310310_INSPECTIONS_20171231

' ©ivision of Water Resources
Facility INumber - j L� O Division of Soil and Water Conservation
� Other Agency
Type of Visit: ID Compliance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: RI L '� Arrival Time: Departure Time: County: Region:
Farm Name:
,tf�^ 1-11 L ,� CY+r Owner Email:
Owner Name: _�---�.(i�C
y (� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
", Onsite Representative: \ 1 —1"
i- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design
Swine LINGapacity
Wean to Finish
Current
Pop.
Wet Poultry
Layer
Design Current Design Current
Capacity Pop. Cattle C►►specify Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
rrow to Wean
rrow to Feeder
ow to Finish
I1, P,auIt ,
Lavers
Non -Layers
Design Current D Cow
Ca aci P,o , Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
ts
!Fai,
ars
Pullets
her
her
Turkeys
TurkeyPouits
Other
Dischar8es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
V No
❑ NA
0 NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
§d NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[P NA
❑ NE
c. What is the estimated volume that re&ched waters of the State (gallons)?
TT
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
aNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
=No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E� No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: 31- Date of Inspection: j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes WrNo ❑ 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): 12
Observed Freeboard (in): 3 �)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ® No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes No D 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
0 Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): V i�.Z
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[j No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
g� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[!9PNo
❑ 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 El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ® Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
❑ NA
yr] NE
Page 2 of 3
21412015 Continued

Farili Number: 3 Date of Inspection:
24. Did the faci4ityfail to calibrate waste application equipment as required by the permit? ❑ Yes N No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes R 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 Q No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No RNA ❑ 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:
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?
'56 '1 � Ct I I � (2 t, e_ I 0V )
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes ❑ No ❑ NA U NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes [f No ❑ NA ❑ NE
❑ Yes No
❑ Yes] No
❑ Yes © No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: q 1 `' [ �b�4
Date: j 1,
Z /20I

Type of Visit: Q-Cbmpliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit:_011fo—utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: d Departure Time: County: Region:
Farm Name: i�1�r hG r >,t r� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Np,l� 9zU t r, r tc
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
Wet Poultry Capacity Pop. Cattle Capacity
Layer Dairy Cow
Current
Pop.
Wean to Feeder
]Non
-Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Design Current Dry Cow
D , P,oult . Ca aci. lv , Non -Dal
Layers Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J:�'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 ;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)
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 E:rNo ❑ NA ❑ NE
❑ Yes [aN//o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - SIG jDate of Inspection: 2-
OF
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 �Fj�No ❑ NA ❑ NE
Struc 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �jj' No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
j'
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes 2 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 Jallo
❑ 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 FlPo
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ZTNo
❑ 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 Ibs. ❑ 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 [E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 6 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 2fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes . No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ 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 r�o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes E]"No ❑ NA ❑ NE
23: If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: 3 - Date of Inspection: C Z
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes qNo ❑ 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 Ef:' No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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 0-No ❑ NA ❑ NE
[] Yes ,6No ❑ NA ❑ NE
❑ Yes ,fNo ❑ NA [] NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes Vivo
❑ Yes No
❑ Yes E NNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Coniments_(refer." to:question #): ,Explain any YES'answers and/or any, additional recommen.dations or any other comments., :
Use drawings of facility,to better explain situations (use additional pages as necessary).
�r 04 (JC4 � 1 r mar17
' Res r a eN) Q (tw n"Qrl - -Ft' r
C(V yCr1z c
�CX f rCcarS S tC')je_- 5csc) .
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Phone: �3
Date:
21412015

it
Type of Visit: IQ -Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: {Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: S Arrival Time: ® Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone:
Phone:
Region:
Integrator: %Y%16
J ) -
Certification Number: I 7
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry C►►opacity Pop.
Layer
Design Current
C►attle C►►opacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P,oultr. Ga aci P,o
I Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ 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 DWR)
❑ Yes EfNo
❑ 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 ❑ No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E3"No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued
r

Facili Number: IDate of Inspection:
Waste Collection & Treatment
4, Is stordge capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
PNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�o
❑ 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
ff 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
VNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P'No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste ADDtication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PKNo ❑ NA ❑ NE
maintenance or improvement? %
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E;rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes.Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 6 No
0 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 kl-No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o ❑ 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 Su �.v\
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � ❑ NA r
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes rN. ❑ NA/
I
20I�
Page 2 of 3 2141`

Facility Number: Date of inspection: /
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 VNo ❑ NA ❑ NE
the appropriate boxes) 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 r No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VrNo [] NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 'UNo ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes / No (DNA ❑ NE
❑ Yes P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments. (refer to question #): Explain any YES answers, and/or any additional recommendations.or any other comments.
Use drawings of facility to better explain situadons(use additional pages as necessary).
cu
10136//y
Reviewer/Inspector Name: Join t _
Reviewer/Inspector Signature:
Page 3 of 3
z�
't� r /Y-L
- ec� w w,
Phone: 2
Date: AOT-A-
21412014

Type of Visit: mpliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit:
L
Arrival T'iine:.
' j-O Departure Time: County: Region:
Farm Name:
r/lp//�
f� Owner Email:
Owner Name:
Mailing Address:
Physical Address: ...
Facility Contact:
Title:
Phone:
Onsite Representative:
Certified Operator:
Back-up Operator='
'�i —
Location of Farm:
Phone:
Integrator:.
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Fop. Wet Poultry
La er
Design Current
C+apacity Fop.
Design Current
Cat#1e Capacity Pop.
Dairy Cow
Dairy Calf
Daja Heifer
Wean to Feeder
a
Non -La er
I
Feeder to Finish
Farrow to Wean
Design Current
Ca aci_ $o .
Dry Cow
Farrow to Feeder
Farrow to Finish
D , P.Qu1t .
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Dischargesand Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes ;]�'Ro ❑ NA ❑ NE
a. Was the conveyance man-made? t ❑ Yes pr'No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ :Yes ' �o ❑ 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 o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters 0 Yes ❑ No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - 3 Date of Inspection: t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 'ffNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes dNo ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
'[allo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes eNo
❑ 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 FZJ 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 [D-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;2,No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes j2'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 ErNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ;INo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �:o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[::]Yes ❑-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �o ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [,-],,No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes )�o 0 NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection: y�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Zo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes o ❑ NA ❑ NE
❑ Yes rrNo ❑ NA ❑ NE
❑ Yes �o
0 Yes P'No
❑ Yes I ,60
❑ Yes �o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes PNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: � 2_Z
z/z_
21412011

(Type of Visit: 42rCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: rriva Time: / eparture Time: County cr Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 17/
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
FFNon-rLayer
Design Current
Wet Poultry Capacity Pop.
a e
Cattle
Da' Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Da' Calf
Feeder to Finish
Da' Heifer
F—TO—th—er
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
Dr.. P,oults Ca aci P,n ,
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
rjBeef Brood Cow
Boars
Pullets
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes,.ErRo ❑ NA ❑ NE
❑ Yes "ffNo ❑ NA ❑ NE
❑ Yes .2-1C8 ❑ NA ❑ NE
❑ Yes �No
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number; 7- Date of Inspection:
,24. Didrthe 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 P!fNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ONo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes ;?fNo ❑ NA ❑ NE
❑ Yes .9 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compiiance 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 � No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes P No ❑ NA ❑ NE
FComments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
—­j
drawings of facility to better explain situations (use additional hazes as necessary).
51ccc�e SUr�c p�� . c.cwh( -WAVY
7jz�`!3 Uf7v
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 2 3
214 011

Facili Number: Date of Inspection: Z
Waste Collection & Treatment
14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesX No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �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 7No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
❑ NA
❑ NE
,C2-No
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P No
❑ NA
❑ NE
maintenance or improvement? T
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, etf)
❑ 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 Q, o
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ YesL2-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes EJO�N 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 o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes J�TNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

rype of Visit: Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
treason for Visit: 01koutine 0 Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: O ,' r Departure Time: County: 4WZ14— Region:
Farm Name: /'& Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: /7BldGj d Integrator:
a�
Certified Operator:
Certification Number: I &
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
ign Current Design
Desh.
h.
C►apacity Pop. Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
D , P,ault ,
Layers
DairyHeifer
Design Current Dry Cow
C_a aci P,o , Non -Dairy
I I 113eef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Boars
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes )2fNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No
❑ Yes 2No
❑ Yes WfNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 21412011 Condmued

J
�Facility Number: X - a6a JDate of Inspection: // / /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes _[2-No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ONo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �1No ❑ 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 P
No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes gNo ❑ 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 �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > i 0% 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 [31No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes )2 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 Q No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ' No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes eo No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes /El -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 4�'] 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? ❑ Yes i�D No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 4!:fNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

- Fad Number: a
24. Did'the facility fail to calibrate waste application equipment as required by the pe it?
y
❑ Yes &No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes Ff No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes16 No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes A� No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes n/ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �'j 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 ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes jNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question f : 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).
�4 I Al) 1,(3z sUPe, 4V & 5lU4f5e Wry tKLF
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
fe.cer0qS Cobh
�r
Phone: / <' — 7��— 77'-a ,4
Date: /l ,7—/.,,,
2/4 011

Type of Visit OC Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Tim : Departure Time: County: Region:
Farm Name: ✓ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ldr ��
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator aL- XI.�
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = ` �" Longitude: = o = `
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish JEJ Layer I I ❑ Dairy Cow
❑ Wean to Feeder 1110 Non -Layer ❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Coyd
❑ Gilts
❑ Boars
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes oNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
BAN' o
❑ NA
❑ NE
❑ Yes
ICJ No
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Npmber: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Struc re 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes KNo ❑ NA ❑ NE
❑ Yes PrNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes -4:�No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes WNo ❑ 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 Fo ElNA [INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes �Wo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PKNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN [--IPAN > 10% or ] O 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
j2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�_eKo
❑ NA
❑ NE
Commentk;(refer to,,quest�on4#) Ezplam any,, -YES answers and/or any r"ecommendations or asy other comriients " w
Used g. ty P ( p. g . w
rawm k of facih to better ex 1`am situations nse add�ti©nai: a es as necessary)- .
i
7
Reviewer/Inspector Name Ii
j s h.= Phone:
Reviewer/Inspector Signature:
Date: Al �7 !C�
Page 2 of 3 12128104 Continued

Facility PNumber: • I— Date of Inspection lc'i 1
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Pio ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Poo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes FZNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes gNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
[:]Yes ONo
[]NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[:]Yes ZNo'
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes .,FeMo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
�o
❑ 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
eNo
❑ 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
ZNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Cl Yes
,2 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�)a7llG 0.,5--7 laoons
6/p/p a.'7,r ioa ,/ h'��
e- 'rmd / e Cov�s /ac/' oo ate.
Page 3 of 3 12128104

- _ .. .. _ tl wvR ive.-'+F dtv° a+.'M � •a�v � "'f
Ilivision of Water Quahty ;y.. r
FaciIity Number O DIYISIon of Soil and Water Conservation_ ��"'<
Type of Visit Z Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint eFollow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D S/Q Arrival Time: j 4Z�.Departure Time: County: Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine ,� b.
N ❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = = « Longitude: ❑ ° ❑ A
Design.. Current Design : Current ' • ODE
a aci Po ulation Wet Poultry Ca aci Po elation =Cattle F Ca
❑ La er r❑ Dairy Cow
❑ Non -Layer ❑ Dairy Calf
__1LJ Boars 1 I }
:'Other _ •�' -�.
❑ Other J .
1)ry Poultry'
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream ImRacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Ll Dry Cow
1 ❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood
Number;
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 (d No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes oNo
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
❑ Yes No
❑ NA ❑ NE
121288104
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes gNo ❑ 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 [�Po ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZrNo ❑ 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 ENo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ZrNo ❑ 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 ,?rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2' o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes S2"No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes JNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ,EN.
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes hlo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes J:I"Ko
❑ NA
❑ NE
Comments (refer to question #): Explain any YES_Answers andlor any recommendations or Any other comments :
e�
Use drawings of facility to better'explain situations. (useiadditlonal pages as ne.,cessary): _ _ _ .._ .,_. � ;4'
Z"Z j con /S /Lac✓ t rr G�"^��4K tom,,
Reviewer/Inspector Name Phone:
Reviewer/inspector Signature: Date:
l2/29/04 / Continued

Type of Visi Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: 7- C_+ o Departure Time: County: ,, Region: —e l"&CP
Farm Name: t.
Owner Name:._,
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: r
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = 6 = I[ Longitude: = o = d = «
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population C*attle
Design
Capacity
C►urrent
Population
❑ an to Finish
airy Cow
❑ an to Feeder
airy Calf
❑ Feeder to Finish
Dry Poultry
❑Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
❑Non -La ers
❑ Pullets
❑ Gilts
❑ Boars
❑ Beef Feeder
❑ Beef Brood Co
❑ Turkeys
❑ Turkey Poults
❑ Other
Other
Number of Structures:
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Pi4b
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
-] No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
eNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: -- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 9.40 ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
0-'No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
V'No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
7 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
VNo
❑ NA ❑ NE
maintenance or improvement?
Waste ApRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
C
❑ NA [:3 NE
maintenance/improvement?
/
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
PNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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 j2No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ONO
17. Does the facility lack adequate acreage for land application? ❑ Yes EI'No
18. Is there a lack of properly operating waste application equipment? ❑ Yes ONO
[I NA ❑NE
El NA ❑NE
El NA El NE
El NA El NE
Reviewer/Inspector Name Y (fa [ Phone:
Reviewerllnspector Signature: Date:
Page 2 of 3 12/28/04 Continued

Facility Number: 31 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes .+E] 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ZrYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard -Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes Z No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ONo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes O'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VfNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;?rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;2rVo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ZNo
❑ 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
��rv!
I� 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
OIL
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[2<o
❑ NA
❑ NE
[Additional Comrnentsandlor'Drawings::�,q
Ilk V/4$
COCA
v
Page 3 of 3 12128104

Division of Water Quality
FaCi Number ' ' Q O'Division of Soil and Water Conservation
_ — — 0 Other Agency V,
Type of Visit 0 Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral Q Emergency O Other ❑1 Denied Access
Date of Visit: Arrival Time: ' d Departure Time: Q; County: gpLs/" Region:
./V
Farm Name: A Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title: Phone No: Q ,,
Onsite Representative: / f/4� 7 I— Integrator: �iPPff�� � X�i2G.J
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 01 QIg Longitude: = ° F T [� Ii
Design Current Design Current Design Current._
Swine CapacityPopulation Wet:Poultry,;. Capacity Population Cattle ,Capacity, Population"".'
❑ Wean to Finish
Wean to Feeder
Qfl
iQ
Ef Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify 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 yfNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes '0, No
❑ NA
❑ NE
ElYes 1CJ No
❑ NA
❑ NE
12128104 Continued

Facility Number: �0
Date of Inspection L�Jl
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
El NA El NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
❑ Yes Ld No
El Yes /❑ No
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes gNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ 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 eNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /PlNo ❑ 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 0 Evidence
eoof/Wind
/Drift ❑ Application Outside of Area
type(s)12. Crop type(s) 6X/71 an /4 ! / 4V
13. Soil type(s) L ! U �p_
14. Do the receiving crops differ from those designated in the CAWMP? El Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes to No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes DNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
2V 9 25)21) ay..�,2
Reviewer/Inspector Name
0/
Reviewer/Inspector Signature:
Page 2 of 3
Date:
12128104 Continued

Facility Number:,?/ — O Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo [DNA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropriate box. ❑ W­Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
Ed No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
/❑ No
JZNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�dNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
P(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZrNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No RfNA ❑ NE
Other Issues <`«<
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes XNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ElNA [-INE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concem? ❑ Yes [ INo ❑ 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 �& ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes /�'(No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ZNo ❑ NA ❑ NE
Additional Comments and/or Drawings: "
o"
r
AO
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit A Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number slate of Visit: j
Permitted(CCertiliiied E] Conditionally Certified 0 Registered
Farm Name-
0 Time: p
O Not Operational O Below
Date Last Operated or Above Threshold:
County: ,t?XJ
Owner Name: , 'Phone No: _
MI LvIing Address:..._,,,
Facility Contact:
Onsite Representative- ..Ue,if. / e'), 4 ku.6 .... W.... .
Certified Operator:
Location of Farm:
Phone No:
Integrator..,,�ldL»
Operator Certification Number:.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude '
."'De
. S*iriecar
Wean to Feeder
Layer
Feeder to Finish
Non -Layer
Farrow to Wean
Other
Farrow to Feeder
Farrow to Finish
s -
Taff Dt
r
Gilts
Boars
Y
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 galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes J3 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes,)2No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes E3-Mo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ..... ! - _
Freeboard (inches):
12112103 Continued

Facility Number: 31 —,3 7 Date of Inspection U
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation marldngs?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PANI ❑ Hydraulic Overload ❑ Frozen Ground. ❑ Copper and/or Zinc
12. cr^ I We PrrI'JI.414&V)
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?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes j2vo
❑ Yes [�Go
❑ Yes _L2,No
❑ Yes 13,No
❑ Yes J:Wo
❑ Yes [2,No
❑ Yes 0'1Qo
❑ Yes : OVo
❑ Yes ®'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes eNo
❑ Yes .8'ko
❑ Yes ff�4o
❑ Yes .4M No
❑ Yes ,O%o
❑ Yes 9'la
... ---�"- Y.. �. -e. � � ,,. -^� :� �-^°-�—...s�=fir :ram - .� ^,�. —.- •x _
Comments {refer to qurs�on�#} <�.Taut aay YE5 answers sadfor aa9 or alry� otli� =:meats. -
_ ,
�ilse dravvtngs oaf fa�,t3' to better acplain s�ti�oas. (u9e twnal P � aec�ry) z � COPY ❑ Fnnal Notes �: � -
�..
T
.' ,. .
viewer/Inspecto Name ' r MM
_ / - - 4 6:' r
Reviewer/Inspector Signature: Date: ,
12112/03 1 ' Con6ued

Facility Number: t —,3 Date of Inspection ! C%
RMMired Records & Documents
2l . Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ZrNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) ❑ Yes ,2 No
23. Does record keeping need improvement? If yes, check the appropriate box below. ,] Yes ❑ No
❑ Waste Application ❑ Freeboard PWaste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes-Z No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes -ENo
26. FaiI to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes _ErNo
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes .$'No
28. Does facility require a follow-up visit by same agency? ❑ Yes )R No
29. Were any additions; problems noted which cause noncompliance of the Certified AWMP? ❑ Yes pYo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes _O-Ro
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes [:]No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35_ Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
Q No violations or deficiencies were noted daring this visit. You will receive no fm ther correspondence about this visit.
93 ' lJ W ii d t,J 0 YV � S c, rrtz O'Co rfa � M !�
can sl I)C— 617
-D
-40
1�'-aed ifs
12/12M3

Type of Visit aC�oompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit CJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t + c/a ` Arrival Time: $ Departure Time: County: QvPL'Itj Region:
Farm Name:
Owner Name: T
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: i! f a- II E rLY A✓t o LPL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 6 0 Longitude: = o= A[=«
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
00 Z a ❑ Non -Layer
❑ Wean to Finish
E[Wean to Feeder
❑ Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets.
ElTurkeys
❑ TurkeyPoults
El Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
El Dairy Cow
❑ DairyCalf
El Dairy Heifer
❑ D Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
El Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
El Yes
El No
❑ Yes
L3N
El NA
El NE
❑ Yes
YNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 3,— b Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
WNo
❑ 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: to,
Spillway?:
Designed Freeboard (in): , S!
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
N
ElNA
ElNE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
[Yes
UNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
L/I No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�<o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
L]"'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
11 Crop type(s) (3(- ay t u '3IL ( 1-j) S c G
13. Soil type(s) 0�j c Fc, t^t } v6
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
EJ Nc
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? El yes
El"NNo
El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations ❑ Yes
Dl!o
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
E No
❑ NA ❑ NE
18_ Is there a lack of properly operating waste application equipment? ❑ Yes
E No
❑ NA ❑ NE
Comments (refer to question,##) Explain any YES`answers�and/or any recommendations or any other comments, � `
drawin s,of facili to better se ex lain situations uaddttsonal� a Use er as ne essa '
tJ eE -G 1-4 AA..% C_a_la s s ON D r ICG W f1 Lc..�
off,) t)eOATC h1i)p , r CLD q NCEOS fo 64( GAL4J-tAT 9 L"-To Z &ONC-5 rok WT'Fgi3t1�
AR.EA CyE , tZ SETS JF 4 SeLLj:o l<_Uka SJ . xf -50 ?5 Nb'T G(JI'j `r WA\'Z'aS-f AND .6157E(A6
63FVNG evwgD vv\uST (.ALUL.Ar( PAN r/ALUE iblrJi`i"S i3(Ryvl�0q. SFt-T 614 w.IN901v
a�) I)POATE C.f-0e +:1ELO f-OkM. AAL S i 06 !" 62A1'NF4t_,,_ ._ NSQLCCfa►J
L>a c A P P �. c a,-r ro,J S? ElZaM J p fl N D +I5 a G D.
Reviewer/Inspector Name l i t-1 Cq�U Q t— s� Phone: Cf/o %9 . ——
Reviewerllnspector Signature: -- Date: 1 O
12128104 Continued

Facility Number: 31 -- 31v Date of Inspection a 1 aS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have II components of the CAWMP readily available? If yes, check
the appropirate box. WUP ❑ Checklists ❑ Design ❑Maps ❑ Qther
❑ Yes No ❑ NA ❑ NE
des ❑ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wee ly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking rop Yield El120 Minute Inspections L_J'Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
eNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
O NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
E NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
To
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[a NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
��
LEI No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ETNo
❑ 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
EINo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
El No
❑ NA
❑ NE
Additi6i ial Comments,and/orDrawiiigs. �, ? � �r � � r `� � � � �_�N t
�.K. �. t �.-��...
12128104

(Type of Visit QfCompliance Inspection Q Operation Review Q Lagoon Evaluation j
Reason for Visit Routine Q Complaint Q Follow up Q Emergency Notification Q Outer [3 Denied Access
Facility Number Date of visit: Time:
Not Operational O Below Threshold
13 Permitted E3 Certifiieed Conditionally Certified 13 Registered Date -Last or Abov Threshold: -
Farm Name:idw �r� r� 1 County: .
Owner Name:
_ .. ... one No:
Mailing Address:..__
Facility Contact: __ __ Title:..__._ .. , Phone No:
Onsite Representative:.. -__ _ Integrator.
Certified Operator: - _. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` 9& Longitude • 4 "
Desgrz *.CnrirMt �Y
Swine _ - _ f.'Q:,4.'..+., .-'P.:.:I.r•:.... P4nifryF's
Wean to Feeder
❑Layer
Feeder to Finish
Feeder
Non -Layer
to Wean
s�
Farrow to Feeder
Farrow to Finish
-
TOf
Celts
Boars
-N"
Discharges & Stream ]meads
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?
�G y _ � Goa -Current`
• Capacity PnpWahon ''
—�=Wr ter•-- ,:
t r
dtgSSLW-�
x
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes E�rNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A2"1Qo
❑ Yes Jallo
❑ Yes 2vo
Structure 6
12112103 Continued

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes O'No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes"�No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes 2 No
S. Does any part of the waste management system other than waste structures require maintenance./improvement?
❑ Yes 2 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
El Yes �No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovement?
❑ Yes -Q.No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes'allo
❑ Excessive Ponding ❑ PAN draulicffOverload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type CAV } _
13. Do the receiving crops differ withthio/s6esignated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes .,ffNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes P-190
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?
_19-fes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes _ L3NO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes .off &o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes'L o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes�lQ0
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes JIQo
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
13 �calllro
el�s /za�� �so lGr� �reas � n
/'-
ReviewerAnspector Name
ReviewerA Spector Signature: Date:
l2/l2/M3

Facility Number: — Date of inspection
i
Iteouire&Records & Documents
21. Fail have Certificate Coverage & General
�No
to of Permit or other Permit readily available?
❑ Yes
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes FNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ETNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ZNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes . EErNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
,!rNo
27. Did Reviewer/Inspector fail to discuss reviewlinspect ion with on -site representative?
❑ Yes .2No
28. Does facility require a follow-up visit by same agency?
❑ Yes )2Vo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 0 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes -�Fo
31. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes [:]No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33_ Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate boa below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access 11
Facility Number Date of Visit: L
Permitted ,Certified [3Conditio ally Certified [3—Registered
Farm Name: k
Owner Name: F t
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
2 D Time: i Q
10 Not O erational 0 Below Threshold
Date Last Operated or Above Threshold:
County: C✓ ��®
Phone No:
P�h�onnenNo::
Integrator: _9AYz 6F
Operator Certification Number:
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 u Longitude ' 6 Du
-Design Current Design . Current Design Current
Swine Capacity Po ul tion Poultry Capacitv Population Cattle Capacity Po ulation
IR Wean to Feeder ❑
Feeder to Finish I ILI Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean — -
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number. of Lagoons I ❑ Subsurface Drains Present ❑ La on Area ❑ Spray Feld Area
Holding Ponds [SoGd,Traps ❑ No Li uid Waste Mana ement S stem
A m
Discharges && Stream Imnacts
L 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): rt
05103101
❑ Yes VNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes zNo
❑ Yes zNo
❑ Yes �No
Structure 6
Continued

Facility Number: 2 —31V Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes P(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 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level !!!�
elevation markings? El Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes O�No
11. Is there evidence of over applicatio jI ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes FrNo
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
P"No
c) This facility is pended for a wettable acre determination?
❑ Yes
/No
15.
Does the receiving crop need improvement?
❑ Yes
EfNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
dNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
!lVNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
,�J No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
ElYes
PIII
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commentts (refer to ghestivn, #) Explain anV YESr answers and/or any, recommendations or apy
Uses aw ngs ©f facility to better explain sttgiihons "(use addittonal pagets as�necessary) Field Cotes El Final Notes
4, 1x .
5) 7* � oo47' ,��sfi,6~,a 7, e_y
e,f 7 f� e7rW 5741LO
H,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: p
O5103101 { Contenued

Facility Number: 3� — l Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
�No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
-- //
ENo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
�NO
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
V 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
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
/1"No
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNO
Additional omments and/orDrawings:
AL
.GF IVoa Alv'.
l
eom Ar t7's- ZIA1- z-
J
5100

Dateof Visit: % Z O1 Time: � i-i i =----, Printed on: 7/21/2000
Facility Number J Q
Not Operational 0 Below Threshold
Permitted E3 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: erber....�1...�.j!G1A..��'r�''° Countv:....lJ .........................................................
............. j.�...........1 nil L...................................................... _......
Owner Name; .............figr.f?4r.4.t .yc,?.d.. Phone No ..............
FacilityContact: .............................................................................. Title:.................................. Phone No
MailingAddress:................................................................................................................................ ....... ........... I.......
Onsite Representative: ,,, f l i f4.._.A jf,.�............................................... Integrator....M.k
Certified Operator: .................. ................................ ............... ............ ................................ Operator Certification N mber:........_.
Location 'of Farm:
❑ Svilne ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 C�44 Longitude • 4 cc
Design Current
Design Current Design Curretst
ii
oultCattle PoCa
lion
=' Wean to Feeder
❑ Layer
Feeder to Finish
IF[]Dairy
❑ Non -Layer IF1 Non -Dairy
Farrow to Wean
Farrow to Feeder
JEI Other
Farrow to Finish
Total Design Capacity
Gilts
Boars
Total SkW
Nintnber qi oisns
Subsurface Drains Present ❑ Lag^�+n Area 10Spray Field Ares -
Sptg Ptsnds ! SoLd Traps
11 WIN
❑ No Liquid Waste Management System
Discharges & Stream Imlacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min!
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..............I ................. ...................................... ....................................
Freeboard (inches): �9
5100 1
❑ Yes R!rNo
❑ Yes JZNo
❑ Yes No
❑ Yes JVNo
❑ Yes fNo
[—]Yes IIo
❑ Yes �9No
Structure 6
Continued on back

Fpcility Number: 3t — ?f O Date of Inspection /l Q
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 YesXNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes J2/No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes J'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes'ji No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes 21'No
elevation markings?
Waste Application
❑ Yes
10. Are there any buffers that need maintenance/improvement?
,!fNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes Z No
12. Crop type &✓',n ud q o a V , ,,Sri -,a i i G&t=',1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes JZ 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 fora wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes J'No
16. Is there a lack of adequate waste application equipment?
❑ Yes )2rNa
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes 0No
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 FrNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes jerNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes -XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Mo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes XNo
24. Does facility require a follow-up visit by same agency? ❑ Yes IQIN0
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes -fi No
f Rio yiipiaii[}t�s ;oe dgciendt were ho(ed �4tt°ing ��4s •visa; • Y vie with •reoeiye 00 fuij ther • - - ✓
conies dence: ah6i this 'visitw
Comments (refer to quefion #) .Fiplai>i,any YFS answers and/or any recommenA"ons or any otter comments W
Use drawu� of ilagi ity to betoi,e�cp risitnations:-(fine"additional pages as necessary')
��e-�ac•j,.� y 1 C�Q � t,,,d r'ccol-ils el -re riecf ty ke(l. Nee4 Jo be 5'Ur
f Z1 1-.! (A �'-t GI/lLt�yS +J G2l� W�'`� (off da'� s O� G��t
�ven4s evt 4he Aid -2 is .
Reviewerllnspector Name 6�e1=vA pi1i3 -� ;)
Reviewer/Inspector Signature: Date: S/pp

Facility Number: JrJ 0 Date of Inspection J 1 Q
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 —0'eIo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONO
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes J:3-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 J2wo
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 ❑ No
f10 - omments an or.Drawings:' r. _
,x
+1
5100

'Division of Water Quality 4 ��
vi
:rr �*
Dision of Soil and Water Conservation
• - Other Agency ` r-}
x
Type of Visit Acompliance inspection Q Operation Review O Lagoon Evaluation
Reason for Visit b.Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �'riine: 1 Printed on: 7/21/2000
`3 v
Q Not O erationat Q Below Threshold
0 Permitted XCertified j] Conditionally Certified © Registered Date Last Operated or Above Threshold:
FarmName: 9 .... County:............................................................
Owner Name:................... ...............
Facility Contact:..............................................................................Title:
MailingAddress: ...........................................................................................
Onsite Representative: _,G��--.lr
Certified Operator:
Location of Farm:
Phone No... ..................................
Phone No: _.......
............. Integrator: .......
..�-tL
............. Operator Certification Number:
AL
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude • 04 Longitude 4 C44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder GCCxi ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Soars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑Lag-nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste -Management System
Discharges & Stream Immact5
1. Is any discharge observed from any part of the operation?
❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No'
h. If discharge is' observed. did it reach Water of the State'? (If yes, notify DWQ)
❑Yes ❑ No
c. If discharge is observed- what is the estimated flow in gal/iitin:'
d. Does discharge bypass a lagoon system'' (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes �(No
3- Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes A No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes XNo
Structure I Structure 2 Structure , Structure 4 Structure 5
Structure b
Identifier:........---'...........................................................
Freehoard (inches): 3 `
5/00
Continued on back

Facility Number: 1 —'j p 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,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
H. Is there evidence of over application? []Excessive Ponding ❑ PAN []Hydraulic Overload
12. Crop type
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?
15. 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?
(ieI WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ieI irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Iio •yit�iaticjris;oir defieiencip$ -were h ed d&irig �his:visit: • Yoijtwiil•reeeive iio further.
�orresporidence: a�ou this visit.:
[]Yes KNo
Cl Yes Ki No
❑ Yes j�(No
Nf Yes ❑ No
❑ Yes E'No
❑ Yes No
❑ Yes No
❑ Yes XNo
❑ Yes UNo
❑ Yes ❑ No
wYes ❑ No
❑ Yes ONO.
❑ Yes �(No
❑ Yes ,X No
❑ Yes
KNo
'Yes
❑ No
❑ Yes
KNo
❑ Yes
;<No
❑ Yes jfa"j No
❑ Yes XNo
❑ Yes [VNo
❑ Yes XNo
Comments (refer to question #): Explain any YES answers and/or any recommendations or any.other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�� �-. l �, a b� �-•eu tee, �s mil .-� �,�e A
Reviewer/Inspector Name
0-- 37 53 Qo
Reviewer/Inspector Signature: '-% I % Y,,_ 0 Date: t %_`1:-{) G' 5100

FAcitity Number: —' Q Date of Inspection Printed on: 7/21/2-000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes No'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes O(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 NfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ANo
Additional -Comments an or rawings: _
�� Lac. � — ���� �'-2�� �f` � s� i� ��' �1�- ►��
v�N-) VZ�
vtf" ,
Orr
J
sioo

Division of Soil aiidsWater-Consservahon - Operat<on Review R
; I Division of Soil and-Water°ConservahoA Compliance Inspection
'13evasion of Water Quality Compliance Inspection r. •>
her Agency _ 0peratioae.Rew`.
UK Routine 0 Complaint 0 follow-ue of DWQ inspection 0 Follow -tip of DS',VC review 0 Other
Facility Number Date of Inspection L
Time of Inspection E� 24 hr. (hh:mm)
Permitted © Certified [3 Conditionally Certified [3 Registered 1E3Not O erational Date Last Operated:
Farm Name: .`4 .G3 .{-T`....,f" `�.t~. C.l .....: f3��-'1�'1 County:...-1...n................................
Owner Name:'r?.--l.` .....�-`..C_0C_V. ............................... Phone No: C`�.�. D.t... Z �.. .�.. .6..................
FacilityContact: ..............................................................................Title:........................ ....... Phone No:...................................................
Mailing Address:.i..L.�.Q...�-`-�.�.I�-�,S.�.....�.r1?..... 2 ....... k.�_17.......�.h?t�.lrl
Onsite Representative:.. 1 - .C3. .ice-T........ `�. C.2. ..i�............... Intel;rator:.'.1!ln LJ.I-..C�.-L r Y................. I................
Certified Operator:... I?�rz,..t Z'..-./ �.. �.� .,.,................. Operator Certification Number: ... t.�..k.�c'Z............
Location of Farm:
........US ...... —oCr'x.E. 7S_D....�?.n......a�L_.t�........ sw ...... 15...Lo. ......Q..r ....5a�...�..£� Z..�...�......................
..k..Q..... .I.L .= ...-..t . o.-t-z-rc.1.......... a..p....... ..................................................................................................... .
Latitude ®0 a�fl` •4 Longitude ©• ®4 ©�4
Design Current, . ,-_r Design:: Current,; Design. Current
Swine - Ca acity Po illation Poultry Ca acity Po elation .. Cattle- Capacity Po ulation
Wean to Feeder ❑ Layer Dairy ❑
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
- ❑ Other —
❑ Farrow to Feeder
❑ Farrow to Finish Total Design. Capacity -2
❑ Gilts
❑ Boars Total SSLW
�Number-ofLagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
r -•
Holdtn°Ponds /Solid Tra s g p ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0,,No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes RTo
b. If discharge is observed, did it reach Water of the Suite? (If yes, notify DWQ) ❑ Yes Wo
c. If discharge is observed, what is the estimated flow in gal/min? _ �j� / A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes qNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Wo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes B No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
4
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
+t
Freeboard(inches): ...2 ............................................................................................................................................. I ... ........... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 'P(No
seepage, etc.)
3/23/99 Continued on back

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 maintenarice/itnprovement?
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 E6 - --jAA
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?
15. 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?
10 yiolati,Dris:oi- deficie>icies were notes during phis:visit: Yoil will i ee4 i 46 Leo f rther.
. • . • correspondence. afar * f this visit. .::
❑ Yes `<Na
❑ Yes KNo
❑ Yes KNo
❑ Yes XNo
❑ Yes JKNo
❑ Yes ❑ No
❑ Yes XNo
❑ Yes We,
❑ Yes KNo
❑ Yes 5<No
❑ Yes qNo
❑ Yes KNo
❑ Yes KNo
❑ Yes KNo
Cl Yes 15(No
❑ Yes )4No
❑ Yes 4 No
❑ Yes qNo
❑ Yes $'No
❑ Yes SNo
❑ Yes $�No
�oritments_(refe� to question #) Eztplain anyzYES,answers andlor' any "recommendateons oc any^o#her comments.'
Jse_drawtngs of faciltty to.better explain, sttuaions (use additional pagt s a§ necessary) s "1
HAT l_OA 157' A--�A-L—`-e s �S
Reviewer/Inspector Name 76
Reviewer/Inspector Signature: 1-7)-` r "1 dDate:
3/23/99

Faciljty Number. 1 — in
Date of Inspection s
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below .❑ Yes `KNo
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes gNo
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNO
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 VINO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes I❑\No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes gN0
ditiona , _omments'an or=_ rawin _ -
T
3123/99

0 Division of Soil and Water Conservation 0 Other Agency
Ig Division of Water Quality
IftRoutine O Com laint O Follow-u of l)W ins ection O Follow-up of DSWC review O Other
Date of Inspection 1
Facility Number _
Time of Inspection ,j=b0 24 hr. (hh:mm)
© Registered 10 Certified © Applied for Permit © Permitted 10 Not Operational I Date Last Operated:.........
Farm Name Wtt fiff.. ........fi.c--.................... County:..... .; t ................... ....................
Owner Name: ........ Uw� .vc�E .................... 1q-wL(L.......................... Phone No:... qL¢� ........................................
Facility Contact: .....................• --.--. .. Title:..................... ..... Phone No:
......................................... ...............
MailingAddress: ....... 1SD0...... 4111 S..... V ... i...................... I ............. I....... ...... ��� c ....t.. {%.................. .......................... ... n.i6k..........
Onsite Representative: P u<x"........ &N.G.o....................................................... Integrator: ...... &.04hE..............................................................
Certified Operator. .......................... ........ Operator Certification Number,........... .. ............�
Location of Farm:
Latitude Longitude �• �' 0"
Design Current Design Current: Design Current ,
Somme ? Capacity` Population rPoultry ^ Capacity Population = Cattle Capacity Population ".
g.
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
N
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other'' x
Total Design Capacity
..Total'.SS
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 11No
2. Is any discharge observed from any part of the operation? ❑ Yes P No
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 gat/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
[� No
❑ Yes
q9 No
N
❑ Yes
No
❑ Yes
® No
❑ Yes
® No
S. Does any part of the waste management system (other than lagoonstholding ponds) require
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes (9 No
❑ Yes �&No
❑ Yes M No
Continued on back

wyac,ilitv Number:.
8. Are there lagoons or storage ponds on site which need to be properly closed? El Yes 159 No
Structures (Lavoons.11olding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes IN No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(ft): ........... L.1 ............... .. ............................. I .... ..... ­.... ....................... .................................... .................................. .
........ .........................
10.
Is seepage observed from any of the structures'?
El Yes
[A No
Il.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
M No
12..
Do any of the structure-, need maintenance/improvement?
� Yes
El No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers'?
El Yes
09 No
Waste Application
14.
Is there physical evidence of over application?
0 Yes
17 No
(If in excess of WIMP. or runoff entering waters of the State, notify DWQ)
15.
Crop type ............. 6umuao ................................................. sr.,-Atk.... Var .. ......................................................... .......................'.-.,.......I.................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Yes
nG No
17.
Does the facility have a lack of adequate acreage for land application'
0 Yes
MNo
18.
Does the receiving crop need improvement?
M Yes
[I No
19.
Is there a lack of available waste application equipment?
El Yes
%No
20.
Does facility require a follow-up visit by same agency?
1AYes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative!
E3 Yes
04 No
22.
Does record keeping need improvement?
Yes
[I No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
FA No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit"
❑ Yes
❑ No
No.viola'tions- or deficiencies were no' te'd-during- this.'visit. You_w'ill receive no further
correspondence About this visit'.,
. .. . . . .. . .
C6inin6nti,(ieNr to question #): Explain any YES answers and/or anv recommendations or any "other comments .
K
el
Use drawings of facility to better explain situations. ons. (useadditionl pages as necessary}
12_ Ow" ko,500- zkL 6y4t S"W 6, rtsow,
04wtej " voju),4,er- r_sSc.S ji, Cw� &.rihj SOJ COO -SW &VOP.
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7/25/97
­K . . .. . ...... ... ....
Reviewer/Inspector Name
Reviewer/Inspector Signature- Date: zJ1 V

Routine 0 Complaint O Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection -7
3 31
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review t�
® Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
FarmName: ......3LY.�lL. ... AA� -- ....-_---- —....------ _......... County: _...Ll, ic%.......... ..........., __.... _..
Land Owner Name:..._.[:ft--._..jLQ�..................... ... Phone No: Cr7i0 Z�s�rt......
Facility Conctact: fGr K1�.fC.1.._ t�. _ :..(� 0 ..... �;�_....�..r............. Title•,..,Q.lathii1C.........�..�_.j_.....,. Phonel Rio• ...� ..$�.-�,,�,a........---�
Mailing Address:. .s� .... _�:X1.�_.. __....._..........._.lN. Q �1:t-f--�Iv�:.......... ...._�.........._2i..._......
Onsite Representative:....... ri.... - 1:lt _..._....:....... W. ...... Integrator:
Certified Operator: ....�...........................................Operator Certification ......................................................_..
Location of Farm:
... .�,.
. ... .. ...
....wi..s..,..y ..... t..._
Latitude •° ©u Longitude
Type of Opera Aon and Design Capacity
Swne , F ; ,,CDesa R;� CCurret �� �
a acr Po uation aciyPo"lltion -� CDaes�gcea Po guuerlrraaehnoE a�.x;
i. Wean to Feeder [ �❑ La ❑ Dairy
Feeder to Finish ElNon-La er ❑ Non-Dalry
R
Farrow to Wean - ,..:
Farrow to Feeder Uy Total Design ,Capacity
Farrow to Finish
3 �y � L
�❑other � `� xTotal SS � � s
x ; r ❑ Labour n --
Number of Lagoons / Holding Ponds ace Drains Present "
g Area ❑Spray Field Area
Gr,neral
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/inin?
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?
S. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes .0 No
❑ Yes Df No
❑ Yes 91 No
❑ Yes No
❑ Yes U No
❑ Yes W No
❑ Yes No
0 Yes ❑ No
Continued on back

Facility Number:.11.......
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?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the 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
uno {ffentering waters of the State, notify DWQ)
15. Crop hype --1� ... ....._ _.......,. ....._,....
❑ Yes Wo
❑ Yes CANo
❑ Yes FZ No
❑ Yes J+No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
F_Qr_Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes E9 No
N Yes ❑ No
UYes ❑ No
❑ Yes N No
❑ Yes N No
Yes ❑ No
❑ Yes MNo
14 Yes ❑ No
❑ Yes (SNo
® Yes ❑ No
❑ Yes PLNo
❑ Yes 2TNo
❑ Yes VLNo
10 Yes ❑ No
Comments (refer to question t#) � Explain ari}+ YES answers ;and/or "any �recommendations or any other comments r �' �
Use drawings`af facility to:better explam'situatrons. (use addrtional:pages as necessary) °� # �'�' � _ __
y-
VAW KooN s�r;AlAr 5kavj -p used t,-\ st a"1 �-dd #3 nLvd- old .t .it- 4
E*&:jov. circa.& Os, irlvur ovjc wo'(� 4)f agoor\ skoufd be �'1(,fol wit, C [6 sv) axj
Ste-�11-� Q 5 b oazeed .
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cc., Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:'
Facility No.c1
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMA.L.FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:. , 1995
Time: f l %l 0
Farm N,
Mailing
County:
Integrate
On Site
Physical
Type of ll�JG1 QL1V11.
Design Capacity: 24,0
,j W 111G r kjulu ' 4QLUL
r w ti.+LY�
Number of Animals on Site: -
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:' 'i'C7 " Longitude: Z:° `� 3_' _j? L. Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) or No Actual Freeboard: Ft. Inches
.Y� Was any seepage'observed from the lagoon(s)? Yes orsi Was any erosion observed? Yes of I
Is adequate land available for spray?<YP7 or No Is the cover crop adequate? ee or No
Crop(s) being utilized: �_ Cup -
Does the facility meet SCS minimum setback criteria? 200 Feet from DwellingszcRor No
100 Feet from Wells? 6 or No
Is the animal waste stockpiled within 100 Feet of USGS BIue Line Stream? Yes 9
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or& 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 od�_
Additional Comments: I z�
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.