310334_INSPECTIONS_20171231

2 V
NUH I H UAHULINA
Department of Environmental Qual

rype of Visit: Z17ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (;Koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: . 2fiiol Arrival Time: 1 1 19 q I' I Departure Time: County:
Farm Name: 1�a t)', V-,_�' a2n' Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: jo n_"' Ud_— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region: �)' t�D
Swi-
me
Wean to Finish
Layer
it
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Dairy Heifer
to Finish
_2Leeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
_gn
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
Mpi-f Brood Cow
I
her I
I 10ther I
Turke s
Turkey Poults
10ther
I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure Application Field El Other:
a. Was the conveyance man-made?
E] Yes NA F] NE
E] Yes 0 No Ej NA C3 NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
Yes
0 No
Ej NA
[3 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)
E] Yes
E] No
[] NA
0 NE
2. Is there evidence of a past discharge from any part of the operation?
[—] Yes
95��
NA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
[:]No
[—] NA
NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

dQ 4
[Facility Number: Si - 11) 1 Date of Inspection:
Waste Collection & Treatment
4. IFt storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes E3 �No[_] NA NE
a. If yes, is waste level into the structural freeboard? 0 Yes E] No 0 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? 0 Yes N 0 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 0 Yes No E3NA C:] 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 DMrR
7. Do any of the structures need maintenance or improvement? Yes ffN0 NA ONE
8. Do any of the structures lack adequate markers as required by the permit? Yes El"No NA ONE
(not applicable to roofed pits, dry stacks, and/or wet stacks) '4"'
9. Does any part of the waste management system other than the waste structures require [:]Yes &No NA [:] NE
maintenance or improvement?
Waste Awlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes 0/��o
0 NA
NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
0 Yes C7/No
0 NA
NE
71 Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground E] Heavy Metals (Cu, Zn, etc.)
0 PAN M PAN > 10% or 10 lbs. E] Total Phosphorus 0 Failure to incorporate Manure/Sludge into
Bare Soil
F] Outside of Acceptable Crop Window 0 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
N A
NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes rN
N
�9
0 NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
0 Yes VNo
0 NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 yes ff��
0 NA
0 NE
18. Is there a lack of properly operating waste application equipment?
Yes rN o
[:] NA
[:] NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
ONo
0 NA
6
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
0 NA
[:] NE
the appropriate box
OWUP OChecklists ODesign E] Maps [] Lease Agreements OOther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes d No [-] NA 0 NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers E] Weather Code
F-1 Rainfall OStocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and I " Rainfall Inspections O.Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? Yes 0 0 NA E) NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes gNo NA
0 NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection
24. Did tKe facility fail to calibrate waste application equipment as required by the permit? E] Yes ErN-o EINA [—] NE
25. s the facility out of compliance with permit conditions related to sludge? If yes, check Ery'es 1:1 No NA 0 NE
the appropriate box(es) below.
�0 Fail complete annual sludge survey Failure to develop a POA for sludge levels
�on-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? E] Yes [:] No Fj`NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes 6No NA NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern? Yes C rNo NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
E] Yes
ZNO
NA
NE
permit? (i.e., discharge, freeboard problems, over -application)
�No
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
NA
NE
[:1 Application Field [] Lagoon/Storage Pond E] Other:
IN;
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
ff
�N
0 NA
Ej NE
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
[D Yes
E� IN g,_
� rNo
[] NA
E:] NA
NE
NE
G-.4, t ( p 4� X.
a) ( 5 4 c(f c f aff 71S
V 1�t_ � A/c—'J 5 C c, P r 0 � _S t CA �'7 e- N PF
F 6 NO �- 19144 (zz cc/,, _�� /,/%-% I -�_ , , )
r I't 5. ��7
57 (C, e(51 C_ C4_ X-_ - _5- j e-- -��F
.9 5
P COP E/— Id
5 � ,.e— I-,, 4,J,,,A
<-- 9 7 � 3 5__�)
Reviewer/Irispector Name: Phone: TO
Reviewer/Inspector Signature Date: 4)(2
Page 3 of 3 21412015

Type of Visit: Q ZRoutine
pliance Inspection Q Operation Review p Structure Evaluation O Technical Assistance
sit:
Reason for ViO Complaint O Follow-up O Referral O Emergency O Other O 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: 4,ImArk)qAl
�(R,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 16513
Certification Number:
Longitude:
Design Current
Design
C_*urgent
III
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Popp"
Gaftle
Capacity
Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to FinishZ..
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D_, Ploultr
C•_a aci.
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
11
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

4 0.; 1
IFficili!j Number: —41 - '5 :Z�j _j Fp�tie of Inspection:
It :I 'I'l to
Wpste Collection & Treatment
4 'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
C�'No D NA D NE
a. If yes, is waste level into the structural freeboard? 0 Yes D No D NA D NE
Structure I Structu 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?
(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?
No D NA D NE
[—]Yes V
[:] Yes WNo 0 NA [:] NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWR
7. Do any of the structures need maintenance or improvement? D Yes ;No' [:] NA NF
8. Do any of the structures lack adequate markers as required by the permit? Yes ; 'No D NA NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require Yes [2/No DNA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need D Yes 2r 'No [:] NA NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes � /No D NA ONE
M Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground Ej Heavy Metals (Cu, Zn, etc.)
D PAN M PAN > 10% or 10 lbs. Total Phosphorus M Failure to Incorporate Manure/Sludge into Bare Soil
M Outside of Acceptable Crop Window Ej 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
eN NA
ONE
15. Does the receiving crop and/or land application site need improvement?
D Yes
p NA
N
VN
D NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
� Zo NA
Ej NE
acres determination?
17. Does the facility lack adequate acreage for land application?
E] Yes
DIN/V NA
NE
18. Is there a lack of properiy operating waste application equipment?
Yes
5Zo NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate ofCoverage & Permit readily available?
0 Yes
o
P� 0 NA
D NE
20. Does the facility fail to have all components ofthe CAWMP readily available? Ifyes, check
Yes
bAlo D NA
N E
the appropriate box.
OWUP E]Checklists D Design 0 Maps 0 Lease Agreements
D Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
D Yes
[�Ko D NA
NE
F-1 Waste Application El Weekly Freeboard El Waste Analysis D Soil Analysis
0 Waste Transfers 0 Weather Code
F1 Rainfall [:] StockingO Crop Yield Ej 120 Minute Inspections [:]Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:] Yes
WNo / D NA
D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
0 [:] NA
D NE
Page 2 of 3
21412015 Continued

Ocility Number: jDate of Inspection:
24.1 Did the facility fail to calibrate waste application equipment as required by the permit? Yes
1
25 . Is the facility out of compliance with permit conditions related to sludge? If yes, check 6ZYes
the appropriate box(es) below.
n FAitilre to complete annual sludge survey Failure to develop a POA for sludge levels
[2(Non-com'pliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance- LA615v12
[��r /No DNA ONE
[-]No ONA ONE
26. Did the facility fail provide documentation of an actively certified operator in charge?
0 Yes
[:] NA
NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
0 Yes
VN0o
E] NA
NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
C3�<No
[:] NA
NE
and report mortality rates that were higher than normal?
ZNo
29. At the time of the inspection did the facility pose an odor or air quality concern?
0 Yes
[j NA
0 NE
If yes, contact a regional Air Quality representative immediately.
/No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
NA
NE
pen -nit? (i.e., discharge, freeboard problems, over-apptication)
/No
3 1. Do subsurface ti te drains exist at the facility? If yes, check the appropriate box below.
Yes
Ca
NA
NE
El Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
Mo
UK
�N
0 NA
0 NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
Yes
4� po
F-1 NA
[-] NE
34. Does the facility require a follow-up visit by the same agency?
Yes_
�40
E] NA
E] NE
Comments (refer to question ft Explain any YES answers and/or any additional, recommendations or any other comments.
Use drawings of facilitV to better explain situations (use additional pages as necessary).
A F 09
Reviewer/Inspector Name: , � �J rAm'VaL'I
Reviewer/inspector Signature:
Page 3 of 3
Phone
Date:
214JO15

Type of Visit: 0 Co pliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 7Routine 0 Complaint 0 Follow-up 0 Referral 0 Emerizenev 0 Other 0 Denied Access
Date of Visit: Arrival Time: I � dh '= Departure Time: C o unty.___C>j R z�j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: J-04TRAIg Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
e
W e to
Wean to Finish I Layer I IDairy Cow
t
W
Wegn to Feeder
e to
L JNon-Layer _I
Dairy Calf
F e
Feeder to Finish
e d e
Dairy Heifer
F
Farrow to Wean
0 w I
F :
Farrow to Feeder
0 w t
Desig
=W�esign
IC
D apaci
tr TYMALOW
'YAW
Layers
Dry Cow
Non -Dairy
ef Stocker
Farrow to Finish
r wt
r 0
G Gj s
ilts
it
Non -Layers
Beef Feeder
B 0 s
oars
ar
Pullets
outts
er
113eef Brood Cow
0 1111
_ t ''!I]
2111eir
her
Ot er
Discharees and Stream Impact
1. Is any discharge observed from any part of the operation? C] Yes JNo ONA [:] NE
Discharge originated at: 0 Structure El Application Field F1 Other:
a. Was the conveyance man-made? 0 Yes 0 No 0 NA 0 NE
b. Did the discharge reach waters of the State? (If yes, notify DWIZ) 0 Yes 0 No [—] NA C] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Yes [:] o
Li
Yes 0
Yes VN io
0 NA ONE
NA NE
NA NE
Page I of 3 21412014 Continued

lFalcility Number: IDate of Ins
pectiow.
Waste Collection & Treatment
4.11s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes D/No NA ONE
a. If yes, is waste level into the structural freeboard? 0 Yes 0 No NA [:] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): IJ
5. Are there any immediate threats to the integrity of any of the structures observed? Yes [2 No 0 NA 0 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 0 Yes ZNo ONA ONE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health o ironmental threat, notify DVVR
7. Do any of the structures need maintenance or improvement? r��Yes [-]No 0 NA 0 NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes C?(No [:] ]�A [:] 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 0 NA 0 NE
maintenance or improvement?
Waste Amlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes M/No
NA
0 NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes WNo
NA
NE
F� Excessive Ponding Ej Hydraulic Overload 0 Frozen Ground
0 Heavy Metals (Cu, Zn, etc.)
M PAN M PAN> 10% or 10 lbs. 0 Total Phosphor -us 0 Failure to Incorporate Manure/Sludge into
Bare Soil
0 Outside of Acceptable Crop Window 0 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 1� 0
[] NA
NE
15. Does the receiving crop and/or land application site need improvement?
E] Yes N
0 NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable 0 Yes VNo
0 NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes D o
0 NA
NE
18. Is there a lack of properly operating waste application equipment?
0 Yes YNo
0 NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes NA NE
20. Does the facility fait to have all components of the CAWMP readily available? If yes, check Yes rNo NA NE
the appropriate box,
OWUP 0 Checklists 0 Design [:]Maps 0 Lease Agreements OOther-
2 1. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes YNo NA Ej NE
0 Waste Application Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Waste Transfers Weather Code
F] Rainfall 0 Stocking Crop Yield 0 120 Minute Inspections [:]Monthly and V Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes gNd 0 NA NE
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes No [:] NA
Page 2 of 3 21412014 Continued

Facility Number: $'I - _Y�4 jDate of Inspection:
Is D ns
No
24' Did the facility fail to calibrate waste application equipment as required by the permit? [1Y e s dTl NA Ej NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes YNo NA Ej NE
the appropriate box(es) below.
F-1 Failure to complete annual sludge survey Failure to develop a POA for sludge levels
F-1 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] NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes gNo [:] 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)
3 1. Do subsurface tile drains exist at the facility'? If yes, check the appropriate box below.
r-1 A 1; ; V. 1A M T �/Qt_ D A M n"U
Yes P40 NA [:] NE
Yes &No NA E] NE
Yes [2rNo NA [D NE
Yes 0 /No NA [:] NE
FF ca on e r'�V ..V"
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes Er�6 F] NA NE
9
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative? Yes [�?'�N�/ [:] NA NE
34. Does the facility require a follow-up visit by the same agency.? Yes ETNo F] NA NE
Comtnents (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitylo better explain situations (use additional pages as necessary).
"Ad �&WV 6061L ;]5�j
otJ ct-�AtJlf-,& &-60JO 0-t�c WAL�`
910)�q6 J-301
Reviewer/Inspector Name: Phon
Reviewer/] nspector Signature: Date: -7/3045-
Page 3 of 3 �1412 � 15

Type of Visit: (2) C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Vi rRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Departure Time: I i I I <-
County: WtZ:d Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: PAIL f::-,(L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
to Finish
Wean to
MENNIMERME
I -t RAW.'401" 1 0
Dairy Cow
t
Wean to
Wean to Feeder
Non -Layer
Dairy Calf
X Feeder to inish
Dairy Heife
EWean
Farrow to Wean
Farrow to Feeder
en en Eg Cow
p- Non -Dairy
arr
Farrow to Finish
Layers
Beef Stocker
Gilt
Gilts
Non -Layers
Beef Feeder
I 113oars
Pullets
Beef Brood C—
er
Poults
Other
��M
Discharges and Stream Impacts
1. Is any discharge observed from any part of the Operation?
E3 Yes
E3/No
[:) NA
[:] NE
Discharge originated at: F] Structure Application Field Other:
a. Was the conveyance man-made?
[3 Yes
E3No
E] NA
E] NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Yes
E] No
E] NA
E] 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)
E] Yes
EEJ
E] NA
F] NE
2. Is there evidence of a past discharge ftom any part of the operation?
E] Yes
�NN�
E] NA
Ej NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[3 Yes
VNo
E] NA
Ej NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

L'79
Iluacility Number: 1 Date of inspection: '11-5111 q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
0 Yes
a. If yes, is waste level into the structural freeboard? [:] Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: A 666 �. 1
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?
0 /No NA E] NE
D No DNA E] NE
Structure 6
D Yes UZ�No D NAO D NE
D Yes E�No EINA E] NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
'�o
7. Do any of the structures need maintenance or improvement? [:] Yes No [:INA D NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes F(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 Zr�o D NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes [3-No D NA [::] NE
maintenance or unprovementl
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes NA D NE
F-1 Excessive Ponding [:] Hydraulic Overload D Frozen Ground D 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 D Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do die receiving crops differ from those designated in the CAWMP?
0 Yes
[j No
D NA
D NE
15. Does the receiving'crop and/or land application site need improvement?
VjYcS
N
Zo
NA
E] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
�
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
NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
NA
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
VNo
NA
NE
the appropriate box.
DWUP DChecklists F] Design D Maps D Lease Agreements DOther:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. D Yes E�'No D NA D NE
D Waste Application D Weekly Freeboard D Waste Analysis 0 Soil Analysis E3Waste Transfers D Weather Code
F-1 Rainfall 0 Stocking D Crop Yield 0 120 Minute Inspections El Monthly and I " Rainfall Inspections Z/O Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:] Yes [3r�� [-] NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes YNo D NA NE
Page 2 of 3 21412014 Condnued

I I .
Fticility Number: Date of Inspection: f) 1 13d 1-1
24� Did the facility fail to calibrate waste application equipment as required by the permit'? 1:1 Yes E< NA E] NE
2�. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes YNo NA [:] NE
the appropriate box(es) below.
Failure to complete annual sludge survey C] Failure to develop a POA for sludge levels
Non -compliant sludge levels in any tagoon
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 F] NA ED 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 property 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 fait to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
[I Application Field E] Lagoon/storage Pond [3 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 ErNo E] NA E3 NE
Yes �fNoZ [:] NA [-] NE
Yes
E] No
E] NA
[3 NE
[:]Yes
[:]No
E] NA
[:] NE
Y e s ffy�NNN
'No
E] Yes 0
[] Yes fN 0
NA NE
NA NE
NA NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages, as,necessary).
AT "w
Reviewer/Inspector Name:
Reviewer/Inspector Signature-.
Page 3 of 3
Phone: ly J� 6�
Date: 1 1 14
214AI 4

-3
Type of Visit:� . GrCo ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Zoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
, - 1�_
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: J'O—M gl$6ri A/)!LLk:S_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1? 03,0
Certification Number:
Longitude:
11
SWine C ap c
C
1111 U
W an to
Wean to Finish
rEeder
op. le
Layer Cow
D signnLgurre
e
a aciKM
p.
U
ean to
Wean to Feeder
I
jNon-Layer _1
Calf
t(
Feeder to Finish
n
Layers
Heifer
I Dry Cow
IFarrow to Wean
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Co—
er
ts
)ther
Discharges and Stream ImRacts
/No
1. Is any discharge observed from any pail of the operation?
El Yes
C�
[3 NA
[] NE
Discharge originated at: E3Structure E] Application Field Other:
a, Was the conveyance man-made?
E] Yes
[:]No
E] NA
E] NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
E] Yes
0 No
E] NA
E] 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)
E] Yes
E3NA
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
rNo
[:] NA
NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Ifacitity Number: 31 -7 1 1
jDate of inspection: Ji
A Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes
a. If yes, is waste level into the structural fireeboard? D Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: LA�� �,J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): QLG 9 L
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?
/No DNA D NE
ONo DNA DNE
Structure 6
D Yes E� No [:] NA D NE
DYes 9'No D NA E] NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en�ranrnental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? D No D NA D NE
8. Do any of the structures lack adequate markers as required by the permit? El Yes ff No D 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 D Yes [;I'No D NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes [-2'/No D NA E] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [;r&o C] NA D NE
Excessive Ponding 0 Hydraulic Overload [:] Frozen Ground [:] Heavy Metals (Cu, Zn, etc.)
PAN [:] PAN > 10% or 10 lbs. E] Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
Outside of Acceptable Crop Window [:] Evidence of Wind Drift D Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
1
14. Do the receiving crops differ from those designated in the CAWN[P?
D Yes
N
2<9
D NA
D NE
15. Does the receiving crop and/or land application site need improvement?
Yes
WNo
NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
EKO
NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
D Yes
[3<o
NA
D NE
18, Is there a lack of properly operating waste application equipment?
D Yes
2<_
D NA
0 NE
Required Records & Documents
19. Did the facility fait to have the Certificate of Coverage & Permit readily available?
E] Yes
M-No
NA
[:] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
ra�o
NA
E3NE
the appropriate box.
DWUP [:]Checklists E]Dcsign [-]MapsE] LeaseAgreements
D Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. El Yes Q_Ko D NA D NE
Waste Application Weekly Freeboard D Waste Analysis D Soil Analysis E] Waste Transfers E] Weather Code
Rainfall M Stocking Crop Yield Ej 120 Minute Inspections D Monthly and I " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? Yes y [
;<O,pXl NA [:) NE
23. If selected, did the facility fai I to install and maintain rainbreakers on irrigation equipment? [:]Yes [DN'o D NA D NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of (Ws—pectiory %2�ak �,3
/VC
24. Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
NA [:] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes
YMo NA E] NE
the appropriate box(es) below.
Failure to complete annual sludge survey E] Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structurc(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
[�J`No F] NA E] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
E] Yes
E3"No E] NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
F] Yes
Ef(No E] 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
[;3'�o 0 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
ff�No [DNA NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
EDNo [:] NA 0 NE
M Application Field El Lagoon/Storage Pond F] Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[D Yes
[j<o E] NA E] NE
33. Did the Reviewer/Inspector fail to discuss reviewhnspection with an on -site representative?
0 Yes
Ej0No Ej NA E] NE
34. Does the facility require a follow-up visit by the same agency?
[:] Yes
12<0 E] NA [] NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use.drawings of faeflity to better explain situations (use additional pages as necessary).
o%ffS-Z_0( DZK—C- VJALL- US S'�KAUL -T'fZ-tC--S - - 51'LtAJ4C Ftivotic
Reviewer/Inspector Name: a(—, Phone
ReviewerlInspector Signature: A. Date:
Page 3 of 3 1
214120b

Type of Visit: Q0 Compliance Inspection U Operation Review (-) Structure Evaluation (_) Technical Assistance
Reason for Visit: (3"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 Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: AeA-TA&P W1=4j_c�
*AW r
Certified Operator:
Back-up Operator:
Location of Form:
Owner Email:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
swine
Wean to Finish
W e an to F
Layer
Non -Layer
t
Da Cow
Dairy Ca
W e an to F
Wean to Feeder
X
de
Feeder to Finish
e e r to
a w to
Farrow to Wean
0
F arrow to Feeder
.F to
q
t ac
Dairy Heifer
Dly_ Cow___
Non -Dairy
Stocker
:ow
arrow to Finish
F ow to
Layers
__1B_eef
Ilt
Gifts
lBeef Feeder
Boars
0 ars
Pullets
B ru Cow
LOt
01her.
.h r
e
r
[Other
Turkey
Turkey Poults;
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure Application Field F1 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?
D Yes EfNo DNA ONE
D Yes
D No
D NA
D NE
D Yes
D No
D NA
D NE
[:] Yes
[:] No
D NA
D NE
[:]Yes
E3/No
D NA
NE
D Yes
(3/No
D NA
NE
Page I of 3 21412011 Continued

lFacility Number-. 51 - 3!*A Date of Inspection:
Waste Collection & Treatment
4. Is heavy less
NE
storage capacity (structural plus storm storage plus rainfall) than adequate?
[:]Yes
EZNo
DNA
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: LA 6tzW I LA600-r42_-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2-1
5. Are there any immediate threats to the integrity of any of the structures oborved?
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
D Yes
No
[DNA
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 environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? D Yes [7�jo [] NA [_] NE
8. Do any of the structures lack adequate markers as required by the permit? E] Yes WNo [DNA D 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 D Yes E�No D NA D NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
D Yes
[�fNo
[DNA
D NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
Yes
r�'No
[:] NA
NE
M Excessive Ponding 0 Hydraulic Overload 0 Frozen Ground E] Heavy Metals (Cu, Zn, etc.)
Ej PAN F] PAN> 10% or 10 lbs. Total Phosphorus D Failure to Incorporate Manure/Sludge into
Bare Soil
n 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
o
g�No
NA
NE
15. Does the receiving crop and/or land application site need improvement?
Yes
NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
D Yes
o
D NA
D ME
acres determination?
�10
17. Does the facility lack adequate acreage for land application?
Yes
Ej
D NA
D NE
18. Is there a lack of properly operating waste application equipment?
D Yes
F3/No
D NA
D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
D 'Yes
C�40
[] NA
D NE
20. Does the facility fail to have all components of the CAWNT readily available? If yes, check
D Yes
Ej/No
DNA
C] NE
the appropriate box.
E]ArUP El Checklists 0 Design D Maps D Lease Agreements D Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes [EI/No C] NA C] NE
M Waste Application El Weekly Freeboard [I Waste Analysis D Soil Analysis D Waste Transfers D Weather Code
0 Rainfall D StockingE] Crop Yield D 120 Minute Inspections D Monthly and I" Rainfall Inspections D Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [-]Yes 0�0 NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes fNo NA NE
Page 2 of 3 21412011 Continued

I I
Ffacility Number: 3L -�3 Date of Inspection: 212q17--
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes c, E] NA 0 NE
25. 14 the facility out of compliance with permit conditions related to sludge? If yes, check Yes WNo E] NA F] 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 Ef No NA NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes F�No NA NE
Otherlssues
28. Did the facility fait to property 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
ZNo
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
[Z No
NA
NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Yes
C!�No
NA
NE
E] Application Field E] Lagoon/Storage Pond M Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
[yNo
0 NA
NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Ej Yes
[]�No
0 NA
Ej NE
34. Does the facility require a follow-up visit by the same agency?
[:] Yes
E�No
[:) NA
F] NE
Comments (refer to questionft Explain. any YES answers and/or any additional recommendations or,, any,other comments.
use drawin2s of facilitv to better explain situations (use additional paues a's necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonc(,716
Date:
21412011

t 01 -Is-;L4
Type of Visit: UC Hance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 7Routine 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 Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: -JO IJ CM14AO COML"a- Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
esign our ent
lipil
11i apaci Ro PO
an to Finish
La er
hg ULU-ur ent
ELCattim "a
an to Feeder
Non -Layer
der to Finish
PO
D.P.
Layers
fer
Dry Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to inish
rpPullets
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Beef Brood Cow I
01
Turkeys
Turkey Poults
10ther
I
I
_19ther
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: D Structure El Application Field F1 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 [2�'No [:] NA [:] NE
DYes
[]No
DNA
DNE
0 Yes
[:] No
0 NA
[:] NE
D Yes [] No NA NE
C3 Yes E�NLA NA NE
[:]Yes �rNo NA NE
Page I of 3 21412011 Condnued

I /
[Facility Number: jDate of Inspectiow. _,% Is 1 1)
Waste Collection & Treatment
4. Is,storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? C3 Yes E(Nci NA E] NE
a. If yes, is waste level into the structural freeboard? Yes E3No NA E] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&WO I CA &w, 7,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1111-7 3 o
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
1�
�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
[�J/No
E] 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 environmeini�ta
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
[2 �o
NA
NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
fNo
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
E3/N o
NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
C�No
NA
E] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
Yes
Vf/No
NA
E] NE
F-1 Excessive Ponding [:] Hydraulic Overload 0 Frozen Ground E] Heavy Metals (Cu, Zn, etc.)
F-1 PAN F-1 PAN > 10% or 10 lbs. Total Phosphor -us 0 Failure to Incorporate Manure/Sludge into Bare Soil
[] Outside of Acceptable Crop Window E] Evidence of Wind Drift Ej 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?
E] Yes [Z] I
NA
F] NE
15. Does the receiving crop and/or land application site need improvement?
Yes rj�o
NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes �`No
NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0
Yes 1/1
NA
NE
18. Is there a lack of properly operating waste application equipment?
Yes YNo
NA
NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
eN
NA
NE
20. Does the facility fail to have a] I components of the CAWMP readily available? If yes, check
Yes o
E3 NA
E] NE.
the appropriate box.
OWUP E3Checklists E] Design E] Maps E] Lease Agreements E]Other:
2 1. Does record keeping need'improvement? If yes, check the appropriate box below. F] Yes ZNo NA NE
Fj Waste Application E] Weekly Freeboard E] Waste Analysis E] Soil Analysis F] Waste Transfers Weather Code
nRainfall [3 Stocking 0 Crop Yield [3120 Minute Inspections E] Monthly and I " Rainfall Inspections Sludge Survey
N NA NE
22. Did the facility fail to install and maintain a rain gauge? [—]Yes ��4
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes YNo NA NE
Page 2 of 3 21412011 Continued

[17acility Number: --51 - en FDate -of Inspection:
24 s b 0
I 1
24. Did the facility fail to calibrate waste application equipment as required by the permit?
F] Yes
o 0 NA 0 NE
25, ig the facility out of compliance with permit conditions related to sludge? If yes, check
F] Yes
WNo [DNA 0 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
2f o NA [:] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
rNo NA 0 NIE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
El Yes
Z/No 0 NA 0 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
ZNo 0 NA 0 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
[E:] Yes
E2/N(o NA 0 NE
permit? (i.e., discharge, freeboard problems, over -application)
;/No
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
Yes
NA [] NE
El Application Field [] Lagoon/Storage Pond M 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?
Reviewer/Inspector Signature:
Page 3 of 3
Yes
Yes
[E:]:] Y e s
cln�c
0
Nc
[:] NA ONE
NA NE
NA NE
Date: 1,q 11)
21412011 '

Facility Number`
31
3 3
�rvesion of 1Water_Quahty :
-Division of Soil andWater Ct
F.Otbei•. Agency- _ .
E
fVisit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: PW
Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: _ i.��INL�fiN Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o = = is Longitude:
Design ✓Current Design Current
Swine„h - Capacity Popula#ion Wet Poultry ,Capacity Po'palahon,
a _ _
❑ Wean to Finish .` ❑ Layer ' [
❑ Wean to Feeder -," ❑ Non -Layer EEE][
91 Feeder to Finish 0000
❑ Farrow to Wean IE PouI ..P
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Lavers [
Boars
ier _
Other
Non-L.
Pullets
Poults
Other I
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood [
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes '�o ElNA ❑ NE
❑Yes t❑/No ❑NA ❑NE
12128104 Continued

Facility Number: Date of Inspection
j I —M
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
0 Yes
No
El NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
E]Yes
No
[I NA
[:1 NE
.
the appropriate box. El WUP El Checklists El Design El Maps D Other
JNo
21.
Does record keeping need irtiprovement? If yes, check the appropriate box below.
0 Yes
El NA
El NE
D Waste Application 0 Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers
El Annual Certification
El Rainfall El Stocking El Crop Yield [:1120 Minute Inspections EJ Monthly and I
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
zo
El NA
NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
VjXo
El NA
NE
24.
Did the facility fail to calibrate waste application equipment as required by the pen -nit?
El Yes
o
FNo
El NA
El NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El NA
[:1 NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
El NA
[:1 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
El NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
D Yes
o
JNo
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[I Yes
El NA
El 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
dNo
[I NA
[_1 NF
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
B'N'o
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Elyes
U/No
[I NA
[:1 NE
33.
Does facility require a follow-up visit by same agency?
0 Yes
O'No
El NA
El NE
Page 3 of 3 12128104

Facility Number: I-nq
I Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
Z(No El NA El NE
a. If yes, is waste level into the structural freeboard?
El Yes
El No El NA El 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?
0 Yes
ONo El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on-sitc which are not properly addressed and/or managed
0 Yes
el'No El NA [--] NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
0 Yes
ONo [:1 NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
0 Yes
o [I 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
0 Yes
[Z/No El NA El NE
maintenance or improvement?
Waste ApRlication
10. Are there any required buffers� setbacks, or compliance alternatives that need
El Yes
.2,1"No [I NA [--] NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
No EINA El NE
El Excessive Ponding El Hydraulic Overload 0 Frozen Ground El Heavy Metals (Cu, Zn, etc.)
El PAN EIPAN > 10% or 10 lbs El Total Phosphor -us El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift C1 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
[I'< [j NA
El NE
15. Does the receiving crop and/or land application site nee . d improvement?
El Yes
7N o, El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El yes
07W El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
VbV El NA
X
[] NE
18. Is there a lack of properly operating waste application equipment?
Yes
-� No [j NA
El NE
n
mmenN (idir--46' 'airiy�Y rdl dat oF�
U pUn- ,ES,,,,answers;an vrAipn��-recomifien ions, ;an-y' I erlycomments.
01
Use diAwines offacilitv,to, better ex0laih situAti6iis:fug&,.a�dditi6iial:oagis�is,�ii0e�s
S!
-Z.;P
-776
Reviewer/Inspector Name Phone
: I
Reviewer/Inspector Signature- Date:
�ilap 2 nf 7 12128101 (Continued

31�;
rType of Visit C5 compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
sol I
Repason for Visit Q40utine 0 Complaint 0 Follow up 0 Referral C) Emergency 0 Other El Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
. I
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: J�Pjqy-AAA rw-Tu,�P_ - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certirication Number:
Back-up Certification Number:
Latitude: =0 =d Longitude: = 0 = = 11
w
C -urrent
t_jo
F6apMaciPo:pj0a iult_r.yjKGFDacit
MesingnIRCH Pre 95t
�Fvufftffn
,yjP
avacit Pop liti
H
_7yl_Z Milt
El Dairy Cow
El Wean to Finish
IM Layer
El Wean to Feeder
IEJ Non -Layer I
I
El Dairy Calf
0 Feeder to Finish
060
ul
Layers
El Non -Layers
El Pullets
El Dairy Heifer
El Farrow to Wean
El Dry Cow
El Farrow to Feeder
El Farrow to Finish
D Non -Dairy
El Beef Stocker
D Beef Feeder
El Beef Brood Cow
Gilts
Boars
I
I
I
I
urkeys
urkey Poults
)ther
um r r
r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: C1 Structure [I Application Field (j 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?
El Yes d No [_1 NA El NE
0 Yes
[I No
Ej NA
El NE
El Yes
El No
[:1 NA
[:1 NE
El NA
[:1 NE
El Yes
El No
[]Yes 26 El NA El NE
El Yes 7No [j NA El NE
Page I of 3 12128104 Continued

;acility Number:
Date of Inspection
Waste Collection & Treatment
T—is—storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA &,zd i LA 6-0tv -k-
0 Yes Z/No D NA [I NE
[I Yes 0 No El NA El NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes dNo El NA El NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes 12fNo [I NA El 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 th eat, notify DWQ
7
7. Do any of the structures need maintenance or improvement? El Yes o 0 NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? E]Yes WNo El NA [3 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 EfNo El NA El NE
maintenance or improvement?
Waste AnDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need D Yes E�No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. E]Yes [� No [INA [__1 NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
[:]PAN EIPAN>10%orl0lbs []Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAVV'MP?
D Yes
E�No
[] NA
El NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
6o
[__1 NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes
KNo
El NA
El NE
17. Does the facility lack adequate acreage for land application?
[] Yes
D/No
El NA
[:1 NE
18. Is there a lack of properly operating waste application equipment?
El Yes
Er/No
El NA
[:1 NE
.r,[6 L.0 Albfp LdM4, AL
JVAT6f-- J�M"" A/VT<- d9,�'meW6�, (3v-r 4444
Lo
RUE-Ag 6 A 'W -y-FA 4
Reviewer/11 nspector Name 6 1 Phone: � eiloT-7f
Reviewer/Inspector Signature: Date: //1,60LO Z
Page 2 of 3 12128104 Continued

I
[)�acility Number,_d I — 33q Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
0 Yes
E��,Nio
El NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
No
El NA
[_1 NE
the appropriate box. El WUP [I Checklists Cl Design El Maps El Other
/No
21.
Does record keeping need improvement? If yes, check the appropriate box below,
0 Yes
0
0 NA
El NE
0 Waste Application El Weekly Freeboard 0 Waste Analysis El Soil Analysis 0 Waste Transfers
[] Annual Certification
[:1 Rainfall El Stocking El Crop Yield El 120 Minute Inspections 0 Monthly and I "
Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
0 Yes
Ej`No
[:1 NA
0 NE
,23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
D`go
[:1 NA
[__1 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
ft(No
El NA
0 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
[Jfqo
0 NA
ONE
26.
Did the facility fail to have an actively certified operator in charge?
0 Yes
Q<o
[:1 NA
El NE
27.
Did the facili fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
EI/No
[:1 NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
CrNo
El NA
[] NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
El Yes
D/No
El NA
0 NE
and report the mortality rates that were higher thari normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
0 Yes
E�Ko
0 NA
0 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
0 Yes
ErNo
[:1 NA
0 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
0 NA
0 NE
33.
Does facility require a follow-up visit by same agency?
El Yes
qNo
0 NA
[:1 NE
12128104

I
Type of Visit 0 C Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technicaf Assistance
P'
Reason for Visit 7Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit- Arrival Time: Departure Time: County: QW-LLTO — Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative.
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [=O =I =it Longitude:= 0 ET = "
esi esign
�gn ca-urr'Cut
Swine Zci�opufftion P itqvlpl
�ap 7Q—u "EAM25 —3ci
Wean to Finish 10 Layer
We
Wean to Feeder 10 Non-L2yer
rE We to 1
IM rFeeder
;ren
esign
Fp-Ec Lt-YAP Muitj
-g-p-
El Dairy Cow
0 Dairy Calf
er to
to Finish
4
El Dairy Heifer
.4
0 Farrow to Wean
0 Farrow to Feeder
El Farrow to Finish
0 Gilts
10 Boars
er
It
El Layers
EJ Non -Layers
M EJ Pullets
Furkeys
urkey Poults.
Other
El Dry Cow
El Non -Dairy
El Beef Stocker
El Beef Feeder
El Beef Brood Cow
Num of
Dischar2es & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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?
El Yes EfNo [:1 NA [I NE
El Yes
[I No
0 NA
El NE
Yes
El No
[] NA
El NE
El NA
El NE
E-1 Yes
0 No
El Yes
El"No
El NA
[I NE
D Yes E�No D NA [I NE
Page I of 3 12128104 Continued

IF;cility Number: 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes 0 No [I NA [__1 NE
a. If yes, is waste level into the structural freeboard? El Yes D No 0 NA [I NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A&&7g/ L.,4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -L'
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes
C, NO [] NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed L] Yes
iN, o El NA [:1 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 envi
r7y.,
tal threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
El No [:1 NA El NE
8. Do any of the stuctures tack adequate markers as required by the permit? El Yes
YNo [__1 NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes
E�/No El NA C1 NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need El Yes
ZNo El NA El NE
maintenance/impTOvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
dNo El NA El NE
El Excessive Ponding El Hydraulic Overload [:1 Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
[:]PAN EIPAN>10%orl0lbs []Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window E] Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
E-1 Yes
O'No
El NA
D NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
�V o
[I NA
El NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
Zo
E3 NA
[__1 NE
17. Does the facility lack adequate acreage for land application?
El Yes
�`No
El NA
[:1 NE
18. Is there a lack of properly operating waste application equipment?
0 Yes
dNo
El NA
0 NE
L_A&,� I 0,t6(_D_5 SMALA- -fo_C-e (_vT iDowO 0/0 4094a' juT-JQ)C_ 0jXC_
W)q LA__ CO " L*Z-
Reviewer/Inspector Name 'ja J-1 J �L6awg't_ l- - ' , . -,- I Phone: 7Y& — 13Y r
ei 10
Reviewer/Inspector Signature: Date:
V
.'I- - -.1

"19acility Number: Date of Inspection
Required Records & Documents
N
19. Did the facility fail to have Certificate of Coverage & Permit readily available? OYcs 0 NA [3 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0 Yes ONo El NA El NE
the appropirate box. El wup OChecklists [] Design [:1 Maps El Other
2 1.
Does record keeping need improvement? if yes, check the appropriate box below.
0 Yes
[�/No
El NA
[:1 NE
[:1 Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers
Cl Annual Certification
0 Rainfall El Stocking El Crop Yield E] 120 Minute Inspections 0 Monthly and I "
Rain Inspections El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El yes
M No
ONA
[:1 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
1:1 Yes
o
94',
0 NA
ONE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
f�'4
[:1 NA
[:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
i�No
0 NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
0 Yes
XTA
Ea/N
0 NA
[:3 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
0 Yes
�rNo
[:1 NA
[:1 NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
P/No
0 NA
0 NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
;Ko
El NA
0 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?
0 Yes
[2'1�o
El NA
El NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
0 Yes
O-N/o
[:3 NA
ONE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
0 Yes
ffNo
[:1 NA
ONE
33. Does facility require a follow-up visit by same agency?
11 Yes
P/No
ONA
0 NE
-andlor..Drawtngs!�'.
Additional Coniinents
Page 3 of 3 12128104

Facility Number
40 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit ()el&
pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
ReasonforVisit
7Rcutine oComplaint
oFollowup OReferral OEmergency
00ther El Denied Access
Date of Visit: Arrival Time: Departure Time: County:,00�'j,_k&/_ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location or Farm: Latitude: =0 = ='. Longitude: = 0 =' = "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish.
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Population WetPoultrY Capacity Population
El Layer I I ::::]
1[__1 Non -Layer I
Dry Poultry
ElLayers
E]Non-Layers
El Pullets
El Turkeys
F—I urkey Poults.
El Other
Discharges & Stream Imimets
1. Is any discharge observed from any part of the operation?
Discharge originated at- El Structure El Application Field El Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Populatiow
El Dairy Cow
El Dairy Calf
I
El Dairy Heifei
El Dry Cow
El Non -Dairy
0 Beef Stocker
El Beef Feeder
El Beef Brood Cow,
Number of Stru
ctures,
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?
N
0 Yes 2No El NA El NE
[:1 Yes
El No
El NA
El NE
El Yes
El No
El NA
NE
I—
El NA
NE
[:] Yes
No
El Yes
E'��
0
ED NA
El NE
El Yes
No
[] NA
El NE
12128104 Continued

Fai�flity Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes EX0_11"EINA [__1 NE
a. If yes, is waste level into the structural fireboard? [_1 Yes [D No El NA [:1 NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
ldentifier:L,4�A,/ 1_ �,A Ccv�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �34 1714
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes 0 No El NA E3 NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes Q4 El NA El 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? El Yes ETNo El NA [_1 NE
8. Do any of the stuctures lack adequate markers as required by the permit? Yes D"No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [__1 Yes G3No E-3 NA [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [I Yes 21"No El NA [__1 NE
maintenance/improvement?
I L Is there evidence of incorrect application? If yes, check the appropriate box below, 0 Yes EE�No [:1 NA [I NE
[]FxcessivePonding [:]Hydraulic Overload [:]FrozenGround El Heavy Metals (Cu, Zn, etc.)
EIPAN EIPAN>10%or]Olbs [I Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
0 Yes
0 No El NA
D NE
15. Does the receiving crop and/or land application site need improvement?
E] Yes
Ej<o [:1 NA
1:1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
D/No El NA
El NE
17. Does the facility lack adequate acreage for land application?
0 Yes
El NA
0 NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
��No El NA
Ej NE
Comments (refer to question Explain-anyYES answers and/or any recomMen-daitiolas or"an"y odier''comments.
Use drawings of facility to better explain situations. (use additional pages as nece
") C'. r Y' 0 F 0-rc L- -L C-e�-V.3 G
A,qse LA 6,.-,,
Reviewer/Inspector Name I --"dlyw I Phone:( ZeZ 7yg
Reviewer/Inspector Signature: Date: f_z & Z-)
Page 2 of 3 12128104 ' Condnued

FVcility Number: -33 Date of Inspection /V7
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes EYNo El NA El NE
20.
Does the facility fait to have all components of the CAWMP readily available? If yes, check
El Yes
EJ/No
[:1 NA
El NE
the appropirate box. El W­UP El Checklists El Design El Maps [3 Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
E5/No
El NA
El NE
El Waste Application D Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers
El Annual Certification
EIRainfall ElStocking E]CropYield El 120 Minute Inspections El Monthly and V
Rain Inspection; P Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
No
El NA
[__1 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
E] Yes
[3/No
[] NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[]NA
[:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
QNo
[:1 NA
El NE
26. Did the facility fail to have an actively certified operator in charge? ErYes [I N [] NA El NE
27. Did the facility fail to secure a phosphorus toss assessment (PLAT) certification? El Yes _FNo Ej NA [:1 NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
P1<0
[:1 NA
[_1 NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
1�1�o
[:1 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
gXb"
[:1 NA
[__1 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
El Yes
nNo
[] NA
E] 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
0-N'o
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes 2<o
E] NA
[:1 NE
Comments and/or Drawings:
12128104

ivision of Water Quality
Vacitity Number 0 Division of Soil and Water Conservation
0 Other Agency
Phone:
Type of Visit '916ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,_'�Ykoutine OComplaint OFG11owup OReferral OEmergency 00ther D Denied Access
JI
Date of Visit: Arrival ime: Departure Time: County: adlu Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
0 Yes El No E-1 NA D NE
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: E__1 1=1' = Longitude: =0[�i
Design Current Design Current Current..
Swine Capacity Population WetPoultry Capacity Population Cattle Capacity, Popqlatiow�"
Layer
Wean to Finish
" .13 Wean to Feeder JLJ Non -Layer
Oteeder to Finish
Farrow to Wean
Dry Poultry
r 117 A
arrow LO ce er
Farrow to Finish
E3 Gilts
El Boars I
Other
,T] Other
11 Layers
Type of Visit '916ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,_'�Ykoutine OComplaint OFG11owup OReferral OEmergency 00ther D Denied Access
JI
Date of Visit: Arrival ime: Departure Time: County: adlu Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
0 Yes El No E-1 NA D NE
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: E__1 1=1' = Longitude: =0[�i
Design Current Design Current Current..
Swine Capacity Population WetPoultry Capacity Population Cattle Capacity, Popqlatiow�"
Layer
Wean to Finish
" .13 Wean to Feeder JLJ Non -Layer
Oteeder to Finish
Farrow to Wean
Dry Poultry
r 117 A
arrow LO ce er
Farrow to Finish
E3 Gilts
El Boars I
Other
,T] Other
11 Layers
0 Non -Layers
0 Pullets
El Turkeys
El Turkey Poults
ILI Other
Ej DaiEy Cow
0 Dairy Calf
El Dairy Heifer
El D!y Cow
0 Non-Daia
El Beef Stocker
El Beef Feeder
El Beef Brood Cowl
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
[I Yes El No El NA El NE
0 Yes El No [:1 NA [:1 NE
El Yes El No El NA F-1 NE
[:]Yes [--]No El NA El NE
0 Yes El No [] NA El NE
12128104 Confinued

LFaciliV Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate?
F-1 Yes
El No
El NA El NE
a. If yes, is waste level into the structural freeboard?
El Yes
El No
0 NA ' El NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (3 12(�
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
El No
El NA 0 NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
El Yes
El No
El NA El 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?
El Yes
El No
El wA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
El No
El NA
El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[I Yes
[I No
El NA
[__1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
El Yes
El No
El NA
[-I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
[I No
El NA
[__1 NE
El Excessive Ponding El Hydraulic Overload E] Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
El PAN EIPAN>10%orl0lbs [I Total Phosphorus [3 Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop t3Te(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
Yes
[I No
[:1 NA
NE
15, Does the receiving crop andior land application site need improvement?
Yes
El No
El NA
NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
El No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
El No
E] NA
E] NE
18. Is there a tack of property operating waste application equipment?
[] Yes
El No
El NA
El NE
77 7
comments th' t
(refer to question Explain any YES answers and/or any., recommea a ny,o. ereornmen
,Use drawin tt 0 s se;Additional:iDA2esks'PO�es��iry
g.sof facility to.be er explain situatil n
Reviewer/Inspector Name ej�ny/,_ jx��' L"/ Phone: -&I / ;7
Reviewer/Inspector Signature: Z Date: 2—Z2 On
Page 2 of 3 1212%11)4' Continued

Facility Number: Date of Inspection
Reguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes [:1 No 0 NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes [:1 No El NA NE
the appropriate box. El WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes [3 No [__1 NA E] NE
[3 Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis [I Waste Transfers El Annual Certification
0 Rainfall El Stocking El Crop Yield El 120 Minute Inspections El Monthly and I" Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
El No
El NA
0 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
E]Yes
El No
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
(__1 No
El NA
[:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
D Yes
E-1 No
EINA
[:1 NE
26.
Did the facility fail to have an actively certified operator in charge?
[I Yes
[:1 No
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
E]Yes
El No
EINA
[3 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
[_1 No
D NA
Ej NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
El No
[I NA
[__1 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
El No
E] NA
[__1 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
El Yes
[-I No
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
0 Yes
El No
El NA
[_1 NE
33.
Does facility require a follow-up visit by same agency?
0 Yes
El No
El NA
El NE
Additional Comments and/or Drawings:
1z
co
A-hy
44 e c:Pe'e.-v ova -f
t"f PA 5 )e-
_5� 1,0"15 e-- 'w
Y�� -)oc 6
Page 3 of 3 .1 12128104

111visio a - ate I Giali
i=mber LXLJ 0 ivisio of No I a Union
Jill e enc
TypeofVisit (6co
pliance Inspection
I
0 operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other El Denied Access
Date of Visit: Arrival Time- Departure Time: countv: 0tA*L;DJ
Farm Name: OA-JJ:S Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 1<z—&)&xr_)y
Certified Operator: (I rAA 5 GQ_<.sjT VA\M�
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator: M 0
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [=O [=A [= Longitude: = 0 = =
Design Current Design Current
Swine Capacity Population WetPoultry Capacity Population Cattle
ID Wean to Finish I I
0 Wean to Feeder I I 1�
gTeeder to Finish 1 391? 1 ZT6_1 D
D Farrow to Wean
El Farrow to Feeder
0 Farrow to Finish
El Gilts
El Boars
Other
IF—] Other
0 Layer
1.0 Non-Layei--
Dry Poultry
E] Layers
0 Non -Layers
0 Pullets
0 Turkeys
10 urkey Poults
10 Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: 0 Structure El Application Field 0 Other
a. Was the conveyance man-made?
Design Current
Capacity Population
0
Dairy Cow
I
0
Dairy Calf
I
I-
0
Dairy Heifei
0
Dry Cow
0
Non-Daia
0
Beef Stocker
0
Beef Feeder
0
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?
El Yes YNo El NA [] NE
OYes
ONo DNA
ONE
0 Yes
D No 0 NA
D NE
El El NA
El NE
El Yes
• Yes
Z9 El NA
El NE
• Yes
�No El NA
0 NE
12128104 Condnued

Facility Number: — j"3`I Date of Inspection US
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: &AC oOn1 1 (-A 6-L--orJ -I-
Spillway?: Na N'✓
Designed Freeboard (in): 6 19
Observed Freeboard (in): 31 2-7
❑ Yes No ❑ NA ❑ NE
El Yes El No El NA El NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [?f 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 1 /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 tty eat, 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 2 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo
El NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 0 (a-M U-OR (G j 5 CAD
13. Soil type(s) Q trrtiq a/r L c-C.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ZNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes DIN
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes R'�No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes o
❑ NA ❑ NE
Comments (refer;to Exptaffi any YES ansRers and/or anyrrecommendations or any other comments,
qu"estron'#�
Use dsawtngs d'f�facthty to:better"eaplatossrtuations "(use Addrtionai,pages-as necessary): .
.�.,s,G;
2,t,) wo) to Tidsp(CT mMV-- WALL-5 AIFTCP-- l" R_A=r FAt_-t--.
�S) �EP usPY v� C��--T2�sCATC- •,� CA�`EQW�E r�=f�l ��9�A5
OgT�� C'P'? of LAC'c5c s PCs a sS r'�tur� t�EP t�CN RC 2o5.
C G(>,y 04 $ C, 6 A rAt_00 V-CU4 wUP
U P D ArtG t-A 6 00-0 R CCO "S RR-D 0.1,, OLD G-lit -M -M NLGv PFW
Reviewer/inspector Name t-i Phone: ?4so x Lo3
Reviewer/inspector Signature: (.' Date: _ 2ha j
12128104 Continued

V
Facility Number: 7j — 3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
2(Yes ❑ No ❑ NA ❑ NE
❑ Yes LI No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [Monthly and 1 " Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E�Na-
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
EENo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El yes
VNO
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
❑ No
❑ NA
U 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? (iel 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?
'Comments and/or Drawings:
❑ Yes 2No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes E�N El NA El NE
El Yes VNo El NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes D&o ❑ NA ❑ NE
12128104

., 6L
Type of Visit )4 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit OCRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number � �Z� Bate of Visit: Time: I 1
rO Not Operational 0 Below Threshold
Cff Permitted UCertified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: /.J/sa fi .E d.'� County -u/o /' S'I
Owner Name:
Mailing Address:
Facility Contact: / Title:
Onsite Representative: g:�&A �✓ /�ur .(ld�+wr ��
Certified Operator:
Location of Farm:
Phone No:
Phone No: II
Integrator: f tr / od l sz
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' " Longitude 0 6
Design
Current Design Current Design Current
S_w__fne Ga aci
P,o ulation P,ou�try Ca aci P,o ulation Cattle Ca acity P.o ulation
to Feeder
❑ La er ❑ Dairy
rWean
Feeder to Finish
❑Non -La er ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of LagoonsVF�
❑ Subsurface Drains Present ❑ La oon Area
❑ S ra Field AreaHolding
Ponds 1 Solitl TrapQ
❑ 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 ❑ 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ! '%
Freeboard (inches): r
0510.3101 Continued

Facility Number: 31 — Date of Inspection 1 2Z
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 anv 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?
N aste Annlication
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type r •t ih
13. Do the receivine crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Reguired Records & Documents
17. Fail to have Certificate of Coveraze & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps. etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21, Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notif}- regional DWQ of emergency situations as required by General Permit?
Oe.l discharge, freeboard problems. over application) ❑ Yes ❑ No
23. Did ReviewerAnspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [:]No
�E3 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Comments (refer to oil.=Eip�:any YES answer pd/o ny can peons o other enmmts,�
Usedrawings of facility to better expiasn dtuatronsjuse addittonal"pages as�aecessary} Field Copv ❑ Final Notes r
❑
-w-r wr.—.• £.:=-s'�'=+ck'-.- Y.. •zn: -.,- `_.ram= S. -. _ i.,x
�.
Reviewer/Inspector Name Z;5 R'-
1.
Reviewer/Inspector Signature: Date:
05103101 Continued

A
Facility Number: 3/ — Date of Inspection I LL 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there 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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
O510310I

Type of Visit 0 compliance inspection 0 Operation Review 0 Lagoon Evaluation
ReasonforVisit &Routine oComplaint OFollowup 0 Emergency Notification 0 Other 0 Denied Access
FFacilitv Number ffili v or visit: Time:
=Not 0 erational 0 Below Threshol
ElPermitted M Certified [3Conditionally Certified 13Reggistered Date Last Operated or Above Threshold:
Farm Name: &elol Aqv"5 Air," Countv: Z10/111n
.OwnerName.' 404 a 115 Phone No:
Mailing Address;
Facilitv Contact. Title. Phone No:
Onsite Representative: 6�4,, 4,7.lejv Integrator: /%(U t4 � V
Certified Operator, Operator Certification Number:
Location of Farnit
ElSwine Elpouitry ElCattle OHorseLatitude a I " Longitude [__ __ * I
-Current-
D�sign
wWe'. -Capacity"Populatio'n
Wean to Feeder
I
I
Feeder to Finish
El Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Ej Boars
Current
esign
D6jgn ;,D
-capacity -Popub on-.-!
lati Cattle Rati iptivii.1a on
Dairy
Laver _F
3 Non -Laver !E] Non -Dairy
A
Ll Other
T -dD'69j9n,Q
ot
cr, _10LagoonAres 10 Sprav Field Area
USubsurface Drains Present
tem
Waste Management Svs�
JD*scharges & Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes "O.No
yj
Discharge'originatedat:, OLagoon E]SprayField El Other
a. if discharge is observed, was the conveyance man-made? Ej Yes El No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) Yes El No
c, If discharge is observed. what is the estimated flow in aal/min?
d. Does discharge bypass a lagoon system" (If yes. notily DWQ) El Yes ONo
2. Is there evidence of past discharge from any part of the operation? El Yes El No
3. Were there any adverse impacts or potential adverse impacts to the Watets of the State other than from a discharge? El Yes tgNo'
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? Snillwav [I Yes G�FNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: I Z_
Freeboard (i nches)�
0510310.1 Continued

''r'=w` .
Facility Number: — �j Date of Inspection jf Z Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion.
El Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
No
immediate public health or enAronmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
- elevation markings?
❑yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
No
11. Is there evidence of over application? ❑ Excessive Ponding` El PAN ❑Hydraulic Overload
❑Yes
®No
! 12. Crop type r //11��_ �C I_Lr•G2YJ _5naw !�%n afty--et _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
W 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
J9 No
15. Does the receiving crop need improvement?
50 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?
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?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes 0 No
❑ Yes ® No
❑ Yes ER No
❑ Yes IgNo
❑ Yes [ZNo
❑ Yes ® No
❑ Yes No
❑ Yes 0 No
© -No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
TjrIS
No axe �,aa 4u ; seomimeuts:-
j:r ❑Field Copy ❑ Final'Notes
I5- / JPI1v[S 7 O t-10 RePll �e4- Yit
w✓ e4f e i,>- O�d� e GOvi-4l Mey ld-la l4�e.
'�
maG[C 4^P�-- Yeol0dd.
,�a,
44- re f- P rh /r�fo1
Reviewer/Inspector Name .'` .`
��
a1 ' T I s ' K �
Y
Reviewer/Inspector Signature:
Date: Qz
05103101
L-MA
Continued

Facility ]Number: 31 -JA Date of Inspection
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours?
28, Is there 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?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 2 No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
05103101

w Q=Division of SE►fi'aad Water CtlOSErf'lon on.
tigEilCp
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for VisittA Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit. Time:
Q Not Operational Q Below Threshold
APermitted © Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
FarmName: ..... ..................................................................................................... County:.... .L1. ..........----------- ..... .
OwnerName: ...... . ......................... . ................ .......................................... ............................. Phone No: .................................... ....................... ......_..._...
Facility Contact: ............................................................................... Title:
Mailing Address:
PhoneNo: ................... .............. ...........
Onsite Representative:.-...............�............................................ Integrator:.......t^
Certified Operator:................................................................................ ................................ Operator Certification Number:.........................................
Location of Farm:
❑ Swine' ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� I�u
Design_ Current
'Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design - Current - • : Design °' Carrrat_
`Poultry:. Ca aci ` Po ulation Cattle Ca cit Piinlittion
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
ToUI-Design Capacity
Total SSLw
Number�of Lagoons 10 Subsurface Drains Present 110LagoonArea 10 Spray Field Area w
Holding Ponds / Solid`Traps":, ❑ No Liquid Waste Management System
Discharges & Stream Impac
1. Is any discharge observed from any part of the operation?
❑ Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
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 kNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...............................................................................................................................................
Freeboard (inches):
5100 Continued on back

Faeility Nymber: I k — in 4 I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
.
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
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 maintenancelimprovement?
❑ Yes
�(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
NfNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
NrYes
' ❑ No
_Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
1 rNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
9No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
O 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
6 No
15. Does the receiving crop need improvement?
❑ Yes
KNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
CqNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�Mo
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?
iQ yiglal�iQr s:o dgfc�e +ties wire pQted d(rifg Ois:visitt. Y:oh witl•teiniye Rio i i thor : .
6riespo deiz& ab6 if this visit. . .
Use dravnngs of facility to better. explain situations. (use "additional pages as necessary)
3� a
KYes PfNat;�,-_
❑ Yes .Ef No
❑ Yes No
❑ Yes ONo
❑ Yes WNo
❑ Yes P No
❑ Yes gNo
❑ Yes ]E(No
vvk� tck
Reviewer/Inspector Name
Revfewer/Inspector Signature: Date:g �a�_o� $100

lFacifity-Number: Date of Inspection 0�
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 t<NO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, 0 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? E] 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.) 0 Yes KNO
31. Do the animals feed storage bins fail to have appropriate cover? El Yes RNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes �No
-Additionalz Comments andfo �P;;;�Ings:
AL
'\5
L"�,\e'X5 IX \5
4�A>
5100

F_ Facility Number 3 Date of Inspection _oc
Time of Inspection 0 124 hr. (hh:mm)
ermitted © Certified [3Conditionally Certified [3 Registered Not Opera tional Date Last Operated: „.............„_
[� t�
FarmName: ........Vlfe� "S V c Vi�........................................................................ County: ............ .............1........................ .......... .............
OwnerName: ................................................... ........................................................................ Phone No: .......
........................................................_.......................
Facility Contact:.............................................................................. Title:................... Phone No.
MailingAddress: ......................................................................................................................................................]....(..................................
.......
..........................
OnsiteRepresentative: }" ................. ` ....��`�:�........... Integrator:........i..."`!-r..............................I................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
........................................................ .......... .. ................ ........... ........ ...... T
Latitude ' A 64 Longitude • 6 46
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 KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes r( No
Waste Collection & Treatment
4. Is storage capacity (Feehoard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .................................. .................................... ....... ......... ....... ............ .............. ...................... .... ................. I .............. ....................................
5. Are there any immediate'threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ,Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

+' Faelility Number: 1 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
O(No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
b(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
DdNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
)INo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
bl'No
12. Crop type , Sq
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
dNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Ig 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
15dNo
16. Is there -a lack of adequate waste application equipment?
❑ Yes
DdNo
Reauired Records & Documents
IT.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
UNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yesio
(ie/ WUP, checklists, design, maps, etc.)
❑
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
M No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
J�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ONo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
10 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
gNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONo
No-yioiat.i66s:or deficiencies were noted diWi ig this: visit; • You will i•& H?46 iio futth& - :
correspo deiice: abaniti thf :visit_ ...
A,
Reviewer/Inspector Name
Reviewer/Inspector Signature: � ( I Date: 6-5

+� Farility Number: 3 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [-]Yes )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 �fNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? Cl Yes 0 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 fj No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes kNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes E�No
Additional, omments:an or rawings: • _-',
_nn ':: .� _ _ _.
[°
ku cr'L=�t'� ""'Q1
.{- ►�s� w�� � �•-�,�-�•� cs�e-tee. �-er-�-�.�,

Division of Soil and' -Water Gonservahon Operation Reveew
D Division of Soil and Water Conservation .Compliance Inssgection
Division of Water Quality :Compliance Inspection _
a� Other Agencyt Operation Review -
Routine Q Complaint O Follow-up of DWQ inspection Q Follow -tip of DSWC review O Other
Facility Number Date of Inspection
Time of Inspection 00 24 hr. (hh:mm)
Permitted © Certifie © Conditionally Certified [3 Registered 0 Not O era4ional.,Date Last Operated:
FarmName: ..... ......... iJ�1........................................................................... County4k�...---......................_...................
Owner Name: ...... „ „ , ........... Phone No:
Facility Contact: ................... ............. .................. .......................... Title:................................. ... Phone No:
Mailing Address: .......
Onsite Representative: 1� � !-- ....�Q Q4 ....... Integrator:......�.
Certified Operator: ................................................... ........................................... ................. Operator Certification Number:..........................................
Locatiorhof Farm:. I I f t . ( (", ;I _ % I _
h.........a..a .. ...y..Y/..L....}.....................................................................................................................................................................................
Latitude �• �� �•� Longitude �•°°
Design Current Design Current . --
F, Swine;:: Poulf
Capacity Population ry l - _` Capacity. Population Cattle'__
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current
.apacity Population '_
Number of Lagoons ®- ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field eil.
,Widen Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes kNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made.? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If ycs, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/tnin'?
d. Dues discharge bypass a lagoon system'? (If yes, notify DWQ) ❑Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �dNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [�rNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0No
Structure I Structure 2 Structure 3 Structure 4 Stnicture 5 Structure 6
Identifier. -
Freeboard(inches): d........................................................................... .........................................................
`�..... ......................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
3/23/99 Continued on back

Datv of' I nspection E:
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 maintenarice/improvement?
8. Does any part of the waste management system other than waste structures require maintenafice/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 E] PAN
12, Crop type U�. 5�h
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?
Z,
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?
.................. .........
61is,oir- iliffilde, .
............ 0. O(Wki this'visit: - Y64Will-teb hr dd fuirth&
9 ..... I ................
...................
c6ir�s�61ridenic, C'. abbiif th' ' i it' I ' * ' ' '
LS.VISI 1. .1 . . . . . . . . . . . . . . . . . . . . . .
0 Yes XNO
n(Yes E] No
0 Yes W(No
teak
0 Yes �gNo
[—]Yes �dNo
E] Yes gNo
El Yes ONo
[] Yes XNo
E] Yes R] No
ayes El No
El Yes XNo
E] Yes IM No
El Yes Of No
El Yes COO
El Yes 0 No
El Yes XNo
0 Yes C<No
El Yes WNo
0 Yes J�d No
[I Yes JVNo
0 Yes �ZNo
nentsm(refer to-',�questi6n,#): -Explain YES, aifiswers. and/oiNny- reco m'm —th,
endationsor--awo ercomments.-
nece�sary).
tawin&.i)f..fai�ity,to.-.Ntter.-tij�plain sitbations.luis�i additionalLuaims-as
V4
I t
t'4
�O�c�-, -A&-A vxejz� Vio tbjz-�,
A.
ReviewertInspecto: r NameFj��_7,=:��`
Reviewer/Inspector Signature:
Date: A6
fl 6NC1
3/23/99

ii.Nxifity Number: 3 — Inspection G
3 Date of
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 CKNo
28. Is there any evidence of wind drift during land application? (i.e- residue on neighboring vegetation, asphalt, ❑ Yes Of No
roads, building structure, and/or public property)
24_ Is the land application spray system intake not located near the liquid surface of the lagoon? Yes JX/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 [VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? )<Yes ❑ No
Additional` Comments an._ or rawin gs• =- _
� :� ro
e
r
3/23/99

Facility Number �3
Registered jn Certified © Applied for Permit Permitted
Farm Name: &. ........` '.. �Vp. ]�k, .... ui �..... .
Owner Name:..... Y=aS ........� .......... .................................
Date of Inspection
Time of Inspection 0.24 hr. (hh:mm)
Not Operational Date Last Operated:
County:....-. ................................... .............
Phone No; ....�`..�:.. 3?.`�..........................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...:....---....------..---.........................
MailingAddress....$ �......�Gac e1r..l ti.!............................................................................ ':k ...S�C S..{... ....................... .. X.V.2....
Onsite Representative:.......... ... Y.i .. a�... iti 5.......................... Integrator: .
I.........................................----.........
Certified Operator: .......................................... .. Operator Certification Number......................
Location of Farm;
Latitude =•4 it Longitude 0* =` 11
Desi' Current -
Design Current Design " Current
S,vvtne _
:
Capacity Population A Poultry :'
Capacity, Population Cattle Capactty.,:Populatton,
❑ Wean to Feeder
❑Layer
El Dairy
171 Feeder to Finish
q
_'
❑ Non -Layer
L 1
❑Non -Dairy
k'
❑ Farrow to Wean
Farrow Feeder
FEI❑ Other
'
to
Total Design Capacity_a
❑ Farrow to Finish
❑ Gilts
atal SS LW
[I Boars
Number of Lagoons / Holding'.Ponds ": ❑Subsurface Drains Present © Lagoon Area © Spray Field Area
w
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes [,a 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 ICJ No
c. If discharge is observed, what is the estimated flow in cal/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 No
5. Does any part of the waste management system {other than lagoonslholding 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 WNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes �W No
7/25/97
Continued on back

Facility Number: 3 1 — 33
8. Are there lagoons or storage ponds on site which need to be properly closed! ❑ Yes 0 No
Structures (Lagoons,Holdinc Ponds, Flush Pits, ete.M
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes VO No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:w�`............. .......Lac..............................................................................................................................................................
Freeboard(ft): ......... Z" z �. .......................... t..................... ....................... ....... ..... ................... ................. ... ................................. .
10. Is seepage observed from any of the structures? ❑ Yes J9 No
11, Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes P3 No
12.. Do any of the structures need maintenance/improvement? JJYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
r
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type .......... P' .uj..,L------------ �..... ..a�.ti lt/__...........:......... 5.1.--............................................---..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application`'
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail"to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit"
0 No violations or deficiencies were noted during this: visit. You will receive no further
correspondence A ou' t this.visit'.
)XlYes ❑ No
❑ Yes No
❑ Yes [J'No
❑ Yes (9 No
Yes No
❑ Yes No
❑ Yes No
❑ Yes O No
QI Yes ❑ No
Cl Yes No
❑ Yes No
❑ Yes 12 No
Co nments,(r4f r'to question#): Explain any YE S answers and/or any recortiinendaiions:4-any other comments
Use drawings of fuctlity t4 better explain `situations. {"rise additi��nal pats as necessarv). r x f f x
6xarkw rVA-V r1`ar+nuc�2r 3Lwin ljna
�Z. �nut,� l k�� iy` �,rtT tLtq(3QY� g�nou�f� p� �xf4�J�� p�Qr � C1r80t� Cci�� 10a�tif-' L'i{�c�
G(q� 4- rewerJcc}. .aat t 4rt&I a►. 5lw(A %e r_ve_y`,kj,
I�., rrlf�C„,,�11�%.t,r i,n/f1� 1drzC.�C. �f..a�cov� Slwu� tl I�4 PtS i aJ� � �Cc
I$. L.Cr\Ti�JL E�'iaY� � ;�,pvDve be.trtxUr��..
2� ja kcc.-for- Lr�1 1� e o �iuP�p+fi�`e` G � CYn�i 56A Lie- tJ`t', &-r -
�.�OriJS,
�J1 C\lob i5-3100 mac -, V2- 7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
_
Date:

0 Routine Q Complaint O Follow-up of DWQ inspection O Follow-ue of DSWC review O Other
Date of Inspection ij
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours �--�
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review J
Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated:... ....... _ .. ._.._......._ .......... __.... _...
FarmName: „ Ye.4...�....�.t.�....�t..x::�:�.................._......_..___............... County:.....al.�,.t�.,r.,..._...._......__....._._..., ..F.�,�.
Land Owner Name: .... ........... _.._ ......_ ...... Phone No -
Facility Conctact:.:.__............. .......... _ ............... ....`.... ... Title: ......... _........ ....... -. Phone No: taj. 5-L.1._Z.z....
Mailing Address: 5.__ gta.,cSs_Qnr.._ .. ..... �.w.... _......3�alr� fs.�,c.a.C...&,�.(� ........5
Onsite Representative:._, .. 7fl at..� .... _ _. Integrator- ..,4%.r _,.t.4.p...1a_
Certified Operator:7l,p! :...... ...... k�? }.5 ...._..... ......... _ .. Operator Certification Number:.
Location of Farm:
_..luau ) ti)1. _�i .� 3.._ .. x ,..xa�a c+. a ... _..aor, i l_e.... L�.. ..._ 1 * . -I
�t p.an......kj.1±k,.__.,� -.��. ......... .. .. .......—.
Latitude Longitude �'] • �•F I 1'
Type of Operation and Design Capacity
Design ' =Cu eot k Design Cori ent , Des gn -: Ctirrettt `>.
Swine Pont ._. f>�. ,
elation tTy =,�°Ca act . Po nlateori . CatEle w Ca actPo ilatio
❑Wean to Feeder
❑ La er ❑ D
3
❑Non -La er 1 ❑ Non -Dairy
Feeder to Finish
Farrow
Total DesignCapacity
f
i b
-:-.- -,..;�,ir ..u�•. -,„n �>�:. a
Farrow to Feeder
Farrow to Finish
❑ Other
. �`^a. - "Y: ,.,..,.>, '::':E'7-:
,:: .:rossa <.,.,
,: ,.::,,,�:,,,. .rya
Number ofL goods I Holding Ponds ❑ Subsurface Drains Present ,
ri n
,A
Lag on Area pray Field Area
o S
QeneLaj
1. Are there any buffers that need maintenance/improvement?
2_ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30
19 7 maintenancelimprovement?
® Yes ❑ No
❑ Yes B No
❑ Yes 4S) No
❑ Yes R1 No
❑ Yes
® No
❑ Yes
® No
❑ Yes
No
❑ Yes
KNo
Continued
on back

Facility Number:..31...... —.... 3,
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 ® No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (Lagoons and/or Ifoldiag Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes J,No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes jo No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
RLYes
❑ No
12.
Do any of the structures need maintenance/improvement?
R[ 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
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type i_-------- .L..u.:'.:r..... _................ -
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[9No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
Ef No
18.
Does the receiving crop need improvement?
®,Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
KNo
20.
Does facility require.a follow-up visit by same agency?
❑ Yes
JR No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
E[No
For
Certified Facilities OnLy
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
,MNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
24.
Does record keeping need improvement?
51 Yes
❑ No
,C- OMtoyquest�an'#,tj Expiam any YES,answersand/or any recommendations'ar any'other comments '
Use drawzrigs±of facility to letter ezplam s�tuat�ons: {use aiidit�onal pages as nec�s�sary) k - � � ` x� � �-
t . D 'I s C'*- vw -e-, 5 V-" i d-t.. vro ! s ,r,., . r 8 1 O +-a o i [ Q-4 r1F
e, t v' e, eti, 4� t.a.S �`Z' a --A, t d. b o 'a'4' .
4
. rr
i Z. C e-t a 10 Cry + I� C
it I. 1 r i C? vL� C-o ,r-ev e—d s r d o 0 d, r-a , t1.► V,
o� �� -e. T, a s
rr
p C, y^ 4$ 2-. AL S C � -r' 1 ` � h f"0 S ti O"Y` C'U s O, e
v 6 11 Z o --� 'r eiv f +£ , R, t.v
v
�t-'t_S 1
cL 1p' a v1 w ck S of 1 o-v,n �f
8 CO r r e C-t w e a-d pro 6 1 , 4. b e r-v,-• v d-A-
y 6-r C " Yr v tirn v, -- c r 4k e l d
Reviewer/Inspector Name' `. HINE..• �<« f':y
Reviewer/Inspector Signature: dp Date: y q
cc: Division of Water Oualitv. Water Ouality Section. Facilitv Assess ent Unit 4/10/97
' w[ V

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
iDATE: '� , 1995 ,
Time:' 3FZ
Farm Nance/Owner: �1 ��N -t� Z—V•e._, t /vMailing Address: Address: Z& V// f
County:
Integrator: Phone:
Od Site Representative: Phone:
Physical Address/Location: .
Type of Operation: Swine l/ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° �' Longitude: 9 1 ° 'I'F ' . Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Desor No Actual Freeboard: .2-- Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adeauate land available for spray? Yes or No Is the
cover crop adequate? Yes or No
Crop(s) being utilized:(.
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 'e or No
100 Feet from Wells? 1s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or Vo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or IQo
Is animal waste discharged into waters of the state by man-made ditch, flushing system-, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste- management records (volumes of manure, land applied,
spray. irrigated bn specific acreage with cover crop)? Yes or
::Additional .Comments:
1 -
Inspector Name
Signature
s.
_ -cc:"Facility Assessment Unit Use Attachments if Needed.