310285_INSPECTIONS_20171231

19
NUH I H ClAHULINA
Department of Environmental Qual

Type of Visit: U70Ufiti`nne
cc Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Arrival Time: Departure Time: p Jr County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �� rC f'-r-o t✓7 t S
Certified Operator:
Sack -up Operator:
Phone:
Phone:
Integrator:
Certification Number: 171 yZ
Certification Number:
Location of Farm: Latitude: Longitude:
11111111111,gDesign Current
Capacity Pop.
Design
Wet Poultry Capacity
La er
Non -La erDa'
Current
Pop.ish Dai Cow
Calf
Design Current
eder
7Feeder
Z4
p n
nish
Design
D . P,oult . Ca aci
Layers
Da' Heifer
Current D Cow
P.o , Non-Dai
Beef Stocker
ean
eeder
Farrow to Finish
I
I
Gilts
Non -Layers
Pullets
I 113eef Feeder
Beef Brood Cow
Boars
Qther
Other
Turkeys
Turkey Poults
Other
Discharizes 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
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �No[—] NA ❑ NE
Page 1 of 3 21412015 Continued,

Facili • Number: - Date of Inspection: Lj
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
2fNo ❑ 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"Noo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E;,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 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
t 1. 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):
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑' o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FZrNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes eNoo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No D. 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 ludge 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? D Yes No D. NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZrNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? ff yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
Vure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
-compliant sludge levels in any lagoon 5 4 f f
List structure(s) and date of first survey indicating non-compliance: U r 4 lam' 0117
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ET5o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [IrN'A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes DNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA
❑ Yes NA
❑ Yes�N`o[o:] NA
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).
D
sJf^ c C s
y
SIB e b,-w P,
/'12� //' , �' I Otis jt-c- 2--a /7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
&— I j U114 [l
❑ NE
❑ NE
❑ NE
Phone: (o r � 1�
Date: A 7
hp
21412015

Type of Visit: 0 rRoutine
Hance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: (* Arrival Time: ® Departure Time: Z 0 County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: �' 1 ��O �"' (C—S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 7
Certification Number:
Longitude:
Swine
an to Finish
Design C*orient
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
U O D Z s
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Rlurkey
I
Design Current
D . P,ouitr. Ca aci P■o
Layers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
JEL
urke sOther 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?
D. Yes ffNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes [—]No
❑ NA ONE
❑NA ❑NE
❑ Yes � ❑ NA ❑ NE
❑ Yes ❑ NA [] NE
❑ Yes rNo [] NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - DInspection: o 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ["No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N ❑ 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 Rio ❑ 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 Rio ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes U'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 E No ❑ NA ❑ NE
maintenance or improvement?
1 I . is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�N ❑ 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
[Z"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[n"No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Rio
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
[�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[7fNo
❑ 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 ENo ❑ 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 Inspectionss ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EJ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes U]"'No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili ty Number: - -L Date of Inspection: 141
24,131d the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ETNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [5 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes / No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Q NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes , ]'No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes E j4o ❑ NA ❑ NE
❑ Yes 0"No
❑ Yes
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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).
( 2 7
cc rC� / if ( r. 9d. A4 n
�1tV► Q n � Q 1
Reviewer/Inspector Name: 1 _ " i
Reviewer/Inspector Signature:
Page 3 of 3
Phone:y o 1 PG 7jo ?
Date: I ( If 0 ZZ&
21412015

2Y-5—
Type of Visit: ©rCompliance Inspection 0 Ope tion Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: l f County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultr3
Capacity
Pop.
Cattle .
Capacity Pop...:„
can to Finish
Layer
Dairy Cow
Wean to Feeder
11
INon-Layer
I
Daia Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P■oultr.
Ca act
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
rke Poults
Other
±oLther
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. 1s there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes !o ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

acili :14 umber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ 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 QNo ❑ 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 dNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 EfNo [] NA ❑ NE
maintenance or improvement?
I I - Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �NE
❑ Excessive 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):
4. o the receiving crops differ from those designated in the CAWMP? ❑ Yes OeNo ❑ NA ❑ NE
oes the receiving crop and/or land application site need improvement? EfYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA Ef NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA V 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 F]--NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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?
Page 2of3
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA [kiE
❑ Weather Code
❑Sludge Survey'
❑ NA
❑ NA NE
21412015 Continued

kacifi umber: '3 - 2 Er 5 Date of Inspection: % 2 t f
24� Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No 0 NA [f NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA Ea<
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA EfNE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No D N ❑ 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 rNo ❑ 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
Q NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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<0
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
6-NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
YYes
❑ 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).
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or
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Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q h 77 k
Date: 712- 1 /
21412015

Type of Visit: (D Com nee Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency 0 Other O Denied Access
Date of Visit: / Arrival Time: Departure Time:l County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Rt LA �� '! `� �t^1Ie S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Gapacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Layer
1 INan-La er
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr Pwoult .
Ca aci
Pao ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood Cow
Other
Turke Pouits
Other
Other
Discharees and Stream Imu2ct5
1. Is any discharge observed from any part of the operation?
❑ Yes
NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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
/allo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EfN o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili dumber: - Date of Inspection: Z
Waste Co lection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): S. 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
UJINo
❑ 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 oren nmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9_ Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E2<o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0o ❑ 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 TTyppe(s):
1 the receiving crops differ from those designated in the CAWMP? ❑ Yes ErNo ❑ NA ❑ NE
15 oes the receiving crop and/or land application site need improvement? Q es ❑ 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 rNo
N ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E]rNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements El Other:
21. Does record keeping need i ovement? If yes, check the appropriate box below. Yes 0 No ❑ NA ❑ NE
❑ Waste Application Weekly Freeboard ❑Waste Analysis ❑Soil Analysis ❑Waste Transfers ❑Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

1E: acili Number: J1 - 2 Date of Inspection: Ap2 3
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
LJ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Eryes
[:]No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ej 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
C 3INo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30.
id 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
Q o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ETNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector faii to discuss review/inspection with an on -site representative?
❑ Yes
01�; ❑ 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.
Usedrawings of facility to better explain situations (use additional pages as necessary).
e-4 5 We e Gb C A-r -c—b
(p 4,
Je *r
S
21 . Qe )l) n ec r, e r 1 -1)
2p f 5 4p 231 10n At zo/ S'
os c 20�r• 5� c�
�QL
0 n Tf
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
06 %-� i � Coo L-e /1
Phone: J - 1 7309
Date: U' ! 2 3 ( X-
21412014

- Divi"sion of -Water Resources
Facility Number � - O Division of Soil and Water Conservation
© Other Ag�y
Type of Visit: ompliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: ,00 toutine O Complaint O Follow-up 0 Referral 0 Emergency O Other O Denied Access
Date of Visit: 1 Arrival Time: V., parture Time: County:
" Farm Name: % - Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of farm:
Phone:
Title: Phone:
Latitude:
Region: �>�
Integrator: --
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current Design C•urreat
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer DairyCow
Dairy Calf
Wean to Feeder
Feeder to Finish
Dairy Heifer
Design Current Dry Cow
Dr. $oultr Ca achy P,o Non -Dairy
Layers Beef Stocker
Non -La ers Beef Feeder
Pullets Beef Brood Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
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 PfNo ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes [� No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

,? h
Type of Visit: .B`Compliance Inspection: 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ,&Routine 0 Complaint., 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access,'Z�
Date of Visit: �� Arrival Time: ,'e arture Time: Coun
P 0 t5 ��l�,r % Region:
Farm Name: //� / t% Owner Email:
- i
Owner Name: Phone: , t
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:f�?
Certified Operator: ';Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Gapacity
Pop.
Wet Pouiiry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrov%o Wean
Design
Current
Dry Cow
Farrow to%Feeder
D , P,oul
Ca aci
P■o
Non-Daiiy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Irboacts
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?
i
3. Were there'any observable adverse impacts or potential adverse impacts to the waters
r
of the State, other than from a discharge?
Page, I of 3
❑ Yes 9No [] NA ❑ NE
❑ Yes Q. No ❑ NA ❑ NE
❑ Yes [2] No ❑ NA ❑ NE
❑ Yes P] No ❑ NA ONE l t
❑ Yes [ No ❑ NA ❑ NEB;
4'
❑ Yes 0 No ;°❑ NA ❑ NE"
21412014 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Ono ❑ NA ❑ NE
Structure ] Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �NoE] ❑ 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 4-5 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 [j-iio ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J'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 ,P],Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance a]tematives that need ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes L2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > tO% 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 ,ETNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,E:r3No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes a"'No ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes E�r]No ❑ NA ❑ NE
❑ Yes jj 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 25*No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,�o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers ❑ on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

ry j Facility Number: - } Date of Inspection:, J 2
WAIste Collection & Treatment ;
4. Is storaggeSpacity (structural plus stormstorageplus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Struct e I Structure 2 Structure 3 Structure 4
Identifier:
- Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑-No ❑ NA [:].NI E
Structure 5 Structure 6
❑ Yes f5No ❑ NA ❑ NE
❑ Yes-[!�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR t;
7. Do any of the structures need maintenance or improvement? ❑ Yes [2-No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
maintenance or improvement?
_Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 'P�No ❑ NA ❑ NE
❑ Yes oNo ❑ NA ❑ NE !t.
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, t ❑ Yes �No ❑ NA ❑ VE ,.""T
❑ 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
fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,E] 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
dNo
❑ NA
❑ NE
I8. Is there a lack of properly operating waste application equipment?
❑ Yes
FJO"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes n No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design [:]Maps [:]Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 121 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes ,❑ No ❑ NA ❑ NE'
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ' [/] No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: --2 it Date of Inspection:
24. bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
0"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
F�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
ONo ❑ 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
dNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
2fNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No C] NA ❑ NE
33. Did the Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
�o ❑ 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 Dages as necessarv).
Reviewer/Inspector Name:
Phone
Reviewer/Inspector Signature: —6 r Date:
Page 3 of 3
S Z 7 AV
/4/20 14

I
x r
lFacility Number IDate of Inspection: 7 /
r -re
24. tiid thecility fail to calibrate waste application equipment as required by the permit? ❑ Yes. -[/]^No
25 1s jlte.� fac Pity out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �E f No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes jz No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jfNo
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
t
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J!J'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ONo ❑ 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 dwo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[]Yes [EfNo ❑ NA ❑ NE
❑ Yes ;allo
❑ Yes o
❑ Yes 'No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments {refer to question f: Explain any YES answers and/or any additional recommendations or„any other comments.;
Use drawints of facility to better explain situations (use additional naves as necessary/.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
Date
r-
9 llel- &17I
s 17
14/ld 14
w

Type of Visit: Q Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Routine C) Complaint 0 Follow-up Q Referral O Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: - Region:
:
Farm Name{�J F� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: It, L5
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator: %1,Z — � I
Certification Number:
Certification Number:
Latitude: Longitude:
•Design Current
Design
Current
Design Current
Swine
Capacity .Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Iry
Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
D . P,ault .
Ca aci
P,o ,
Non-Dai
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]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
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection -
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? 0 Yes [:5 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): - -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2 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 . f No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ,EfNo ❑ 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 jZrNo ❑ NA [] NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,Ej No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes _,O-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes_,ET,No ❑ NA ❑ NE
❑ Yes ,�No ❑ NA ❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ YesNo ❑ 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 ,E5'-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking O 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 J:� No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes,&No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes EI'No ❑ NA ❑ NE
�25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ff No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ff' No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30_ Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ZfNo ❑ NA ❑ NE
❑ Yes IdNo ❑ NA ❑ NE
❑ Yes gfON- o
❑ Yes 6No
DNA ❑NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ff 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? ❑ YesNo ❑ NA ❑ NE
Gomments (refer to question #}: Ezpl`ain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations {use�additiional pages as�necessarfy,}.
51 q 0,17 G
3 13 /3 D- �_8
lZ 17-F1,Z 0, 7 7
Reviewer/Inspector Name: 6 Phone:
Reviewer/Inspector Signature: Z&/Date:
Page 3 of 3 /4/2 1

i
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: J) xoutIne 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: rrival Time: Departure Time: County:
Farm Name: r&r Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Region:61/_/�
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number: 1 a 0
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
VVet Poultry Capacity Pop. Cattle Capacity Pop.
Layer DairyCow
Non -La er DairyCalf
Wean to Feeder
Feeder to Finish
Farrow to Wean
DairyHeifer
Design Current D Cow
Dt. P,oult . Ca aci P,o Non -Da'
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
JILIOther
Turkeys
Turkey Poults
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]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
)d No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
0No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
dNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Ir 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 KNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesX 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 16No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes �No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 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 ZfNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes EfNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Z/ No
❑ 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes)ZrNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes PrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes o
❑ NA
❑ NE
acres determination?
r
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes �ro
❑ Yes oNo
❑ Yes dNo
❑ Yes �' o
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �' No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z f No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,El"No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe t? ❑ Yes ONo ❑ NA ❑ NE
25.`Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [,}'No ❑ NA ❑ NE
the appropriate box(es) below. ]`-'
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 0No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes RfNo ❑ NA ❑ NE
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes ,Z-No ❑ NA ❑ NE
❑ Yes )ZNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ;?j'No ❑ NA ❑ NE
0. 6 Y �� 7 ql(2- �520 - 3 6'10
a ja, f I-L o. goZ, 7`
/01a111t 0,63 A-' 7-
Reviewerllnspector Name:
Revieweranspector Signature:
Page 3 of 3
l Le,
Phone�fiO 7?G—%:M
Date:
/4/z0l

Type of Visit (Df Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �V Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: I Departure Time: County: Region:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: e4w�2'��
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certi tcation Number:
Back-up Certification Number:
Latitude: ❑ o ❑ ' ❑ Longitude: ❑ ° = ' =
Design Current Design Current Design C►urrent
Swine ' " Capa%tyPop"uiation• Wet Poultry - Capacity Population Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder
JEI
Non -Layer I
I ❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Non-DaiEy
❑ Layers
❑ Beef Stacker
❑ Non -Layers
❑Beef Feeder
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
El Pullets
❑ Turkeys
❑ Beef Brood Cow
dumber of Structures:
❑ Boars
Other
❑ Turkey Poults
[:1 Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
[--]Yes
;],No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
7No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
,ZNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Ely e s
j Z No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes JZNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes [�No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ONo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes O'No
❑ NA ❑ NE
maintenance or improvement?
Waste ADalication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yeso ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
21No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ElNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
" �"'o El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�'1`Io ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 7
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128164 Continued

Facility lumber: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Eqiqo ❑ NA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes FerNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ErNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesZ"No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes 9, ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �dNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 2TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes .A No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes J No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Cl Yes _0 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 2(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes 0 No
❑ NA
❑ NE
Comments and/or Drawings:
z / (eah Je / 66 /n bpi 4/f1l tIA4 )
Page 3 of 3 12128104

IType of Visit (D-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 10-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Ww&fArrival Time:; Departure Time:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Region:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:�� _
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= o = , =66 Longitude: = ° = 6 = N
Design
Swine Capacity
Current Design
Population Wimp. Capacity
Current Design Current
Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer I
1 ❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non
ers
R__
s
❑ 1 - urkey Poults
❑ Other
-Dairy
Beef Stocker
Beef Feeder
❑ Beef Brood Co❑ure
Number of Structures:
❑ Farrow to Finish
Gilts
Boars
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 ,Z—No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
fi3No
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes
tJ No
❑ NA
❑ NE
12128104 Continued

Facility Dumber: j — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storrn storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
l2�No
No ❑ NA ❑ NE
Struct re I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
;?'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
� No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[2rNo ❑ 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
O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need
El Yes
P??No ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
;5L
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
oNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
X No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
;!rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/6i- ahy'recammendations or any ot>ier comments
Use drawings of facility to better explain situations. (use additional pages as necessary):
....a_ ..� a.
Reviewer/inspector Name � � Phone: O
ReviewerlInspector Signature: Date: / U
LL1Ld1V4 uonrinuea

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0110 ❑ NA ❑ NE
!
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes Y No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections
❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I[J No ❑ NA ❑ NE
- 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes A No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �& ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes XNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes '0 No ❑ NA [I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes ;No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes )Z�4o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes gNo ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 4o ❑ 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 XNo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes XNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes �rNo ❑ NA ❑ NE
Additional Comments and/ror Drawings:
W� Aj II �furU 4r o160e
/ � �',
5�� L ,6 e 45�1� �o dr rze fD r' vo o�
��e etxet �
I2,28/04

Z Division of Water Quality
0 Division of Soil and Water Conservation
Faciliiy Number
Type of Visit 6Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 011outine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: �
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Title: Phon
e No:
Integrator• �
Operator Certification Number:
Back-up Certification Number:
Latitude: = = 0 Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I ❑ Non -La er
Dry Poultry
Non-L
Pullets
U Turkey Poults
❑ Other
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes g—No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
�Na
❑ Yes
❑ NA
[I NE
❑ Yes
�Na
�Fa
❑ NA
❑ NE
12/28/04 Continued

Facility Number: 3� a , Date of Inspection 3 G
-'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?
El NA El NE
Cl NA ❑NE
Strure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: uc
❑ Yes [-1V0
❑ Yes Po
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes .(/]'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ['No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑�lo ❑ NA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) //
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ElNE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o ❑ 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
EJ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;�Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
ZNNo
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
Z`
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
IQ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
,t17 f &7 j,3 r N p
0,-7 *r- l�s yeA�._ l0ay. wa), _ Cc-'C-L)Skj' A
�f c (t✓e L,5 c tt s 13P �Suj'G A, c iy r`3G ! ' moo yr Nuci.
rl C n .0 �(��� 6-1 ,_ r. /_ r
Reviewer/Inspector Name l/ / Phone:
Reviewer/Inspector Signature: % Date: ?3 G
,+ 12128104 Continued

&I H a?
Type of Visit Q--Cbmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit aRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 1 D Arrival Time: - Q Departure Time: County:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
�o
Latitude:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
< =c=6
Longitude:
Design Current
Design Current
NeIMPRo—ultirCapacity
Design
Current
Swine C►specify Population
Population
Cattle Capacity
Population
1.
❑ Wean to Finish
❑Layer
��
❑ Dairy Cow
Wean to Feeder
I ❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dey Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
EI'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 )2rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Str7ture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes A�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 eNo []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 [2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E`No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EINo ❑ NA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,ONo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes UNo ❑ 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 Accentable Cron Window ❑ Evidence of Wind Drift ❑ Aonlication Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[--]Yes ,ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]Yes EJ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
[:]Yes Ej No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
[--]Yes eNo
❑ NA
❑ NE
Reviewer/Inspector Nametiln �_` T F phone: — 7
Reviewer/Inspector Signature le, Date: Q C3
Pape 2 of 12 8/04 Continued

t
Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,0No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes OVo ❑ NA ❑ NE
the appropriate box.
❑ WIJP ❑Checklists ❑Design El 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 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
L2"No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,❑i No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9"No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CZ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
J2NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'PfNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
PrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
S ��L �l�l ~cl 4n.I Q re co"' � AL
Page 3 of 3 12128104

F
ype c Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
eason for Visit 42r§outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L Arrival Time: i U6 Departure Time: County:
Farm Name: - CT u[( fIG /V(Jf'���j l/ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ui...g, S ,
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: ❑ 0 0 i �" Longitude: = e = = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I :::::]
2606 1 L�C70 1 1❑Non-Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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 Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: F
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)
?. 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 �;Ko ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
El No
❑ Yes,ff'No
❑ NA
❑ NE
❑ Yes
g No
❑ NA
❑ NE
12128104 Continued

Facility Number:,3— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes '�Ko
❑ 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): -2- -%
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 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 L2fNo
❑ NA ❑ NE
$. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes P "o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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 J;]'No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below,
❑ Yes .01' o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0r] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes en No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes /'EJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �TNo
❑ NA
❑ NE
Reviewer/Inspector Name W VIM= ��� ;T!M Phone:
Reviewer/Inspector Signature: Date: �Z2 G
12128104 Continued

Facility Number:")) Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes,2[No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yeses No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No E 1VA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No J -NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge`?
❑ E Yes - No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yeso
ElNA
ElNE
If yes, contact a regional Air Quality representative immediately
/�,/
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes JQ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments nndlor Drawings:
spfcT'Qn (jp,1k4t( eatc lGt Ya/n ecIP1
ocj4 errdw_r
12128104

L
Type of Visit (5 7noutine
pliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Complaint O Follow up O Emergency Notification O Other p Denied Access
Facility Number Z Date of Visit: Wr=
Time: tf 1
erational O Below Threshold
Permitted CfCertified © Conditionally Certified C3 Registered Date Last Operated or Above Threshold : ................. .......
Farm Name: 1 �u 1.� [ .�5 �.Q1�S YL . County. G1:0
OwnerName: ................................................... ...... ......... . .............. ........... Phone No:....................
MailingAddress:......---.................................. .....................................................-•---....... ............ -......... ._.-................................................ ..........................
Facility Contact:.....................•---.................----•----...------.................. Title: Phone No:
Onsite Representative:RW E_......._....................... Integrator: ._... .l .......T— i..[........................... _ ...... Certified Operator: ... ................... . ........... .............. . ................................................... Operator Certification Number: ........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' =` 44 Longitude • 6 64
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes 13<0
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 1-3 No2. Is there evidence of past discharge from any part of the operation? ❑ Yes LAN
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes L7 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes E1 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... I ................. ....................... ........... .................................
Freeboard (inches):
12/I2103 Continued

FacSlity Number: 3 — Z $ Date of inspection I y f
y 5. Are'there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ YesIN
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes V
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes o
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes Q' o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes L] N
11. Is there evidence of over application? If yes, check the appropriate box below. El Yes No
❑ Excessive Pondinng ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type CS W (-&) 5 C„b
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 wo
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes O
15. Does the receiving crop need improvement? [Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes &4/
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes c o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 6'v
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes O No
Air Quality representative immediately.
Comments {rimer to gnesteofi #) �F.xplatn-any Yl� answers and/or any recommendations or_any other romaiea�� �' �;� . i
,Use drawings-af factLty tobetter explain sttttat oas. { aeddrtionai }rages as necessary) ❑Field Copy ❑ Final Notes 5 z
CoxSTe-o 1. j PULA— 1 ,
j7�c o rt,� S ZJ 0"6&
T
Reviewer/InspectorName o'u1� �(
„_
_ v. f _ _ _ _
Reviewer/Inspector Signature: Date: % d
12112103 1 Continued

F.Acility Number: 3 —� Date of Inspection ` [
Required Records & documents
/
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
o
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
o/
23. Does record keeping need improvement? If yes, check the appropriate box below.
ElYes
❑► o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
/
(ie/ discharge, freeboard problems, over application)
❑
01 o
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
io
'�TPDES Permitted Facilities
/
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
o
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required farms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit ISLCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit qLRoutine 0 Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: 'Time: �
Not OlDerational 0 Below Threshold
0 Permitted ©Certified � [3
Conditi�onnaallly Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: County: �� %�/f
Owner Name:
Mailing Address:
Facility Contact:
Title:
Onsite Representative: f��✓f►p.L,�- -
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:�%11
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ° " Longitude • �' u
::.Design;
Current Design Current...
Design Current
Swine Ca ac!
Po ulation Poultry Capacitv Population",',. Cattle Capacity Po tilation .
Wean to Feeder Z GUD
JEJ Layer 0j)airy�.,
❑ Feeder to Finish
I F IEJ Non -Layer I I JEJ Non -Dairy
:d
❑ Farrow to Wean
. . ............. .
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
1. T©tal Deslgn Capacity
'
❑ Gilts
SSLW
❑ Boars
Total
Number of Lagoons g � � ❑Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
Ho�&J-Soltd Traps
❑ No Li uid Waste Management System
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Laizoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [3No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;D No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Freeboard (inches):
27 ''
05103101 Continued

4
Faciiig- Number:
Date of Inspection Z��
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 am, stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markines?
«'ante Application
10. Are there any buffers that need maintenanceiimprovement?
I I - Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Ga✓ 4 /24,0, 5.4,E / zwoaWe - h'4y / 15 �4 /
❑ Yes �TNo
❑ Yes Z No
❑ Yes EZ No
❑ Yes ZNo
❑ Yes �ZNo
❑ Yes [ZNo
❑ Yes [ZNo
11 Do the receiving crops differ with those designated in the Certified AnimahWaste Management Plan (CA'WMI P)?
❑ Yes
m No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
El No
b) Does the facility need a n•ertable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
No
16. is there a lack of adequate waste application equipment?
❑ Yes
21 No
Re uired Records &- Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
'%IUP,
(ie/ checklists. design. maps. etc.)
❑ Yes
1� No
19. Does record keeping need improvemew? (ie/ irrigation. freeboard, waste analysis & soil sample reports)
❑ Yes
ZNo
20. Is facility not in compliance with any applicable setback critcria in effect at the time of design?
❑ Yes
El No
21. Did the facilit fail to have a actively certified operator in charge?
❑ Yes
ZNo
22. Fail to notify^ regional D)N--Q of emergency situations as required by General Permit?
(ie' discharge. freeboard problems. over application)
❑ Yes
ZNo
D. Did Reviewer,'Inspector fail to discuss review;`inspection with on -site representative?
❑ Yes
PINo
24. Does facility require a follow-up visit by same agency?
❑Yes
RNo
25. Were any additional problems noted which cause noncompliance of the Certified AWW?
❑ Yes
EZ No
JR, N. o violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
`Z ( answers'andlor any,recomme�adattons 9r $�* Dither eotutments_ '
Comments ^cefef to" gees on . Eiplaite any,-, YES' � 'y « `
_mow
_
Use drawings of facility to better explain situations. (use addlaonal pages as necessary) ❑Field Copv ❑Final Notes
,!k,:y&�FR/x _K ^.'��..tli..:iB"� «.,e5'A�P.,,e......a ice"' �'...I t:.e.���. A../-� . :�.-:rd:.y.w.'� _-^��rer�-..•.u.+......e:�ere . � ..:..A,e"
3i'/, /t 9 %n 7�e %`0 G� �i.l�s �1_ � /
�if,f;
i ��e��r ����_►� % �.dY l� c .L S Ile'
7ia �lrtfz°r�irf h'Io�f f'r�IaLG
Reviewer/Inspector Name �'- G `' � ✓_ � ' - s„ .>_ .._� tom` x`r
�... .
Reviewer/Inspector Signature: Date: L 6
O510310I Continued

" P.
Facility Number:_�� — � Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or laggoon fail to discharuc Wor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there an.- evidence of wind drift during land application? (i.e. residue on nci;hborin;2 vegetation, asphalt.
roads. building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. «'crc an} major maintenance problems With the ventilation fan(s) noted? (i.e. broken fan belts. missing or
or broken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
Additional Comments
❑ Yes 1z No
❑ Yes No
❑ Yes No
❑ Yes PNo
❑ Yes E'No
❑ Yes [:;kNo
❑ Yes ONO
05103,101

Facility Number Date of Visit: 3 Z Time:
rO Z`�
Not Operational 0 Below Threshold
13 Permitted U Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: 7-4U/1 /llit.-5/ County: /s
Owner Name: '4B✓ !T e rA Phone No:
Mailing Address:
Facility Contact: ��jj Title:
Onsite Representative: 11(N/FL°✓
Certified Operator:
Location of Farm:
Phone No:
Integrator:U//df, t/
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 01 " Longitude * { o
Design Current
arsine La aciry ra utanon
10 Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population.
❑ Layer I I a2airy
❑ Non -Layer I ❑ Non -Dairy
❑ Other
Total Design Capacity
I ❑ Boars I uTotal SSLW I I'
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / SobdeTraps 1❑ No Liquid Waste Management System
Discharges & Stream lrttuacts
1. is any discharge observed from any part of the operation? ❑ Yes MNo
Discharge originated at: ❑ Laizoon ❑ 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 galimin?
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 45No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ErNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes CR No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Freeboard (inches):
05103101 Continued

Facilify Numbhr: 31 — f
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?
❑ Yes 0 No
❑ Yes ® No
❑ Yes RNo
❑ Yes O No
❑ Yes [3No
Waste A lication
10. Are there any buffers that need maintenance/improvement? ❑ Yes Z1 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [S No
12. Crop type — Z2/ 4 kA e-t4 �n-
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [3 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes allo
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes 15 No
15.
Does the receiving crop need improvement?
❑ Yes
[RNo
16.
is there a lack of adequate waste application equipment?
❑ Yes
P No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
M 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
[gNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20_
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
MNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
E� No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [S No
® No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question f#): 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): ❑Field Copy El Final Notes
7
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 3 ��
05103101 l Continued

Facility Number: jj Date of inspection Printed on: 7/21/2000
f Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes JqNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Z[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 ?SNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes RNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 9 No
Additional:Comments and/orDrawings:
5100

D�tvt roti of Water Qualrt3' _ -
+ Q Division of Soil and Water Conservation
Agency - ti
Type of Visit A9 Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit 'Routine Q Complaint O Follow up O Emergency Notification O Other © Denied Access
Facility Number
Date ofVisit; 3 23 dJ Time; /00 Printed on. 7/21/2000
31 � B
0 Not Operational 0 Below Threshold
0 Permitted f'Certified ❑ Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ..................
Farm Name:.......................................�jz`v1 e'��... is t, rSQ.Y.......................................
............r County: ...............
Owner Name: .............. C erA 1A XAA,1V I. S................................................ Phone No•.......................................................................................
Facility Contact:.............................................................................. Title: .
MailingAddress:............................................................................................j.........
Onsite Representative: Q�''�++�...... �wU J�q! K'��W+Cs
..tom .............`..... �..............i......'..I................................
Certified Operator:
Location 'of Farm-
................................. Phone No:
....... Integrator:.... f of p.'.5 �.�..`.� e r t..�...
...... Operator Certification• Number: .............
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 64 Longitude • ° 96
Design Current
- �-.Ca sa Po ulation .
Wean to Feeder
0 d
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
sNr of Lagoons
dding�Pondsa Solid Tnips
Design Current,
Poultry ..
Capacity Population Cattle ,
[ILayer
❑Dairy
❑ Non -Layer
❑Non -Dairy
❑ Other
Total Deft m.cw1city . L
TotaUSSLW^: [
I❑ Subsurface Drains Present JI❑ Lagoon Area
No Liouid Waste
Dischar¢es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made''
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in galhnin`?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
urrent'
❑ Spray Field Area
Yf
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
Q. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I jj Structure 2 Structure 3
Identifier: n�"1 1
Freeboard (inches): ZQ AM
5100
❑ Spillway
Structure 4 Structure 5
.. I ..............................
❑ Yes No
❑ Yes §`No
Cl Yes No
ri 0)
❑ Yes ��e, No
p� ❑ Yes No
❑ Yes 19 No
❑ Yes 0 No
Structure 6
Continued on back

Facility Number: ,j — Z Date of Inspection 3 D] 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 Ei No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes fiff'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 J No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes] No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes No
11. Is there evidence doff over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes ] No
12. Crop type &12'-''►� 19a SJ✓re. rivet 1 ��+�''1 c4r �ui h f d bo
.
13. Do the receiving crops differ with those designated in the Certified Animal aste Management Plan (CAWMP)?
❑Yes ONo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes jo No
b) Does the facility need a wettable acre determination?
❑ Yes No
c) This facility is pended for a wettable acre determination?
❑ Yes No
15. Does the receiving crop need improvement?
❑ Yes No
16. Is there a lack of adequate waste application equipment?
❑ Yes No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes 6 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 0 No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes j No
21 _ Did the facility fail to have a actively certified operator in charge?
❑ Yes $0 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes No
(ie/ discharge, freeboard problems, over application)
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-ANo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes JRT10
:: No-i iblations :or deficiencies -mere h ed• diWitiii t;his'visit' • Y:o4 will reeeiye iio: further: :
correspondence. about this .visit. • . • . • . • . • . . ...... . . . .... .... . . ..... . . .. . .
omtiients (rater to question #}: Eafplain any YES answersand/or any recommendations or.any otlier comments -T
lse drawings of facility, to better eiplain situations {use addifloiiial pages as:necessary)
r t
6qe- -A 4 e wipe list 11ti��+''�� irI'10 IGt�4o,� �ru,.i �oc�Te•
F,6 1 t 1y Anpt Art" vrerl welt ke(l. 6OO6(
IV
Reviewer/Inspector Name S
�e.nLwa
Reviewer/Inspector Signature: Date: a 3 Q 5100

Facility Number: _?I --Z Date of Inspection I3 2 Q 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 Wor helow 'OYes ❑ 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 N'&o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes yNo.
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 ZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Pr No
32. Do the flush tanks lack a submerged FII pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings:
A,
5100

W
Routine O Com taint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection F5 9
Time of Inspection 4 24 hr. (hh:mm)
© Permitted Certified E3 Conditionally Certified [r Registered 0 Not O erational Date Last Operated:
r
FarmName: ..... d "���- ..................�.�v3-.r.................................................. County:.....................1.!-. .......................... .......................
Owner Name - --------------- - Phone No:
Facility Contact: ...:...... .................................................................... Title Phone No:
MailingAddress:........................................................................................................................................................................................................... ..........................
Onsite Representative: ..Gt^1"-`....................................................................... Integrator:....1'\/.!!l".................................................
Certified Operator: ................................................. ; . ...................................... I ...................... Operator Certification Number:..........................................
Location of Farm:
...... ... ................ ............................. ............................. ..............
Latitude �� �' 44 Longitude 0
- Desi gn iir'rentz Design Current :. Design Current
..-..-- ,"ationPolnSwine Poultry
Ca acy..Pelation-.. Caaeit ~Po ul
IR Wean to Feeder 10 Layer 1 ❑ Dairy 11
im
❑ Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Up.acityP F
❑ Gilts
❑ Boars Total`SSLW.
Number of Lagoons : ❑Subsurface Drains Present ❑Lagoon Area - ©Spray Field Area
Holding--onds / SoR&Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �<No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dues 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 IYNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes M'No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !�
Freeboard(inches): GT�....................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
3123/99 Continued on back

s
Facility Number:'3--,,13Date of Inspection
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 maintenancelimprovement?
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 maintenancelimprovement?
11. Is there evidence f over applicatio ? r ❑ Excessive Ponding [I PAN
12. Crop type Sri f C ��+
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
I4. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a Iack of adequate waste application equipment?
Required Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20- Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�0 -yiolatiaris:oi deficiencies were pofe41- during fhis:visit: - You will ec......&..*i futther -
6 res�oride..e abouf this visit. .
❑ Yes KNo
❑ Yes b<No
❑ Yes gNo
❑ Yes &No
❑ Yes 0 No
❑ Yes E�No
❑ Yes WNo
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ' gNo
❑ Yes 0 No
❑ Yes &No
❑ Yes XNo
❑ Yes U(No
❑ Yes N'No
❑ Yes Pg No
❑ Yes WNo
❑ Yes J� No
❑ Yes 10 No
❑ Yes P No
`J4](� '����� Gt7 0`.
At � tee► -mod: k-,.
41125�_Iel_� CWiVe_*vy,1 —
Reviewer/Inspector Namei,,' T
1yy�.... , 8
`JCS
Reviewer/Inspector Signature. Date: —9OG

+ Faclbty Number: — a Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
KNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
�INo
roads, building structure, and/or public property)
1
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
KNo
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
kNo
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
[ Wo
3/23199

'0 Division of
[;Division of
' � . �-Divisian of
=Upearation Review
Compliance 11iispectto%
F Inspection = r
0 Other Agency (Wration_Review -
4
Routine 0 Com laint O Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number Date of Inspection 3
Time of Inspection ® 24 hr. (hh:mm)
0 Permitted WCertif ed Conditionally Certified Q Registered Not Operational Date Last Operated: p ..........................
Farm Name: C1>✓! [< 1���1Q County: y ........................ .......................
Owner Name: ................................
Facility Contact: .............................................................
Mailing Address: .........................................................
Onsite Representative:..t'`,,,,,,
Certified Operator: .....
Lpeation of Karm: % I t I
Phone No: ............................
.._. Title: ........................................................ _1 ..... Phone No:.......
.............................................................................................................. .........................
......................... Integrator: .........
........................ Operator Certification Number:.........................................
`...>>•+'a......2��....1.1..!...............................................
...........................
Latitude �•�� Longitude �• �° ���
-. _ Design
Current Design Current:_ Design Current
_ Ca act
S ne .Ty
..
Cattle -`�
Population Poultry :'ACa �acity -Population Capacity Population_
Wean to Feeder
!,?4600
❑Layer
-.
❑Dairy
,
❑ Feeder to Finish
❑ Non -Layer
❑Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder
❑ Other
❑Farrow to Finish
Total Des2 n Ca atilt Y
4
❑ Gilts,
_P
..
❑ Boars
rT '` :. _T6tfiLSSLW
T
Number of Lagoons -
�. ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
HoldingPonds /Solid Traps
~_
❑ No Liquid Waste Management System
=.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes CR No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made'? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. 1f discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes D4 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes CgNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ..._.....1;....g. ............................................................................................................................ I ........ I........ ....
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes No
Continued on back
3/23/99

Facility Number: '7�� —�glj Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
X No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
(Yes
[-]No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[)(No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
ff No
11. Is there evidence of over application? Excessive Ponding ❑ PAN
❑ Yes
No
Crop P("►
12. type 5' C f
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[9No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
N No
b) Does the facility need a wettable acre determination?
❑ Yes
0 No
c) This facility is pended for a wettable acre determination?
❑ Yes
t%No
15. Does the receiving crop need improvement?
❑ Yes
XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
9No
Required Records & Documents
e of Coverage &General Permit readily available?
17. Fail to have Certificate
El Yes
9No
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
IgNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
P No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O(No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
D?No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes $No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes q No
24. Does facility require a follow-up visit by same agency? ❑ Yes PNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes VNo
0: Rio.violations ot- def cie dbc W.erb noted• during this:visit; - Yott :will-i. eeeiye Rio fu th& - : -.
t6rresp6fidehce. albiuu' f this visit. -. �. -..... . ..... .
Use.drawtngs of facility to ,better explaEn sttuatioos (useadcLhonal pages As,necessaiy)
3/23/99

Facility Number: 31 —eA5 Date of inspection ` q
r
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ® No
roads, building structure, and/or public property)
29_ Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ 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 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? OYes ❑ No
3/23/99

[3 Division of Soil and Water Conservation 13 Other Agency
R Division of Water Quality
10 Routine 0 Complaint 0 Fono,%--up or DNVQ inspcvtion 0 Follow-up of DSWC review 0 Other
Date of Inspection
L —Facilit y Number pfTime of Inspection � Ell� 24 hr. (hh:mm)
[3 Registered 0 Certified 13 Applied for Permit [3 Permitted 10 Not :0Ze=rafionaI Date Last Operated: .....................
Farm Name: T'0� ... Countv:...'D.\j.v .. Vk.x ...................................
L ................. * .......
OwnerName: ............... ...... ..... ...... . ............................... Phone No: ....................
FacilityContact: ... ........................................................................... Title: ................................................................ Phone No: ...................................................
Mailing Address: ....... ....... ...... 1p— e-
............... ... .... ...... . .............. 2-.&IL
Onsite Representative . .............................................. ............................................................ Integrator:......
............................. I ........
Certified
. ........................ Operator Certification Number_.-J.,'I ... G .. ra ... I .........
Location of Farm:
Latitude 0 6 46 Longitude 0 6 4 46
0 Wean to Feeder
2- 1p
2-4 Vo
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
0 Gilts
[I Boars
N
No Liquid Waste
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Dischar-
ge originated at: [I Lagoon El Spray Field [I 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 -,kVmin?
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?
N
Upon Area 1[3 Spray Field Area
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
I--] Yes
13 No
El Yes
0 No
0 Yes
No
[I Yes
No
0 Yes
[a No
C3 Yes
ka No
El Yes
25 No
9 Yes
[I No
0 Yes
121 No
[I Yes
allo
Continued
an back

Facility Number: SI - Z$S
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
19 No
Structures fLagoons,11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
CR-No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: . (Q
Freeboard (ft):............................................
10. Is seepage observed from any of the structures?
❑ Yes
N1 No
11_ Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
allo
12. Do any of the structures need maintenance/improvement?
❑ Yes
K 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
N No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
JR No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... .�nr,nt:>�.................. ..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
KNo
17. Does the facility have a lack of adequate acreage for land application?
C.Yes
❑ No
18. Does the receiving crop need improvement?
RYes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
E.No
20. Does facility require a follow-up visit by same agency?
❑ Yes
91 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
B No
22. Does record keeping need improvement?
ELYes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
&No
[] No.violitions•or deficiencies. we. re-notedduring this:visit.-:You'will receive no•f irther-:
:-:-correspondenceab"aut�this:visit:-".•;�: ..�:• •: �:•.:�::�: .: .•.-.•.-:•::�:. ..
-CO
(refer, to�queshon #) Explainany YES answers aodlvr any reccamniendatt or any aiher cotnments"
Use drwtgs of faculty to befter expla> sttuadoas(use sddiEtoaal'pages assnecessary) �� ,
access �s��••-vlI. a I
l ro s s,
o . T e. tale.. v & ca L�
'�'�.t-.1� �. 0..� `4.t.- v v►'� -� W i,'( ,S � 1c�-v�-e� �t a^^w�- o.-
j� ` J C V r'► k! , • ✓� tt v�fi = t b I iv i,� ; t^i
L 1 y f �d-
oti-o
N v i t a1� v ,n-� g' }-�- W o v t L S f-, -o c.a
ro 1Q. >:,t +n--Y 7125/97
` fl nrlla'ieer/Inspector Name
wDate:
t
R

IFacility Number:.,........ E�-- Date of Inspection: I 2_ I IZ Iq
.Additional e6mments and/or Drawings:
2-Z c li t(L VQ, re c 0 Itt,i S s w. ct 4 0--^ UL i ZT, f-,
LV IOL CL w C-2- CL
A k e r
t o v f e C-0
%r e c-o CL 0 1 CL I p 4 r i KA cL r � u r-c
Sol Y-k 0 V,
vi LAI',
4/30/97

CISWC Animal Feedlot Operation Review,
,3-•,::�:, i'
.yy
-4�? sb�e ��� - �1, :_ d �� - S_-„yam, _�`• � ,:
'� -.
-
®DWQ1Animal Feedlot OperatlonXSi<te Inspect><on
�_��
® Routine O Cam laint O Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection : 24 hr. (hh:mm)
Total Time (in fraction of hours �--�
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review f_LJ
.Certified ❑ Permitted Jor Inspection includes travel and processing)
❑ Not Operational Date Last Operated:... __.... .... ....._......_...... ....... ....................... ........ ..._..... _....._....... ............... _......
Farm Name: f..Asi.l .i~ C..S ....�.st_�f t�..�c County:.—b..VVITI;.rn........ _._.............
Land Owner Name: ... Phone No:
Facility Conctact .. Title: ....... Phone No:
14lailmg Address:_ .... ._...... .... �. d..tiL!.. t.1 Q 1..Ev.....r.�� �....f
Onsite Representative:.. cam :i .. � IzL... .:. �sn1o:,Integrator:... �(.a1..r._�?
Certified Operator:....._ ......................... ..... ...... ..... _.... _... Operator Certification Number:
Location of Farm:
.�r.+...sa.stii�..eKa..c........5� .�...... .............` 9
.......�T1 �1s�......_l}............. _......................................................... ............._......................... ................................................... _............ �
Latitude �•®L Longitude �' ��•
Type of Operation and Design Capacity
`Design Current', Design Y Current De Currei>tt
�gn
S�n�eP� _- P.oul ..
Cx„ F Cattle -
�s F a sc�Po elation t?y Ca ace : Po ulat�on .. �.Ca ace �Po elation
Wean to Feeder La er
® 2 r5�❑, ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer z _ ❑ Non-D
Farrow to Wean h�
Farrow to Feeder Total Design Capacity
Farrow to Finish
:.._ Y� 11Tota1,SSLW
❑ Other �.
s DE
Number of Lagoons J Holdmg Pon❑S
ds: ubsurface rains Pre-
sent
9 ,
> v� -< ❑Lagoon Area fl
❑Spray Field Area
b.: W:
Hera
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance Fran -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
4/30/47 maintenance/improvement?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes Q9 No
❑ Yes
No
❑ Yes
® No
❑ Yes
1K No
® Yes
❑ No
Continued
on back

® Division of Soil and Water Conservation ❑ Other Agency
❑ Division of Water Quality
• Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
r Date of Inspection 11/10/97
Facility NumUcr 31 285
Time of Inspection 1500 24 hr. (hh:mm)
❑ Registered MCertified ❑ Applied for Permit ❑ Permitted [3 Not O erational Date Last Operated:
Farm Name: Pi ulctle's..Niarscry.................................................................................. ..... County: D.uplim............................................... . .11RQ.........
OwnerName: laera d.................................... Kno.H'1e9...................................................... Phone No: 2.10,2,.b.-R29S......................... ..................................
Facility Contact: 1�dul�tle. xlQN:ltis.......................................... Title: .C9.:AA'.tee'.......................................... Phone No:...................................................
Mailing Address: 3114..Karhy.Q.ujjDn.Hal.................................................
Onsite Representative: G��al�,Kpgat:S.................................................
Certified Operator: .W.Alter.G............................... Knorr -lea...................
Location of Farm:
Latitude F 35--1 • F 02 F 36 fi
Kenan willeNC.................................................... 2,83.49 .............
..................... Integrator: N[ rphy-Family-Fa:rinxs.............................._.......
Operator Certification Number: ,1Q.G�.1....
Longitude 77 ' S7 6 24
General
1. Are there any buffers that need maintenance/improvement? Q Yes M No
2. Is any discharge observed from any part of the operation?
Discharge originated at; [] Lagoon [l 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
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
[] Yes X No
[:] Yes El No
Cj Yes [] No
[} Yes
© No
❑ Yes
M No
[] Yes
M No
❑ Yes
M No
[} Yes M No
❑ Yes M No
7/25/97

Facility Number: 31-285
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures a oohs Holdin Ponds Flush Pits etc.
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
E] Yes
M No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier:
Freeboard(ft):................................... .................... ................ ...................................
......................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
® No
11.
Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
M No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
M 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
M No
Waste Application
14.
Is there physical evidence of over application?
Q Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type 9 U..1a1..13amda..Umas.............................k'csrvu�...........................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
12'NWviolations:or:de%ienEieS iver'e'rioteci:ctiuYitl this -visit._ `You Vv11Urete1Ve-wD'fdr ber:.
• .carrespoudence ahouf titis.v sit
..........................................................
done with Mr. Knowles.
0 Yes
© No
© Yes
M No
[] Yes
M No
[] Yes
M No
0 Yes
M No
❑ Yes
M No
M Yes
E] No
❑ Yes
M No
❑ Yes
M No
❑ Yes
M No
16) BP is in plan on tract 523 field 2. Field is in mixed grass/fescue, Is planning on over seeding & resprigging in spring.
22) Need to balance N for farm on IRR-2 based on recommendations in WJP. Need waste sample within 60 days of irrigation.
Need to fill out emergency action plan.
Need to till out odor, insect, and mortality checklists. A T.S. at Murphy or Duplin SWCD can assist you with this.
7/25197
Reviewer/Inspector Name Jgltntt�gerald
Revie%rer/Inspector Signature: Date:

Facility Number;..3 �.....--._.�
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
NJNo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
C9No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (Lagoons and/or Holding Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
ENo
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10.
Is seepage observed from any of the structures?
❑ Yes
C3 No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need 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
CNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
0No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...: ...... ........... .... �------... s ►�4a i .... u��..,n........... ......... ..........................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Yes
[:]No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
® Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
JO No
2I.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
Q[ No
Eor
Cgrtified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
allo
24.
Does record keeping need improvement?
® Yes
❑ No
Comments (refer t6'qiu'e§tion' ft. Explain any YES `answers'andlor any recommendations or any other comments.
Use drawings,of facility to better explain situations. (use aaditioiial pages as necessary) 0.
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a
Reviewer/Inspector Name
Reviewer/Inspector Signature: , Date:
cc: Division of Water duality. Water Ouality Section. Facifitv Assessment Unit 4/30/97

Facility Number:Date of Inspection:
Additional. Comments and/or Drawings:
Z I • r-; e. k-j- v,-u b�.rs w�- cJ� rr� c. f v► J ,..1 a ,., ,r r ; q a� a ,.� 4
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4/30/97

•
•
Farm Name/Owner:
Mailing Address:
County:
Inte-m*ator. r
On Site Representative:
Physical Address/I
Type of Operation
Design Capacity:
DEM Certification Number: ACE.
Site Requires 1=ediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
A.Nj U lAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 10 - 'i , 1995
Time: It: 1' CGS t o l5wv Gh cyl
JQ 5 b",r
� w4w_b
I�W'
Phone:
Phone:
Number of Animals on Site:
DEM Certification Number: ACNEW
Latitude: I ttLongitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm evert
(approximately 1 Foot + 7 inches) 'e �r No Actual Freeboard: 2- Ft. Inches
Was anv seepage observed from the lagoon(s)? Yes o N Was any erosion observed? Yes o No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback cmeria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 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 orher
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
L Lzt,-5
Inspector Name
cc: Facility Assessment Unit
Signature
LUs�! Attachments if N,:ded.
le0-.
f

is
0
G7t oS[,.)
Site Requires Immediate Attention:
Facility No. - 31
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �- , 1995
Time:
Farm Name/Own(
Mailing Address: 35tq . r b! K act-t' I le"N _ C;�_ __205oy_57
County:
Integrator. _W Lcq jO � Phone:
&0 a96 J74)
On Site Representative: �'J, 1/UI�. off, Phone: 7„r — (�
Physical Address/Location-_5 P' /. / �__�O 4 e) , l - r�A� :3 6
Type of Operation: Swine. '✓ Poultry Cattle T\JUA
Design Capacity: -0 6;, t !7 Number of Animals on Site:
DEM Certification Number: ACE DEM. Certification. Number: ACNEW
Latitude: .5 b 1 Longitude:? S 3 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes o -Actual Freeboard: _/ Ft. Inches
Was any seepage observed from the lagoon(s)?
Is adequate land available for spray? &_4
orNo
Crops) being utilized: �,l r a4-
Yes or& Was any erosion observed? Yes o>�
Is the cover crop adequate? Ye or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?QbA or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS.Blue Line Stream? Yes 00
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes oIS9 If Yes, Please Explain.
Does the facility maintain adequate waste management records _(volumes of manure, land applied,
spray irrigated on specific 'a eage with cover crop)?' ey or No
Additional Comments: %%
O 1 l v 100
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.