310269_INSPECTIONS_20171231

m
J
Department of Environmental Qua!
W)

1(
Reason for Visit: Q Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j r Arrival Time: 1 0­1 Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �� 54 ( I V k. (, (,5 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 2 14 0'Q 5—
Certification Number:
Longitude:
Swine
Wean to Finish
W n to Feeder
Design Current
City P.
apac
We[ Poultry
La er
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Da' Calf
Feeder to Finish
q 20 O
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oult .
Layers
Design
Ca aci r
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I lBeef Brood Cow
Q[her
Other
Turke s
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 DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili N ber: Z G Date of Inspection:
main
r 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
0'
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Z
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ETNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
C " o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ffNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑
❑ NA
❑ NE
[ t?
enance or rmprovemen
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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
L-YKc
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]e�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
❑ NA
❑ NE
acres determination?
/
17. Does the facility lack adequate acreage for land application?
❑ Yes
E N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g
❑ 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
YNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
VYJN ❑NA NE
No ❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
❑
❑ NE
lNA_
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
W NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EErNo
❑ 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
EfNo
❑ 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
0 'V V
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question'#): Explain any YES answers and/or any additional recommendations or any other comments..,
Use drawings of facility to better explain situations (use additional pages as necessary).'
Reviewer/Inspector Name: Y 4` I �o�/� Phone: 90 7?G 730 y
Reviewer/Inspector Signature: ,( Date: Z 117 17
Page 3 of 3 21412015

W,
(Type of Visit: Q'Co pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up Q Referral Q Emergency Q Other O Denied Access
Date of Visit: / t Arrival Time: ® Departure Time: Z 2 .7 County: W trt III ^ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: // Title: Phone:
Onsite Representative: It fn i, /iy'/S Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: ,L � T-O
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
gapacity Pop.
Wet Poultry
Layer
Design
gapacity
gurrent
Pop.
Design Current
Cattle gapacity Pop.
DairyCow
an to Feeder
Non -La er
DairyCalf
eeder to Finish
7J6sfq
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P�oul[ .
Layers
Design
ga tacity
gurreat
P.o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No / ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
El Yes ❑ NA ❑ NE
ElYes N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412015 Continued

Facili Number: - Date of Inspection: t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes GErlTo '❑ 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): -37-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ffNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0<0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes Qo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
Yes ❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes El'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 -�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. s record keeping need improvement? If yes, check the ropriate box below. Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard aste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ff No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L"J No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F cili Number: Date of Ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
❑NA ONE
❑ NA ETNE
❑ NE
YJ
NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑Mo
❑ 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
Z f 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 I�
❑ 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
[[/]�N %
❑ NA ❑ NE
34. Does the facility require a. follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #)r-Explain any YES answers and/or any additional recommendations or any other comments.
Use drawincs'offacility to'better-exolaiu situations (useadditional paces as necessarv).
...
11/L` ��Sfr (�nc(S.SS t012 be CSC f,'f_d_�
fie
sou I ��� aPP .
/ I � ,,.4
^�a�tLtpn�/�
/M{•nk
/.0.n .�.> .♦? : V. .�vG-.t 11 VJ nC.�p11 / ;� .j {,-
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of
Phone: (17 rf C 730 y
Date: 1
21412015

Operation Review
for Visit:
Referral
Evaluation
Other O Denied Access
Date of Visit: i r u- Arrival Time: Departure Time: County; U• �(� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: g Q= EVooAs
V
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
�E1111
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to sh
Wet PoWtry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean [o Feeder
Non -Layer
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to can
Farrow to Feeder
Farrow to Finish
I) . P,oulh.
Layers
Design
Ca A I
or en
Pao
Dry 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 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 ff No ❑ NA ❑ NE
❑ Yes W'No
❑ Yes FTNo
❑ Yes
ONo
❑ Yes
[ENo
❑ Yes
ENo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3
21412014 Continued

' Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
E!rNo
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
iff No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
m No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
IC_7 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
[ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Zr No
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes n/ No
T�
❑ 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?
T
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
�allo
❑ NA
❑ NE
Required Records & Documents
�yr
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CJ 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.
❑ WIN []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
V]/ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili ' Number: 231
Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
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?
❑ Yes VrNo
❑ Yes W No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
I/I No
❑ NA
❑ NE
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Reviewer/InspectorName: -µ 44'n Phone:
Reviewer/InspectorSignature: I/ a ,e Date: IV2^14
Page 3 of 3 21412014

for Visit: gRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ®— 3 Arrival Time: Departure Time: :3Di} M County: Region: �Lf
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: ayyo
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: -p�. , 05 pt3
Certification Number:
Longitude:
Design C•ucrent
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. + P,ouI
Layers
Design
sa acity
Current
$o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke 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 7No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes P.No
❑ Yes C'No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

i
cili dumber: - Date of Inspection: — 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2rNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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.)
❑ NA ❑ NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes FNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes oo ❑ 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 PNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes PTNo ❑ 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
O No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
P 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
2?No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ca No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r no
❑ NA
❑ NE
acres determination?
�"
17. Does the facility lack adequate acreage for land application?
❑ Yes
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
We
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
PjrNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
r�lo
❑ NA
❑ NE
the appropriate box.
T
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield El120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
� ❑ Yes N
❑ Yes QN
o ❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
o ❑NA ❑NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

cili Number; Date of Inspection:6-13
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L?fNo
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?
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes
XNo
❑ NA
❑ NE
❑ Yes
P!fNo
❑ NA
❑ NE
❑ Yes
.7No
❑ NA
❑ NE
❑ Yes [,ZNo ❑ NA ❑ NE
[—]Yes VNo
❑ Yes 6 No
❑ Yes VfNo
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
Reviewer/Inspector Name: �ay-a Phone: pj[�Qi-3bi�
Reviewer/Inspector Signature: l � 1%-aatz Date:
Page 3 of 3 21412011

Review U Structure Evaluation
for Visit: GLRoutine O Complaint O Follow-up O Referral O Emereencv O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: t.-!N Region:
Farm Name: M A FAc m S L LC Owner Email:
(
Owner Name: 01 4 P jy&(. , s /` LC_ Phone: 916 iiii D96 -QI (1]`p
Mailing Address: 9p
33 WFKZ�S j� � iZ)Ge��A�SA(yf/�C Op3%p
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
F f
Lk_
`f' 1-i/ C.1.1 ��nn
integrator:
Certified Operator:
n�� p�,�1q
yc..v�-�
( I: 1=Vf'r'VS
CertifcOationNumber:
p,/t"ipGS
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Swine
h
Design
Capacity
Curren[
Pop.
Wet Poultry
Layer
Design
Capacity
Cucrept
Pop.
Design Current
C>attle Capacity Pop.
DairyCow
er
Non -La er
DairyCalf
sh
M7toFeeder
qC>
6b
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
an
der
Farrow to Finish
Design Current
11,, Ppultrar Ca acity P,o
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
IMI Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
El
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

t
Facility _umber: -3 1 jDate of Inspection: /
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):
Sttrruu�ctureI Structure 2
1 0
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 *o ❑ NA ❑ NE
❑ Yes K 1 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) ��oo
9. Does any part of the waste management system other than the waste structures require ❑ Yes 17. I No ❑ NA ❑ NE
maintenance or improvement? Y"�
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): C t_AzT- l (2EQ� � SC l 2_q _
13. Soil Type(s): QD4_&;(F(L 'z,TON %}u774LUl)/tLE
14. Do the receiving crops differ from those designated in the CAWMP?
�[
❑ Yes }k I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yesw`(,D�j��lf! 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 o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP Checklists Q Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. '❑ Yes No ❑ NA ❑ NE
0 Waste Application El Weekly Freeboard El Waste Analysis 0 Soil Analysis ❑ yvaste Trans ers Q Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections 0 Monthly and l" Rainfall Inspections 0 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 J� 21412011 Continued

1�.
Facility Number: ( - l.o Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes I xl No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 7❑"`No
"`���:::�NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes [ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
46
❑ 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 56No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 4 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 ft Explain any YES answers and/or any additional recommendations or any other comments y
Use drawings of facility to better explain situations (use additional pages as necessary).
*x r
r ,a a-(L ( tq O(n E
tN.A•
60113111 �`D- Lf
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ci(11 25 & 130
Date: Dh)la
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 ❑ Denied Access
Date of Visit: �� 1 Arrival Time: Departure Time: County: Region:
Farm Name: 1.nI n' A E-AOQ- m (- LC- Owner Email: n
Owner Name: " l '� r/ 1)`(_6 Q S (0 C (J r . \ Phone: 916 —o)% --0 1 11
Mailing Address: J �JAR-OS IJQN��lFC F-6 wA2-SPLA3,IVC—
Physical Address:
Facility Contact: Title:
(�
Onsite Representative: �AR'SN�I LL 1 Fi IU-1 Rs
Certified Operator: e rirw 1 Vt� N�
Back-up Operator:
Phone No:
Integrator: pp
Operator Certification Number: o/'70OS
Back-up Certification Number:
Location of Farm: Latitude: [ ---- 10 [ ---- 1. [ ---- T Longitude: [ ---- ]o M.
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
%No
❑ NA
❑ NE
❑ Yes 1 No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

acility-Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1-8460N
Spillway?:
Designed Freeboard (in): 15
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ix No ❑ NA ❑ NE
❑ Yes �kNo ❑ 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 KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0No ❑ 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 ❑ Yes 0No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ViNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
oNo ❑ NA ❑ NE
Wo ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages•as necessary);
W. � �uP�0a9-T10N VOoN� �wRt7tI�lGO/�7 PaQE�wo2l�
c�lfilib a 8 �+x ,—o : afla/ : ArXA A,0.4 6t4eivE5 `)/a-3So,
-aacN
/0151/D l ' A W457E p/!4CL S15 HAS g+<fN 5FNT - P15 &k(3'At7tl
sj►abo � �- _
IReviewer/Inspector Name I` — K R/- S '",Phone: 9/6-TAD-iW-4 I
Reviewer/Inspector Signature: Date: /
Page 2 of 3 12128104 Continued

r
•Facility Number. — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. O WUP ❑ Checklists 0 Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes // `` �No [INA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis ElSoil Analysis El Waste �tWaste Transfers '/ nual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ED Monthly and I" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
(Additional Comments and/or Drawings:
❑ Yes �114No
❑ NA
❑ NE
❑ Yes
X No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
)4 NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
)�No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes IgNo ❑ NA ❑ NE
❑ Yes § No ❑ NA ❑ NE
❑ Yes )iNo ❑ NA ❑ NE
❑ Yes /1�No ❑ NA El NE
El Yes h No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
Page 3 of 3 12128104

j 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 ❑ Denied Access
Date of Visit: �y;%�Jbn Arrival Time: Departure Time: County: II✓ Region:
Farm Name: (Y) �i'/P (IPP(ri t � Owner Email: n`
Owner Name: 1 I I4'\'((1�� �t H IIL,LII S { L LC_P�h�one:
Mailing Address: J l/w--�4 ��-1 t✓�1 [_ Y-� vyY-7�� f� �� 0��� 1 Zc
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: ) Z LIps Integrator:
u WAI S ,off
Certified Operator: 664 Operator Certification Number: qEGS
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: D o = 0 Longitude: mom, o«
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
JLJ Non -Layer I
Dairy Calf
Feeder to Finish W16410 I I KOO
❑ Dairy Heifer
LJ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow [o Finish
El❑
Laers
❑Beef Stocker
❑ Gilts
❑ Non -Layers
El Pullets
❑Beef Feeder
❑ Beef Brood Co
❑ Boars
❑ 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 El NA El NE
❑ Yes /+❑�\No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�5ZNo
❑ NA
❑ NE
❑ Yes
gNo
❑ NA
❑ NE
12128104 Continued

Facility Number: I -Q(gg Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
�
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I v g-A
Spillway?: n
Designed Freeboard (in): 'L .
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes IblNo ❑ NA ❑ NE
El Yes �'❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes I No
❑ Yes 'E�No
❑ NA ❑ NE
❑ 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? Elp Yes ,,,�t{❑ No ❑ NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes �t,�l 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 )lq�o ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 11�No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
v
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
❑ NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,yMNo
L} No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
60No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
iNo
❑ NA
❑ NE
oComments (refer to'question4Explain any YES srraohmr ens § 'Nndttns
Use drawings of facilityYdbetter explain situations. (use additionatpages as`necessary)
IReviewer/Inspector Name Phone: -17(i -{ I
Reviewer/Inspector Signature: Date: S-

Facility Number: 3 —`a(ry Date of Inspection ]
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box. 3 WUP ❑ Checklists ❑ Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )0 No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ / 'Ste Transfers ❑)Aual Certification
El Rainfall ❑ Stocking [I Crop Yield ❑ 120 Minute Inspections Q Monthly and V Rain Inspections Q 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 1gNo
❑ Yes { No
❑ Yes XNo
❑ Yes No
❑ Yes No
❑ Yes ONo
❑ Yes9No
❑ Yes B[No
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ,gNo
❑ NA
❑ NE
❑ Yes 191'No
❑ NA
❑ NE
❑ Yes VNo
❑ NA
❑ NE
❑ Yes &No
❑ NA
❑ NE
Additional Commeuts:amd/or Drawings
W. n
7-5
(�l3 /og 1. 3
I N ��10
12a8/04

I Type of Visit RCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I /M Arrival Time: Departure Time: County: Region:
Farm Name: 11 I a- A? H i' w p s Lcc' Owner Email: n
Owner Name: AA4 )4 (1'HILLIpS LLC Phone:
Mailing Address: % fea U,349-SRL42')y /VC /a 2C3�1 s
Physical Address:
Facility Contact: Title:
/y�
Onsite Representative: 1 t 1 jq"#ALL- �>14I U'1 25 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = « Longitude: = o = ,
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capac.Mu
ty Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
W10 (0
❑ DairyHeifer
El Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
ElNon-Layers
e f Feeder
❑Be
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes $.�40 ❑ NA ❑ NE
Page I of 3 12128104 Continued

Fac' ity NumDate of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
ElNE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �_4400W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _3
5. Are there any immediate threats to the integrity of any of the structures observed?
.{
El Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not. properly addressed and/or managed
rrrAAA\
El Yes ,yam No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ��A//{ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes g,.l No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? ���yyy{{{
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �(I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
,❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
E�No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
(3aaa� C-UpAIS OIC-- j}GT/UE V°Itc- PtATGoPL� IiV f30olC L&ViS" lag
� A-��5 cCSM E ac�T
Reviewer/InspectorName I Phone: `110-1`1(O- 15obt
Reviewer/Inspector Signature: Date: J
Paao 7 of 7 12/7R/Od ('nnBnnad

Fazility NbDate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes td No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )A_No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ 1 aste Transfers ❑ j)inual Certification
❑ Rainfall 0 Stocking ❑ Crop Yield 0 120 Minute Inspections Q Monthly and V Rain Inspections El 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
❑ NA
❑ NE
❑ Yes
Dq No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
*o
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
1M No
❑ NA
❑ NE
❑ Yes %No ❑ NA ❑ NE
Page 3 of 3 12128104

i'
0 Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
-- — — D Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: y- / Arrivalal Time: %�0 Departure Time: �i�� County:
Farm Name: ��^Aa//t /7 f%�i "'�'� Owner Email:
Owner Name: 422 Ll­ei Phone: _
Mailing Address:
Physical Address:
Facility Contact: n Title:
Onsite Representative: >_PS
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
n0
Region:
//// Phone No:
Integrator: 6zaaL t
Operator Certification Number: Z�6025
Back-up Certification Number:
Longitude: " 0 0
Design Current Design. >Current
Swine Capacity 'Population Wet Poultry Capacity Population Cattle
Other
Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy 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)?
Numberof 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
ElNA
ElNE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection if
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?
S cture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: A)0—
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes A 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
0 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
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
P No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
0 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Pr
❑ NA
❑ NE
maintenance/im rovement?
P ___///
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 1� No El NA El NE
El Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground El Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
0 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
Pf No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain, situations. (use additional pages as necessary): - - -
lSs
/J5fD 5 % 6 70 Lzini /cam„
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
rage 2 Of s 12128104 Continued

Facility Number: j — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes / ly ,,����///No [I NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 0 No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes �No
El NA
El NE
El Yes fflNo
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA ONE
❑ Yes )zNo
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
)2J No
❑ NA
❑ NE
❑ Yes
�dNo
❑ NA
[INE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes'ONo
❑ NA
❑ NE
❑ Yes
jZfNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Dc�o�Fiz
Page 3 of 12/28/04

Division of Water Quality -
Facility Number 3 (0 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 9f Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 011outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 7 (P 0 Arri
nval Ti e: ; / /Deeparture Time: ,�� County: ���N Region: �'v I&
Farm Name: Ado /�f F�Z/.GZOS 11�nCt� Owner Email:
Owner Name: A14p �' 9=GL_�OS l�C, Phone:
i
Mailing Address:
Physical Address:
Facility Contact: A Title:
Onsite Representative: /��1�1L �ifZGLZ.0,q,5
Certified Operator: , 4bLlS
Back-up Operator:
Phone No:
Integrator: ///l�iPy—���✓/`�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = u 0 , 0„ Longitude: 0 0 [--A,
, 0 „
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ Yes 2E1 NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
❑ Yes PTNo ❑ NA ❑ NE
12128104 Continued

r, r
Facility Number: —2 Date of Inspection
! _
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes PlNo ❑ 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?: fYfL—
_
Designed Freeboard (in): e
Observed Freeboard (in):
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 ❑ 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 y'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes m No El NA El 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
l I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window O Evidence of Wind Drift ❑ Application Outside of Area /.
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
0No ❑NA ❑NE
9No ❑ NA ❑ NE
1P No ❑ NA ❑ NE
ANo ❑ NA ❑ NE
❑ Yes m No ❑ NA ❑ NE
Comments (refer to question ff): 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):
_ /� F o�,DS �ouco 'J6 +CJF_ �>6iz D2G./}.✓zz ��
ReviewerQnspectorName I /'S7f2 �g�Jj Phone: 9/D,— i7 —;W
Reviewer/Inspector Signature:
Page 2 of 3
Date:

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 'VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes PrNo ❑ 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 ElXJ Stocking ❑ Crop Yield 120 Minute Inspections ❑ Monthly and 1" Rain Inspections eloweather Code
22. Did the facility fail tc install and maintain a rain gauge? ❑ Yes YrNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ONE
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?
oYes ❑ No
❑ Yes )21No
❑ Yes El No
❑ Yes YJ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA grNE
❑NA El NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
F(No
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
ElYes
VJ No
❑ NA
❑ NE
El Yes
/XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
2)-
X�'Ir2oQ
N��i� s �Jf/�N7�f�.✓� //L s// 2Z.j &0c�.
Page 3 of 3 12128104

06 04:48p
A
JESSE H. BROWN
9102960711
N
cj 9

Jun 8 06 04:48p
' t
JESSE H. BROWN
9102960711 p.2
115
ena28349
J:. .
�:It�� t t :1 � It :•,t I • et
Farm Name. _
Date of Field Calibration _
Flour Meter Serial Number _
�S 3/ 3
�39g0 �5 �
went Number ---_
Mc.,n
/S Inches J
Measured Size
1"
Is ring size within 0.0of original
x Yes or _ No. If replace
mamlfaatured size?
rw . - — --
_ _
pressure Ga a Readings: ___
/o
a Psi t
-Ad Pump
t Traveler _ _��_
Psi if a livable t
A S erlGun —
i
Expected Flow Rate (from manufacturers
02�,5
GPM
chart —�
Measure Flow from flow Or 0�
1
GFM
-- 2
Flow rate variance eater thaw 10%? Yes or No
Expected Wetted Diameter (from the
3) S
wetted a determination _
3 / �
Ft.
Tvieastlred Wetted Diameter _ _
Wetted diameter variance greater then 15% Yes or �<_ No.
If des,>' then
measured flow variance greater than contact a teeboical spec�iatist
or irrigation
and/or
10% dealer for assistance.. Rolain
fsndings in
lox below.
Explanation of Findings:
-
A
Calibrator's Signature:�—
Irrigation HquiPmwt Field Calibration Yoon 8-15-03
Retention Period: 3 Years
00,
F
original 2
4C
E

y�417 06,08:08a JESSE H. BROWN 9102960711 p.1
i
Rainman En ental, LLC
Post 113 j
Kenan ' , 28349
91; 60
Irrigation Equipment Field Calibratlon
M
0
Is ring A= within 0.01" of Original I-i es or
manufactured size? _-- rhis._ - _.— �---
i
Rate
Measure Flow Kate (MM glow
Flow rate variance gmater than lt}%7 Yes o.5 0 ;l
Expected Wetted Diauteter (fmm the
wetted acreage determinations---.---
Measured Wetted Diameter __3j-2 —
Wetted diameter variance greater than I P"a Yes or No. If"yes," then
and/or measured- flow variance greater than contact a or irrigation
1011/0 dealer for assistance. Explain findings in
box below.
Explanation of Findings:
Calibrator's Signature: l -�_t_�-------- —�
lrrigatim tigwpmeau FiOld Calibraaiui Pixm. 8-15-03
Retwtim Period: 3 Years
Original 2

May 1 7 06 08:08a JESSE H. BROWN 9102960711 p.2
� ring size within 0.01o
Kenar y r .q
(_ .cir28349
91'V '
60
or --No.
l:llaaa
Measure Flow . from now me
10°/a?
,v u ,
No
Yes °r-----
- Flow ,,., variance greater than
Expectad wetted Diameter (from the
315
wetted a determi �t'i�t n
Measured Wetted Diameter er than 15%
varlatlae great
Yes or �N
Wetted diameter
and/or measured flow variance greater than
contact a teclmieal sE
dealer for amistame-
100%
box below-
E. Planation. of Findings:
Calibrator's Signature:
irrigation Equipment Fly Calibration Poml 5-1"3
Retention period: 3 Tears
i
a
es," then
or irrigation
t findings in
Original 2
4
n

IType of Visit Rf compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 9rRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
`%-
Date of visit: "7-"" Arrival Time: Departure Time: ; �� ounty: Region: Zvzho
Farm Name: Owner Email:
Owner Name: 1Q1 'k. A Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: {,L7�G�f
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone No:
Integrator: ai kc_ 9
Operator Certification Number:
Back-up Certification Number:
Latitude: a o = , = Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ 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 DW Q)
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 �INo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes V1 No ❑ NA ❑ NE
❑ Yes j�No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;ZNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Identifier: 10/
Structure 5
Structure 6
Spillway?: �l
Designed Freeboard (in): ' .&
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PNo
❑ 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
KNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
A No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
1
V No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
rrrr--------����
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
VNo
❑ 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 0 Application Outside of Area
Z
.�
12.
Crop type(s) /v�Zyf �./��ieQ/%l L
6/ „ t/
ev U-11XA ��
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
)dNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes
[I NA
El NE
17.
Does the facility lack adequate acreage for land application?
El Yes
r2No
t-/J� No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
YJ No
❑ NA
❑ NE
142-; C
Reviewer/Inspector Name ��� rI Phop
Reviewer/Inspector Signature: . Date:

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fait to have Certificate of Coverage & Permit readily available? ❑ Yes 1[I No ❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. OYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall 0 Stocking ), Crop Yield ❑ 120 Minute Inspections Omonthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EfNo ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA 9NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
VNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
4 NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ANo
❑ NA
[__1(((NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
yJ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
[I 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 concem?
❑ Yes
,mot
ET
❑ 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
ffNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
El Yes
,,,---,,,rrt
/�[J
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
,y�(No
No
❑ NA
❑ NE
[Additional Comments and/or Drawings: _ 3
'/7�iZi✓fi?� /�/fL�-�� � ,�F �COQDED lC/.9=G�
-/Uf�O .�� �F �N/�✓a� C��,Le.�zGs �,��-TzJo�✓ �a,>1 Gvt>��
/�/� �Ql(ZP/�%1i✓� �/✓ Sze, ��!/Ll�70lL �.45�/fin
12128104

(Type of Visit jrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit VRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 0 Time:
Not Operational Q Below Threshold
Permitted Certified 0 Conditionally Certified 0 Registered Date Last Operatedd or Above eshold:...__.-
FarmName: ....... ........._._....._. __--••--- County: _._._.v!!�.._.___._._ .......1Y1.....A. �AYYI �.................._.
Owner Name:
Mailing Address:
Phone No:
FacilityContact: .. ...... ..... .......................... _..................._......._... Title: ... ................................................... Phone No:
OnsiteRepresentative: ...... (,','!,i�Sl7.r:..L�/... L(cl.I( l_....__..__. Integrator _._. CAWILLS
S__.
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude F__10 =' =11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .......... ._I --- _----------- _.....__........_...................._._......._._............................. ......... ._--- _...----
Freeboard (inches): 31
12112103
❑ Yes
Structure 6
❑ No
L� No
No
No
Continued

Facility Numbe_r-_j_j_—__269j Date of Inspection
5'.
Are there any immediate threats to the integrity of any of the structures observed? (i(ie// trees, severe erosion,
❑ Yes
EJ/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 46 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?
❑ YesNe
—//
8.
Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes9.
KNo
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
jNo
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.
Crop type (e wm,tA � 6� Cr-'N11►'E of Mats; ovep Sty
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
��
[ NV
b) Does the facility need a wettable acre determination?
❑ Yes
LL�-77N
c) This facility is pended for a wettable acre determination?
ElYes
15.
Does the receiving crop need improvement?
❑ Yes
N
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes OICO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes I No
Air Quality representative immediately.
Field Copy ❑ Final Notes
5vjP6E Se)(Wei. d(_Cb _S
7% 036 bonJE 6/
APIZ,
ZY
/VSPEcT2j,�J A(W-.A, 1 r/e_wJ
NfEos T6
l3F
WPOW
L)P .D AT6 ClzAP 1',r6-CD Fa«✓l
T-o xtJzT-_tA(, AFTe6L ►7, MrN+rF
A F6 P t, r-cAT cJ'
Reviewer/Inspector Name O't^a�kAtRl)(.t�� r
Reviewer/Inspector Signature: yl � A, p Date: I rr4
wUmmuea

Facility Number: — Uj Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(id WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need impro ment? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall Inspection After 1" Rain
[ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes — No
❑ Yes 21No
y
❑ Yes [� o
❑ Yes I1
❑ Yes No
❑ Yes Q"No
❑ Yes No�No
❑ Yes ❑ Yes
/Yes❑
❑ Yes
❑ Yes No
❑ Yes
❑N
�N
es
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ittonal Comments andlor Drawings
ui v_F i
12112103

Rf Dwrsion of Water Quahty
O Dmsion of Soil and Water Conservation
E
O Other Agency,
of Visit F Compliance Inspection O Operation Review O Lagoon Evaluation
an for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: I rime: ® Printed on: 7/21/2000
Facility Number /
O Not Operational O Below Threshold
0 Permitted E3 Certified ❑ Conditionall Cer4tifiedy/��E3 Registered / �Date Last Operated or Above Threshold: .........................
Farm Name: .......M......................./............ q ..... .�._t...!...'!.t' �...(w.'.:^-' County:... /. il�............................... We. //....
AAA
Owner Name:.J..(./......�)p.....1.'i:.......1`.1i�LL t�{��......41— .......................... Phone No:................................................._.....................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ............................................................. ........................
�/j y /S
Onsite Representative: ..... ...11.�R-5-85---........f.><. i............................ Integrator:........�y.�.�.��:._�i.....................................
Certified Operator: .................................. ................ ............................... /......................... Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Design Current Design Current Design Gurent
CaPn Poultry CeCa_PoSilaouatioo
=ei Wean to Feeder - ❑Layer ❑ Dairy
x
Feeder to Finish 19 ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
Boars TOW SSLW
JU Subsurface Drains Present P Lagmn
IN .=.MMd3ng Yonds / Sohd Traps.. No Liquid Waste Management System -
Discharees & Stream Im 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 S
Identifier:............................................................................................................................................................................
Freeboard (inches): 310
5/00
❑ Yes /11 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes /� No
❑ Yes P"0
Structure 6
Continued on back

I, . 11.
Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evid
12. Crop type
❑ Yes LLl No
❑Yes LANo
❑ Yes VNo
❑ Yes IQ No
❑ Yes EdNo
❑ Yes [YNo
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[XNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
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
W(No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
I( No
Required
17.
Records & Documents
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
/�
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
ElYes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
1
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
zNo
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
VNO
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
I9� 0CF(D I o _r& K E YEAgLy
oA-rE Ts Oro O[\STE-
Final Notes
qkE
Reviewer/Inspector Name
x � e
Reviewer/Inspector Signature: Date:J 10�
05103101 I Continued

� 0
• Facility Number: — Date of Inspection/3 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 dt/or below ❑ Yes m No -
liquid level of lagoon or storage pond with no agitation? /
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ YesNo
roads, building structure, and/or public property) x
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes �No
_AdditionalComments orDrawings: - _ --
/I�DiF
nnT c� eXe
L ii`�/,9W n/ C/ P�t,ga✓ 7�T
5/00

Facility Number Date of Visit: Time: ® Printed on: 7/21/2000
�[ 0 Not Operational O Below Threshold
® Permitted [3 Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: ........................
Farm Name: l7 SQti V......................................................................... County:........."1..........................._................ ......
............. ............
OwnerName: ................................................... ----------------------------------------------------------- ---------- .. Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ...............s..(.............\....................D..............................................................................................---............................1.`....`....................... ..........................
Onsite Representative: _I, `\f!)v8_" \._`.-\1�r_f.............................................. Integrator:.... 1.'�1...................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =1 =11 Longitude =- =' =..
Design Current Design Current Design Current
Ste' CaDacitv Poinulation Poultry capacity Population Cattle Capacity._.Population
Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish Wqo - ❑ Non -Layer ❑Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total MLW
vf
--Number otLagoons Subsurface Drains Present ❑Lagoon Area ❑Spray Freld Area
Holrbrtg Ponds / Solid Treps ❑ No Liquid Waste Management System77
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Wo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. if discharge is observed, what is the estimated (low in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................0..................................................................................................................................................................................................
Freeboard (inches): �o
5100 Continued on back

ol
(Facility Number:31 --Wcj I Date of Inspection CJ 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 lj No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes � No
(If any of questions 4-6 was answered yes, and the situation poses -an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? 0 Yes
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes
� o� (n t r
12. Crop type C2� t �"" b c o� 9i , Wlti a,�4 �1
VNo
No
❑ No
VNo
A No
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
kNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
& 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?
N(Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
NrYes
❑ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
UrNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
J<No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
&'No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
WNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'!
❑ Yes
9No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®'No
lyo •yiglatigtis.'oi: deficiencies *. . 6rh6..f.ed.d&i.fig this:visit. - Y u. , will i•eceiye fio further
cori•esnoridence:abotiCthis:visit::::::::::::::::................... ...
�� �Cot`tti2t KS1�9�2��2�.tc ic� Cp��r a` f sues
d4 k "�cli2d 4 ,1`—di-2 41,j \%VQ- o rjt_,4 i4
r � \,y Pam , C cv_Nr C?.- U-, Gh rt , -� t.r
Reviewer/Inspector Name
Reviewer/Inspector Signature: ,aj1,P Ck Date: $— ('/-01- 5/00

Facility Number-. —XcJJ Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation? XZ
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes bo No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporarycover? ❑ Yes No
Additional -omments and/orDrawings: - - -
ly�
r-aL.ejl `.,af
o�-
��e�ee
L,►� �,�p,c. ,� Q��c�d�o,et
Stl'-JAS Liz
101, \ l4 �T2 ���t \ �G ►1QQ�cJ
0,9, 4 i re �- V-tcc;A�J � -, gad s,
fk icy V4 how C—r-^ 5764 -Je vlrrk,4� S ,
s/00

�i '_ 0 Division of Soi
0 Division of Soi
`., UDion of Wi
10�Routjne O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other
Facility Number $ Date of Inspection
Time of Inspection : 3 D 24 hr. (hh:mm)
Permitted E3 Certified 0 Conditionally Certified E3 Registered 0 Not O erational Date Las[ Operated: P .............................
....... Farm Name: L........CK1ULpa............(.....�enSQ!.1............................................................... County:......... .. .... �: h................................/�°
....... . Owner Name: ,.,.,,,Lt.h wood yP37.Sor
.........................................pp........................................................ Phone No:.......................................................................................
Facility Contact: ...L.ti+WOO,�I................y^........ Title: ....... ................................... Phone No:...................................................
Mailing Address:
Swine
❑ Wean to Feeder
j$ Feeder to Finish
Z (r tie
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons 1
Holding Ponds / Solid Traps C
Design ', -Current t'
Poultry
Capacity 'Population Cattle
❑ Layer
❑ Dairy
❑ Non -Layer
I
❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW :._C
❑ No Liquid Waste
ipray Field Area
t)iscnarges & Nream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes [)(No
❑ Yes ❑ No
❑ Yes ❑ No
—/Vif —
❑ Yes ❑ No
❑ Yes D(No
❑ Yes 2No
❑ Yes ((No
Structure 6
Identifier:
Freeboard(inches): .......................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? fie/ trees, severe erosion, []Yes *0
seepage, etc.)
3/23/99 Continued on back

Facility Number: ?) —�i' G Date of Inspection /D '00 -
Odor Ism ��� jjj
26 " Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below El Yes �1Vo
liquid level of lagoon or storage pond with no agitation? /
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P(No
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)/\
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or �\
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 1,(NNNo
AdditionalComments and/or rawtngs:.T�
i'D .. 0 -F rtGu\r-L- LDS �o�-
caqtvAy).
�r, j3{nson mots dry,..( t~pN -eya) • 4 Ll� o/K +k-A lats� sPval�t4
pe d
�nrY i fan e6w. OD
rar�l,�tu S �
Ob
Q r� 4�e. S 7 C c� i g� �, �Z " �1 p4- &12 00 0
�.Wvt^/Z00 O , Goro�
Y2 coed l�pt1

Facility Number: I —a�j Date of Inspection /lt� Printed on: 7/21/2000
5.
A,re there any immediate threats to the integrity of any of the structures obse ed? (ie/ trees, severe erosion,
❑ Yes
gkNo
' seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? -
❑Yes
O'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
IGi�N0
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
5; �,17
7�
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
RNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
NNO
,�*o
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [I Hydraulic Overload
El Yes
Ct P
12.
Crop type ��, 4 :c d a R . M W li
13.
Do the receiving crops differ with those designated i�Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
�*o
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
l No
b) Does the facility need a wettable acre determination?
❑ Yes
13&o
c) This facility is pended for a wettable acre determination?
❑ Yes
C�tv<No
15.
Does the receiving crop need improvement?
El Yes
10
/{�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
/ `
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?
fie/ WUP, checklists, design, maps, etc.)
❑ Yes
C2riqo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
jX�No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
`No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes )2�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes P(No
24. Does facility require a follow-up visit by same agency? ❑ Yes 0No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [` 1Qo
I.
(Vd violatiotis:oT 8eficieucfes wer8 poled doling this:visit:-You will i eeeiYe tio: further
. cories ofideitce:about:thisvisit::....::.. .
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):
lvu? was it/Ac4�.iw, Fib . "ow /jy A,, �,`sd,, f. Alt-. 8ens-t'.5 w1, P is
, r l I K Oar-Af s tto to (" 1014 e&t-- r.rt/ 6 res. V) . Mt- 8 e;4, s t't- (mitts ko.1t
AFr Ctr�i`Pu( 9r�ss i� p(.t�c` a sa tb^s.
04V, �.t.r✓N �il/A4r i i`S ')'l.,[ i%L� / C_tY<�-. ��� ) .
-•ru.1._
Reviewer/Inspector Name
Reviewer/Inspector Signature: y///�/, okA Date: F Pe 5100

i
0 Division of Soil and' -Water Conservation -:Operation Review)-
0 Division of Soil and Water.Conservation Compliance Inspection ,vision of Water Quality. -,Compliance Inspection - - r
E3 Other Agency -;Operation-Revtew«,
outine Q Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection Zn
Time of Inspection ?' a'c, 24 hr. (hh:mm)
0 Permitted eCertified, 13 Conditionally Certified 0 Registered 0 No[ O crational Date Last Operated:
Farm Name: ..LtJ✓5:�.1.gs� �7 .. County :.............. ..1C+!<r!.............................................
... �...Ce. L.+i%.........................................................................
Owner Name: - _ ______.. _._.... _. Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: ...... ..........................
..................................................................................................................... ...............................................................................
Onsite Representative: ........................................................................................................... Integrator: ........ CA ..........ffto ... An.S........................................
.
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude =•=' =•' Longitude =• =' ="
n
-: Design Desi .;:Current CurrentDesi -
Capacity tyPopulation
-
Poultry Cattle
ity Capacity Population.
❑ Wean to Feeder
= ❑ Layer ❑Dairy
12 Feeder to Finish J _
❑ Non -Layer ❑ Non -Dairy
:... ❑ Farrow to Wean:,_:_:..
-- ❑ Farrow to Feeder
_ ❑ Other -
❑ Farrow to Finish
Total Design Capacity
- : ❑ Gilts,
❑ Boars
Total SSLW
,Number of -Lagoons
❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
:., Holding Ponds /. Solid Traps
JEI No Liquid Waste Management System
Discharges fir Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes Zo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes jJ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes Plrgo
c. if discharge is observed, what is die estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes p'No
2. Is there evidence of past discharge from any pan of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Y" " o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3.....................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �tvo
seepage, etc.)
3/23/99 Continued on back

Date of* Inspection Za
Facility Num
6.
Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
❑ Yes
0<0
(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
L2rNo
8.
Does�any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
L�'No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
P110
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
I�o
11.
Is there evidence of over application? ❑ Excessive Ponding [IPAN -
❑ Yes
J'No
N+r
12.
Crop type C_ PGC.h-roA S C. tf S•5
13.
Do the receiving crops differ with those designated in the Certified Ani al Aste Management Plan (CAWMP)?
❑ Yes
P40
14.
a) Does the facility lack adequate acreage for land application? -
❑ Yes
RKO
b) Does the facility need a wettable acre determination?
❑ Yes
[;rNo
c) This facility is pended for a wettable acre determination?
❑ Yes
P40
15.
Does the receiving crop need improvement?
❑ Yes
�?No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
j•No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
S" 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
19.
oard
Does record keeping need improvement? (ie/ inigati6n, freeb, waste analys<& soil sample reports)
❑ Yes
/no
r
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Sa "o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
J2/No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
7/
24.
Does facility require a follow-up visit.by same agency?
❑ Yes
J 1`
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
i14d 06,lhtiotis:ok- deficiencies •were iwted dta ifid this:visit'. - You will _feeeiy@ f)O futthgr
curies oridence:abotitithisvisit.:•:::::•:::::•::::: ; :::::•::::•:•::•:•::::::
. _ _it .
Comments -(refer togueshon �):. Explain any YESranswers__a and/or ny recommendations or any"other commbents -'=
'Use drawings of facility to betterexplain situations: (use additional -pages as necessary): _ •=_ __
-<
---
0 395-39n
Reviewer/Inspector Name en'
Reviewer/Inspector Signature:
Date:
3/23/99

r

rFacility Number: 31 — 7„b cl Date of Inspection $
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
;3'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-No
28.
Is there any evidence of wind drift during laird application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
FrNo
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
ZNo
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
EjNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
R'No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
J" M 0
3/23/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
or DSWC
Facility Number Date of Inspection G b
Time of Inspection Q O 24 he (hh:mm)
0 Registered 1,Certifred CApplied for Permit 13Permitted JE3 Not Operational IDate Last Operated:
..........................
FarmName: ......�g....&,:�--................................................................... County:.... \..........................................................
Owner Name: ... ....... ` h �--W — O 6 Lf
c4.......ii�! su............................................................. Phone No:.�C?..�........................................1.6.................
FacilityContact: .............................................................................. Title: ............. ................................................ ... Phone No:
MailingAddress: ..................................................................................................................... .................................l...s................................................
Onsite Representative:. ©..:!`.^.................................................................................. Integrator: ...... l.......b
................................................................
Certified Operator:............................................................................................................... Operator Certification Number:..................:......................
1jaxatjon Rf Farm:
.. . ...................._�55........... 5.................... 1."J........... ..........._G�-............ .......................... 6..S .... `.-9a \ ...............
,..1....:.,..._ls_16..,..Tr- 1.........1...._,-,-'.is.....c�..s.>=��_ur..............
Latitude =&=, =" Longitude 0' =' =«
,, Designer ,Current.
a
Design
Current _ Design Current
.` e
Swmeapacity
Population
PoultryCapacity
Pdpulaton `Cattle £Capacity Population
❑ Wean to Feeder
ID Layer I
❑ Dairy
Feeder [o Finish
t-(�
❑ Non -Layer I
❑ Non -Dairy
❑ Farrow to Wean
�--� ❑Farrow to Feeder
� Other
e
❑ Farrow to Finish
-
Total Design Capacity
'3 ❑ Gilts
s
❑ Boars
Total SSLW
Numberof Lagoons%Holdmg
Ponds ��' ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
s
•' < ❑ No Liquid Waste Management S stem '
General
1. Are there any buffers that need maintenance/improvement?
❑ 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
WNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
14 No
c. If discharge is observed, what is the estimated flow in gal/min?
4A-
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
ONO
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
R No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
ONO
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
PfNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
,.,/
b No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
15 No
7/25/97

Facility Number: -3 — r
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes gNo
Structures (Laeoons.HoldinL Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes to No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:......................q.......................................................................................................................
Freeboard (ft): �'a • L
...................................................................................................................................................................................................................
......................................................................
..
10.
Is seepage observed from any of the structures?
❑ Yes
C<No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
[X No
12.
Do any of the structures need maintenance/improvement?
DAYes
❑ No.
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
;P No
(If in excess of WMjP, or runoff entering ate of the State, notify DWQ)
15. Crop type ....... �7 -! 1�.. ........................................ p r t... _�..�......, .......................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes VNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
IWNo
18.
Does the receiving crop need improvement?
❑ Yes
NNo
19.
Is there a lack of available waste application equipment?
❑ Yes
fgNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
P(No
22.
Does record keeping need improvement?
((Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
o
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
Zo
[3-No.vidlitioitsoi
de iiciencies.wereittited dtiiirig this.visit. You:win receive iiti ftirtliei-
correspondepce itiout this: visit:• : • ; :::: ; - : • : -: • ; ::: :. -,
V2-) �cr. a �-� �'c ' r 1z list �e 1 �l -e_ e v -�i e L'4 r,
c4
CO W�n t v2 sZ , ` C�c �`�a(/i�`LG 42 a 61, &, t 1
Od 1 ( I �r i,,.-1- t��� "� �v5 1 r�r � 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: a _ Date:

Routine Complaint O Follow-up of D`WQ inspection O Follow-up of DSWC review O Other
Facility Number 3 2
Farm Status: ❑ Registered ❑ Applied for Permit
® Certified ❑ Permitted
❑ Not Operational Date Last Operated:
FarmName:.... J. `5).....&X51 ..__...._..... — ..... _..... �.. _..___.... County: it1.._._..�.. _....�.... _.... _...._.
Land Owner Name:..JO\p��.pn __...._ ...._._....._ ....__.... ...... Phone No: `� �� z�1�f-.t`5(a'��,........
_.....__....._...._...
Facility Conctact:...^�t��Ylpfj.�!'1t5Ctn....... _..... _.. Title: _...0Qrj i[...._.... r....� Phone No:...1 St(1�.. ..._.....
Mailing Address:...... t/
Onsite Representative:..... .h(dtL.... `_....__..__.... _...._....._...._ Integrator: _.......... .... ..._.... ._....
�.
Certified Operator: p __.. Operator Certification
Location of Farm:
Latitude ©•�`®« Longitude ©•®•=`
General
1. Are there any buffets 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 gal/min?
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
4/30/97 maintenance/improvement?
❑ Yes ICJ No
❑ Yes J] No
❑ Yes 1P No
4
❑ Yes M No
❑ Yes
qNo
❑ Yes
1A No
❑ Yes
® No
Continued on back

Facility Number: ....
r
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J'No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
j No
Structures fLaaoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Freeboard (li): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
...._ z:l_....—. ... _.... —.... ... ....... _.... _........ _ ..... .
_
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
W No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
EANo
Waste Application
14. Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....—llt--- —------ ......—....—_.._...._.....1!aaA.-—...._._....—.... ...._.....r...._
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
09 No
19..Is there a lack of available waste application equipment?
❑ Yes
E3 No
20. Does facility require a follow-up visit by same agency?
❑ Yes
[A No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �9 No
For Certified Facilities only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes P No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
24. Does record keeping need improvement? Yes ❑ No
Comments (refer to question # Explain any YES answers'and/or any recommend_atrons or any other comments
Use drawrn s,of facili , better ex lam situations use additional " a es as neces
�.
avaYJ ,,LIk Vyes on 1V Y%ev' (Agco,v L'V s�pu�d be � Iwd� reSerr7c�. �rG
She 156V 1 be rkee .
zy. 5� rrcott�s 5lm,ic1 be, �4.�fi by ;ic�f) a� rt,>\ number; Cer�,}�e� ��an Sala ��(��
;rtsec� s oabr Cot+61 a4
$e core�ul U;�'4. a�utn�nun. �i, e se� vp,
Reviewer/Inspector Name ��faf} ti 'a.� r I
Reviewer/Inspector Signature: &jl z , A I,— _ Date: I,&'- 67
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit
4/30/97

S
t Site Requires Immediate Attention: -hj4
Facility No. Z - 2l¢q
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. - 6/8 9 1995
Time: I `1 I T
Farm Name/Owner: U✓tc w00 J
Mailing
County:
Integrator: t S-- Q
i
On Site Representative:
Physical Address/Location.
Type of Operation: `'`Swine
Design Capacity: ?Cy-4 (X,,
DEM Certification Number:. A(
Latitude: �~ '
Phone: (g/t'\ a 9 Le - oUSS
Phone:
� I+
Poultry _ Cattle
Number of Animals on Site:
DEM Certification Number: ACNEW
Longitude: 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 inche s or No Actual Freeboard: �_Ft. Inches
Was any seepage observed from t�goon(s)? Yes o<N) Was any erosion observed? Yes or(i
Is adequate land available for spray? Yes or No Is the cover crop adequate? or
or No
Crop(s) being utilized: c-o
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? -6 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 or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oAI If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: cc,,S. c-rt.� r)'o
;, • Y� L Lit- �/�� < .:c �7 ,Q .��r—
Inspector Name Signat e
cc: Facility Assessment Unit
Use Attachments if Needed.