310362_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Quai

Type of Visit: Q Coroutin
ce Inspection V Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: e 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: Utzc y S '-' 4 4 Integrator:
Phone:
Certified Operator: Certification Number: 1 ? 6 1 T
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design
Wet Poultry Capacity Pop. Cattle C+apacity
Layer Dairy Cow
Current
Pop.
can to Feeder I
INon-Layer I
Ell
Dairy Calf
eeder to Finish L '1 q
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design C**urrent Dry Cow
D . P■Dolt , Ca aci_ P.o _ Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other LJOther
Turkeys
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
6 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
FNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

FaciliNumber: _ Date of Inspection:
~Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EfNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):{
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen I threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o ❑ NA
RNo
❑ 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
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesVNo
❑ NA
❑ NE
Required Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
jNo
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
[:]Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stacking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
- ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L_J '�� ❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facie" Number: jDate of Inspection: L 9 r
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes dN0 ❑7NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ffNo ❑ 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 0 /No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes ONo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes FNo
. ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ 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).
C� rr'C C.r
Sq r~ "✓C' S Ale 0 �j — l4 7 70 Z �G
�C4-(I�
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: [phone]ny
Date: 2 7
21412015

Type of Visit: Co iance Inspection Q Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit�Ro itine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of,Visit: l 1 L U Arrival Time: 00 Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: lfi 17
Certification Number:
Longitude:
M@ffffciHop.
Design CurrenSwinety
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
airy Cow
Wean to Feeder
Non -La er
airy Calf
airy Heifer
eder to Finish b >
0
Farrow to Wean
Design Current
D . P,oult , Ca aci P,o ,
D Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Layers
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I Beef Brood Cow
EL_L(Lther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Q'No U NA ❑ NE
❑ 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
[]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ENo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ala
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3
21412015 Continued

Facility, Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)
Structure I Structure 2 Structure 3 Structure 4
-3 Z-- M )
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?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Ed No ❑ NA ❑ NE
f
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) J
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 FL] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect t
application? If yes, check the appropriate box below. Yes [] No ❑ NA ❑ NE
Excessive Ponding draulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
12. Crop Type(s):
❑ Yes ❑�o ❑ NA ❑ NE
❑ Yes ][/No ❑ NA ❑ NE
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LJ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
] No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
/
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
6
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ffNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease' Agreements
❑ Other;
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
No
❑ NA
[] NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspect'
El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
� o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: '3 I - 2 (, Date of Inspection: O
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [3-No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2 Tqo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑1lgo ❑ NAB ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑4VA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[3No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
! No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
Ej 1 o
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
❑ No
❑ NA
�TE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E:[—No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
FErio
❑ NA
❑ NE
icevieweninspector iName:
Reviewer/Inspector Signature: �i���` l Date:
Page 3 of 3 21412015

.4z
(Type of Visit: 0Co ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ! Arrival Time: Departure Time: t--1�-z—J County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: %62 �111
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
s
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
ILayer
Cattle
Dairy Cow
Design Current
Capacity Pop.
to Feeder
I
INon-Layer
I
Dairy Calf
'Feeder to Finish
34 7Z,
QplJ
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D , P,oul , Ca aci P,o _
Dry Cow
Non -Dairy
Farrow to Finish
ILayers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes El"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N ❑NA ❑NE
[3 Yes [jNN ❑ NA ❑ NE
❑ Yes L No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - 7 Date of Inspection: (P 11 7/J
r'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
To
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: �� 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑"1 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
❑ Yes
It,d,
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[:]Yes ff No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes La'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 eNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes ❑ No
❑ NA
❑ NE
E 6essive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
p❑
AN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑-Koo
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E:J�qo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
]["No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E3 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Othe :
21. Does record keeping need improvement? If yes, check the appropriate box below. Eryes [—]No
❑ Waste Application ❑ Weekly Freeboard []Waste Analysis 0 Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes El� o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ONE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: N3 I - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes Ej< ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Q NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes []-go ❑ 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 L'J No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes EfNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EfNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ffSNo_ ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes E No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
7 If 0"F00 tl `cd� Rye jb5 Owe f—CA-4wo
t welt io
r\ Zane- S/ G, -1Le A>� re,►��-,,,. � H,� �°� ��► fs �� upP�y � � rc�
P4K
p a,�- r�; r �- �,�+�;� 3 Q �1 yso� ; rrl, u'o�t 9�� adz
tv- pr 9 o4 L lD [` f o- Y s X.
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I r(9 ;77 j(7?aY
Date: r 9Ll
21412014

Type of Visit: C-plompliance Inspection0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: 5WArrival Time: eparture Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator ply
Certifica Numb
Certification Number:
Longitude:
Design Current Design Current
Swine cli =pacify Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
DairyCow
Dai Calf
Da' Heifer
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oul C•_a aci P,o P.
Layers
D Caw
Non -Dairy
Beef Stocker
Gilts
Non- ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other�]�M
=I
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
15No
❑ NA
❑ NE
❑ Yes
PE� No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) [:]Yes E�rNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [:]Yes ZfNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes P�`No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -�
5. Are there any immediate threats to the integrity of any of the structures observed?
[:]Yes [:]No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑.Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes D—No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E2No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
FyNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
;ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Cg-No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check appropriate box below.
Or Yes
[] No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
eNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
E3<o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: jDate of Inspection:
24. laid the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes jEf`No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fFNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yesj�j'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes :3'Ro ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ErNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes _AETNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes FZ(No ❑ NA ❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facilitv to better exulain situations (use additional Daaes as necessarv).
11.27)IV
Reviewer/inspector Name:
❑ Yes [2'No ❑ NA ❑ NE
❑ Yes allo ❑ NA ❑ NE
❑ Yes_j2'No ❑ NA ❑ NE
❑ Yes jallo ❑ NA ❑ NE
P'P" t, ww-rl w3 . 6C
,Sure,_ 4, j�r,! j,aSGv6z/--
Yin
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
I
Date:
21412011

Type of Visit: QL,eompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: JMutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,� 0' 7 Departure Time: County: er /. Region:
Farm Name: `l/r'� _ _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: G t
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
on -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oultr. Ca aci P,o .
Lavers
DairyHeifer
D Cow
Non-Dai ry
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes xf No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
E6 No
❑ NA
❑ NE
[:]Yes
�?No
❑ NA
❑ NE
Page I of 3 21412011 Continued

FaGility Number: - Date of Inspection: Z
W Iste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ yes ❑ NA ❑ NE
Stru_--__,� StrucStructure 3 Structure 4 Structure Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to -the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(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 C'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes [],No
TF—INo
❑ NA
NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
7"
9. Does any part of the waste management system other than the waste structures require
❑ Yes Callo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes W No
❑ NA
❑ NE
maintenance or improvement?
1 I. Is there evidence of incorrect land application? If yes, check the appropriate box below;
❑ Yes [�fo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes .10No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 'ONo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes p]-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
_;2"No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
P�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
jfNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections [:]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes &No ❑ NA ❑ NE
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? ❑ Yes Zf No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection la
24( Did, the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2fNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes -F2`No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW? P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[]Yes EfNo
[:]Yes ZT No
❑ Yes Zj No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes Z) No ❑ NA ❑ NE
[3 Yes Z] No ❑ NA ❑ NE
❑ Yes
21 No
❑ NA
❑ NE
❑ Yes
2) No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
[—]Yes
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
1J
�?//3// 3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�.3V
IM
Q C) Ic
s
Phone:
Date: 'e L lD
214 011

� +Division of Water Quality
Facility Number -31 - 3 (oo� +O Division of Soil and Water Conservation E/
O Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[season for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j l Arrival Time: © Departure Time: County:
Farm Name: Wl Owner Email:
Owner Name: (SA CA S A/k- I T« Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: J m / 114
Certified Operator: 0 9_ JA AAA17H
Back-up Operator:
Phone:
Inte rator:
11
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
9C99-4
Design Current
Swine Capacity Pop. "
Design Current Design Current
Wet Poultry C+apacity Poi. Cattl�e(-- apacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -Layer
Da' Calf
Feeder to Finish
Farrow to Wean
Da' Heifer
Design Current D Cow
I) , P,oult , Ca aei_ P,o , Non -Dairy
I 113eef Stocker
Non -Layers IBeef Feeder
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
I Beef Brood Cow
er
er
tTo"ther
urke s
urke Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes *No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes o ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Fac,ili Number: - 7& 1 Date of inspection: f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 9No ❑ NA ❑ NE
Structure 1 Structure 2- Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I O�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): " 1 5 3 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?
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
O_No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C6,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): — V_L )) Ces ct C— 6� 1 1"y 1 Lt_ LTT ( 6) 2� 66 1
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
MNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP QChecklists r7l Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
Q Waste Application [3Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ Waste T ers Q Weather Code
❑ Rainfall ❑ Stocking ❑ C//P Yield Q 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: l - 3 (0 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No ❑ NA ❑ NE
0
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No VkNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require afollow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments::_::...:, L;
Use drawings of facility to better explain situations (use additional pages as necessary).
Ulf
�o 6 E S �>l:� ) s e x E µpT
S 7 1-�1✓ C>A �'-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�c ao y�>
�pa c� G� c�A C CaolA
S �
Phone: 916-) %-?
Date: ( 0 ID / //Z
2/4/ 011

(Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit fiYRoutine Q Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: ✓C- d Arrival Time: Departure Time: County: Region��
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 6�1.y.
Certified Operator:
Back-up Operator:
Phone No
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = 4 = {! Longitude: = ° = ` = "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
pty p©ultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
Pullets
❑Beef Brood Co
El Turkeys
Other
❑
❑ Turkey Poults
❑Other
Number of Structures
Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility,Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 12rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LEI No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
;
a
21.
Does record keeping need improvement? If yes, check the appropriate box below.
[I 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"
9
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ffNo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ET�o ❑kNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ErNo ❑INA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
9Yes ❑ No ' ❑ NA
❑ 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?
[:]Yes �aNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ;R'No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Jallo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
,ET -No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
[:]Yes
2-No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
4fTNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
f��c�orl ors new. �- cr c '(
�veb-
;
G//a . �-
� 3 4 ?
t4 j1—
3 I,h�
s rew��
_ �. ,
rsf s�
Page 3 of 3 1Zia45iv4

Type of Visit f 'CCommpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D , Arrival Time: �Departure Time: County:
Farm Name: ��,�- f�/✓f'Yl Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator; IF Z43
Operator Certification Number:
Back-up Certification Number:
Region: 4j/
Latitude: = o = 4 Longitude: = ° = ` [= `4
Design Current
Design
Current
Design
Cnrrent
SwineI Capacity Population Wet Poultry
Capacity
Population
I
Cattle Capacity
i Cow
Population
❑ Wean to Finish 10 Layer I
❑ Wean to Feeder ❑ Non -Layer
iry Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Layers
❑ Farrow to Finish
El Non-Laers
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cowl
I
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ILI Other
Number of Structures:
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?
❑ Ye sx] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
❑ NE
❑ Yes
❑ Yes
/,11'No
<`
❑ NA
❑ NE
❑ Yes
[ Wo
❑ NA
❑ NE
12128104 - Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2r]Vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 7No ❑ NA ❑ NE
Structt;t e 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O'No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes fNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Z-No ❑ NA [I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V]rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CA WMP?
❑ Yes
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[(No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
t1adX '5 -o
slime s��v
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: P
Page 2 of- .f 121Z61U4 continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YesZrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E .1 o
❑ 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
ONo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LNo
❑ NA
❑ 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?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[?CNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
1[J No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�No
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
VrNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E7'Neo
❑ NA
❑ NE
Additional Comments and/or Drawings:
'2 8'
/�� (', /0 Y 0
12128104

vision of Water Quality
k�ac>Riity.Nutntier/ 0 Division of Soil and Water Conservation
$� Other Agency
4 �
Type of Visit Q<o'mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,,(�Routine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: tj /La g; �j Arrrivaal�Ti^me: 0 /V 0 Departure Time: County: Region:
Farm Name: C 5 d/ tT r�� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: =' =' = Longitude: [=] ° =' = «
Design "Current Design Current
Swine Capacity ,Population WetPoultry Capacity- Population.
❑ Wean to Finish ❑ Layer j
❑ Wean to Feeder . ❑ Non -Layer
Feeder to Finish C3
❑ Farrow to Wean Dry Poultry
❑ Farrow to Fceder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a- Was the conveyance man-made?
Cattle
Design Current:'_
Capacity. Population.
f''
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
M
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes 4 No
❑ Yes
ON.
❑ NA
❑ NE
❑ Yes
�N.
❑ NA
❑ NE
12128104 Continued

Facility Number: , I - Date of Inspection / O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [�,No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): l
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes J2 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes; and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑+No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,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 fo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
l0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2TNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J`No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Z� No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes X No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �No ❑ NA ❑ NE
,Comments (refer io question#): Explain any YES answers and/or any.recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages:as.necessary)
Reviewer/Inspector Name i t E"C I Phone:
Reviewer/Inspector Signature: Date: / G�
Page 2 of 12128104 Continued

FacilitXNumber: 31 -- Date of Inspection 3 /
--I,-
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes .El No ❑ NA - ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 10Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections,,ETMonthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ErNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
J9 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes)�Mo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ZrNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ETNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
/,
31.
Did the facility fail to notify the regional office of emergency situations as required by
ElYes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
lid No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VJ No
❑ NA
❑ NE
Additional Comments and`/or Drawings:
�f `Cl!� �G l/�C�t �;�/�✓ � �! �!`r �l � lJ'��G ire r
.,
Page 3 of 3 12128104

r
Type of Visit C(Com ance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of Visit: to Tune:
Facility Number
10 Not Operational 0 Below Threshold
Permitted cer
tified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ...... ._... County:.....i/IJt,T�I' +1. ....... .........
� ... ....... ......
OwnerName: --. ._._. �......��........................... _ ...._ .. W.W...�... Phone No: ..._..........
Mailing Address:.._ .............................._.........._. ....�_� .
Facilitv Contact: .._ ... �. + ....._ ........_ ....._ ...... Title:.._....__ ._ .... ..._.. Phone No:
Onsite Representative: U A Ry s±� Integrator:
Certified Operator:._...._..__,...---�........ ..... _.. __._ _ W_......... Operator Certification
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * 4 44 Longitude • 4 «
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
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Ta
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: _...� ............. Z..... _ .. ...._...._.....-- _. .--
Freeboard (inches): ✓� 7 U
12112103 Continued

Facility Number: — Z 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 ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes VNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes WO
elevation marldngs?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑Yes 10
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type F�ESt-UE C G') __ i2> CVnnviDA (G) S&O 1-11
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes Ko
❑ Yes L <10*
El Yes L7 No
❑ Yes l o
:Comments {refer td gnes�on #) F.zplarn auy YIa.S answers aud/oir any recomnee�atonrs ashy other comment '
__ eld Copy
=Use drawings of facil,ty to better cx�►laeu sttuattions. {usi" tionai pages as necessary)i Fi ❑Final Nates -
_ Kw=
kECf COP oC AN"1111L CEQLT FCL�RECo"-5.
2,src�ftAS NOD
-
T
Reviewer/InspectorName
Reviewer/Inspector Signature: Date:
12112103 1 1
Continued

Facility Number. —36 Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes No
❑ Yes LLF o—
❑ Yes
❑ Yes
0.90
❑ Yes
❑ Yes
To
❑ Yes
❑ Yes
❑ Yes
❑'No
Now
QN-10
es ❑ No
❑ Yes �ro
�ElYes
❑ Yes 3<,O
❑ Yes [ hi
❑ Yes o
12112103

Type of Visit QLCompliance Inspection O Operation Review ' 0 Lagoon Evaluation
Reason for Visit -Routine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Late of visit: Z Time: DEFacility Number
10 Not Operational 0 Below Threshold
M Permitted © Certified Q Conditionally Certified 0 Registered Date Last Operated r Above Threshold:
Farm Name: `F+ 6 Ff m Countv:
Owner Name: 6MI Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: Wit/
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 u Longitude
- __De§ign Current. _ W Design= �Currept' _ Design Curivnt-
outteSwine Ca aciri Po alattaii � aaco ulatiati
❑ Wean to Feeder JEJ Layer_ ❑ Da
Feeder to Finish ❑ Non -Layer ❑Non -Dairy
1:3 , J
' ❑ Farrow to Wean
❑ Farrow to Feeder ❑Other _
❑ Farrow to Finish T©tal Design Capacih _
❑ Gilts
❑ Boars Total ssm
Number of Lagoons ;© ❑ Subsurface Drains Present Lagoon Area ❑ Spray Field Area '
Holding: Ponds ! Solid Traps ❑ No Liquid Waste Management Svstem
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes MNo
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) El 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)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
Freeboard (inches): YO 37
05103101
❑ Yes ❑ No
❑ Yes KNo
❑ Yes allo
❑ Yes allo
Structure 6
Continued

Facility Number: 31 — Z
Date of Inspection y--"If
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, notif- DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes S.No
❑ Yes RLNo
❑ Yes [.No
❑ Yes P9 No
❑ Yes r No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes P3No
11. Is there evidence of over application? ❑ Excessive PonddiCingg ❑ PAN ❑ Hydraulic Overload ❑ Yes �LNo
12. Crop type r -'16k t-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N 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
CA -No
16.
is there a lack of adequate waste application equipment?
❑ Yes
Q�lNo
Required Records &_Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
CK No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ )&UP, checklists, design, maps, etc.)
❑ Yes
5E No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
N Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[Z No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
KI No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes V] No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ® No
24. Does facility require a follow-up visit by same agency? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes t4 No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Conlineats (refer<to:questio`#j Explainang YES $ns�ers andloreany recammenilaho©s or anv other oonments.-
6se drawings of.facpits to better.explatn situa#tons: (ase iiddtttonat pagesyas necessary) 2" El Field Copv �❑ Final Notes
4!9 At #141rt� Gd+'�4ov-t V1, f.�fao�l sA*,#/00, �Qsulf C f�k/sr� Al.
resa N-f �a nt ka%cf� 154P 14-10 0 1
Reviewer/InspectorName G ,
Reviewer/Inspector Signature: Date: t7 � .Z
05103101 y Continued

[Facility Number: 7i Date of Inspvciinu
Qlior Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes UNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N.i\To
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes S:No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �6No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s)> inoperable shutters, etc.) ❑ Yes �§-No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a perntanentitemporary cover? ❑ Yes & No
05103101

r - *Di
r z
aYISIOri of Water QUall r P v
i
rr _ Water C .O,DinsioOnservatlorl
D Other Agency
a €,
,Type of Visit - Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ;;Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 5) 3 Z Date of Visit: I
Permitted [3 Certified E3 Conditionally Certified [3 Registered
FarmName: ...........6 P...1..`.'^!n........................... ........ ...................................
Owner Name:.......... tE r... ................. ���.�
Facility Contact:
Mailing Address:
Title:
'L Time:
Not Operational O Below Threshold
Date Last Operated or Above Threshold: •........................
County:..
.'1..................................I...............
PhoneNo:.......................................................................................
Phone No:
Onsite Representative: ...61t Sr,.,..t.`............................................................ Integrator: ,,• V f.r_" '.--a../!.5......................
........
Operator:................................................................................................................ Operator Certification Number:.. "................... I...............
Location of Farm:
Swine ❑ Poultry ❑ Cattle []Horse Latitude ' 4 &6 Longitude • 6 .i6
_' Swine
Current
Ponnlatinn
❑ Wean to Feeder
Feeder to Finish
3107 7—
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
LEE]
❑ Boars
Number of Lagoons 2—
HoMing Ponds / Solid Traps
Design Current;Current
Poultry Ca aci Po ulafioil Cattle Ca - ii ty
=' Po ulatio --
❑ Layer PO
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total; Design. Capacity
Total SSLW
❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts '
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation? .
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .................. I. ............... .............. .�.......... ................................... .......... .......................... .............................
Freeboard (inches): 2 Z
5100
❑ Yes gNo
❑ Yes ' 1No
❑ Yes ;ffNo
r�
❑ Yes ;'No
❑ Yes No
❑ Yes No
[]Yes ,j No
Structure 6
Continued on back

Facility Number: 3/ — 3b Date of Inspection Printed on: 1/9/2001
f 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?
El Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes )dNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ 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 maintenancelimprovement?
❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
ElYes P'No
12. Crop type b vv� ZQ Q. SG U e y)n,Ze I / gr4 ; .1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes Q No
b) Does the facility need a wettable acre determination?
❑ Yes XNo
c) This facility is pended for a wettable acre determination?
❑ Yes VNo
15. Does the receiving crop need improvement?
❑ Yes 10'No
16. Is there a lack of adequate waste application equipment?
❑ Yes Q'No
/
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
/VNo
❑ Yes ;�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes )ZfNo
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 i No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes PNo
-yioiatioris'o deffcienctes were a4te4 during �his;vislt� - Yoit wd j-teb ' iye o futther' .
• correspondence. about this 'visit-'-'.'
Comments={re%r to question #) � Explain aiiy YES answers and/or any recommendations or' other _
yUse drawings of facility,to better:. ezplaigsifuations _ nse additional es as'»e�sar} s
{.: p
r'Q GD.rO� S qre tie �j kr?�, 6 fe l ],.�,e c.GGOr6f ;�. �p `
}
Reviewer/Inspector NameD T!
Reviewer/Inspector Signature: Date: Lf_ smo

Facility Number: 3 ] — Z Date of Inspection Jilb0 �
der issues
t
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ .Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
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 ONo
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 fi3!No
31. Do the animals feed storage bins fail to have appropriate cover? El Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? []Yes (:]No
Additional-_Cornments.an or rawings:

- = Dive on of Soil andzWater Conservation 71erahoWlkevu
�` Ihvrswn of Soil and Water Conservation Compliance Ins
_��Dmsion of ►'Va[er Q�a11ty Compliance Itispeetion _'"
OR Routine tD Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection y-- T
Time of Inspection 24 hr. (hh:mm)
0 Permitted Certified PConditionally Certified [] Registered 113 Not Operational Date Last Operated:
FarmName: ......G.................................................................................................. County:...... ..1�%�1 �'1...................................................
OwnerName:............................................................................................ ........... Phone No:..........................
FacilityContact:......................................•----................................... Title:................................................................ Phone No:
Mailing Address: ....................................
Onsite Representative:. ...........................................
..-----• Integrator:...... `s............................................. ..
Certified Operator:................................................................................................................
Operator Certification Number:............................. ......
Location of Farm:
Latitude 0 ` « Longitude 0 ° 46
Design Current .y ; "
- Design Current y Design Current ,
Ca achy.=Po Mahon'- .Poultry
Ca achy_ aPo "`ula6oa._ . Cattle a _ ...Ca aciPo-Mahon '.
- ,
❑ Wean to Feeder
'
❑ Layer
;,'
❑ Dairy
Feeder to Finish
r
❑Non -Layer
° `'
❑Non -Dairy
❑ Farrow to Wean
='
El Farrow to Feeder
: = ❑Other
- - r:
Farrow to Finish
Total Design Capacity
-
❑ Gilts
it
❑ Boars
Total' SSLW
r:
,..
:.
Niirnber;of Lagoons _
❑ Subsurface Drains Present 11OLagoonArea
❑Spray Field Area
;
Holdling;Ponds / Solid -Traps = ; ❑ No Liquid Waste Management, System d
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 Watcr 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 C_iT No
3. Were there any adverse Impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes QR No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): OQ ................. ....
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes (XNo
seepage, etc.)
3/23199 Continued on back

Facility Number:3 -- 4?, Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
b6o
closure plan?
❑ Yes
(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?
ff Yes
❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
r[ rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
XNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
el�fNo
11. Is there evidene of over ❑ Excessive Ponding ❑ PAN
ElYes
JVNo
clication?
12. Crop
type S
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
9No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This -facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
Oyes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
dNo
Reouired Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
�(No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
KYes
(ie1 WUP, checklists, design, maps, etc.)
❑ No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
OYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
5;rNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
;5No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
KNo
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
ElYes
[ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N No
0: Ito •yi61afi6fis;or• &ficierictes •*&ie hogs(l• OtWiijig �bis'visit. • ."ii will •i•eeeiye iJ6 ftifth
cories�6Tidence: a�' f this :visit:... . .
Comments (refer,to gaestion #):"'Explain any YES.answers and/or;any recommehdations"or, anyotHer:coniments
Use drawings of facility to better explam situations. (use addition pages as necessary)
Are
r
Reviewer/inspector Name AY
Reviewer/Inspector Signature: ���� Date: - �� QCl

Facility Number:3 —rMa�- Date of Inspection 1 17 00
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond dr lagoon fail to discharge at/or below KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Q(No
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 4No
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 �' O
31. Do the animals feed storage bins fail to have appropriate cover? ❑Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes qNo
'Additional -_Comments an or' rawmgs:. : ' ,, —
k,�
s
('l�� st� C�e�►- C��d�r+tG}•Q.k cQ�1��'1�c� lit C.�� ,\ 4•`�s 7 G��.�,
vv 7
�F
,L-.. s
cv
IC
JL
• V R( �i1
�� SD \` 7a,7
S-k

f y © Division of Soil and WaterConservation 'aOpaaration Review
µ vision of Soil andWater Co
nseiyatron MCompl�ance'Lyspecticin
Division of Water Quality'-.Compljanee inspection _
;� Other Agency = Operitio Review
my
JQ Routine 0 Complaint 0 Fallow -up of DW2 inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 a Date of Inspection _ -_`N
.._ .. _ Time of Inspection ® 24 hr. (hh:mm)
Permitted 13 Certified [3 Conditionally Certified 0 Registered 113 Not Operationaij Date Last Operated:
FarmName: .....1 _Al)' ................................................................................................. County. .............ey It'1................................................._.._.
Owner Name: ............
Facility Contact: .............................................................
Flailing Address: ...............................................................
...................................
Onsite Representative:
Certified Operator: .................................................... ........
Location of Farm:. . . r 1 t
Phone No:
... Title: ................................................................ Phone No: ...
.......................................................... ..............j............................._ ..........................
.................. Integrator:...... ki-jo.' �.........................
......................
..
....•...........• Operator Certification Number:...
`y...........................................................................................................................................................
Latitude Longitude
Design Current
Swine. „ _ Capacity Population
❑ Wean to Feeder
Feeder to Finish
a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
i Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
H61abi -Ponds' ].Solid°Traps ., ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does, discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes %No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
jNo
❑ Yes
U9 No
❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ......... .................................................. ................. ................... ................................... ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes Wf No
Continued on back
3/23/99

Facility Number: 31 — 36a Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of overapvlication? ❑ Excessive Ponding ❑ PAN
12. Crop type
0
[&No
❑ Yes
❑ Yes
Z No
❑ Yes
[�(No
❑ Yes
O�No
❑ Yes
0 No
❑ Yes
U(No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio yiolafi6ris:or• d flcientke were ngtec during this:visit; Yoif will reeeiye Rio i'urthe
corres• oiide** * abmit: this visit.. . ::: :
❑ Yes Wq
❑ Yes —" No
❑ Yes No
❑ Yes 9No
1-1% ❑ No
❑ Yes VNo
❑ Yes K No
❑ Yes XNo
VIYes ❑ No
❑ Yes Wo
❑ Yes 56 No
❑ Yes V No
❑ Yes 9f No
❑ Yes � No
❑ Yes 0 No
Comments (refer aagnestion #} 'Explain any YES answers and/or aQy recommendations or any other comments; . :_.
Use;drawings of facility -to better explain "situations (use additional pages as necessary} µ -
cep
� S ��1 �C C ^ t � V�Cd•,-.t� �G Ci� l� � � � � 1 II
�.G ,�
"CLe ar
QQA
Reviewer/Inspector Name `
Reviewer/Inspector Signature:
Date: , Z 1
3/23/99

Faeiljty Number: ?,,l — Date of.Inspection
r'
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below Yes Q No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
29_ is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes j�"'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or '� 11
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes WNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes *No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
Additional. Comments,and/or awin -.-
-•rsue ��s C�: �� ����
J
3/23/99

Facility Number 31
© Registered [A Certtified 0 Applied for Permit* © Permitted
Farm Name:................1 1 ... ..... �`.:4+ ........ ...............
Owner Name: ...................... . ..... +
Facility Contact:
Title:
Date of Inspection /.
Time of Inspection I V Z6 24 hr. (hh:mm)
0 Not O erational Date Last Operated:
County:....................................................................
Phone No:...... On.kn.'..3f.7..Z......................................
Mailing Address:.--- � �......1� ..... 6�rr..4.`1JC.....:mod............................
Onsite Representative:............... Veil.......: i'.k..............................................
Certified Operator. ....................................................
Location of Farm:
PhoneNo: ...................................................
.......... ...!............................................... ...-MIr........
Integrator: ........11 ...........................................................
Operator Certification Numbers .........................................
dcQf - 3 R.S. ....4..... 7! 2:............... ...................... �
• .I ................. ...................................................... T
Latitude Longitude
Design Current Design ,Current
Gapaeity
Population -
=n ❑ Wean to Feeder
Feeder to Finish
j
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry ", - Capacity Population Catt
... ...._.. .
Design Current
w _CaoacitV ,:Pontilation
LW
❑ Subsurface Drains Present [:]Lagoon Area j❑ Spray Field Area
❑ No Liquid Waste Management System -
General
1'. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes; notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is fatality not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [9 No
❑ Yes ® No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
® No
❑ Yes M No
%Yes Op No
❑ Yes [� No
❑ Yes I� No
Continued on back

Facility Number: — b2
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,lloldingPonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier: t 7—
Freeboard (ft):.............1.1...................... ... 'Zr..............I......... .... .................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed!
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers''
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type .................�t .rmu&..,.............. "'0._.............. �tt�a L�......�"��i3
Cl Yes (INo
❑ Yes W No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW,MP)?
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''
... ....... I ................... I........
❑ Yes CA No
❑ Yes q No
0 Yes ❑ No -
❑ Yes
Rko
❑ Yes
X No'
❑ Yes
No
❑ Yes
No
0 No.violations or defcieneie's.were note'd-during' this.visit.- You.will receive no further
correspondence ii oiit this.visit:
PP Yes ❑ No
❑ Yes ($j No
"Yes ❑ No
❑ Yes PD No
4Yes ❑ No
❑ Yes ® No
❑ Yes P3 No
❑ Yes 0 No
Comments (refer'to;questeon #) Explain any.Y`ES'answers and/or aty recommendations or any other comrnents:�
Use drawings offocihty tohetter explain`situations. (use' additional, pages`as necessa~v}`'
I � �w 3 � a� �0`�- i Wj(3o►ti �i� GJa-L� S SI.oU�� �� vr.�es��,
�g. �erMvda� S�aute� �e i� Yovf t�. `5,►Y4 YWK S kou[3 �e_ reward P SkJi►L) o�
6-,Mu6O_. _ReM o-- ►xa+� �.�..t1 4to Ise K-S�ri
7z. RQ�� � r,-, tf- `97 1kQU J be- c r`�� � . lk— corrc.&
Show %1e. -se fir\ Sp r�Crnr45,
�
7125/97
Reviewer/InspectorMame " —
Reviewer/Inspector Signature: ad&— Date:

10 Routine Q Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number Date of Inspection 3
Time of Inspection D 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
Certified ❑ Permitted jor Inspection includes travel and rocessin
❑ Not Operational Date Last Operated: .... . .... ...: �. ...
Farm Name: ar .. ... a � . �rx.t. i.xa c .....__... _ _. County:_;?., r�. La ar..... ..... w.... i�1� _U2.
Land Owner Name:... �J w ... _.... .3or►. t ! .... �.... _ ...........-........ Phone No: - ........................
FacilityConctact:... _.. ..... _ ............. Phone No: ........................... Title: ....... .......... ...............---�•--- ---•-............,.......
Mailing Address:
Onsite Representative:... . .... Integrator:. l�L �1.w 1r.�17"­
_.... . . ....._ ..... .... .. 1..._._....
Certified Operator:... tEary............. ..... � ......�{n t�.. .... ,..........�...._ .. Operator Certification Numbe
Location of Farm:
......
_„ 4............_.... ............. ....... ........_...... ......_
......_......_........ ......----..--------__-------
�y
Latitude ?5 ' fl2 ` Longitude ®' 4 14
Type of Operation and Design Capacity
F-MrSwrne
Design Gtirrent Desi Carrent Design `..Current
.... _,
xa.• Ca aci , APo ula#lon 5�Poult'y Ca aci Po ulatton Cattle M..Ca aci Po"ulatioo
❑ Wean to Feeder f ❑ Layer ❑ D
® Feeder to Finish ❑Non -Layer ❑Non -Dairy
Farrow to Wean �K So a
y
FarrQw to Feeder � Tutal Design CapaeityMg,6 Z
Farrow to Finish .
a
n '' Total SSL _
s
❑ OtheUlm
r
er
x
Number of�Lagoons J Holduig Ponds . ❑Subsurface Drams Present "�°°
r
_ - �.�� ... -� ❑Lagoon Area �` � Spray Field Area = �
General
1. Are there any buffers that need maintenance/improvement? Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Eg No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes El No
c. If discharge is observed, what is the estimated flow in gal/min? 1,11 Lk
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0No
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 allo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 0 No
4/30/97 maintenance/improvement? Continued on back

Facility Number: 3 �..... — _4
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fLI n. and/or Holding Reads)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
;,No
❑ Yes
® No
❑ Yes
® No
❑ Yes
RNo
Structure S Structure 6
❑ Yes
E1 No
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... _....... .... ..-C.i ! £ ..................... A1..t�.�Y�r�.!-i.......... .._.............
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 Iand 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?
For Certified
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
® Yes ❑ No
❑ Yes 29 No
❑ Yes [a No
❑ Yes
KNo
❑ Yes
® No
® Yes
❑ No
❑ Yes
B No
❑ Yes
RNo
❑ Yes
® No
❑ Yes $1 No
❑ Yes Ef No
® Yes ❑ No
Comments (refer to question #) Explaut'any YES answers andlor'any recommendations or any other comments
Use drawings,of in facility to better explasitu atiioons use addittonal pages as necessary]
I Y-.e.Q-'r o- e[ k
4
d,, t e-s
eV-0 d IN I v1 C..► t i- W a l l ►. e ctv- a U S a-+.- r Qom! q r� 1 S o 1
re,veJ.i?_ t-o-k be Sf. o V-L
1 g. W o r K- OLIN C� y'✓�'c ti4 - 9 w to-c�-S
y • Cr e-t C.v v`✓ e-,.. E S d 1 I . `Jp .� G� tnl 0-4 (-:f �i1 ��t . 5-60.,f. c_.j
v►Ul;vi
yo.tr 4e Gk ioov\ &-S rois�bi�, Mw1`e i.,Yt �oe�#J
� 1.a, riv ..vti, b Fib i v. w d�S t✓ 2. � 1-o�-w, p*-. � � +'"� C-o"`�-i .
t,, `tnj �f L.,,o.,Lj_ ba �^�-d�^'�
b
r."'6i cL ood �de� fo w,yv bc+�IS ww
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: -1 3
ce: Division of Water Quality, Water Quality Section. Facifity Assessment ITU 4/30/97

Site Requires Immediate Attention:
' Facility No. 3 4 - Sr Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: -7 :22 , 1995
Time: A r r -
Integrator. Phone:
On Site Representative: S Yyl' 'Phone:.
Physical Address/Location: t J,
Type of Operation: Swine ✓ Poultry Cattle Tt _ncsI.-A;Y�s
Design Capacity: Number of Animals on Site: �L
DEM Cer�imtion Number: ACE DEM Certification Number: ACNEW
Latitude: 3*5 e3 aY I " Longitude: 78r , ° Elevation: Feet
Circle Yes or No
Does the Animal Waste Laor
goon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6 or No Actual Freeboard: �_Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o Was any erosion observed? Yes or No
Is adequate land available for spray? nes-0r No Is the cover crop adequate?- (6or No
Crop(s) being udEzed: Q C vim-L � � CA _
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?(&or No
100 Feet from Wells? 6 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oz(o
Is animal waste land applied or.spray irrigated within 25 Feet of a USGS Map Blue Line? Yes of
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o io If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yew -
Additional Comments:_-
nspector Name
Signature .
cc: Facility Assessment Unit
Use Attachments if Needed.