C t ^ n integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Swine
Wean to Finish
Desigu Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
IDairyCalf
Feeder to Finish
Farrow to Wean
a
DUV P,oult ,
I Layers
Design
Ca aci
I
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
Turkeys
Turkey Poults
Other
Eil
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ NA
KNo
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
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)
❑ YesNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation? -
❑ Yes
NA
PNo
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued

r' Facility Number: 31 - 2 Date of Inspection: 4 Z I J —/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ZeNo NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
o ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
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 rest, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 ZNoO_]
NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): !;P d
t /"r s, 0-t S M ) r-A t ✓L.
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�ZNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N ❑ 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
f� ❑ 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
d❑ 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 16No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfeps__.0 Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectiotr/</o0O
udge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 1 - S Date ofinspection: 2-/3
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�(//
[3 NA
❑ NE .
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
50>0NA
❑ 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•simations (use additional pages as necessary).
Si- Kok/ ?_ ZZ-��
Reviewer/Inspector Name:
Reviewer/Inspector Signature: t3e� 54-W 7;ytjz Y
Page 3 of 3
Phone: CI I q ? cj / q 2.o0
Date: 12 —(3 — /
21412015

Type of Visit: (} Co ance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: h Arrival Time: Departure Time: County: FL>(/PL Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Q "d Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: 1 -7 L-.2-1
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)ry P.oultr,
Layers
Design
Ca �aci_
Current
P,o
D Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
lather
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes ❑ o
❑ Yes
❑ T
Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: ^ Da[e of Ins ectioo:
Waste Collection & Treatment
Fg. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
&No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
�No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
No
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E3
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2 /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 El
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNoNA
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
�/*,_
❑ Yes e o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and N Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �" ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of ins ection:44
n 13 /
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes L N ❑ NA ❑ NE
21 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 o ❑ 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 CAW W?
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 , jNo ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
[—]Yes
No
❑ Yes
I.J N
❑ Yes
❑ Yes
LJ '� )
ET No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or -any additional recommendations or other comments: =
Use drawines of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date: it

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: QrRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: WiEl
Arrival Time:
Departure Time: County:
Farm Name: y
Owner Email:
Owner Name: Phone:
Mailing Address: `1-
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Region: V
Integrator: Z
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oul
Layers
Design
Ca nacit
Curren[
P,o .
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [-]No
❑ Yes [INo
❑ Yes ZpNo
❑NA ❑NE
❑ NA' ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: Date of Inspection: -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )?!r 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 PTNo ❑ 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 P -No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes Pno ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ���```
9. Does any part of the waste management system other than the waste structures require ❑ Yes ' No ❑ NA ❑ NE
maintenance or improvement? r
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes I�'No ❑ NA ❑ NE
maintenance or improvement? j�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes f'TNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ZFNo ❑ NA ❑ NE
[—]Yes No
❑ Yes [� No
❑ Yes J]'No
[:]Yes ;2No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes T:?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 dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes [;�'No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

lFacili Number: Date of Inspection
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E f'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes U `Io ❑ 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?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ,0 No
❑ Yes 1 n No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes CXNo ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes VTNo ❑ NA ❑ NE
❑ Yes
O'No
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
[:]Yes
O'No
❑ NA
❑ NE
Phone: 1, �a-3Cjl —0)��
Date: 4 V_aA - I S
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 195)$/ja Arrival Time:® Departure Time: /® County: I Y.(. 4L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: Jnl 1 Q(J 'L�, C\U Integrator_ (�
Certified Operator: I & ROLASJTQr/ Certification Number: �� pr QJ
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D +P,oul .+
Layers
Design
/!a Bel
Current
P,o P.
DairyHeifer
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes )No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes o
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment tzo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
aoa
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes �' \ No ❑ NA ❑ NE
❑ Yes �Xj 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 I ❑ 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 A 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 a Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from th so designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes o
ElYes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Q WUP ❑Checklists Q Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes t
❑ NA ❑ NE
0 Waste Application Q Weekly Freeboard ❑Waste Analysis 0 Soil Analysis ❑ste T ❑Weather Code
0 Rainfall [:]Stocking ❑ Crop Yield 0120 Minute Inspections Q Monthly and I" 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 INo ❑ NA ❑ NE
Page 2 of 21412011 Continued

Faciliq Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
�(
❑ Yes r[I 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 IyNo ❑ 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?
�0
❑ Yes ,No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
r
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)
3 1. 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?
�j
❑ Yes IXI 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 UNo ❑ 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).
lv-A
31-�13�1
SSE
aOl a
CAu�AT pN bU�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: / )0'
Date: 513 I oc
21412011

Inspection U Operation Review U Structure
Reason for Visit: 99kRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / 1 Arrival Time: ® Departure Time: County: I J�'W'6/ Region:
Farm Name: t2.1 (J� �1,V) / �/- I (W �—
Owner Name: JONA IHAIV 112. i (2RLJu /Aow
Mailing Address: I g tp /AJC NwLk (�t' III J
Physical Address:
Facility Contact:
Title:
i7 4 1 NN
t Onsite Representative: (t1 ! I , \ 1
Certified Operator: �a>iLL.\ �� . �` aLLs 7<2)7-,1
Back-up Operator:
Location of Farm:
Owner Email:
Phone: 9/6 -099—"-�qa to
Phone:
integrator:
'03'Certification Number:
Certification Number:
Latitude: Longitude:
1-4 as 1
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
O
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oult , +
Layers
Design
Ca aci +
or eat
P,o ,
D Cow
Non -Da
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Pouets
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 XNo ❑ 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 21412011 Continued

[Facility Number: Date of Inspection: 409411
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
TC?
l t. 5
0-71
Structure 3 Structure 4
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?
❑ NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 1� No ❑ NA ❑ NE
❑ Yes V 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 d�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 Q�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): .5(,- (H)
13. Soil Type(s): LLkc
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 t4 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.
777^""CCC
QWUP ❑Checklists ❑Design Q Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )0 No ❑ NA ❑ NE
❑ Waste Application Q Weekly Freeboard Q Waste Analysis ❑ Soil Analysis ❑Paste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking 0 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 21412011 Continued

Facility Number: -j ( - S Date of Inspection: (p
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA ❑ NE
25. Is the facility out of compliance with pemut conditions related to sludge? If yes, check
❑ Yes No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
�y
❑ Yes 17�1 No
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 777❑] No
y❑]
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 0 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 ij 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 jaEo ❑ 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).
w. A-
'_0'las 11( i . c9
T!W �l"Z- ao�S
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 'T16 3�1
Date: cqm
21412011

Type of visit 0Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit Y Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: /_ Departure Time: County: uN Region:
Farm Name: t21 [fie 4f: UA Wn/ F-7(4Q-M Owner Email: n
Owner Name: �ONATNAN 1 R-tep QUINN Phone: 9�o�R8'39a(O
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: El LL I'NN
Certified Operator: ��tla IIptTSfCY/
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
92'c� �aa�
Operator Certification Number:
Back-up Certification Number:
Latitude: = = = Longitude: [� e
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish7
10 Layer 1
❑ Dairy Cow
❑ Wean to Feeder I
JLJ Non -Layer I
❑ Dairy Calf
Feeder to Finish JOY90 I
❑ Dairy Heifer
❑ Farrow to Wean
Dn_v Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
El Farrow
Layers
❑Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �] No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
12128104 Continued

Facility Number: 3�j —,953 Date of Inspection
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ElNA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (4 now I Q
Spillway?: p
Designed Freeboard (in): /. S
Observed Freeboard (in): Wig_
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
p(3 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
\(((
6.
Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
'\
If any
of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental notify DWQ
7.
Do any of the structures need maintenance or improvement?
❑ Yes
(((threat,
❑ NA
El NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
El Yes
,,,,�����No
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 p{J No ❑ NA ❑ NE
maintenance/improvement? /���\///
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes Il No El NA El NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) ✓\
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) S
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes,
No [I NA
9
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�C,t�
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
`Comments (refer to question tI): Explain any YES answers and/or any'recommendati"onsror any'otler Comm n[s ,
Use drawings of facility to better explain situations. (use additional pages as necessary): x
w tt _ w
VJ 1
/.60
yas/o9 t y
Reviewer/Inspector Name
Phone:
Reviewer/inspector Signature:
Date: L i N ho
Page 2 of 3 12128104 Continued

FaFility Number: 3) p S� Date of Inspection LII
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes 'KNo ❑ NA ❑ NE
the appropriate box. El WUP ❑ Checklists Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes OCJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Xle%ste Transfers \03t Ainual Certification
Or
El Rainfall ❑ Stocking 0 Crop Yield El 120 Minute Inspections El Monthly and I" Rain Inspections /� Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes] No
❑ Yes No
❑ Yes No
❑ Yes X No
❑ Yes XNo
❑ Yes )�'No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
ptr No
,%No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes C[,, No ❑ NA ❑ NE
El Yes d] No ❑ NA ❑ NE
[]Yes {QNo ❑ NA ❑ NE
lAddifional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit XRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ),S Arrival Time: � Departure Time: County: t-J /V Region:
Farm Name: QulNlJ PALM Owner Email,:,,, r1
Owner Name: YJN�if}-TEl/�%11 'l _t� C (C41/11* Phone: C%/ybr%8'S37c to XO'ST4
Mailing Address: 1$510 Ne NwK L4) I 1 S 63. NC a8S)R
Physical Address:
Facility Contact: Title:
Onsite Representative: i�% (2Mit I Iy A !
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 1 7) a S1
Back-up Certification Number:
Latitude: = o = ' =.. Longitude: [� o [� ' [� ..
glll
Desi n
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer 1
❑ Dairy Calf
Feeder to Finish
M Q
Oq
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
❑ Pullets
❑ Turkeys
❑Beef Feeder
❑Beef Brood Co
❑ Boars
Other
❑Turke Points
Number of Structures:
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
❑ No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
'No
❑ NA
❑ NE
Page I of 3 12128104 Continued

)
Facility Number: — Date of Inspection IS]
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: tAoof-4
Spillway?:
Designed Freeboard (in):
�Q-
Observed Freeboard (in): O
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 'ONo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes $ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VM ❑ 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes '9 No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes qGl No El NA ❑ NE
❑ Excessive Ponding El 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/ 110 Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 5(&
13.
Soil type(s) I _LACt
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
KNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
, [ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[KNo
❑ NA
❑ NE
U)A GGT C��dFCOG °Y(�t�T t�S�4�Ccs�R�s
►�lalln� 1-0
Reviewer/InspectorName 19 Clq/ Phone: /0-716--
Reviewer/Inspector Signature: y 1 - VIAac.-+ Date: LIP 5; A3
Page 2 of 3 12128104 Continued

1
ti
Facility Number: ?j — Date of Inspection q
Required Records & Documents
19. Did the facility fail to have Certificate of Coveraee & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the approprrate box. El WUP El Checklists
0 Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ICt.No
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑
�ste Transfers❑/rtnual
Certification
El Rainfall [3 Stocking 0 Crop Yield El 120 Minute Inspections 0 Monthly and 1"
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
)Mct No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[% No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
evi
IA No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CA WMP? ❑ Yes OfNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
l" 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
P�rNo
❑ 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
ONo
❑ NA
❑ NE
Page 3 of 3 12128104

wt
;y Division of Water Quality
Fae lity Number �', 0 Division of Soil and Water Conservation.
-- - O Other Agency
Type of Visit X Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ' �I�I� Arrival Time: �U Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: I LA 92 IA I A//N/ Integrator:
Certified Operator: (�-L CS'i� Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = U Longitude: = o `
Design Current Design Current iDestgn Current'
,Swine - Capacity Population I Wet Poultry Capacity, Population Cattle Capacity Population."'
<: ❑ Wean to Finish 10 Laver I IM Dairy Cow I
Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
- Number of Structures.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

I
Facility plumbDate of Inspection LZL�J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
StructureStructure 2 Structure 3 Structure 4
Structure
5
Structure 6
'I
Identifier: LA60O r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 8
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
1ANo
❑ 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? ❑ YesgNo ❑ NA ❑ NE
8. Do any of the smctures lack adequate markers as required by the permit? ❑ Yes O�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require ❑ yes K No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I�No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes KNo ❑ 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 ONo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes )V No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes [�No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes [TNo
❑ NA
❑ NE
Comments (refer to question #i): 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):
GET cc�u,,0w
tb$ C)1(L'V ?LAT w ) 9-ECOQDS
Reviewer/InspectorName [ HQDAND4 �A/MES (Phone: �IQ' � p 1
Reviewer/Inspector Signature: Date: �dp
P..7nfI
r 51nxine

Facility Number: , — j Date of Inspection (fl J(3
Required Records & Documents }}y//
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes l„� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes V No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes gNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [WNo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
qNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'a'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
6�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
K No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
& No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
11 Facility Number ZS,=,> 0 Division of Soil and Water Conservation
0 Other Agency
(Type of Visit to Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Qf Routine O Complaint O Follow up O Referral o Emergency 0 O0ttherr —� I❑ Denied Access J/
Date of Visit: % Arrival Time: /�7�: Departure Time: r County: Region: llt/i-V
Farm Name: �ZGP Owner Email:
Owner Name: Phone:
Mailing Address: _
Physical Address: _
Facility Contact: _
Onsite Representad
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
n
Other
❑ Other
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =0 =' = Longitude: ET M, F� «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
--- I _ I I❑Non-Layer I -----
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any 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 VJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
No
❑ NA
❑ NE
El Yes
�INo
ElNA
El NE
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than. adequate?
❑ Yes )2rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
S cture l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?: /V10
Designed Freeboard (in): �95
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �No ❑ NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes/No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElI /I Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes XNo
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 ElYes ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes .21No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes)dNo [INA ❑ NE
❑ Excessive Ponding ElHydraulic 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 ❑ Applilircation Outside of Area
12. Crop type(s) �/e/nl(DR /', ,. 3 Ud�2 FaO
13. Soil type(s) �Pc
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 A ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes ) 'No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft 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):
�5 Jr 2/e(o T/SazL�
OTC �f
Reviewer/Inspector Name ���f`f 9.f/1 � g Phone: Q/D (� - 32 '-2
Reviewer/Inspector Signature: ��� %��� , Date:
12128104 Continued

Facility Number: ,4 Date of Inspection 2 Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L o ❑ NA ❑ NE
/
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes 14 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
ElNA
ElNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transferss Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
rr❑lNo
El Yes Yes No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes X/ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ff No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes PNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
j I
l /va0i
❑ Yes ANo
❑ NA
❑ NE
❑ YesNo
ElNA
El NE
❑ Yes'ix,
No
[INA
ElNE
ElYes
No
[I NA
El NE
El Yes
!//!XNo
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
/ /;"%' 60
1" aly)P `pj t1 i6 cvc)
0 Oct
12/28/04

0Division of Water Quality -,
FacilityNumber 0 Division of Soil and Water Conservation
0 Other Agency +..
Type of Visit 9fcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit jjRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I'ryG{O/Q_/��Arrival Time: rZD. Departure Time: %i County:
Farm Name: / iY'� Pik D a A;A) �Owner Email:
Owner Name: On//� %/iA/rtl CXUZ/v/1% Phone: _
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone No:
OnsiteRepresentative: / �1T�1� 7�LL/JN. cJ��l%/d� Integrator:-J/Lf4�'l��'�—��G<O�[%n)
Certified Operator: ZGGL 0 Aj Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
I
Location of Farm: Latitude: o Longitude: o
a
Design Cprrent Design` Current Design Cprrent�
Svgne Capacity Population Wet Poultry Capacity, Population Cattle ` CapacityPopal , bit
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars —
- -- —
Other
❑ Other
❑ La er
s
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: [
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: 3 -
Date of Inspection
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 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes oNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo
El 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 ANo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �ZNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
,-,�"
9. Does any part of the waste management system other than the waste structures require ❑ Yes P too
❑ NA ❑ NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo
❑ NA ❑ NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I / No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12.
Crop type(s) ��f�l �T_� �. 6)
)� �• %f�{%f�iCSfL-tom
)
13.
Soil type(s) s 6
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2�No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes RfNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes '21"No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes XNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes XNo
❑ NA
❑ NE
Comments (refer to question ft 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):
15) 3�i//o 5 fo 40" l T.� L zi r e ac
/✓L.�.oE.o / D2 �/.
Zn
Iff
Reviewer/Inspector Name I
//�
I Phone: D - T/
ReviewertInspector Signature: /
Date:
Page 2 oJ3 12128104 Continued

r
Facility Number., Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ;2(No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes No ElNA [INE
the appropriate box. ❑ WUp ❑ Checklists ElDesign El Maps El Other Pf
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes y 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
V(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Ld No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ld No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
)21No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
XNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,,,......,,,///
�,[�j/No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
/l,� 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
Ld 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
IVo
[INA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I .4/2z/05I Arrival Time: GDeparture Time:. 7ij County:
FarmName: /17�i✓ Owner Email:
Owner Name:. �!>< Zit/ ✓ Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title: /
OnsiteRepresentative: _r /'14_746�/ tlZi✓/`'
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region
Latitude: = o = ' Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Rf Feeder to Finish
'L 8 0
©�
❑ Farrow to Wean
❑ Farrow to Feeder
_
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
I
❑ Dairy Heifei
-
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: F Top
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
1" No
❑ NA
❑ NE
❑ Yes
)] No
❑ NA
❑ NE
12128104
Continued

br
I a
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
S cture 1 Structure 2 Structure 3 Structure 4 Structure 5. Structure 6
Identifier:
Spillway?: 449
Designed Freeboard (in):i_
Observed Freeboard (in): 19
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
to
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
A No
❑ NA
[:1 NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
V] No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require
❑ Yes
VfNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A 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 ❑Evid' enccee of
Wind Drift El Application Outside of Area
12. Crop type(s) _ e<AVj_.24t h1l \l/
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
0 No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
A No
❑ NA
❑ NE
KE�o/tt �% l• �/ 7o us
Reviewer/Inspector Name Phone: t]` 37M,.Z
Reviewer/Inspector Signature: Date: 5/
Continued

Facility Number: Date of Inspection O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes /�No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists Design ❑ Maps
❑ Desi p ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
A No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
[INE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
/
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Elyu Yes
rrr0No
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
ElYes
kI No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
[INE
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
[ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional Comments and/or Drawings: -
maov/J �
`
12128104

of Visit RrGompliance Inspection O Operation Review O Lagoon Evaluation
for Visit grRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number (�ZS3� Date or Visit: ,?j 1 O Time:
Q Not Operational Q Below Threshold
Permitted M Certified D Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ... __.....
11 Farm Name: ... !kw ...,l� I m9p.j..... Re .. County: _ «9uPL
Owner Name:
-Mailing Address:
Phone No:
Facility Contact: ___._._.----_._..._._._......._........ _._.___Title:.._..:---_.__._.__.._.__...____.. _. Phone No:
OnsiteRepresentative:.._. QTr�.Q 1Jl� OfzowNts
_�._..._._.___.__...._.__.. Integrator:
Certified Operator: ._........................ _._ Operator Certification Number:._..._._....
—...........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• 01 =H Longitude =• =1 =11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )ZrNo
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)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ... ............ i................. _................. .... ... __.._._._.._...._....---..................................... ..... _...................... _.....
Freeboard (inches): 31
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes XNo
❑ Yes XNo
❑ Yes XNo
Structure 6
12112103 Continued

Facility Number:,Date of Inspection()
9
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
❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
OYes ❑ No
8.
Does any part of the waste management system other than waste structures require maintenancefimprovement?
❑ Yes �No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes PTNo
elevation markings?
Waste Application
10.
Are there any buffers that need maintenancelrmprovement?
❑ Yes JVNo
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes INo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type EP-M Q '5rA-VPe - Ga,,TPJ a G
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes P6o
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes IQ/
b) Does the facility need a wettable acre determination?
❑ Yes X0
c) This facility is pended for a wettable acre determination?
❑ Yes �Wn
15.
Does the receiving crop need improvement?
❑ Yes N
16.
Is there a lack of adequate waste application equipment?
❑ Yes CJ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes Wo
liquid level of lagoon or storage pond with no agitation? J
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes OONo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Of /No
Air Quality representative immediately.
Field Copy ❑ Final Notes
p"\j 6RA55 CoVE(L oN I AcTodnl W ql L
5W0&f. 5t)2v6Y 7o &L 0614(- fg`? APR., Z.y
CALZ6aATsoaJ ro (36 00rJE 3y APR., 24
SS6c-K,rN4 RECO"J PEEo r, ac oopL Cpooll. C-RAPTS I(Jeff)
CR.oP 11.r tp fO(Ltr NEEIJS ro &- Dw,�.
3S% E0r_,rAt, TrJSpCc-tMoA MJ611// RArAYALL,
FmeLos
Ca C
rj Coo t7 CON 0T-Tt wJ .
P 6L(S (-N'C
Reviewer/Inspector Name i
Reviewer/Inspector Signature:
Auot,)G WEIR Mo9_-TflLttY AOD INSECT C0drk,0L (r_ST,
Date:

Facility Number: 31 — 3 Date of Inspection
In
Required Records & Documents
/
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P No
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
,e]
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Ia N
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
7No
(ie/ discharge, freeboard problems, over application)
❑ Yes
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
UNI
28.
Does facility require a follow-up visit by same agency?
❑ Yes
H/
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
[Yes
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
to
33,
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑%es
❑ No
35.
Does record keeping for NPDES required forms need impro ement? If yes, check the appropriate box below.
(� Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ® Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
dditional Comments andlor Drawtngs =x
12112103

'a -
LType of Visit OrCompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit ,0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
FaciGt_v Number
Date of Visit: .S 36 02 Time:rO
6
S
Not Operational 0 Below Threshold
0 Permitted O Certified D Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: T�e)e 6//J/�; n.% �G rr^�. County: Du p l r h
Owner Name: Tom' re `-Cy '-I Phone No:
Mailing Address:
Facility Contact: A Title: Phone No:
Onsite Representative: dam'%Pt0 �y;nn Integrator: �roWnrS OF G�iroitl'LCt
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine []Poultry ❑ Cattle ❑ Horse Latitude =* =` 0,. Longitude =' =I = u
Design Current
a,a anry ru wauun
❑ Wean to Feeder
n Feeder to Finish
IL I Farrow to Finish I I
Number of Lagoons
Holding Ponds /Solid Traps
Design Current - Design Current
Poultry
Ca ai Po ula 'on Cattle Capacitv Population
❑ Layer
I
❑ Dai
❑ Non -Layer
I
I
JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present IILJ Lagoon Area
Discharges & Stream Inert acts
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: I
Freeboard (inches): 30
❑ Yes RfNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes El No
El Yes �I No
❑ Yes ❑ No
❑ Yes F�TNo
Structure 6
05103101
Continued

.1 r
Facility Number: 31 — 2 S3
Date of Inspection S 30 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes JzNo
❑ Yes ZfNo
❑ Yes J�,o
[IYes yJ No
❑ Yes ,E(No
Waste Aoolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ONO
11.
Is there evidence of over application? ❑ Excessive ❑ PAN [IHydraulic Overload
❑ Yes
A!{No
12.
/P�ondin)g
Crop type l3cov.,,d4 MegsjedBce^.✓da Cb 't f�O11��1 Gra ze�,Smal1 G.^Ai/t
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
_OlNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
j2No
b) Does the facility need a wettable acre determination?
❑ Yes
12 No
c) This facility is pended for a wettable acre determination?
❑ Yes
allo
15.
Does the receiving crop need improvement?
❑ Yes
ONO
16.
Is there a lack of adequate waste application equipment?
❑ Yes
E!rNo
Remuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Oyes
❑ 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
ONO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
01Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J2 No
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?
❑ Yes
ONO
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
;3'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
IONo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
'10 Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
t6Y w, , t- r .kR « %. k Jx. 4 ..e„ •s. _.C' 'IV ;3
GommenYs(refer to quesdon�"il): Eaplaia any YES answers�and/ortamyrecommendahons orany other, comments ya; _ ;
; -
s x;, Y
g t try ` liet
Use drawin_ s of facdr to etter ezplam sitaehpns (nse addrtmnalYpages "Jhecessary) j 'j- Field Copy ❑Final Notes
Qv;ti', deet ✓707 114ve 4 Cee4',f G,,14C pr' C#Ve".GC,a LiV4;1gbie
wh;el, h,;s 6eeh i.fsved �0 hGM• _4 ei et✓4,v;c0e. of Gove�a5e he's
beeh jssved )n h ,-lL,en �'� necd-s 4o tie zwNt able fo�,J rns�oecf,cc�,
-F e, Glu-)e bP Ceve—ay 1-Ig1 nvD Lre� beeii issvcp ,+6on l7� /'rfi•.
v:nn ]leas -{a �11& Zie, ;,P , -%o ��P O/r)2 ) rSve -
)Pi,�.11OCt� -rid ilnsccl Cb✓74ro) eheck Ni4
1
�
Reviewer/InspedorName r VOnCj: 4 "4MA 4 h'r-S
Reviewer/InspectorSignature: Date: .S ye Z
O5103101 Continued

- - C.
Facility Number: I —Z 53 Date of Inspection s 30 az,
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 o
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 ❑ 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 E!No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes Jfi'o
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
Additional Comments and/or Drawings:
,., ,„..
1�.rYcc6&e,-rj re. eav'dJ ,-- e 1o4 be;-,y kef4 1'Veekl1i —';'
rreeboAr01 e'eCe-dS rleeAi 4,n fie kep4 weekl1, mead 40 be sure
-}e v.Se 4l e GO rre C* fie nq rk nJ Cn
n.A ro e, RllWnG
a*e c.
�11e 2.15, cweertk(y uS;hSlq Si ,t,'�':Ggrt A�,ou„} /oWe,/ 4ZArN
w45�a pl�� Allows gtN 50�d o�ihe �,e-2 S .Jae n04e belvt'V-
25. 'r►rFre Is An a0r-ee-6&I4 beaweer lt,e for ,ems OLVbSe"15 01
EI,t -Facet^. o,nol 4he 464eby h0• eowrte✓"S 4k-t4 -4-e 4,,-one.
ewnerS GOHId 57
l9rA / to, Zoo -/ecq of 4he cwwe//i-J r.
a4 --ry r104 be.allew.1ble Po, perr+lrS,eh 4e be 9eA,14&
ae fkrs _ E-vt„� ,1>l IJ o,l/OWG ble 4o qe� ✓%E✓wt.iSibn 1 4ke✓'
Mr, Will nee Al 1<O JFG} pgrrti Ssi irf -r , 711e �lo�^COw+t2Y3.
1 q,n GvrrebPV in.r¢I% �a-c"a( 5imllCi✓' S)'4LA} ors w;a1, �l,e
n4orile� Gev+e�a/rs nF{;ce.
Also, %l,.e 10,kOc Meth ;/,d:,-a'les -Fbrt# in 4ke 0-2r,'c,4've 41a4
;,e 41 F;e^lds qre 9eAZed 4�7ev, ..�j�e cows n1a.l be eo4,q cd
6e-fwtcz h i elris Ib 3, ,t,i le m0.ih Tpl�lih a1 r1,/4rkt%l
-fhe ,c,l rr, . -X4 stke ylcl fie ma d e claav f ` a�� f h; s oa�a lla� of sows
wlay no4 6e g1letied d,rl-Ae sa."e leq' AS 4i,ere does
nef ad DC'q. 40 6e eHousl, deP�<,"� �o� ah:s .
A)e4e : nV. Q Cvrrengly hay,r)5 -"';e-ids wk;le pletn k,4s Seme
pvth< Showvl AS 6e," We, Cv�llrvl oJrot,le; 4eeAn,'mlSfeci4lA
5*11ou 0 Frev,'Qe ir� ha y ei i4eoye \ owe ,» t,lAJie plot✓t .
10a4e` -I-Acre iS eit, exGellro� Sfghal O,r 6er,^ t4p,, 0Ae.-
IhiA" I-Ae4c-0l e4ove; 4),e-Facll;4y ;s r1e4g1l Aep,
O5103101

f
Ll�
W.Di;igi6n of Watei Quality
DIVISIORi'rif Soil and Water Com_eti rva on
0 Other Agency-_._
k
Type of Visit compliance inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 5lRoutine OComplaint OFollow up 0 Emergency Notification 0 Other 0 Denied Access
Facility Number Date of Visit: Time. DO P, i nted on: 7/21/2000
10 Not Operational 0Below Threshold
1
[3 Permitted [3 Certified 0 Conditionally Certified Megistered Date Last Operated or Above Threshold: .......................
Farm Name ...... 0.q
. . . ...................... r4 :5 County: Z-Al
................................. .............................. ........... ........
OwnerName: 4 a7lvN . ......... v................ Phone No: ....................... ..................................................
Facility Contact:
Title:
Phone No:
MailingAddress: ..................................................................................................................... ..................................... . . . ..................................... ......................
Onsite Representative: ... ......... ......... A-MIAl .......... 7e ....... Integrator: .... .............................................
..........
Certified Operator:
Location of Farm:
Operator Certification Number:
XSW,ne OPoultry []Cattle []Horse Latitude Longitude
Design Current Design Current Desi rflrip.t
Capacity
Population Poultry Ca pact
Popul tion Cattle
Wean to Feeder
[] Layer
10 Dairy
I
FeedertoFimsb
I[] Non -Layer
10 Non -Dairy
Farrow to Wean
—Other
_..
Farrow to Feeder
FOE
Farrow to Finish
Total Design Caltad . ty
Gilts
Total SSi
F—
Boars
U_ -7
�PondsLSoLdTJU Subsurface Drains Present 110 Lag Area
n 0 No Li uid Waste Management System=]
[EISpraylilkId Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑Yes
No
Discharge originated at: E]Lagoon C]Spray Field []Other
a- If discharge is observed, was the conveyance man-made?
E] Yes
No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
❑ Yes
E] 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?
0 Yes
["No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
E] Yes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway
[I Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ..... . ......... . ....... * ... . ... ...............
30'
Freeboard (inches):
5100
Continued on back

G
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 No
seepage, etc.) - -
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? [I Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) 1
7. Do any of the structures need maintenance/improvement? ❑ Yes 1[J /No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes //[d No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level T
elevation markings? ❑ Yes PNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONo
11. Is there evidence of over application ❑ Ezc sive Pondinng� []PAN [I Hydraulic Overload Yes ❑ No
12. Crop type Fpr�Dh R�
13. Do the receiving crops differ with those desi fated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes JXNo .
14. a) Does the facility lack adequate acreage for land application? ❑ Yes P 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 F(No
16. Is there a lack of adequate waste application equipment? ❑ Yes Y(No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes �No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? -
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes EINO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes tNo
o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes IQ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit? /1
(ie/ discharge, freeboard problems, over application) ❑ Yes �Q I o
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes. T(No
Q •yi9la�igtis e ilgfjcjtzncle •wire j19Ctz lljtritig thjs;vWt; - You y ilj •Seo$ive o . f.. t. r • ; • ;
curies ..deuce:about: this AsW...:':':':':':':-:•:':':•:':•:':':•:':':':':':':•:•:•:':':':•:•:•:':':':
Comments (reiec mD question #) 'Eriplam ny YFS"answers and/or any recomm ndahons or any oth m nts
Use`drawmgs of fac�ttyto 6etter,•ertplain srtuatiOac. (use adthh�nal pagesas Recersary)
54�LY 1f,11 3, / ;
n / Tzp
&FOR � /✓ o��� � JFC oNO per�,
Reviewer/Inspector Name
Reviewer/Inspector Signature: ( FADate: /& 2d o/ 5)00

L
Facility Number: — Z Date of Inspection ['7
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes PIo
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 onneighboringvegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes jeKO
❑ Yes _0 0
❑ Yes Zo
❑ Yes
❑ Yes No
❑ Yes No
Additionalomments and/or Drawings:_
%� �UFs Des ��� Ak 09-
5100

Facility Number 31 z., Date of Visit: // ZOO Time: I Printed on: 7/2112000
Q Not Operational Q Below Threshold
®. Permitted Q Certified 0 Conditionally Certified E3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: 1 A . County:..,.,. U !� /.
......G............F..._R.H................................................................................
Owner Name:........�7....%il`.�i.t..........`./Q........................................................... Phone No:........�!.) O
Facilitv Contact: IX ...`!.. F{...... .i:9Q.. UR. ................. Title:......1� t,t� wT_ JZ............................. Phone No:...................................................
`1 per[
MailingAddress: ..... 1.u.l4!tS.....i":.............._............ ............................................................I........................ ..........................
OnsiteRepresentative: ...._........_.._...�........................._.......................................................... Integrator:..... � kqo—y7Js..................................._...............
Certified Operator:......... vJ Operator Certification Number:
Location of Farm: _
MoWrHpR5T OF SAe&-T-N Or4 NW 51DE of SR 17a1 APAft. 1.5 Mrle_s NE OF 52 /700 �.
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude F-3-4-1• ®` F.317 Longitude 177 • 56 ,
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Po ulation Cattle
Capacity Population
❑
Wean to Feeder
❑ Layer
❑Dairy
Feeder to Finish
3000
❑ Non -Layer
❑ Non -Dairy
❑
Farrow to Wean
❑
Farrow to Feeder
❑ Other
❑
Farrow to Finish
Total Design Capacity
Z�B�
❑
Gilts
Total SSLW
3Wj 8,-,o
❑
Boars
I Number of Lagoons JE3 Subsurface Drains Present ❑ Lag ... m Area 10 Spray Field Area I
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
h. 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 galhnin?
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 KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JKNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes CEISo
Structure I Structure 2 Structure Structure 4 Structure i Structure 6
Identifierruc
: ........s>z". �...................................................................................................................................................................................................
Freeboard (inches):
5/00 Continued on back

Facility Number: 3 — 2 5-3 Date of Inspection If-ZOQ Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Mlo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes &0
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes �To
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ,1Vo
12. Crop type ANt7 U A f - Go
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes etyvo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [K'o
b) Does the facility need a wettable acre determination? ❑ Yes [/)$,4o
c) This facility is pended for a wettable acre determination? - ❑ Yes XNo
15. Does the receiving crop need improvement? - ❑ Yes L*
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
U. i'9d.violaOdris:or deficiencies -were nofed-during this:visiC -:You wifl-receive citi further
. - . - correspondence: about: this visit:
❑ Yes ❑ No
❑ Yes &o
❑ Yes
An
Yes
❑ No
❑ Yes
*0
❑ Yes
�No
❑ Yes
dINo
❑ Yes
*0
❑ Yes
AO
❑ Yes
t*
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):
NEG—D5 G%Ja-2E T tQS r wA-&TE Rl+v46tiSj c
Reviewer/Inspector Name
Reviewer/Inspector Signature:
1�
Date: 5100

Facility Number: J1 — 2$3 Date of Inspection // 2 00 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 8t/or below ❑ Yes b,o-
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional:Comments -an or. rawings:
I. .1 oI
f,1tos I p.rR4
S,,QQECTA . CABIN
/70a a�1
Itiol
t-t15
};6NAt•gV�tt,E I�o2
ud 7
WOO Z't jACgs'pi V I le
❑ Yes No
❑ Yes ����6 No
❑ Yes !gJ No
❑ Yes CR(No
❑ Yes C<No
❑ Yes " \No
5100

Division of Soil and Water Conservation =Operation -Review '
E3 Division of Soil and Water Conservation - Compliance Inspection _
Division of Water Quality Compliance Inspection
'0 Other Agency-- Operation Review
O Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other 1
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
® Permitted 1] Certified [3 Conditionally Certified ❑ Registered Not O ct:rtional Date Last Operated:
Farm Name: ...... ..YY1�.`Li0.YnS[......�f.ASS:........ G'wC1Y.!..........._.......................................- County: ..... LU��Cr....................__.........................................
Owner Name:..Llo(IC�II. ` .J4W CS..............5 ....................................... Phone No:
........................................................ ................. ..............
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing�tldress:....1.15.1...._I oc`.�r:...�,t�xfrxt:x....r�.1 k.fh�....}%"i).�.I.... ML................................. .Z.g.5:3.�......
.. L.0.............................................. ............
Onsite Representative:........ ....... wj IAA.YhS................................................. Integrator:....... B rw..+S.............................................................
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number:
Latitude =a=1 =1 Longitude =• =` ="
❑ Wean to Feeder
[�LFeeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity Z-no
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ Nu Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made:'
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min'?
d.. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
❑ Yes M No
❑Yees�slI^^lpNo
I
❑ Yes ® No
❑ Yes (p No
❑ Yes M No
❑ Yes 55 No
Structure 5 Structure 6
Freeboard (inches): .............32..............
a
1/6/99 Continued on back

( Faciliv Number: 3 1 — ZSS Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
C Vo
seepage, etc.) -
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
M 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 pact of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
EiNo
9.
Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
t'No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
11.
Is there evidence of over application? ❑ Ponding ❑ Nitrogen
❑ Yes
® No
12.
Crop type ...................�R...1nern.1...........S.tY.4A�'..............................COY.(h�.i�i1� ..17 /.:?G...........................................
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
Does the facility lack wettable acreage for land application'? (footprint)
{] Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
rn No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
IpNo
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
ONo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
(gYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
54 No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
P 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
No
24.
Does facility require a follow-up visit by same agency? I
❑ Yes
P No
NU.VIUlations'On deticiencle's were'noted during this -visit.. Y'ou will.receive nu further.'.'
.corresp6ddeiice:abi)it'this:visit:•.. • • • • • . • • ••.•:•:•:•:•:•_•:•:•.•:•:•:•:•:•:... • • • • • •
Comments (refer to question #): Explain any YES answers and/or any:recommendi tions`or any other comments
-`. `°--
Use -drawings -of facility to'betterexplain situations. (use additional pages as necessary
T Cbr,}Aovt, e4 riifur
-6 ne/��x{t it,,
14. VGro. wili 6- fl&V] WA
00 ir\rJ' 1r�� ,kki ojfj�% ;'
19. � 1 rt urt)s L� i Q fntise3
0'. rrtr Air' Ioa 0�tS ko
1 OLKO S ON 4k ( aq'V,. div-c i.XIL
tl ril�1G-TaOh Utt4.t 44,.,. 4u_, ,s JVV%JfJ
Uosk Or,ita40x avr0 t, 10CU acre
4 &(lu{ 4tc" acW o{rpIt(akova
IN -R, irr)aryoq k%iy, 5i, O be
i n it, 4-e ld .
I
Reviewer/Inspector Name
Reviewer/Inspector Signature: ri-' 4 ) Date: �,3r9q 1/6/99

E3 Division of Soil and Water Conservation Q Other Agency
HAM� Division of Water Quality
Date of Inspection
Facility Number 2S
Time of Inspection .: � Q 24 hr. (hh:mm)
0 Registered (Certified 13 Applied for Permit 0 Permitted 0 Not Operational Date Last Operated:
p l�
Farm Name: .....................p1.�.licit,.5....&-au..S........rt—c-ei............................. County:.........11.U1. �.i.vt,.................................. .......................
i
` Sz
/
OwnerName: ................... Va*cs............... ....... .i.I.I.i.aMa3..................................... Phone No:.... ........................................
gu
FacilityContact: .............................................................................. Title:.........................................................'.......... Phone No:...................................................
Mailing Address:....... ,�A..........`Nalr.16%.......11111.�i.arvtS...... FNd......................... ..........C. ! ...h11�1.I..%v�.................................. ..aS�.�......
Onsite Representative:............Vp S........ ......... tli.il.I.LQhaS................................. Integrator: .......... 6rwn..........................................................
Certified Operator:............................................................................................................... Operator Certification Number;
Location of Farm:
Latitude =•=' =11 Longitude 0' 0' ="
Design Current,' Design ` '-Current Design Cuiienf
Swine `:rt P'- Capacity, Population_ Poultry Capacity Population- Cattle, Capacity Population,
❑ Wean to Feeder :, ❑ Layer ❑ Dairy
Feeder to Finish y, ❑ Non -Layer ❑Non -Dairy'
Farrow to Wean _--
❑ Farrow to Feeder ❑ Other e
❑ Farrow to Finish Total Design Capacity ]
❑ Gilts Total SSLW
❑ Boars
Number of Lagoons I Holdmg Ponds ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
.>
- --- -...
x g „ - 10 No Liquid Waste Management System ,
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
[A No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
( No
c. If discharge is observed, what is the estimated flow in gaVmin?
ri
►Q
�]
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
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
® No
- maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
i, No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
W No
7/25/97

Facifity Number: 31 — z
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (LaEoons.HoldinE Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:...................................................................................................................................................................................................................
Freeboard(ft):............2:g...................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
I$ Yes
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 maintenancelimprovement?
Y+ Yes
❑ No
(H 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
P No
Waste ApRfication
14.
Is there physical evidence of over application?
❑ Yes
01 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .................. hmnuja.....................SdAak.....�1wLM...................... ...............................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
0 No
17.
Does the facility have'a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
❑ Yes
0 No
19.
Is there a lack of available waste application equipment?
❑ Yes
R No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
1A Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[ANo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
1p No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
§3 No
OU No.vitilationsor deficiencieswere holed during this:visit. You.R7R receive ito ftirtber
correspotidehce about this:visit.
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7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: %G_ _ IVA __ Date:

❑ Division of Soil and Water Conservation I] Other Agency
® Division of Water Quality
16 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review V Other
(� Date of Inspection 16 le 9
t Facility Number _
i Prime of Inspection 1` 24 hr. (hh:mm)
0 Registered `E3' `Certified E3 Applied for Permit 0 Permitted JE3 Not Operational I Date Last Operated: ..........................
Farm Name: .... 3:°. ..1....A.:x::_t.S...... %..0...................... County:....R_IV_,.L................................... w..t..L.+4..t.
Owner Name: .................T (z i_ ` \................................. .C...... ......
-.�.1.•;h.vest.ta...... ...\_k.k�.tL_v�`.:................................. }'hone No: ......
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: ...... u.q..i.......N.V.er...I?KN .....��ii1,�1.N..v ............... !T_...i /...................... .2d.. ..�.L
Onsite Representative: ---- W.1_...a...�xv:_,..... a.:Yn.t1^..?^�5............................. Integrator: ...... g..v..>x.[!�?.!^'3
Certified Operator:............................................................................................................... Operator Certification
Location of Farm:
Latitude =• =' =" Longitude =• =' ="
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ER No
❑ Yes [R No
❑ Yes
® No
❑ Yes
J�j No
nil A
❑ Yes
ER No
❑ Yes
® No
❑ Yes ® No
❑ Yes tR No
❑ Yes Q No
❑Yes 2fNo
Continued on back

Facility Number:
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
fKNo
Structures (Lagoons Holding Ponds, Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
JqNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: ;.L,_fpi.._.........
' Freeboard (ft):.......................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
KNo
12.
Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
9INo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
&LNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...6_&vr..s-d—%. ..........................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
RNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
pp N0
18.
Does the receiving crop need improvement?
❑ Yes
ER No
19.
Is there a lack of available waste application equipment?
❑ Yes
iD No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
RNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
QNo
22.
Does record keeping need improvement?
❑ Yes
® No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
0 No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
1RNo
® No. violatituts- or deficiencies were noted during this.visit. You 4ill receive no further
correspondence about this:visit::::.:
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7/25/97
Reviewer/Inspector Name .,A
Reviewer/Inspector Signature:
V.
Date:

Site Requires Immediate Attention:
Facility No. ; 12
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
0
A
Swine
Farm Name/Owner:
Mailing Address: _
DATE: V3 1995
Time: 13 Z 5
ojhe.s / I motes. e Dae)
s kd. Pi'/7k- M71 tiC * 2
County: 1)Unl t q
Integrator. brow/ 5 Phone: ZC13 -3(ew
On Site Representative: Phone: 9Ict Tsce 9 — 35 L
Physical Address/Location:
Type of Operation:
Poultry _ Cattle _ 1-7 A / 5h
Design Capacity: 2A$0 Number of Animals on Site: 1z8 90
DEM Certification Number. ACE DEM Certification Number: ACNEW
Latitude: �' �' Z901 Longitude: � ' 90 ' �4.1 l 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) Ye or No Actual Freeboard: Fr Inches
Was any seepage observed from the lagoon(s)? Yes or Was any erosion observed? Yes otO
Is adeauate land available for spray? es r No Is the cover crop adequate? es r No
Crop(s) being utilized:
2
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? fe or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o N
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oi(N� 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)? Ye /rr No
Additional Comments: M (jor-P.�'!� SiUn 2 T e() Q12Ge S / l f
L.
Inspector Name
5 & {' _
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.