310291_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
II

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Ja�] j� Arrival Time: p Departure Time: ® County: A P1, Region:
Farm Name:—� ; { r Owner Email:
Owner Name: _ 7�,,,,* Lt_ -�) 6; Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design
Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish �
Des�n Current
D . P©ut Ca aei )Po ,
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
I. Is any discharge observed from any part of the operation? [] Yes 2-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes o ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes UR<o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes EU.N'o [] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: 31 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure t Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 1<
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ Q�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EINo
❑ 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
©-*o
❑ 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
[J�
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[a-iQo
❑ 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 [j>o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Eq-No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes B /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes DKo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [0-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [�,Ko ❑ 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 [Ala ❑ NA ❑ NE
❑ Yes E+ivo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ge<o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EJ Ko ❑ 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 B-1 o
❑ 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? [:]Yes [E�No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [q o
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of inspection:
Nk
144. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [JNb ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ ❑ 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 Q�Ko ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 9-IC1A ❑ 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes M►Ko- ❑ NA ❑ NE
❑ Yes [ENo ❑ NA ❑ NE
❑ Yes [a -No ❑ NA ❑ NE
❑ Yes El -No ❑ NA [] NE
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
[:]Yes
CjNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Eg[No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Commeiits;(refer to question): Ezplairi'oyYES answers `andlor anygddit�onal"recomrne©da`tions or: any other comments
llsedrawings oYfacLtyto.better explain stnat�ons (use adtiition.al=pages as necessary)..,: _ ,
Si k _�- ct C J i1j6kCj 4) I-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-^ Phone: Po M &I
r
Date: 4 ec 2 4 � 44)
21412015

I ype or v Istr: yti,om nanee inspecrion �j vperauon review lJ structure r vatuauun V i ecnntcat P►sststattce
Reason for Visit: outine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Departure Time: County: Region:
Farm Name: jr4jM,,g __tkX ` �r �,,, �� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Pointry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current Dry Cow
D . P.ouI Ca aci P,o Non -Dairy
Layers Beef Stocker
Non -Layers lBeef Feeder
Pullets I Beef Brood Cow
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?
❑ Yes JZNo ❑ NA ❑ NE
❑ Yes J�jNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
g No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
E214o
❑ NA
❑ NE
2, Is there evidence of a past discharge from any part of the operation?
[:]Yes
dNo
❑ 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 21412015 Continued

Facili 'Number: - Date of Ins ectlon:
Waste Collection & Treatment
4..Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes [yNo ❑ NA ❑ NE
f
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): —F --�-
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA
ONE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes EfNo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes J' No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes PNo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ONo ❑ 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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ONo ❑ 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 0 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'ZNo 0 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 [::]Yes [Ao ❑ 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?
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)2-No
❑ Yes ;'Rfo
❑ Yes �No
❑ Yes P No
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,g3"N0 ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ..CJ No ❑ NA ❑ NE
❑ Yes .E5'*JNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 15- Date of Inspection:
r
24. Did the facility fail to calibrate waste application equipment as required by the permit?
r
Yes J'No
❑ NA ❑ NE
25. Ii the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes O No
[DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [;]'No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes eNo
❑ 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 JZ"No
❑ NA
0 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 [21<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 o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes [2No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �2 No
❑ NA
❑ NE
Reviewer/Inspector Signature: �C - -- _ Date: `
Page 3 of 3 21412015

r kdw
Type of Visit: O'Compliance Inspe n U Operation Review 0 Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
-Designm
Swine Capacity
Current Design Current
Pop. Wet Poultry Capacity . P.
Cattle
Design Current
Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
ILNon-La
er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Farrow to Finish
Dry P,oul_t_ry C■_a aci_ P,o ,
Layers
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ONE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA D NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ]❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21412015 Continued

Facili Number: - 2 jDate of Inspection: .L I /l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C3'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: r o n /3 a c. /t
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 20 Y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 '-�` -
❑ 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
4o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑'ice
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
[] No
❑ NA
E TV
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
Q" lqEE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
[ �
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
❑ No
❑ NA
[2-lq
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
[] NA
L_7 1Vi
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
Q NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
[:�NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
P]`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 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 ❑ N
❑ NA f�E
❑ Weather Code
❑ Sludge Survey
❑ I__I "' NA E
o L_i ❑ NA �
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection: 2 t 77
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA �NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NoFn-NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes O No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes ❑ No ❑ NA '['"E
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? TErYes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). .
-40
Od V
C9ivr..�,
� Q n � la f n ��yL 6i� �'LP...iE t, �� 1/ I� � r•� fc� � � � � rp Flu � �/�
A k ^1 e.,-- e" ti �.-�_ o w�� fib c a It
cct/ � //
.J4,47r,,r,,//`t Cs� �Cla� Ire s C__ �s,9ekjkrc, dr
Reviewer/Inspector Name: �L_ I ( VD ____ t//
Reviewer/Inspector Signature: `'rT
Page 3 of 3
�(o7g6 73�y
Phone:
Date: �a�Z f /6
21412015

type of Visit: gXbmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Season for Visit: �outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i ,'b Arrival Time:® Departure Time: County: Region:
Farm Name: Owner Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Xak-'Z4
Certified Operator:
Title:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to finish
Design Current Design Current
Wet Poultry Capacity Pap. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
I
iNon-Layer
Dairy Calf
Feeder to Finish
p
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Farrow to Feeder
D , PlouIt_ . Ca ac'tt P,o , Non -Dairy
Farrow to Finish
I Layers
I jBeef Stocker
Gilts
Non -Layers
Pullets
Turke s
Turkey Poults
Other
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2] 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 DWR)
❑ Yes
��o
T
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
O No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ej No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ZNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: I Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes P'No ❑ NA .❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes , ffNo ❑ 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 _�3 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 JZ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes _Q 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 Jam' No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
J[2-
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
12No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes ❑'No ' ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes _Q No ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes j::�o
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes o
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

Facility Number: - Date of inspection:
24.. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes _[a No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E`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 J:j..No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 4E No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes _0 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 allo ❑ 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 �allo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes J2!rNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes J 'K o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0 No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �o
❑ NA
❑ NE
Reviewer/Inspector Signature: �� Date:
Page 3 of 3 21412015

i ype of visit: t,,d-uompnance inspection tJ uperatnon xeview V brructure tvatuation V i ecnmcai Assistance
Reason for Visit: outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: jQ , � & Region: F
Farm Name: Owner Email: �`�"" c
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: r'! A3
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish I JLayer
Design Current
Capacity Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Feeder to Finish
I INon-Layer
I
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D . P,outt .
Design Current
Ca aci P,o
Dry Cow
Non -Dairy
Farrow to Finish
ILayers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turke Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach`waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �' o ❑ NA ❑ NE
❑ Yes ,EffNo
❑ Yes ja'No
❑ Yes Ito
[:]Yes Oi o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 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): t.
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes [ZNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
,En No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
[—]Yes
❑/''No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
�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
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
a No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
P No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
O-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
'P No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes tT No
❑ 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 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [El"No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: 3 1 JDate of Inspection:
24. Did the, facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Ts the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ZNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes C2rNo
❑ 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 [dNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes &No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [XNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ENo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes PNo ❑ NA ❑ NE
Reviewer/Inspector Signature: Date: // &Z�
Page 3 of 3 /4/ 4

Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: - �U eparture Time: County: Region: ref
Farm Name: ��=(rt� f SGI� S Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:�r
Certified Operator:
Back-up Operator:
Title:
Phone:
Integrator: Cf
Certification Number: -,j @S 0, 7 �� f3
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish ILayer
Wean to Feeder Non -La er
Design Current
Capacity Pop.
I
Design Current
Cattle Capacity Pop.
ow
I
alf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P.. ulh.
Layers
Design Current
Ca aci Po ,iNon-Dairy
Dry Cow
jBeef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
"Turkey Poults
10ther
Beef Broad Cow
Other
Other 31
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
e-0
a. Was the conveyance man-made?
❑ Yes
Vf No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
ZNo
❑ 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
Zf No
❑ NA
0 NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
P
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ff No
❑ NA
❑ NE
of the State other than from a discharge?
2. Page I of 3 21412011 Continued

Facili Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
o
❑ NA
❑ NE
Structure 1 Structure 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
ONo
❑ 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
EffNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2—No ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E2'No ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
F'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�Z No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P 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 Z No
❑ 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 ]21 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [2 `V
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 214120II Contdnued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ZNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ONo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes O—No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E;Ko
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o
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 o
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 I /jNo
permit? (i.e., discharge, freeboard problems, over -application) TT
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ['Rfo
❑ Application Field ❑ Lagoon/storage Pond ❑ Other: T
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ;�TNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 1.No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [3 Yes T o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or anf other comments.
Use drawines of facility to better explain situations (use additional paees as necessarv).
wA
81ay)�3
/ /1 -z // 3
Reviewer/Inspector Name:
Reviewer/Inspector Signature: �-
Page 3 of 3
3 S7 7
3 ?of
e [�r, j-
Ick'V
Phone: ��� �� -7
Date: 2_2-+
/4/ZOl1

Type of Visit: a Co phance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I__l� Departure Time: County:! Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: %�%j JQ,T�QL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: Y
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry C►►specify Pop.
La er IDairy
Design Current
Cattle Capacity Pop.
Cow
jyj Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urgent
Dr. P,o_ul Ca aci_ P,o
ILayers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouits
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ 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)
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 � ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
Page I of 3 21412011 Continued

lFacility Number: 31
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
ZNo ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ^L
Spillway?:
Designed Freeboard (in):
t /}
Observed Freeboard (in): �s O
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E, 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
LJ 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
o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[—]Yes
VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
C. No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
INo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�(N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio;"No
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E7 No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 7 1- Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe t? ❑Yes [ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes YNo ❑ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes lrNo ❑ 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
❑ Yes No ❑ NA ❑ NE
❑ Yes ✓ No
❑ Yes I__I 1Vo
❑ Yes 0/No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any,additionalrecommendationaorRany other comments.
Use drawings of facility to better explain situations (use additional pages as necessary):: ..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C
Date:
2/ /20l

Type of Visit: QI Compliance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason Ear Visit: 6 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 11 Z t+ Arrival Time: 4S 1 Departure Time: County: 1. m) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Yq�QLLGVL �U3�C— l,L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: kgal�y'
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
C►attle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
L 2>
I
JNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dr. P,oulti.
ILayers
Design
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Q#her
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ AppIication Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [�j No ❑ NA ❑ NE
❑ 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?
o
[:]Yes �/�TNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: -ast Date of Inspection: W2, i,..
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: aN L �)'J Z
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in): 2u-t _ a5
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 dNo ❑ 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 D"/,No NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ 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?
No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
0 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 EjNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ENo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ 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?
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 �o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes
dNo
❑ NA
❑ NE
[:)Yes
[]/No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L21'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes g
❑ Yes 110
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
[DNA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: l - Date of Inspection: 2. it
24. Did the facility fail to calibrate waste application equipment as required by thepermit?. Yes No NA ❑NE
25lIs the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes &No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes ❑ o [DNA ❑ 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 L?(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:fNo ❑ 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
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 <o ❑ NA ❑ NE
❑ Yes [:P<o ❑ NA ❑ NE
❑ Yes [-(No
❑ Yes rNo
ElYes o
❑ 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).` x
,, _) rj E C 5 Go P y Or(— C-A(LP 6-rm1+1 ? E Co9_QS,
&:,riA 11AVC a -s SLt►pGE ?,OrT-6 .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 4` !U 7
Date: t zit
21112011

Type of Visit GrCompliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit 9outine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
rrival/T�ime: Departure Time: � County:
of `-r Owner Email:
Phone:
Facility Contact: le: Phone o:
Onsite Representative: Ti Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [=] ' = Longitude: = c
Region:1
Design Current
ation
Wet Poultry
Design IIUC=t Design C►urrent
Capacity Population CattleCapacity Population
Finish
r1eeadnerilo
❑ La er
❑Dai Cow
Feeder
❑Non -La er
❑ Dai Calf
Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ La ers
❑Non -La ers Pullets
❑
❑ Turke s
❑ Turkey Poults
10 Other
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes KNo ❑ NA ❑ NE
El Yes El No ❑NA ❑NE"
❑ Yes
❑ No
❑ NA
s
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes
/U(No
❑ NA
❑ NE
12128104
Continued
►\

I
Facility Number: - Date of inspection
Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes RNo ❑ 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 ;eNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes I;lNo ❑ 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 910
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;;rNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ 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 J9No ❑ 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
EYNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes )eNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
JrNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
XNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PrNo
❑ NA
❑ NE
Reviewer/Inspector Name Phone: 4 '
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128101 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
IN
❑ Yes I(J No ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewhnspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:VJA
J
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
J9 No
❑ NA
❑ NE
❑ Yes
'FdrNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
00 No
❑ NA
❑ NE
❑ Yes ;;?No ❑ NA ❑ NE
❑ Yes Z�No ❑ NA ❑ NE
❑ Yes 2fNo ❑ NA ❑ NE
❑ Yes
[allo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit 0 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: $ t7 o Arrival Time: �� Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: JA1Y _T_r__ A ZU,
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Title:
Region:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
�o
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
7.tsri �.p ❑ Non -La et
❑
Wean to Finish
©
Wean to Feeder
El
Feeder to Finish
El
Farrow to Wean
El
Farrow to Feeder
El
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other -- -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke 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?
Longitude: =
0
Design Current
Cattle Capacity Population
El Dairy Cow
El Dairy Calf
El Dairy Heifei
El Dry Cow
ElNon-Dairy
El Beef Stocket
El Beef Feeder
El Beef Brood Co
Dumber 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 UdNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
[INE
❑ Yes
❑ No
ElYes
No
El NA
El NE
El Yes
,E
E� //o
❑ NA
❑ NE
12128104 Continued

Facility Number: SETdilDate of Inspection 1 0
;Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St cture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 3 3?7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 S �j3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2/-No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ 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 thh t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7No
ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ 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 " ❑ NA ❑ 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) (YLrLL-Ep 5-66 CEQ44. )q �•��
13. Soil type(s) FA TA
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes L_d'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? es 7No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes E ` ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El Yes L No ❑ NA ❑ NE
Comments (refer to gnestio # 4EgplamanyYES�answers and/or any recommendations or any other comments.
Use drawings ofifacrlity to better�explamNituahops-•(use=additional pages as necessary):
!s) ►J(+ o CoN7NJ C. Ocra10014 etas
C 0P` o f f Ear. --�rCA T � Co I 6 e A�� PE,zrI�T i �� W� �
a/,� y �?EC.a7t-D �A.IAI.�I.L ANC 1� �-fl� �"�� t1AC�a+-► � l.s. i2o n�t-x�.1-�-N�.��tS
At4b WE�rNF�. cor TR-R.i . 1>Er Sfocx-r�,IG,
1,6.) u0c-A Tf- LA rj 00N b E ST-(sdJ QNO ICE P W.CTA P,_'60SX_r'
Reviewer/Inspector Name J(j j3 R�/L VL, k. r Phone-
91 " t �`;r G'
Reviewer/Inspector Signature: Date: 1-7 o 5�
'[Z/_' vVf uonnnuea

Yes ❑ NA ❑ INE
❑ Yes Ed"No ❑ NA ❑ NE
Facfl!V Number: 3 f — Date of Inspection 2 S
fieguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WLTP El Checklists El Design El Maps El Other
—1-111
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly freeboard C1 Waste Analysis ❑ SoillAA alysis ❑ Waste Transfers
❑ Annua Certification
O'IGainfall ❑ Stocking ❑ Crop Yield 060 Minute Inspections ld Monthly and 1"
Rain Inspections
eather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dVN
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ N
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
EZ
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
7NA
❑ NE'
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E?14o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
04A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes:No�OEINA
NoNA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
❑ 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
KNo ❑ 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
2<o ❑ 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
0 ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
D o ❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: 3 3 0 Time: �
I IQ Not Operational Q Below Threshold
M Permitted ® Certified [,3Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
FarmName: __ t� 14L N4: i11At ese✓'r'ES _ County: ulaljh
Owner Name: Lia.rnl L Phone No:
Mailing Address:
Facility Contact:
Onsite Representative: this
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator: � Ui`©�
Operator Certification Number:
[]Swine ❑ Poultry ❑ Cattle ❑Horse Latitude a 6 " Longitude • '
Design
Swine Ca aci
Feeder
Current Design Current Design Current
P,o elation Poultr. Ca aci P,o elation Cattle Ca aci P.a elation
❑ Layer ❑ Da'
Finish
❑ Non -La er
❑Non -Da'
Wean
Feeder
Finish
NGi1ts
Other
Total Desin C►►apaciEE] Total SS
Nnmber of Lagoons
Holding Ponds /Solid Traps
��
❑ Subsurface Drains Present
❑ Lagoon Area ❑ Spray Field Area
❑ No Li uid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c_ If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: l 2-
Freeboard (inches):
05103101
❑ Yes X[No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [2 No
❑ Yes ® No
❑ Yes WNo
Structure b
Continued

Facility Number: 31 — 74 FI Date of Inspection �--�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 5j No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ]K 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 W No
11. Is there evidence of over application? ❑ Excessive P/onding ❑ PAIN ❑ Hydraulic Overload ❑ Yes M No
12. Crop type t✓hl C '"LL� jf 1117C t - Pwy!sed <"% I tr� ialV-
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does.the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ®No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
5g 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.)
N Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [A No
24. Does facility require a follow-up visit by same agency? ❑ Yes CR No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments: refer to q66hon4) .EXplain`any YES answer and/or:any recommen ahons or any,ot�ter comments`
Use ,[Irawings of�facility to „better�explatn situations: (use addihonalipages BE in essary)
._ ❑ Field Couv ❑ Final Notes
elm
" — 41AP h0 t Q✓-o'b�k, GP" r+srt bff a elk fb %�%ur�4�ji s 7`a Ilia �� .Zn >♦iu�t�
to ieef /a c e�%I lur`I -At to carii5 st a///� �,° t' 5,
1Vee�L fo bl,-.l 4#'ed16ABr/Lff9ciorlCs 70 iJiS�6N/v/i.
Hsu45 4'_ ZOd 1. .S.t,MP/� l..�s yr�,Ike^ /D%! 6r.f resv/fs W)w
A1,1 4v rA 4ra�•+s� f7n. �, „e p/c, nc cal d 6c , ,��s
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 3,
05103101 Continued

. 1 1
Facility Number: ,V — 2VI Date of Inspection
or Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
[N 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
M No
2&
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? ❑ Yes �3 No
Additional Comments and/or Drawings,:�I!
4t`A
/f/07,• I RG /GG��E<dt /t4�t+�IS i►t �j0 to100h3 IS �r't7 h7 Yi✓'/
�1�.
05103101

Drston of Water Quality
c J
Q Drvrsron of sort and Water Conservation
w• a O-Other Agency;
Type of Visit RGompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit J&Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Datc of Visit: Time: �'(5 _— Printed on: 7/21/2000
Facility Number !a,
Q Not O erational O Below Threshold
Permitted 0 Certified ©[Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .............
S� fZ 01�l\ 1 t..� Countv:..... .... 1\
Farm Name: .................................................. ....................I.....`"F...................................................................................................
OwnerName: ..................................................... Phone No:.......................................................................................
FacilityContact:.............................................................................. Title:.................................................... Phone No:
Mailing Address: ............................................................
Onsite Representative:.,-?.."�
Certified Operator:
Location 'of Farm:
.............................�....................................----............ ..........................
Integrator:...................... t�,,
. ...........................................................
Operator Certification Number:_.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� C�«
Design Current Design Current Design Curi-ent
uiion Poultry Cattle.Ca "Population
;.. Wean to Feeder 0 ❑ Layer ❑ Dairy
Feeder to Finish ❑Non -Layer 10 Non -Dairy
Farrow to Wean a
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
lt.: Gilts
''�R: Boars Total SSIW
subsurface Drains Present ❑ Lagam ❑ S
. � Number oi<Lagrwns
Ares pray Field Area
How Ponds / Solyd'TrapsIffNo Liquid Waste Management System
.�.-�.k v_..•, ':..,rPL(3! .c.=: i`_Y. � tines_..-:. �.... �:.... _ _.-.. -_ _ � � �.: _ ..;
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -nude?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/ruin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .................................... .................................... ........................... I ....... -1......... .............
Freeboard (inches):
5100
[]Yes A No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
btlio
❑ Yes
OfNo
❑ Yes qNo
Structure 6
Continued on back

Facility Number: '�� Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[I Yes
�(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
NNo
(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
ONo
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONO
Waste Application
10_ Are there any buffers that need maintenancelimprovement?
❑ Yes
NfNo
11. Is there evidenceofover application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
�No
12. Crop type 5 W V�Vz.2 i �e�' ci4-c�2 �. Sti Q\H;-I.� �1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
RNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
,kNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
t!KNo
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONo
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
2TNo
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
9No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
IffNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
QTNo
(ie/ discharge, freeboard problems, over application)
❑
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N'No
24. Does facility require a follow-up visit by same agency?
❑ Yes
O No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNa
:: Rio •yiolatid is:or defcie dii ,g Were noted• during this'visit; •'"ft lAfteeelve ii0 further
cor'resporideitce about this :visit` • • ..... .
L,.: rA, 5- p
Sb C 1Q3 S
Reviewer/Inspector Name 4x_' ` � �
i?a
Reviewer/Inspector Signature: Date: -J4 G 1 5/00

,FaWity Number: I Date of Inspection I ill�{1(G {
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
es
XY
❑ 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
roads, building structure, and/or public property)
YNO
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
T 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
k�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?
❑ Yes
P'No
itional Cotnments and/or -,Drawings-
...... s:.
u,
-1

i "
Division of Soil and'WaterConservahon=`Operatton Revtew ; z
�J DEVLSIO of.Soil and;Water Conservation 'Compliance Inspection
ivasio� of Water Quality aComplianee Inspection
e �. `�� 0 Other Agency Opera4on Review
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number oL Date of Inspection —Vp
Time of Inspection jT30 24 hr. (hh:mm)
©Permitted Q Certified Q Conditionally Certified © Registered © Not Operational] Date Last Operated: ..........................
............ County ...... ......
I
Farm Name: �.Y^--I�. ,1'..�-.L. t^.��`.� ................ ... �.....................................................
OwnerName: ................................................... ........................................................................ Phone No:
Facility Contact: .................................................................... ... Title: Phone No:
Mailing Address:
Onsite Representative: OI�1L-2..
........................................................... Integrator:......................................................
'-rQ' ............................................
CertifiedOperator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude 0 4 16 Longitude ' 4 "
Design _ Current .
Nvvine
Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current T';.,Desigiu Current
Poultry Capacity.: populationCattle
xCa ppaci Po elation
❑ Layer ❑ Dairy
❑ Non -Layer I I I JE1 Non -Dairy
,._
❑ Other - _ —
Total-Msign.`Capadty:
Total SSLW--,>.
Number of:I:agoons C❑Subsurface Drains Present ❑Lagoon Area ID Spray Field Area
`Holding Ponds / Soli& Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
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 gaUrnin'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
' Idcntificr: LJ
3CFreeboard (inches): l
...........................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ❑ No
❑ Yes XNo
❑ Yes XNo
❑ Yes XNo
Structure 6
❑ Yes hfNo
Continued on back

1
Facility Number: 3` —
Date of Inspection
6_ Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
❑Yes
XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
WNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
)RrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
VNo
Waste Application
10. Are there any buffers that need maintenance/improvement?.
[:]Yes
VNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
DUNo
12. Crop type S(n�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
b<No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
9No
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
j rNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes WNo
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 WNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 'MfNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes )4No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 2No
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 b�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
El. yiQl'atigris:o� deficier;cies mere hofg(l• 046fig fbis'visit; Y;oi� wiil reeeiye ii6 funh'i r
Tories inidence' atbotit. this visit'--'
Conriments (refer to'gwtesbop #) 4Explain any _YES answers and/or any. recommendations o>r any other comments
'Use drawings:of facil ty to -better expld
ain sihations r{use adilitianal4pages°as necessary)
r.
C�•-��L•� ���e.�r -� �{fie c�' �
weeds, AL
L'V-6'"J " I-T
IReviewer/inspector Name ����� �'- � � I to - 3 G 4
Reviewer/InspectorSignature:,\\-, Date:

Facility Number:'.3—' Date of Inspection Q
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
'`OINo
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
gNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
XNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
J!�No
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
3 i .
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
9 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
)4No
Additional, omments and/orDrawings:
A.

`fJ Name of Farm/Facility
Lagoon Dike Inspection Report
at,. / 7-4-e- /
Location of Fami/Tacility
3 -77
M4,n&e.r
Owner's Name, Address
andf� Telephone Number
-S/ ? 6
Date of Inspection
Structural Height, Feet
11
9 `2Y r 19 Names of Inspectors
-< /7
Freeboard, Feet
Lagoon Surface Area, Acres 0 s0 Top Width, Feet
11YR )rz—, -
Upstream S1ope,xH:1 V 3; 1 Downstream Slope, xH: l V 3 j
Embankment Sliding? Yes (/ No
(Check One, Describe if Yes)
Seepage?
Yes No
(Check One, Describe if Yes)
Erosion?
Yes _t,��No
(Check One, Describe if Yes)
Condition of _ i
�%R e arm ba,-e ,,at k egc 44 ne(YSf�-y 40,415`
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Yes 1-0�No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed?
Yes �� o
Engineering Study Needed?
Yes � No
Is Dam Jurisdictional to the Darn
Safety Law of 19679 Yes No
Other Comments _
aQ0a,,'7 woks' M a ✓7G���_

Lagoon Dike Inspection Report 3/
Name of FarnVFacility J d r� _ y Uri J /V44 J -_5-er / 2--
Location of Farm/Facility
q - 3s7g
Owner's Name, Address
and Telephone Number
Date of inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:I V
Embankment Sliding?
(Check One, Describe if Yes)
Names of Inspectors��
t• S Freeboard, Feet
C)•S Top Width, Feet
e3'
a I
Yes _ZNo
Downstream Slope, xH: IV yy�`
Seepage? Yes No C,,SA ja o S�-
(Check One, Describe if Yes) 6 Q+�✓� Q� }—cam
Erosion? Yes No
(Check One, Describe if Yes)
Condition of q o
Vegetative Cover ✓�
(Grass, Trees)
'Did Dike Overtop? Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes V No
Engineering Study Needed? Yesy No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes L
Other Comments O �t

Division of Soil aiiil Water Conseryabon =Operation Review ��
` ? 'Q Division Of $811 and Water COnservahon Compliance Inspection
DivLsron of Water Quality Cotnpliaitce Ltspeed©n x €
x
Other Agency; Opf'rSt0on�RE=VieW c� - a, _ ? aiY�
JWRoutine Q Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number
Permitted &ertified . [3 Conditionally Certified 13 Registered
Farm Name. ......:.... !�..�� .... .................
!r .............................
Owner Name:...........................................................
Facility Contact:.............................................................................. Title:...........
MailingAddress:.......................................................................................................
Date of Inspection
Time of Inspection L3p 24 hr. (hh:mm)
113
Not O erational Date Last Operated: ........... .
V
County: ............. 044 1%.
... Phone No: ....1..�.�.. J .�CTQ.0k.
Onsite Representative:...........................................................................................................
Certified Operator: ,,,.ram
..........................................................
Location of Farm:
Phone No-
.......................................................... .........................
Integrator:........... ..
Operator Certification Number:... g cD
........................................................................................................................................................................................................................................................................
Latitude Longitude �• �� �«
--Design Current :.., vDesign Curretnt Design.- Current
v
Swine -Ca acity Po ulation poultry; Capacity. Population Cattle Capacity Population _
Wean to Feeder
a0 o
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts, .
❑ Boars
Holdtnu Ponds Sohoons ❑ q g y g n Area ❑Spray Feld Area
g Subsurface Drains Present ❑ La o0
g. d'Teaps �, _ ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes gNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 4No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: "IV
Freeboard (inches): .............Q.'"..
..........Q..............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes 0 No
Continued on back

r _
Facility Number: Date 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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I - Is there evidence of over application? []Excessive Ponding [-]PAN
12. Crop type A�jo�'_ , L' r .SQ
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. 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?
t5. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a 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?
❑ Yes VNo
❑ Yes NrNo
❑ Yes MNo
❑ Yes [YNo
❑ Yes VNo
❑ Yes N 'No
❑ Yes t<No
❑ Yes � No
❑ Yes 9No
❑ Yes r—e" CNo
❑ Yes gNo
❑ Yes ONO
[]Yes O(No
❑ Yes No
❑ Yes No
❑ Yes KNo
❑ Yes D�No
❑ Yes WNo
❑ Yes jV No
❑ Yes 0 No
❑ Yes EN No
9-'}o ytolatidris.-or• defciend.pN were h6.fed• diWME! this'visit.' • Yoir *H1-t&4Aye d6 further • . "
••correspondence.abouLt�is.visit.......-... .•.•.•.•.......... ......... .•-'•'-'-.-••;-
Comments-(refer'to uestion #)':Explain any -YES answers and/or-anyrecommendations or any other comments::
q
Use'dt swings of facility to Better -explain situatinns. (use addi Eional pages as necessary,)
3/23/99

r
Facility Number: — �� Date of Inspection
Odor .Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ 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 J� No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 43 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 gNo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes D<No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [-]Yes NfNo
3/23/99

0 Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
12 Routine O Complaint O Follow-up of DNVQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered ® Certified 17 Applied for Permit © Permitted JE3 Not Opera Date Last Operated: ..........................
Farm Name: !`!.�G+Yt 1 ..... `...i. ... J. t ##Z County: �x1�.................. ......................
OwnerName :.......... 1?%.o.,nC _j..... �12114►�............. Phone No:.... �lLi .�e`ir�...........................................................................................................
Facility Contact:.............................................................................. Title:...................... Phone No:
MailingAddress: .... [GIs ...bvtaanQ ..GiU"-.S...... �.............................................. ....�e.0 1l��..C�.................. I.......................... .. ?.�..........,
Onsite Representative:....... h6ew S ..... "d'0 .. Integrator:......, .[1�f
Certified Operator; ......................... .......... Operator Certification Number;.---........--...........................
Location of Farm:
:..txr,...��...ar......r:444 ... .....e ..........L. {t..t...�}.:. .m�;t,.............. ...........................................................................
J
...... ... .......... .......... ... .... .. ................. 7
Latitude ' ' " Longitude ' ' 64
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 1�No
2. Is any discharge observed from any part of the operation? ❑ Yes $4No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenancdimprovement?
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?
7/25197
❑ Yes [,No
❑ Yes M No
❑ Yes
03 No
❑ Yes
[)�No
❑ Yes
fANo
EP Yes
❑ No
❑ Yes t? No
❑ Yes RNo
Continued on back

Facility Number: 31 — Zql
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,t•lolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes N No
❑ Yes R No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2
Freeboard(ft): ................. ............... ................................... .................................... .................................... ................ .................
...
10. Is seepage obsen-ed from any of the structures'? ❑ Yes g] No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
r
13. Do any of the structures lack adequate; minimum or maximum liquid level markers'?
Waste :application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type CL1t.................... wlka.�l.. .............. :50s,��,.,............ ........... .....................................................
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 tack 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?
r
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'?
0 No.violations or de'r16encie's4ere note'd-during" this visit.- :You 4ill receive no further
corrt spondence Mbout this.visit :
❑ Yes
No
; ) Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes
N No
❑ Yes
No
❑ Yes
No
❑ Yes
No
ts Yes
❑ No
❑ Yes
09 No
N) Yes
❑ No
❑ Yes W No
Yes ❑ No
Yes ❑ No
Camments (refer to" question,#): -Explain any YES answers and/or any recommendations or any: other 66]hii rents.
Use drawings of facility to better explain situations: (use additional pages as necessarv):. •, 3
�` • � o..rtFr-� ter. lr rene-eJej, lV%Alr r,z.lt of �Q�cvr # 1 s oti� �,� Z►�.o '
�'1
i tt L
Kco�T �[t1 6e. V.C. j Ll [pV[j "i �iC�U nvrl't r) us, i�l CGVCCC� &e � 6
i0.Ctr. pcl i s Ur; Wa��c
j�`ic(ti�;oh �lLVjOL40V1S. tnrrcc�
lurat
em'A' + e'O'd— �iCW tit, Was�t, 0,1 `,cct�i n� f rric �ior` 91tlrt� �— �b��oo�n O1P,$i�►�
S��a be_ Al � ��,, MCkN4 w mow . I. t i
��
�llktis4e t��!re�d s i n t?Xce55 0�' 3�a�S �1h`% �v� 4-�57125197
Reviewer/Inspector Name
Reviewer/inspector Signature: Date: q

® Routine O Complaint O Follow-up of DWQ inspection O Follow-u of DSWC review O Other
Date of Inspection Z
Facility Number ti q 1 •
Time of Inspection { D 124 hr. (hh:mm)
Total Time (in fraction of hours
Farm Stains: ❑ Registered [I Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
Certified 0 Permitted Jor Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: L�....A. i.{ - �A ..r�.�`�s... ...._ . _ ._...lQ..
JA
Land Owner Name:.. la�ac .tom �?.5......... .p iJ�...... .....__...................... Phone No: ....�. a-4. a...z... S ..: ?.. 7 7 ...... _........ ...
Facility Conctact:...................................................... .. Title: ....— Phone No:
Mailing Address: { �..1_...p_.V..ie,l�.�^ Li'... .. a S ...9.sa.:
Onsite Representatise:... .. . . Integrator:.-M.,s.cp..
Certified Operator:.... _... ...... ......... , ... ----
Operator Certification N mber: .11Q
Location of Farm:
-O�ca._...e..iL.s.t-....s.` .,�......:2 .....�R,�.1�..6.. _.,.......o..�,.�.x::a.x.�_.� .._..f��...��.......� ...e.,s...--Fo
._......._......................•-•......_............._..............................................._.I.............._.........
Latitude • Sj C Q f� " Longitude• ®• ©"
Type of Operation and Design Capacity
�v DesignCurrent Design Current battle Design Crrent
Swine Ca aci Po elation Poultry -,Ca aci . Po ulation••k ,.. Ca aci Po ulatton
Wean to Feeder 2,600 La ❑ Da
n' ElFeeder to Finish ❑Non La er ❑ Non Dairy
Farrow to Wean g T,
. '° s�A.
Farrow to Feeder Total Design Capat
Farrow to Finish ��=
❑ Other �fa� SSLW� � <
=a m a¢
�Number�of LagoonsHolding Ponds Subsurface Drams Present
�.��' f
� '� " � � ❑Lagoon Area ❑Spray Field Area � � `�
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in 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?
❑ Yes 0 No
❑ Yes M No
❑ Yes P] No
❑ Yes (g No
0i A
❑ Yes ® No
❑ Yes 9 No
❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
JRLYes ❑ No
Continued on back

Facility Number: ...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes $1 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
10 No
Structures ajagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
RNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
..s.,... ......_ ............. ....... .._..... .-...... .. .... _....... ............ ... ... ....... .._...._ ..»
....... .........
......... _
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
No
12. Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-1:2 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type Ca@-tG,sa. __._. ........... .Sxn&.L t_�....... S.O.t L........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
19 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
91 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[&No
For
Certified Facilities Qnly
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
ESNo
24.
Does record keeping need improvement?
C&Yes
❑ No
Comments {refer to gizeshoa'# Explainany YES answers and/or any recommendations or any other comments 'r ';'
Use'drawings of facility to^lietter ea:pla�n situations ;(use additional::pages as necessary} z "
e >
QL�` e �i d S s 1ti-o v L` b e �u I I .� V ,�q� e a C-e4. 4
J)0 V% b 5 /� e-o-� �/ i M' "' Q �-3 jv 't I f t h t it r e< f-V i T`�� S
�Wti,e.Y.� ar Juv g�, ,yea r E1z�s@ c.f�'c�ti.e�v-e�e_-Orf' be
12-' Mev.x bn.M'e areas aLcr tL.e wca (�.
16. Z(' ���J�i o� So�6za►�� ►�ov v��- b.a.,e �L:) C_ P
o L a t l o. c� d e ,t . to o V ,r u V% ; V -• aL r V,, a- S t-e V^-
Z A +-a_ c -t a v,n v 5 6* W i (--L 1,
+n..s w. b e'-r- p T y o j�l ►/ S `�-1 e- i d.� . •, a 1
1 ! �
Reviewer/Inspector Name w k� _ < 'T xr '' :rsw y :_
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section. Facility Assessmen Unit 4/30/97
ra„� J

V Site Requires Immediate Attention:
' Facility No.�//
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: Z.
Farm Name/Owner:
Mailing Address:
County:
Integrator:
On Site Representative: —
Physical Address/Location:
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: _�2 (,an Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' 00" Lonb tude: 7-e ' Z Z' 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)6r No. Actual Freeboard: _Ft. Inches
. Was any seepage observed from the lagoon(s)? Yes oa Was any erosion observed? Yes o 1Vo
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
0
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 49 or No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or V&o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters o the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o N If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
cc: Facility Assessment Unit Use Attachments if Needed.

r
•
•
Site Requires immediate Attention:
Facility No. — 'Z
DNISION OF ENVIRONMENTAL MANAGEMENNT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD �?
DATE. �� , 1995
Time: ! Z 44S a
Farm Name/Owner:
Mailing Address: { Z
County:-
InteY-ator_ - W1 �t Phone:
On Site Representative: 4 Phone: -Z(o z// ] _
Physical Address/Locadon: j!j to 14—1 94�L.L--..G__ AZor-YA- i�, 6�wy IZZ AP
Type of Operation: S wine _2L Poultry Cattle
Design Capacity: 2 Le_00 Number of Animals on Site: 2- Lf
DEM Certification Number: ACE DEM Certification Number: ACNv'EW
Latitude: 3q - 5 1' 00 " Longitude: -:71-' 4(1 ' 6(' " 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) Yes or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? es r No Is the cover crop adequate? Yes or o
Crop(s) being utilized: -0
Does the facility mect SCS minimum setback criteria? 200 Feet from Dwellings? i-.00r No
100 Feet from Wells DPO
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o1cm
Is animal waste land applied or spray irrigated within 25 Feet of a U SGS Mau Blue Line? Ye" or
Is animal waste discharged into waters of the state by man-made ditch, flushing sv_ stem, or other
similar man-made devices? Yes o452 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:
Inspector e
r
cc: Facility Assessment Unit if Needed.