310324_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Date of Visit: Arrival Time: Departure Time: I County: DWA to Region:
Farm Name: Y l S r&*rn Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: (d -b
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number: C1
Certification Number:
Latitude: I Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Q
Elviign Current
Dry P,uultr' C•_a aci_ Pia ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes
❑ No
IONA
❑ NE
❑ Yes
❑ No
[;(NA
❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
V-r
[9NA
❑ NE
❑ NA
❑ NE
❑NA
❑NE
Page I of 3 21412015 Continued

jDate of in
umber. spection:
e)
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
No
[—] NA
[-] NE
a. If yes, is waste level into the structural freeboard?
D Yes
D No
D NA
D NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway9:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
X No
D NA
ONE
(i,e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
D Yes
'fZ No
D NA
D 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 KA No NA NE
LIP(
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 0 Yes F�71 No DNA D NE
maintenance or improvement? IN
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes No [:] NA [—] NE
V14
Fj Excessive Ponding Hydraulic Overload [:] Frozen Ground D Heavy Metals (Cu, Zn, etc.)
F-1 PAN F] PAN> 10% or 10 lbs. 0 Total Phosphorus D 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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres detennination?
17. Does the facility lack adequate acreage for land application?
18. Is there a tack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Perinit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 Yes
MNo
NA
NE
El Yes
Lr"' No
r*
NA
NE
D Yes
%No
NA
ONE
Yes
�g No
D NA
[:] NE
Yes
9 No
C-] NA
E] NE
Yes
jj§ No
[:] NA
D NE
0 Yes
No
D NA
D NE
[:]WUP F—]Checklists D Design [:] Maps E] Lease Agreements 00ther:
21. Does record keeping need improvement? If yes, check the appropriate box below. D Yes fA No
Waste Application El Weekly Freeboard E] Waste Analysis D Soil Analysis 0 Waste Transfers
Rainfall D Stocking 0 Crop Yield [j 120 Minute Inspections E] Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:] Yes [�-No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes No
Page 2 of 3
NA ONE
Weather Code
Sludge Survey
NA NE
NA NE
21412015 Continued

Facili ` ° Number: 6 k - 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
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
'�§No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑Yes
INTNof
NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
1� 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
Cd No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
%No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers. and/or any additional recommendations or any otherycomments.
Use drawings of facility to better explain situations (use additional, pages as necessary):
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ,® -19� ^1 S X 7
Date: i
21412015

Type of Visit: (D Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 hollow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: .Z 20 County:.�� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative.,�7J [�L{ JL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: 9qq !35
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
row to Wean
row to Feeder
Desig=@urre.J t D Cow
D ► P,oult , Ea aciNon-Dairy
row to Finish
Layers
Beef Stocker
s
Non -Layers
Beef Feeder
!Far
rs
Pullets
Beef Brood Cow
er
Turke s
ouits
Other
i i ::d
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ZNo ❑ NA ONE
❑ 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)
❑ Yes ❑ Igo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ®
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

lFacifity Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
i
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1j Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
2j"No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes ZNo ❑ NA ❑ NE
[—]Yes U�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 Z 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, et
❑ PAN ❑ PAN > 10% or M lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑Yes [Z o ❑NA ❑NE
❑ Yes ❑ NA ❑ NE
❑ Yes
❑ YesWN
o
❑ Yes
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑NA ONE
❑NA ❑NE
❑ NA ❑ NE
DNA ❑NE
❑ Other:
❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes yNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ NA ❑ NE
25. 13 the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes VNo [DNA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
V<O
❑ NA ❑ NE
and report mortality rates that were higher than normal?
No
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:)Yes
LO
❑ 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
M/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
WNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Cj N
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers :and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional oa2es as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
V_0(-
Phone
Date: !0
11412015

Type of Visit: Q riWjoduj
liance Inspection V Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: tineO Complaint O Follow-up 0 Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: D A�j YKErIJ-01ZIntegrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: ! Uq 3 3
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Wet Poultry
Layer
Non -La er
Design
Capacity
I
Current
Pop.
El
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D I;oW
Layers
Design
Ga aci.
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I I
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
[—]Yes rNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412014 Continued

jDate of Inspection:
Facility Number: _'�-j -_- - 1 1-1 MY
='
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
E2r/No
E] NA
[—] NE
a. If yes, is waste level into the structural freeboard?
0 Yes
0 No
ONA
ONE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
0 ) (es
I&No
0 NA
ONE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[:]Yes
[2/No
0 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? 0 Yes [3'yo NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit? Yes fNo NA 0 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 C-] Yes [�J/No NA [:] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes [ZINo F] NA 0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes EZ� /No 0 NA [—] NE
Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground OHeavy Metals (Cu, Zn, etc.)
PAN M PAN > 10% or 10 lbs. Total Phosphorus 0 Failure to incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window 0 Evidence of Wind Drift OApplication Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
y
El Y
[3/No
0 NA
NE
15. Does the receiving crop and/or land application site need improvement?
rYe s
0 No
0 NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
�J/No
[3 NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes
2�/No
0 NA
0 NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
[:2/No
0 NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
EZKO
NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
E] Yes
�FNo
NA
NE
the appropriate box.
OWUP 0 Checklists 0 Design 0 Maps [:]Lease Agreements O0ther:
2 1, Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes E3"N'o 0 NA 0 NE
Waste Application El Weekly Freeboard E3 Waste Analysis Soil Analysis OWaste Transfers 0 Weather Code
Rainfall 0 StockingE] Crop Yield [] 120 Minute Inspections 0 Monthly and V Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? E] Yes E] NA [:] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes t [:] NA 0 NE
Page 2 of 3 21412014 Continued

[Facility Number: - Date of Inspection:
* 24.'Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ENo ❑ 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 E No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes N ❑ 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 "'o ❑ NA ❑ NE
❑ Yes [/] No ❑ NA ❑ NE
❑ Yes [(No ❑ NA ❑ NE
❑ Yes FrNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
Io ❑ NA ❑ NE
io ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES,answers and/or any additional recommendations or,any other comments.
a.
Use drawings of facility to 1 better ex p ain situations
(use addial pages as necessary).;
(5,) l.ZihE IV6000✓
Reviewer/Inspector Name:
Rl
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 V21412015

Type of Visit: C3 Co Hance Inspection 0 Operation Review 0 Structure Evaluation C) Technical Assistance
Reason for Vh �routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
41=10 Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Latitude:
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure D 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)?
Certification Number:
Longitude:
y Cow
y Calf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
DYes Z]No DNA ONE
0 Yes
D No
NA-
NE
D Yes
D No
NA
NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) Yes D o NA NE
2. Is there evidence of a past discharge from any part of the operation? Yes
NA NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters Yes VNo NA D NE
of the State other than from a discharge?
Page I of 3 21412011 Confinued

f
Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E5 /NoE] NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 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?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Fe No ❑ NA ❑ NE
❑ Yes E2/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes /No
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [n/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 or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �Io ❑ 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
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L'J Npo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Q No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes57o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ YesZo
❑ NA
El NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
El Yes
N
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
./ N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6o
❑ NA
❑ NE
Page 2 of 3
2/4,2014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes Zo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ 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:
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
ffNo
/No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
LJ l�o ❑ NA ❑ NE
/❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional paces as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( illo
Date:
2141201

Il ype of visit: �q lu puance inspection U Uperatton Review U Structure evaluation U 7 echnlcal Assistance I
Reason for Visit: [}`Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: J0 ►J IgThA 0 Integrator:
Certified Operator:
Phone:
Certification Number: f (J,j
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C«urrent
Swine Capacity Pop.
Wean to Finish
Design C+urrent
Wet Poultry Capacity Pop. Cattle
Layer Dairy Cow
Design Current
C**opacity Pop.
Wean to Feeder
I
INon-Layer I Dairy Calf
EEJ
Dairy Heifer
MDesign Current D Cow
D , P,oultr. Ca aci P,o Non -Dairy
Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
—Layers_
Boars
Other
Other
I
Turkeys
Turkey Poults
10ther
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[] Yes 0
o ❑ NA ❑ NE
[:]Yeso ❑NA ❑NE
❑ Yes JTNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - 2
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: [ ACsQiILi
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Na ❑ 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
E!(No ❑ NA
0 NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment
threat, notify 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
U "O ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
0 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?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Eo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
M/No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
of o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VN�❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesrNo
❑ 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 V Rainfall Inspections ZZISludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
Z
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: - Date of inspection: p
24. Did•the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes [;j"No [DNA ❑ 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?
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 I VNo ❑ NA ❑ NE
❑ Yes E5/No ❑ NA ❑ NE
[—]Yes ONo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Xo ❑ NA ❑ NE
o ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: t�pl.jlj 'fl�{rJ�(,�� Phone:(_
Reviewer/Inspector Signature: Date: 0 3
Page 3 of 3 21412011

(Type of Visit: 0 7Routine
pliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up 0 Referral Q Emergency O Other O Denied Access
Date of Visit: Tom- Arrival Time: QW Departure Time: County: Ov - Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: _ 1-70NRT k� M-u t FEE_, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: _q1 9 1 33
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
INon-LMer I
Daig Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Al &0 r234y
Design
Dry P,oul_ C•_a aci_ P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
I
113eef Feeder
Boars
Pullets
I
I Beef Brood Cow
Other
Other
Turke s
Turke Pouets
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes Ej No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ o
❑ Yes Wo
❑ Yes WNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: iDt!3 I'L
I f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2 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 [DNA ❑ 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 P�Ko
❑ 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 Ca/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 2(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
Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EKNo
❑ NA
❑ NE
Required Records & Documents
��
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
'f no
L&N.
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other: 10,
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes r--I-<o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? —]Yes LErNo
25 ,Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes a<o
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA 0 NE
❑ Yes
[D No
❑ NA
❑ NE
❑ Yes
[]'No
❑ NA
❑ NE
❑ Yes
Q- Flo
❑ NA
❑ NE
❑ Yes D_1�0 ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[-]Yes I__i No ❑ NA ❑ NE
❑ Yes �io
❑ Yes
❑ Yes �W�o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or. any additional recommendations or,any other comments
Use drawings of facility to better explain situations (use additional pages4s necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: CqjaM—A O
Date: bl'--
214611

(Type of Visit: Q C pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: �E] Arrival Time:I I : -41) Departure Time: I 10 6 County: " Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: - QdNAUA14 (VIZA[—k2 T Integrator:
Certified Operator:
Phone:
Certification Number: 01 VSd 33
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
C►attle Capacity Pap.
Dairy Cow
Non -Layer
Dairy Calf
Feeder to Finish
Daia Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dr, P,oul_ti, Ca aci P.o
La ers
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field - ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

lFacHity 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
:4
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAGiZld
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 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 [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 environmZo
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes hio ❑ 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 El Yes I VNo ❑ NA ❑ NE
maintenance or improvement? 777
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
2 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 0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
RYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E(N o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
WNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes VNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of -Inspection: d U
24. Vid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
45. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �Zo ❑ 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?
24. 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
P40
❑ NA
❑ NE
[:]Yes
7/No
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require afollow-up visit by the same agency? ❑ Yes
Y
fo ❑ NA ❑ NE
o ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #)::Explain any YES answers, and/or any additional recommendations or, any other comments.
ilse`drawins of facilitv`to better -explain situations use additional naeesas.necessary}:
K,) FzewS N C-c-D LXM E
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
SIN r tq
Phone:
Date:
21412011

Division of Water
acin �'-Number �j W 3 O Drvtston of,Sotl and V4'ater Conservation
fl Q'OtherAgeucy
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /° 2 Arrival Time: Departure Time: County: _0LP%d54-­" Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
J
Onsite Representative: t4"j M Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = , = Longitude: = o [� g = S,
Desegn Current' Design , Current ` Design Current
�rSvsirie
Capacity PoPula#ion Wet Poultry Capacity PopulationCattle CapacttyPopulation
❑ Layer El Dairy Cow
❑Non -La er El Dairy Calf
°� r_s El Dairy Heifer
ElD Cow
"w ❑Non -Dairy
S ❑Beef Stocker
El Beef Feeder
�p< ❑ Beef Brood Co
� r
Other �k g -�
❑ Other Number ofStructures"�
... .... .. r:. =s rX.`.a:.. ="i:xk 6 ..ram ����fs',._3; :�`y:�a_,�r:•;. a-.
El
❑
Wean to Finish
El
Wean to Feeder
Feeder to Finish
El
Farrow to Wean
El
Farrow to Feeder
❑
Farrow to Finish
❑
Boars
Turkeys
Discharges &Stream lmpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure [I Application Field El Other
a. Was the conveyance roan -made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
[]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
❑ N
❑ Yes
�1 No
❑ NA
❑ NE
❑ Yes 7(No ❑ NA ❑ NE
12/28/04 Continued

Facility N. mber: Date of Inspection d Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZI No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IWNo
/J No El NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ 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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? [I Yes environmental
❑ NA ❑ NE
8. Do any of the stuctures 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 ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
t0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes WNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,_,o
I No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
WNo ❑ NA
❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
o ElNA
tNo
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
❑ NA
❑ NE
Comments,(refer to questio
n n #):,Explain any YES answers antllor any recommentlaiions or any other comments �' : F
Use drawin s.of,facili to better ex lain situattons� useaddtttonal a es as necessa , e-
g.. facility p ( P g,.)�
Reviewer/Inspector Name Phone-
Reviewer/Inspector Signature: Date:
1) ,.r 2 12/2R/04 nntinued
_o _ j

Facility lumber: 2i — ?, Date of Inspection
Rewired Records & Documents ,�(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes .�'J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes kf]No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes YJ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
IC1 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
L_.I N
[I NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I�lo
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
❑ Yes
E�
❑ NA
❑ NE
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit OCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C:J ftutine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: ovpa'� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: J u N/�V,J M
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = i = is Longitude: = ° = E 0
is
Design Cnrrent
Swine Capacity Population
Wet Poultry
Design
Capacity
C*urrent
Population Cattle
Design Current
Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
Layer
❑Dairy Calf
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Xt4 3 b
2AMry
Dry Poultry
Heifer
❑ Dry Cow
[INon-Dairy
El Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
Number of Structures:
❑ Turkeys
Other ❑ Turkey Pouets
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
4o
❑ 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
ElNA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Yes
El Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

It
Facility Number: — Z Date of Inspection
' [
'.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: CA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Pll�o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑Vo El NA [I NE
maintenance or improvement?
VV
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L'J No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
[3NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[,- o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ETINo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
Reviewer/Inspector Name ! (_�..I Phone: 710 IC —7.37K
Reviewer/Inspector Signature: Date: q
Page 2 of 3 V 12128104 Condnued

f -
Facility Number: 31 -3291 Date of Inspection c3
s
keguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�No ❑ NA Cl NE
the appropriate box. ❑ WUp ❑ checklists ❑ Desig
n El maps Cl Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
L� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ffNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L'I No
❑ NA
❑ NE
Other Issues
�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
f
30. At the time of the inspection did the facility pose an odor or air quality concern?
ElYes
O No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
"No
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,�
El
❑ 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
TJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
1228104

'3 ?A
(i
Type of Visit co Nance Inspection O Operation Review O Structure Evaluation O Technica=Assistance
Reason for Visit Routine 0 Complaint Follow up Referral Emergency Other ❑
Date of Visit: 6p Arrival Time: Od Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite RepresentativeIntegrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 6 = Longitude: = ° = t
Design Current
Design
Current
Design C*urrent
Swine C►apacity Population
Wet Poultry
C►apacity
Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feede
10 Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
El Heifer
❑ Farrow to Wean
Dry Poultry
ElD Cow
El
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑Non -La ers
❑ Beef Feeder
EGilts
Boars
❑ Pullets
❑ Beef Brood Co
El Turkeys
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ El NA
El NE
El Yes
❑ Yes
eNo ❑ NA
❑ NE
❑ Yes
U15140 ❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection 9 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [Xlo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes U(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 LI 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 environmentalth
[Ieat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen'Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[`NO ❑ NA
❑ NE
❑�l�io ❑ NA
❑ NE
/[No ❑ NA
❑ NE
[I NA
❑NE
No ❑ NA
❑ NE
iComm..ent r fer t eshon4#Ex fain an YESans� wens ndlor an recommendations or an 11101
Y Y other comments.
Use draw►ngs of faciliiyw#o better ezplarrt siteous:, use�addrhonallpages+as:,necessa ,
i asp. �,.A., �
P��r�s� Pip wt PrXIZ-sr dfPdonAstY .
r
Reviewer/Inspector Name r Phone: j rAP
Reviewer/Inspector Signature: Date: d
Page 2 of 3 12128104 Uontinued

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

Type of Visit Co(pliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: 04�Pl.al) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: '' Title:
rr
Onsite Representative: C�NC> KEP NLO�
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator: MAJ( -P )Ae
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = d = « Longitude: = o = ,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other - _-
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes iNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
❑ NE
❑ Yes
El Yes
o ❑ NA
❑ NE
❑ Yes
;rNo ❑ NA
❑ NE
12128104 Continued

[facility Number: 31— 3 7y Date of Inspection 1 D S
v
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
tdentifier: (JAGoop'j
Spillway?:
Designed Freeboard (in): 1 Cj
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[XNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ ntal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes
❑]No ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
L� No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
L✓1 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
!J No ❑ NA ❑ NE
maintenance/improvement?
�No
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t 0 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) C S W VQzm V 11 5 6-6
13. Soil type(s) R U j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:]
Yes
ElNA
❑ NE
17. Does the facility lack adequate acreage for land application?
El
❑ NA
FNo
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
1) �.r��-tom �+� bs. kE wYlLIl, coo 6 L&" !�5 .
Reviewer/Inspector Name [ � U :.: l% t � Phone: Lg10 3V--,7oo
Reviewer/Inspector Signature: Date: O "`
rcicwvr 't'undfrffNCu

Facility Number: —3z Date of Inspection =
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
UrYes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
l �J D o
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
LJi/ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
o
7NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
LI NA
❑ NE
Other Issues
9
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N
El NA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
Ld No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
El�
�f No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
El
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
dl�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[INA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
Z
El NA
❑ NE
Additional Comments and/or Drawings:
12128104

0 Division of Water Quality
Facility Number O Division of Soil and Water Conservation /
0 Other Agency ✓
Type of Visit eCornpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: // 0 Arrival Time: ® Departure Time: L—� County: b Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: U TZ
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: == 1 0 Longitude: = o= d 0 If
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish Z Z00C.)
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Laver
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood CowF
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 UlNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N ❑ NA
El NE
❑ Yes
[IYesZo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection o ! d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
II ,�Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 LA Identifier: &-,5uA/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a.
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes to ❑ 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? ❑ E Yes Kreo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ErNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
E] No
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El yes
1-3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Ek<o'
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
M'No
❑ NA
❑ NE
No
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E7
❑ 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):
0 E b N 64/ woe (Mat' 4w►cTjPmENr . ow, rF Z 4/ l Pig Pro-- � Z rtomr
�4C R-EA lsE tad Alvf /Y n ck
Reviewer/Inspector Name A Rat! k [ L Phone: 9 9 6-
Reviewer/Inspector Signature: Date: /o /
12128104 Continued

Facility Number: —3 Date of Inspection v 1 O
Required Records & Documents ,,__,,,``
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes LdNo ❑ NA ❑ NE
20. Does the facility fail to have a components of the CAWMP readily available? If yes, check [Yes ❑ No ❑ NA ❑ NE
the appropiate box. WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E 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
No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El[�� Yes
,,,
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes❑
NA
❑ NE
26.
Did the facilityfail to have an actively certified operator in charge?
Y P g
❑ Yes
VN
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
YJ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Cf No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E
❑ 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
,�/
L� 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 940 ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application) �/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? El Yes 7N,0
0 ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? El Yes ❑ NA ❑ NE
Additional Comments and/or Drawings:
12128104

U]"sion of Water Quality
'Facility -Number Q Division of. Soil and Water Conservation
- - Q Other Agency
Type of Visit l215ompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit oRoutine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: �S SL1, 4 t t,- _ ..,. Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 62 N b Integrator• _
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population.
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = c 0 & = Longitude: = o 0' = i!
Design Current
Wet Poultry. Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design .;: �Ctirret
Cattle Capacity Populati
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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 I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility_ ember: 3 f� Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
St7ture 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures 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 ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
❑ 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
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any, recommendations or.any other comments ,;44
Use drawings of facility to better explain situations. (use additional pages as necessary): ,
f 11VI' d6 3. U
el
gel
13e _ &v-e
Reviewer/Inspector`Name Phone:
Reviewer/Inspector Signature: Date:
vK Q
Page 2 of 3 1 128104 Continued

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 'Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: Tll D Time:
rO Z
Not Operational 0 Below Threshold
E-Permitted 1f-Certified © Conditionally Certified 0 Registered Date Last Operated orAbove Threshold:
Farm Name: County:
n,v..or Iv4...o• Ph... N_.
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No: /
Integrator: ✓�6/tt S/
T"
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 44 Longitude 0 4
Design Current Design Current Design Current
Swine
Ca aci P,o ulation Plou_Itry Ca acity Eo ulation Cattle Ca achy P,o ulation
❑ Wean to Feeder
❑ Layer 10 Dairy
❑ Non -Layer JQ Non-Dai
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
❑ Gilts
Total Design C►agaeity r—��
Total SSLW
❑ Boars
0 ❑ Subsurface Drains Present ❑ La oon Area_ ❑ Spray Field Area
11111=Number.151IL"agoons
Holding Ponds / Solid Traps ❑ No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other r }
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches):
05103101 Continued

Facility Number: 4 -- Z Date of Inspection I4 O
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, notifj° 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 anv stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings?
Was e AR12lication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified AnimaI Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
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/ Wi)P, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard; waste analysis & soil sample reports)
Yes
❑ No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21 _ Did the facility fail to have a actively cenified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DNVQ of emergency situations as required by General Permit?
(ie discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewerrinspector fail to discuss reviewlinspecrion with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were,noted during this visit. You wiU receive no further correspondence aboui this visit.
Gom�enis°(refer to gieestionEzplata.airy YES'sttsweiis nd/or airy Comm nifates or�srrvoth omments -Y
Use drawings of facillity to better ezplain sitna#toris.,(nse addtttoaal pages as necessary) , u
�,. 7 ❑ Field Copv ❑ Final Notes s ,� •,
F v,
�G �
! �7'GG ��ie�/�/rI u i'it 4 dolo t J f�r A';1'" 5k 4 Glvp� 41 Zj�r60 N Z✓011 Al��-
zoo3
v unt, w1W „70-,Cn y lwwwo-�I"^,d 1 ,-e�s � scow way .
X L;V d A 1146Ws 'h JG O�&— Aa,01 � e'i�, L1061h h C1l5 7--0 !tee—�Q,a�r�1sC
D ow" u4e4 kilt 4mwr elf 'v.
Revtewer/InspectorName
Reviewer/Inspector Signature: Date: / i!b D
05103101 Continued

Facility Number: ?j Date of Inspection
r
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
3/23/99

I
L
i
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (% Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: 3 0 Time:
LFacility Number z
rO Not O erational 9 Below Threshold
® Permitted IffCe/rtified E3 Conditionally Certified O Registered Date Last Operated or Above 'Threshold:
Farm Name:. GtiviI j rift, County: 40
Owner Name: Phone No:
Mailing Address:
Facility Contact:
Onsite Representative: 45 i 10 /C Po�/J!/
Title:
/Plhoone No:
Integrator: _ C .�//J►�i
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 Du Longitude a �I
Des an .CurrentCurrent"Design
Current
S'Poultry acy•PolatoCattle :Ca achy Po ilafion �--capacity Po ufatiun
❑ Dai
,r El Wean ❑ Laver r Dairy
Y . ❑ Non -Laver p_ ❑ Non -Dairy
❑OtherY,
Ts�t —,�', 'r•—=s r:' Y.;.�,
c Y.
�la: a. Tv ,�,�, _y
' ;_�_ Total Design Capacity ..
•
Total
r 5 Number of Lagtwns+ , ❑ Subsurface Drains Present ❑ La oon Area
❑ Sp ray Field Area
Holding nds`ISoltd Ttags y ❑ No Liquid Waste Management System
t4
to Feeder
Feeder to Finish
Z
[] Farrow to Wean
❑Farrow to Feeder
❑Farrow to Finish
❑Gilts
❑Boars
_
Disci &Stream Impacts _
1. Is.any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ 5nrav 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 flaw in galimin?
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 8 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Freeboard (inches): S711
05103101 Continued
❑ Yes 5� No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes
❑ No
❑ Yes J"S No
❑ Yes ®No
❑ Yes Z No
Structure 6

Facility Number: 3 — 3Z Date of Inspection 2 6Z
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 ngt.properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes CENo
❑ Yes 19No
J&Yes ❑ No
❑ Yes V�LNo
❑ Yes ERNo
Waste Aonlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes n No
IL Is there evidence of over aap�pliccation? ❑ Excessive Ponding El PAN ❑ hydraulic Overload El Yes � No
12. Crop type �'n,C �, l-f ,YIc�l
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes E� No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 91 No
b) Does the facility need a wettable acre determination? -❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes O.No
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Z No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
® No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
54 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
®No
22.' Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
®No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
;@ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
EgNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
LgNo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
es6��mc�dsfio�smr=YAD'
- ❑Field Copy ❑Final Notes
7 — %tcs a/�v5 n<<.� yc� �G oaf 07 c J¢r'el o�/�fvarr rv�1�
t—irC� We e O G( �O�f�i��ror•� lOdr�r crD�O of eel le- 14/a<�
Zi'
Reviewer/Inspector Name d,
Reviewer/Inspector Signature: Date:
05103101
u
Continued

>racility Dumber: 3l — Date of Inspection S Oz
dor hmgE
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to dischargq atlor below
liquid level of lagoon or storage pond with no agitation?
r 27_ Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure. and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes MNo
❑ Yes [ No
❑ Yes No
❑ Yes [RNo
❑ Yes [RNo
❑ Yes ONo
❑ Yes ® No

Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit j(Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Bate of Visil:~� �"U Time:
Facility Number a
Q Not Operational 0 Below Threshold
*ermitted [3 Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
FarmName: ... S ..iS.!.`1................................... .......................... County: ...1i....................................................
OwnerName: ....... .......................................... .................................... . .............. ................... Phone No:......................................................................................
FacilityContact: ............................................................................... Title: ................................................................ Phone No:...................................................
MailingAddress: ............... . ....... . ..................................................
Onsite Representative-. .. ?..`�h►-.2d1c.................................. I............ Integrator: _ � U._........_.._.........._. .............
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:.............. ............................
Location of Farm:
cl �iU �..u-A-E---, <� sib
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 64 Longitude • ' 44
Di'sigo.;' ;Current:`` : Design;. ` . Cuirrent =Design=`C>i�rent;
Swine Capacity Po tilalaon Poeiltry Ca iiici ' .;Po` ulation Cattle Ca aci Po Mahon
Wean to Feeder 7 ❑ Layer ❑ Dairy
Feeder to Finish aZ4 90 , ❑ Non -Layer 10 Non -Dairy
„ ❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish ToW Design Capacity_
❑ Gilts
❑ Boars Total SSLW
Subsurface Drains Present Lagoon Area ❑ Spray Field Area
-
Number of Lkgoons P
Holdidg Pond§ /Solid Traps; ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. 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 PjrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure S Structure b
Identifier: ............................................................................................................................................... ........................................................................
Freeboard (inches):
5/00 Continued on back

` F'acillty Number: 3 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
G.,G
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?
0:.10 yiQiainjs:e defic�encis vtre noted ding t�is:vis�ti Yoh wig ree�iye too #'u4-th�r
correspondence. abotii this visit: ................................... .
#) Explain:aay YES ansvvei:^s and/or atty-:recoinmendatioas or
❑ Yes Id No
❑ Yes VNo
Yes ❑ No
❑ Yes (ZNo
❑ Yes KNo
❑ Yes [�(No
❑ Yes 0 No
OYes
MNoQr--
❑ Yes
gNo
❑ Yes
❑ No
❑ Yes
❑ No
OYes
❑ No
❑ Yes
QWo
❑ Yes eNo
❑ Yes ❑ No
A"Yes ❑ No
❑ Yes ,4No
❑ Yes WNo
❑ Yes &No
❑ Yes ,"No
❑ Yes t9rNo
❑ Yes PtNo
Li t `ff-e 5AW-1.e_A et 13Z_ ��.,��� 04U.A ge
�-��e��
"'
kL 2&
rid
Reviewer/Inspector Name
4h.. Uh
Reviewer/Inspector Signature: Date: —� (_ _y __ 5100

Facility Number: — a Date of Inspection — --G(
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below kYes ❑ 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 ,JP'NO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? []Yes [*No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ['No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
Addifion;dComments andor ravings:
A.
'Z' l t-^1- Y t.-4
.
tL-" 63�> L
G`
5/00

Division of Soil andWater Conservation ';Operation Review
t
13 Division of Soil and Water Conservation Compliance Inspection
ivis�an-of Water Quality :Compliance Inspection
-.0 Other Agency Operation Review7.
f
_ t
rt
�VLRoutine 0 Complaint 0 Follow-up of DWQ inseection 0 Follow-up of DSWC review 0 Other
Facility Number �� Date of Inspection /8=
Time of Inspection 24 hr. (hh:mm)
ermitted Ce Tied [] Condition v Certified [3 Registered Not O erational Dj L�s. Last Operated:
aGL _
Farm Name: ........_....__.. ........ "... ...� .................
/...5.......................:.. ... %nCounty:.......................
Owner Name: .....
Phone No: ...
FacilityContact:........................................................... Title:......................
... Phone No: ...................................................
MailingAddress: .....................
Onsite Representative :.....
...............
... ..��., -I& .......1.........
......../.....................................
................................._..........
...... Integrator : ..............�l� f��..-....................................
Certified Operator:..........................................................:.....................................................
Operator Certification Number:.................-......-.-...............
Location of Farm:
Latitude Longitude
Design Current ' Design'v Current.— _.. Design. Current
;,
,Poult ----:"Cattle Capacity Population rY � Caacity Population - Capacity Po ulation
❑ Wean to Feeder = ❑ Layer - ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
ElFarrow to Wean
❑ Farrow to Feeder A: ❑ Other -
❑ Farrow to Finish TtitaT Design Capacity
❑ Gilts _
❑ Boars Tota1;SS M
Number of Lagoons,.. ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Feld Area
Holdijj.!onds / Solid Traps ❑ No Liquid Waste Management System _
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a- if discharge is observed, was the'conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure J
Identifier: I
Freeboard(inches): ......---- •----••........................... 11....................... ........... ... ................. .... ......... ........_................. ... 1—.,...................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
❑ Yes I�No
❑ Yes ❑ No
❑ Yes ❑ No
_41.4
❑ Yes ❑ No
❑ Yes ONO
❑ Yes )<No
❑ Yes 'All
No
Structure 6 \
Ayes ❑ No
Continued on back
3123/99

s
Facility Number: ?j —. Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or.
closure plan?
❑ Yes
KNo
(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?
KYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
�No
Waste Application
10. Are there any buffers that need maintenance/improvement?
El -yes
XNo
11. Is there evidencef over application? ❑ Excessive Ponding ❑ PAN
❑ Yes`•/<No
12. Croptype UA (3/P
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
R No
b) Does the facility need a wettable acre determination?
❑ Yes
ONO
c) This facility is pended for a wettable acre determination?
❑ Yes
RNo
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
VNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
QNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(le/ WUP, checklists, design, maps, etc.)
❑ Yes
RN
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ANo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
� No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24.' Does facility require a follow-up visit by same agency?
❑ Yes
WNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Wo
v; N,O- . iolatioris:or deficiencies •mere no, ed•:luring tl�is:visit: You witl r eceiye Rio fuirther ; ::�
correspondence: about this visit.... . • . . • ::::.: :. . :
Comments- refer to, uesbon # Ex lai ( q ). p in YES answers and/or aiiy recommend'atio Wo%any other co_mments.-
Use drawings of facility to better explain situatidirs {use addiitionalpages as necessary}
Ada"�' �'Y �-✓ 1/l avn- •
r
�•• 1j1%O�� � `�� �� � ®ii�C� /t—sf••[L�dL� �" �ar�v� ��� / 7Y`{-tJ
e�f� baf a,/c� . `vim✓ . I r c�-
Kv"w
Reviewer/Inspector Name17.
Reviewer/Inspector Signatu A o„) Date: S g lj(J
3123/99

Facility Numbes:� (, T �7y Date of Inspection y /�
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
liquid level of lagoon or storage pond with no agitation?
f�-
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
AVo
roads, building structure, and/or public property)
✓
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ YesNo
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
I'No
31.
Do the animals feed storage bins fail to have appropriate cover?
Cl Yes
?No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
[Yes
❑ No
itiona omments an or rawin - _ _
: _
3/23/99

r&"UL- CAL/ Cl
Lsitfal Evaluation ' O Follow-up Evaluation E3 Denied Access © Does Facility Require a Follow-up
Facility Number Date of Evaluation -/7�
Time of Evaluation G 24 hr. (hh:mm)
E3 Permitted © Certified ❑ Registered ❑ Nan -Registered ❑ Inactive Facility Date Last Operated:
._._._-t'ytJi ... _ ..._ �G. _____ County:
Farm Name:
Owner Name:...»...._..__--._ww_ _ __._.. _ _ ...._..._.._.. „ .». Phone No:
Facility Contact:__._ . ,_.____.»..._—_—__--Title:. .__.»......»....».... ___ Phone No:
Onsite Representative:._—_»._.»__-_� Integrator: I42
Location of Farm:
R�charzes & Strewn im
I. Is any discharge observed from any lagoon? ❑ Yes ❑ No
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Neater of the Slate? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in galftnin?
2. Is there evidence of past discharge from any lagoon? (] Yes ONO
Waste Collection & Treatment '
3. Estimate Freeboard Level: ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure ti
Identifier:
Freeboard(inches): ._ .__.»_ »_. . ___. �__. _.. _ _ _ ___ . _ . _ ».. _ _ . - --_—_• »» ...._. �» _ » _
�...� '---- y�ec,.. ����=.ram- r�..•-r��rr-:"-�:r�,x. �. �,:=^y:.7•.;t:`.�za,L:..,-.y-.'_-cw�eaa�:�w--�:•�...--��..
Retiien erflnspector Name MFs
Reviewerfiaspector Signature: Date:
ILEF
1/12/00 1

15. Application Equipment and/or Sprayfield Not Available
I6. Contact could not be made with on -site representative
uww null L.LZAuv;Rat bX PAGE 84/08
," Inactive Lagoon Field Data Sheet
Facility Number. ED - Inactive Lagoon Number:
Latitude F__J . 0 ' F_'j p Longitude ' a " GPS ❑ Map
4. Waste Last Added (mm/yy) ❑ Owner ❑Estimated
5. Estimate of lagoon surface area (acres)
6. Effective height of embankment (feet)
7. Distance to Blue Line or Intermittent Stream (feet) ❑ < 250 ❑ 250 - 1000 ❑ > 1000
❑ Determined From Field Measurement ❑ Map
S. Down Gradient Well
a. Is there a down gradient well located within 250 feet? ❑ Yes &No
b. Is an intervening stream not located between any part of the lagoon and the nearest well? Yes ❑ i`10
9• Distance to WS waters or HQW (mi.) < 5 ❑ 5 - 10 ❑ > 10
10. Does the representative know of overtopping from outside waters? ❑ Yes §LNo ❑ Unknown
11. Appearance of Lagoon Liquid
r
a. Sludge Near Surface �FB a�
b. Lagoon Liquid Dark, Discolored
c_ Lagoon Liquid Clear
12. Embankment Condition
a_ Poorly Built, Large Trees, Erosion, Burrows, Slumping, Seepage, Tile Drains, etc.
b_ Construction Specification Unknown But Daze Appears in Good Condition
c. Constructed and Maintained to Current NRCS Standards
13. Outside Drainage Area
a. Poorly Maintained Diversions or Large Drainage Area not Addressed in Design
b. Has Drainage Area Whicb is Addressed in Lagoon Design
c. No Drainage Area or Diversions Well Maintained
14. Liner Status
'■
■
11
a. High Potential for Leaking, No Liner, Sxidy Soil, Rock Outcrops Present, etc. -- — ❑
b. No Liner, Soil Appears to Have Low Permeability ❑
c. Meets NRCS Liner Requirements G, A 4 r 3 (yYN- �2L
❑ Yes MiNo ❑ Unknown
❑ Yes Ko
tLFDS
1/12voa 1

ali1812eee 12:55 919-715-6048 DWO NW DISCHARGE BR
Site Sketch Showing All Active and Inactive Lagoons
PACE 03/08
4j ;� Op el
110
ILEF
1/12100 2

Groundwater Rating
The following questions will be incorporated into the current inspection form or answered at the
central office.
Rating Questions for Groundwater
YE
N
UNKNOW
S
VO
N
1
Has the lagoon/sprayfield been in use for 5 years or more?
V,/
2
Is there a water supply well within 250' of the potential
pollution source (lagoon or sprayfield) with no intervening
groundwater discharge?
3
Is the predominant soil drainage classification well drained
to excessively drained?
4
Are rock outcrops present?
5
Are either of the following true?
• The lagoon was constructed before I993 MRCS**
✓
J
standards
• There is no verification of adherence to the 1993
MRCS standards
b
Have groundwater standards been exceeded at this site
based on existing monitoring records?
7
Was groundwater encountered during construction of any
laizoon?
Depth to Groundwater {feet below land surface}
...
*Generally unknown, but if this data is available is should be recorded.
**Natural Resources Conservation Service
i
Responses to the questions will be entered into a computerized version of the scoring table on the
following page to detern- ne the rating
el
1

' Water Quality Active Lagoon Ranking
Draft
Central Office Criteria
1. Was facility constructed before 1993 NRCS Standards or there is no verification of standard?
2. Plant Available Nitrogen (PAN) Deficit < 500 '1' per year or F 1, F3 or F4 Wettable Acre Determination
Flags
F1 Lack of Acreage resulted in over application in last two years
F3 Obvious field limitations ditches, buffers irregular shape S
F4 Application acreage in excess of 75% of total acreage
s�3. Lagoon Capacity greater than 1,000,000 cubic feet N O
4. Was there a discharge from waste system in last five years? �0
Central Office Criteria available after new verified GIS data is gathered from field GPS Units
5. Distance from Lagoon to Water of the State (WOS) > 300'? pl-
6. Is lagoon in 100 year flood plain? A46 /y
Field Inspector Criteria
7. Modify Question f4 from current inspection_ add choice box: Is high freeboard due to storm water or
management? Ff� ( f 1 I h
S. Modif}• Question m 3 from `current inspection form (take immediate out) and define inform instructions_
Current question: Are there immediate threats to the integrity of any of the structures observed? (trees,
erosion)
r
9. Add question on effective embanlanent Height > 10' j4d G iv
2/3100

C1 Division of Soil and Water, Conservation-'Operation:Review a
©Division of Soil and Water Conservaaan =:Compliance Inspection �.Y , ' -' '
y
Div-' ion of Water fQualtty`=:Compliance his:
a
r .D Other Agency Operahot Rev�ew`z L , i q _ _
K Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other_. I
Facility Number 3 3 Z Date of Inspection
Time of Inspection 24 hr. (hh:mm)
[Permitted © Certified Q Conditionally Certified [3 Registered Not Op erational Date Last Operated:
Farm Name: , ..�.�- (�.I..q..)I . ..............Q..................................... Count .5S._ 531
Owner Name:......Phone No:........a_
U
Facilitv Contact: ....................................1.......................................... Title:................. .......... Phone No:
Mailing Address: J-D h �. 1�1 r S r 1 nd �� J T Y2 AI G 2 S ra
33/..........................n........e.......a...........ia....�1 ...................... ...•..Q..............t...................j..)...........3.....-S
Onsite Representative: ...5.►'►.0.......��e.!?.�'}P�` .... .. Integrator:.....r'1.Y'�..{.[.r...QO.GS+1G
...... ..
Certified Operator:, .e js SEMI- .............................................................. Operator Certification Number:..........................................
Location of Farm:
..F'a.r, .....15:...4''1....fh ....r.. Ls- ..s.i.r�1 .....Q£..SR.....kS.4>"i.....i .`. i.l .ctr-►...........514 ISOU....................................
.......................................... ................................ ................... .......................................................... ............... ................................. I..................................
Latitude ' ° Longitude • 4 4'
Swine
Design Current Design Current = Design Current_
Capacity Population' Poultry CapacityPopulation .-. Cattle Capacity Population 7r
El Wean to Feeder
Feeder to Finish
24f
2 Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�Xumber of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
.Holdin&onds / Solid Traps U - ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at:. ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ,®`No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes $9 No
c. If discharge is observed, what is the estimated flow in gal/min? -JA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes NNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes §3�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes SNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (inches): ......... 7.1 .............................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,KNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31 — 3 Data 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/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type be.-
VNIM--.
e A4V1t1W /Srybq.,r
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?
I& 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?
violations or &fictendees -mere noted• during
. .. ' visit'- ok Wll•redi6 RouYthr
........ i.. ....
correso6fdence. bputhisysit.- • • • -
❑ Yes XNo
j4Yes ❑ No
[]Yes 'j No
❑ Yes )Z No
❑ Yes XNo
❑ Yes 12rNo
❑ Yes XNo
❑ Yes a No
❑ Yes SNo
E[Yes ❑ No
❑ Yes NNo
[]Yes )KNo
❑ Yes 0 No
❑ Yes $UNo
Iff Yes ❑ No
❑ Yes El No
❑ Yes X1 No
❑ Yes 10 No
❑ Yes ANo
❑ Yes 9No
❑ Yes '( No
Comments (refer to question #j.',Explain any YES: answers and/or`'any, recommend at�ons.or any other comments:
Use;drawiogs of facility to`better expla�n.situations (use add►tionak pages4a necessary)
r7. ^Lo, aak% ol,"kef,odl ThokIat � mowed,, ron+;,we ef�'a•fs 4v es4otb1 9Iq
pry of �ras� t�eyGfa-�-ivn �� d,k�waf Jt.
lac, r;4 kas &eetj ended Jor, r.,,4,nWe goer de4-erm;nA4;v
�q. LAjooji core-eboelpA records should be- ker-k Week[ , Correc+ FAN
Sh:OLA1d, be la�je_A an EKg_- 2 a>r� , y
Reviewer/Inspector Name .>4 G �:, �' R ._ l s` x a a=�
-1
�.
Reviewer/Inspector Signature: J,, m Date: �—
3/23199

Facility Number: — 2 Date of I nspection
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 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ,4 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 j No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
dtttonal : omments an or rawings
'&I
3123/99

I
�� .Divisio Sit and Water Conservation�Other Agency ` -�
E1P Routine O Complaint Q Follow-up of DWO inspection O Follow-up of I?SWC review O Other
FFacility Number
Date of Inspection 6 zo -
3Z
Time of Inspection a 24 hr. (lth:mm)
E3 Registered (, Certified © Applied for Permit [3 Permitted JE3Not22erationaLJ Date Last Operated:
Farm Name:
........... ��....1�:...5.g.^,t........................................ ............. County: .......... Duf ^..............................................
Owner Name: ........ . ............. l.?i$.v'........c!.................................................. Phone No:`;.I.f}..`�� .........................................
Facility Contact: .............................................................................. Title:.................. ........ Phone No:
Mailing Address:........ t+a...S}a7nn.... ► ...fix y........
a ........................ ......I`! ix ..... qli yL....(w.c ...... L$:sk.K.........
CC
+ `f I
Onsite Representative: ...........1.C........tx . . ..... Integrator: ........... Ct ar.".i..5.....................................................
Certified Operator; ...............................
Location of Farm:
Operator Certification Number;.
..................... ....... I.Ar... .............................._........
............... aS id.L..41....... .............................................................................................................................................................................................................
......
Latitude • ' " Longitude • ' "
Design .Current Design. Current Design Current
Capacity Population Poultry 'Capacity Population Cattle - . Capacity Poriulahon
❑ Wean to Feeder
Feeder to Finish
Z9�
r`!"
❑ Farrow to Wean
M
❑ Farrow to Feeder
°:
[] Farrow to Finish
m
❑ Gilts
:'
❑ Boars
M
Subsurface Drains Present III Lagoon Area pp Spray Field Area
No Liquid Waste
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
( No
2. Is any discharge observed from any part of the operation?
❑ Yes
(] No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
( No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
[ No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
fj No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
i,� No
7/25/97 '

a.
Facility Number: 3 — 3
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 0 No
Structures (LagoonsMolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):............ .i~,A................ .................................... ..... .............................. .................................... .................................... .....................................
10. is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes $1 No
12. Do any of the structures need maintenance/improvement? EP Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes [A No
Waste Application
14. Is there physical evidence of over application? ❑ Yes 18 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...........CA.........C.Rrr........W ,►.[.......... &) ............6r.rn as=................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 10 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
( No
18.
Does the receiving crop need improvement?
❑ Yes
K) No
19.
Is there a lack of available waste application equipment?
❑ Yes
V No
20.
Does facility require a follow-up visit by same agency?
[� Yes
[3 No'
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
C lNo
22.
Does record keeping need improvement?
❑ Yes
O No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
Yes
❑ No
0 No.vialatioils•or. de:rcieincies-werenoted-during this. visit.- Yo_ u.will• recei�e4it6, irtliei- :.
: eprre pondence ii ouf Phis:visit.•:
i is (efer to gttest�t att #} ,<Explatn any YES answers a1416r ariy rerommendaaons or arty other co _ enIRS
'�
�
�� faCt�tt•�'��€3�I�etter explaut sttuatloas (use additional pages as necessary) �� : � '��"'��
�Userasvt�gs
v�.
+z. Korn arei:5 sl.cu�J la¢ yxvel�• J:1_ 00-tl away �lnovf� jam ^'asiez.
1�v iof
1
W �t LIe�W O�^��`�1s Oti S 4S b Y�OUSeS. Q1u DxC►al�� ea.�CM— CAI &5s or, �YDuno. cf"VmSies
O cnr Zit ways. NIL v e W , [ l
7/25/97
•
Reviewer/Inspector Name
Reviewer/Inspector Signature: - Date: 6

Af.�'
TE3 Division of SoilandWater Conservation ❑ Other Agency
x a ivision of Water Quality
GLItoutine 0 Complaint 0 Follow-up of DWO inspection O Follow-up of DSWC review 0 Other
Date of Inspection 11
Facility Number .�Z
Time of Inspection Ey : 24 hr. (hh:mm)
© Registered Iff Certified © Applied for Permit 0 Permitted 10 Not O erational Date Last Operated: ..........................
Farm Name:...-v,.r County: p ....... .
Owner Name:....... er,,,, 34......G................ .,_................... ..................... Phone No.- 1_c ; q.J.....6. ......S .Q. ........................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
r p
it..................�rxnl..l .l.......(.. .. .. .............. Mailing Address:....�.2✓..�.......... -} �- �-ri.' �.�..:......Q.�.�..r..e... �..� 3.�.�..
Onsite Representative:...,(.,4 ,c,f..'. �....... wn-►. �t1............................................ Integrator:........ .. L...........................................
Certified Operators.-L�P�i�f�,C. ...... ..... c .7 A.�............................................... Operator Certification Number:..1. j .. .7.7..............
Location of Farm.
Q,r�....t?.�xt,c.#...s;. e.......SKJ., .n..�.,....s ..� ...,.. o. I ....... .�.......!h.b..y..I`►....c.......
f.M.. .-..
_ . - - .v,....Kr.. ......S.R.. . D.t...................................................................................................................................................................
Latitude ©' �1©" Longitude ©• ®4 "
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If dischar-e is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than laQoonslholding ponds) require
4 maintenance/improvement?
5. 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
K No
❑ Yes
9No
❑ Yes
® No
❑ Yes
UjNo
❑ Yes
Jallo
❑ Yes
S.NO
❑ Yes
tgNo
❑ Yes
CgNo
❑ Yes
WNo
❑ Yes
KNo
Continued
on back

c. r
f Facility Number: %1
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Noldine Ponds, FIush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure
Identifier:
Freeboard(tt):........................................................................
10. Is seepage observed from any of the structures?
Structure 3 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 entering waters of the State, notify DWQ)
❑ Yes KNo
❑ Yes VNo
Structure 5 Structure 6
...........................................................................
15. Crop type ....C,.A............... ^?........... S."11a.atio—...........
1�......�a f L xL
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18: Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Pernytted Facilities Out
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violationsor defteiencies.were noted during this:visit.- Yoi .'W'iU i&ei ivemi o' -ftirther-:
0&6pbtldence 2 o6t this'. visit.,'-,..,
❑ Yes +LNo
❑ Yes IE�No
Pff Yes ❑ No
❑ Yes gNo
❑ Yes RNo
......I ..........................
❑ Yes
R No
❑ Yes
DiNo
❑ Yes
($No
❑ Yes
N No
❑ Yes
19 No
❑ Yes
i$No
® Yes
❑ No
❑ Yes [&No
)8 Yes ❑ No
❑ Yes 0 No
1 Z . O a.r¢ o ka S "'�--�N ► Ya eI M 2 S �-li J- �1 t. a-q " k vJ a. t I • 1 O C rL r�i t c. *-v -0-t� -k
•�-o cc ,., . e i n x a a av v...k.L �rj v e e d. o P t�J tL S 6 -.;� .
O v� c.e 4 R R `(t 3 but r+.. d-e. v.-o v�2 c o rd
l 44 ,ti ttv
C:Q .v t-t +' �-,^ • '�+ rt 4. ten- �- he_ P 0 ...4 S t^ e V t•oLO z t-1--¢.
T-:; ,tea L 1 {_ ,,. t �r d o-k i ce ,-t G 10 j L CO L eN S ko V �- _ P V v..�-p c� 0 ul +� C,
OL+.r� S C a ,.. a Q o S S 1 7125/97
?k � nl r Q A h A C , r U t % L 1 lo.e-- . C,2­+ �..r � r, : i i l-4 JVV k-4.i2.r� S ) I-. v-Q.. ca VZ4 �
me
Reviewer/Inspector Signature:
Date:

V,
Site Requires Immediate Attention: AO 0
Facility No. I -- 3 a
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
-Time: I ya
Farm Name/Owner: LCu f s
Mailing Address:
County:
Integrator: - CCL4L"Il — Phone:
On Site Representative: Phone:
Physical Address/Location: O h - lti T-0 0 -- cyv-.
Type of Operation: Swine Poultry Cattle
Design Capacity: C5O Number of Animals on Site-
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 5 '35. "J Longitude: S`r 'El 34 Elevation: Feet"',.
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot f 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: 3 Ft_ Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No
Crop(s) being utilized: K_ u�� C74
Is the cover crop adequate? _Yes or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or.No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by roan -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 or No
Additional Comments:
Inspector Name
Signa e
cc: Facility Assessment Unit Use Attachments if Needed.