310383_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

I , Di'vis"ion of Water Resources
Facility Number W - ® '� Division of Soi! and Water Conservation
Other Ageney
Type of visit: 0 Compliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: 40 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 0 Arrival Time:1-- Departure Time: County: k
Farm Name: M U c i' b, ans , LLC_ S' r� Owner Email:
Region:
Owner Name: / y Q Phone: J
Mailing Address: lr� ��j ���-w:.� {nl ►�Menr� {lpo���. %►►lb+�, l_p� l�f4Z, / V lr
.
Physical Address:jDj����c,L,l"�1d
Facility Contact: Title:
Onsite Representative:
Integrator:
Phone:
Certified Operator: :EV ' M L Certification Number: Omgo�
Back-up Operator: RECEIVED/1IICDRfljqWon Number:
UOCrIL1Ull Ul rA11u: L'AIILuUC: MAn 9 � LU11g1LUUV.
Water Quality Re Iona!
.. QAemtj.,ng
Design
Current
a•
Design Current � Design Current
Swine Capacity
Pop.
Wet Poultry Capacity Pop. Cattle C►►specify Pop.
Wean to Finish
Layer DairyCow
Wean to Feeder
Non -La er
DairyCalf
DairyHeifer
Feeder to Finish
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D . P■ouI , Caci_ P■o a P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Beef Brood
Other
HCow
Turke Puults
NJ
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [allo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-]Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
[—]Yes EjNo
❑ Yes 6 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: 'L - 3-CI I Date of Inspection-
r
Waste 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
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L— j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q 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
[fNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[j No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q 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
D Yes
[allo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[Z No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[2, No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
D 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
© No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [;?No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C3-1�7
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
a ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Ii'acili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [jTNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ N6n-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Q No ❑ NA ❑ NE
❑ Yes 2[ No ❑ NA ❑ NE
❑Yes ©No ❑NA ❑NE
❑ Yes 2 No ❑ NA ❑ NE
[:]Yes E�No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other. comments. -1,
Use drawings of facility to better explain situations (use additional paces as nmessarv): M
Ca1,z�'F;k� 6"1>b-1\o
LG�U� -vl-n Qx�� ��
L_7a-a\-n i:tI
Soak v'� li-G-15
z� 4aSD
Reviewer/Inspector Name:����
Phone: (: rsa ml-
Reviewer/Inspector Signature:
Page 3 of 3
Date: I- `"Or"I
21412015

Type of Visit: Q Co pliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Vet✓ f-['iA1 M ' 1'Lx 1-
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: I
9//l
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pap.
Design Current
Wet PoultryI Capacity Pop.
Cattle
Design
Capacity
Current
Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Dairy Heifer
Dry Cow
Feeder to Finish
Farrow to Wean
Design Current
Farrow to Feeder
Farrow to Finish
D , P,oultr, Ca aci P,o ,
Layers
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ 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
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facil' Number: -27 jDate of Inspection: Q
.-Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes UNo ❑ 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): A�rj
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 l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesVNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes D NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Q - ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P"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 0 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑Yes Xo ❑ 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 o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ZrNo ❑ 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 dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo
" ❑ NA ❑ NE 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FacilityNumber: - Date of Ins ection:
•24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E>* o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 2 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 ZNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes u No ❑ NA 0 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [/o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [] Yes5�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).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Date:
5
M

i
Type of Visit: Q) 7Routine
pliance Inspection O Operation Review O Structure Evaluation p Technical Assistance 0
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:
Farm Name:
Arrival Time: ® Departure Time: ® County: Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title
Onsite Representative:
V_6m[ilAv
/10-6y­
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
y
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry C►opacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dr, P,ou! Ca act P,o ,
Lavers
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non-Laers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Ocher
Other
Turkeys
Turkey Poults
Other
Discharees and Stream impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) D. Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ ❑ NA ❑ NE
❑ Yes [?I ❑ NA ❑ NE
❑ Yes rZ/No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: 31- Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ef 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 0 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 1 threat, notify DWR
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 I" Rainfall Inspectio�)14'o
❑ 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 No ❑ NA ❑ NE
7. Do any of the structures need maintenan
ce or improvement?
❑Yes o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes VNto
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[-]Yes dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes N
❑ 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 LO lbs. ❑Total Phosphorus ❑Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes ❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes FZ/No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes � o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes [/�No
❑ NA
❑ NE
Required Records &Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes a
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑Yes �FNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑Lease Agreements
❑Other: ,
Page 2 of 3 21412014 Continued

Facility Number: Date of Inspection:
24. Did the farcility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes j(No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes tom`
40
❑ Yes �Ko
❑ Yes �No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [�/No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Comments, (refer yto question #):.Explain any YES answers and/or any,'additional recommendations or any other comments.
Use drawings of facilitY to better ex lain.s'ituations (use additional pages as necessa ry)� =�
Reviewer/Inspector Name:
lid
Reviewer/Inspector Signature:
Date:
Page 3 of 3 P21412015

l
Type of Visit: 0 C pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Pt Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: ` j,,, q�m xj —Liat Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity . Pop. Wet Roultry Capacity Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Design CEEJ
urrent
Dry P,oultr, Ca aci P,o
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Beef Feeder
Boars
E]r[
ullets
Beef Brood Cow
Other.
Other
Turke s
Turkey Poults
Other
Discharees and Stream Imoacts
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 6No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
[-]Yes ��No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facil' Number: - Date of inspection: ,j
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
ENo ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health orZYes
'ronmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Nn ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ Noo ❑ 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 �'N0 ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes EAINo
❑ 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 o
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesVNo,,
❑ NA
❑ 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?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes c
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes fo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA 0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfal I ❑ 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes WNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25.'Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes io ❑ 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 CAWNIP?
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 M/No ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
❑ Yes Q No []NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �o
[:]Yes
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #f): Explain any YES answers and/or any additional recommendations. or any other. comments.
Use drawings of facility to better, explain situations (use additional pages as necessary):..
I'). �6'q Ca-w uckGac or Ae_Cm1qbt
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�� Iv Phone:( ?-3 OP
Date: zr1If
y
2/ 014
/2

Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: l� Departure Time: County: DJPQLA Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Joo frr gh� Tyy .0 j — Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: 1 V ``±
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design
Wet Poultry Capacity Pop. Cattle Capacity
Layer Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish a
Dairy Heifer
Farrow to Wean
OIL_gn Current D Cow
D , P,oultr. Ca aci P,o , Non -Dairy
La ers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Dischar eg s 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 5No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ONE
❑ Yes Ej No 0 NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: 10 1-3111:1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
9• 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 ZINo ❑ 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 F] 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 environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesVNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes la No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
/No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
[3 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rN
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes jNoo
NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes [] NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yesg�Nci ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: -I jDate of Inspection: jo '3
;4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes eN�o ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes To ❑ NA ❑ NE
t.
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:
25. Did the facility fail to provide documentation of an actively certified operator in charge? ❑Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EKO ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 5KO ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes ZfNo ❑ NA ❑ NE
❑ Yes Ef No .
❑ Yes
❑ Yes FNo
Yes
[DNA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility. to better explain situations {use additional pages as necessary).
Reviewer/Inspector Name: In OIA t 4' agt k/
Reviewer/Inspector Signature:
Page 3 of 3
Phone: b �—�3
Date:
4/2 J1I

Type of Visit: <3 Co pflance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1b Z Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 18 l l �
Certification Number:
Longitude:
Design Current
Swine C**opacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
Layer
Current Design
Pop. C►attle Capacity
DairyCow
Current
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeLEI
ifer
Farrow to Wean
Farrow to Feeder
Design
U! P,o_uI . Ca aci-
Current
P,o P.
D Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other I JELLQther
Turke s
Turkey 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)?
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 ZNo
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes ❑ No
❑ Yes Z) o
❑ Yes WNo
❑NA ❑NE
J
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Fa ill Number: - Date of Inspection:
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 1. Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: iA -
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?
dyes
❑ No ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
[]Yes
DNo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[j'4o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P/N(o
❑ 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
�(Yes
6 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Wo
❑ 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
VN0o
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 15KO ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24.-,Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes YNo
❑ NA ❑ NE
n
25.afs the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Q o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 2r'N'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
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
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
rX0
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
d' 'p'n4i
Comments,(refer to question #: Explain any YES answers and/or any additional recommendations or any other comments s
Use'drawings of facility to better. explain" situations (use additional pages as necessary):
DUS w6c U ot6W W00-
W CC9 CaNIT" t,- NE-6DCD
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
CL.EA (L' To-c Es ,
�,o tj Phone[ 16 rib ' 3
Date: �-
2 4/2011

' 'Divi"sign of Water Quality
Facility Number 31 - X3 Coin servation
® Other Agency
Type of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: (7"Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: I L7 t Arrival Time: n3 ' Departure Time: County: DWLEA) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
On site Representative: <�di1AT}j(L
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: 1s It y
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity- Pap.
Wean to Finish Layer
Design
Cattle Capacity
DairyCow
Current
Pop.
Wean to Feeder
Non -Layer
DairyCalf
k
Feeder to Finish
o
Ler, 6
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design CurrentH]DryCow
D , P.ou! Ca aci P.o ,
Layers
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ffNo ❑ NA ONE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes V
o
Yes
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA-('"1J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[:] ❑ 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 or7ye0s
nmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Z
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes 21/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 [2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s).
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
N
❑ Yes Wo
E(yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes E(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[] Yes E No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes F2/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes �-,Q ""
❑ 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 [31Nfo
❑ 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 �o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes 6-N/0
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: 3 - 3 3 Date of Inspection: 10113111
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 01To ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes D-I o ❑ NA ❑ NE
[] Yes I-DA ❑ NA ❑ NE
❑ Yes 13'No ❑ NA ❑ NE
❑ Yes C2.Po" ❑ NA ❑ NE
❑ Yes
LD'1 o
❑ Yes
Q-Ko'
[-]Yes
�]40
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations,or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
1►) f� Cep cqjT"L, .rn/ S��-sN�T�►�f n1E bE O,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( I rU d —73 V
Date:
21412011

D►vision of Water Quality
Faeflity Nninlier i r( O Di"vision ofrSfltl andWater Caiiservataouh
Other; Agency.
Type of Visit ooLLmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
G Reason for Visit -Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i► re I Arrival Time: IaY Departure Time: County: OUPLMAL Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: /qi'/ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e = == Longitude: = ° = _ 0 =_
Design ` Current Design Ci
g Swine Capacity .Population Wet PoitlryCapacity Rip
mw
Irk
ZOth'er
❑Other ...
❑ Wean to Finish
ElWean to Feeder
13 Feeder to Finish+
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
El Boars
Non -Layer
Ury Poultry
m
Lavers
Pullets
Other
Poul
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
El Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coy
" rtNumber of'St
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure [IApplication Field ElOther
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes Cl/No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑�No ❑ NA
❑ NE
❑ Yes
❑ Yes
CJ N ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility -Number: 3 j — 3 3 Date of Inspection 1cr t
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: (_,Q(�a61J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U/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 R No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ea No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 101bs ❑ 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
[A No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I440❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[3/No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
�rWN
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o❑ NA
❑ NE
Comments (refer to'queshon #) Explain any YES answersand/ or any . ecommendations or any�other�eomnients ,
Use d;awrngs of facility to°better explain situation"s (use additional pages as necessary)
Reviewer/Inspector Name Q LL
Phon Q�D����.�a
Reviewer/Inspector Signature:
Date: )
Page 2 of 3 1 I2128104 ' Continued

Facility Number: 31 7-3'31 Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps. ❑Other
21. Does record keeping need improvement? if yes, check the appropriate box below, ❑ Yes U<O ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspection❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �Z/NN ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes 1 ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes f ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes o El NA El 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
E2rN.
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
N
El NA
El NE
and report the mortality rates that were higher than normal?
WN9
30. At the time of the inspection dial the facility pose an odor or air quality concern?
❑ Yes❑
NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
;_1
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes❑
�No
NA
❑ NE
Additional Comments and/or Drawings:.
Page 3 of 3 12128104

Type of Visit (rTRoutine
pliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: $ l o Arrival Time: ® Departure Time: County: DWL__Wj Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: s r4#J#CrrWAiJ MSkAA0—
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = I = Longitude: = o = , = «
Design
Current
Design Current
Design Current
Swine
Capacity
Popu latian
Wet Poultry Eapacity Population
@attle Capacity Population
to Finish
❑La er
❑ Dai Cow
DWean
can to Feeder
❑ Non -La er
❑ Dai Calf
eeder to Finish �w
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
Non -La ersEl
❑Beef Feeder
Fc] Boars
Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turke Pouets
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
En 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
�-
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

L9
Facility Number: 31— 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 J Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L A&oan1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 14
5_ Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes UNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ZNo
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes eNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? ❑ Yes 2No ❑ 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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Pf No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CNo ❑ 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 [ZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes o ❑ NA El NE
17. Does the facility lack adequate acreage for land application? ElFNo
El [I NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
Comments (refer to question.#) Explam,any YES,ansKers ah&6,r apy.recommendattons or-janv other�comments
Use drawings of facility to better explain situations: {use" addi#ional pages as necessary)
;
AL
w
Reviewer/Inspector Name
�/ Phone
Reviewer/Inspector Signature:
Date: !
O
J 12178104 Continued

`� % 3
Facility Number: 1 —30 Date of Inspection EIE lol
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo
El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑Yes
❑ NA ❑ NE
the appropirate box. ❑ VYIUp ❑ Checklists ❑ Design [I Maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
LdNo
❑ 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
eNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�I No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNo
ElNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElR Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
d o
[-INA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
WNo
❑ NA
❑ NE
Other Issues �,—,,!!
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes E o ❑ NA ❑ NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L'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?
❑ Yes
L7 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
[I Yes
��
L�J No
❑ NA
❑ NE
General Permit? (ie/ discharge, fireeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

1 H 393
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I `? ti c$ Arrival Time: J Jp Departure Time: County: J)11 --r4J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: foelnAwed . ,Z-Lkr
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = 6 = «
Design Current Design 5FuEapAciyXP:pM1
ation Wet Poultry C**opacity Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
JEJ Non -Layer I
1
❑ Dairy Calf
Feeder to Finish d ❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
El Beef Feeder
❑ Pullets
❑ Boars ❑ Beef Brood Co
❑ Turkeys
Other ❑Turke Points
❑ Other ther I 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?
Page I of 3
❑ Yes E I No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
d
❑ NA
❑ NE
❑ Yes
Zo
❑ NA
❑ NE
12128104 Continued

Faci9ty Number: — Date of Inspection
i
ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L✓J 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: lA b-NIJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Lr 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 0 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? es ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes B 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 ElYes O No ❑ NA ❑ NE
maintenance or improvement?
Waste Aaulication ,..�
10. Are there any required buffers, setbacks, or compliance alternatives that need ElE,Yes No ❑ NA ❑ NE
maintenance/improvement? ,��
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes IQ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CJ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�10
[I NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
E, o
❑ NA
❑ NE
/'o
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
WNo
❑ NA
❑ NE
`t. j B Auc� +�� vI D�c��. ►,.� t4 w a c �� s c.c�,�4ct�i G.
Reviewertinspector Name lam. 1 Phone: ( 9/d) 7q ` —73
Reviewer/Inspector Signature: Date:
rage L of 3 iZ1/ZCVU-r ununuCu

Facility Number: 3 — Date of Inspection
t
Rtguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Ej'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E" l No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
I( No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
6/N,YNo
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,�
E No
❑ NA
' ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IJ NElNA
❑ 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
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
El Yes
,_ ,
LYNo
❑ 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
o
NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Page 3 of 3 12128104

�y Q Division of Water Quality
=acilityumber Q Division of Soil and Water Conservation /
O Other Agency
E
ofVisit ;rRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
on for Visit Complaint Follow up Referral Emergency Other El Denied Access
Date of Visit: 1 tr ' 6Arrival Time: fl d Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Ons'rte Representative: C%� �141� "%J ~� L�n Integrator:
Certified Operator: Operator Certification Number:
Sack -up Operator: Back-up Certification Number:
Location of Farm: Latitude: c = 9 = {f Longitude: ❑ °
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
____. ❑ La er
�� ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population .
❑ 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?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
E No
❑ NA
❑ NE
❑ Yes 03 No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Qo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure ] Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1A&xil
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Y3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ['No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ['Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EYNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E:(No ❑ NA ❑ NE
maintenance/improvement?
t. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA [I NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [ONO
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes Mo
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes �
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L_J No
❑ NA
❑ NE
Comments (refer to question ft 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):
dA)e cPPN(Z c t A &W x2rkf ty ALL 11 AS 6" 500k A0j0& SJ &&4Y F. eAq
4 wAk i 149 s, ClevivV I ,
Reviewer/Inspector Name Phone: 3
Reviewer/inspector Signature: Date:
1 12128104 Continued

Facility Number: — Date of inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
dxo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[No
❑ 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
Q4
❑ 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
Ef'No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LLl No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,U'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
;kNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ N/A
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
El1 A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,0
LJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O 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
�j No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fait to discuss review/inspection with an on -site representative?
❑ Yes
2 No
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[2No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Ftkility Number g
-.O'Division of Water Quality I
D Division of Soil and Water Conservation v
0,Other Agency
Type of Visit -0 Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit utine O Complaint Q Follow up O Referral Q [IEmergency O Other Denied Accesses �'�o
Date of Visit: Arrival Time: : (]0 Departure Time: County: 1A— Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
e No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 e= 6❑ Longitude: = o= 4
Design Current Design- ` Current
Swine.Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ La er
❑ Wean to Feeder 10 Non -Layer
❑ Feeder to Finish -
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
LI
Gilts
❑ Boars
Other
❑ Other
El Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current ."
Cattle Capacity Population
❑ Dairy Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current ."
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
y
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection �r
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
St ru ture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > 10% or ] 0 lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #1): 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):
r 4lee cc,, .-,> /'r-ec l�-t ����� e 71 s
Ileerc
Reviewer/Inspector Name _ �� T F Phone:
Reviewer/Inspector Signature: 'C J Date:
Page 2 of 3 I212`8104 Continued

Facility Number: 3j— Date of Inspection ra D
Required Records _&_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25 id the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes El No ❑NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
w't r/G C
7%311v6 !� f
�11310C 47
a l) Fran s
eqfx /-Ovvfl
� a su� C" /'4�k Gil
J
P� J� v6x
3'�- f_C,o=y
Page 3 of 3 12128104

Type of Visit
Co pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 174 1.1 Mi Arrival Time: lt'� S Departure Time: Z $ County: DykziRegion:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: CCU►. �C MRIbJ
Certified Operator: _.Gay m521Cj''"
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
a
1 19RH
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , Longitude: = o = I = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ 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?
Design Current
Cattle Capacity Population
❑ 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?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
[I NE
❑ Yes
El Yes
ZN [-I NAEl
NE
El Yes
❑ NA
❑ NE
12128104 Continued

i.
✓ Facility Number: 3 r 3 3
Date of Inspection 12 Oil
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structu`re 1 Structure 2 Structure 3 Structure 4
Identifier: , 00-d
Spillway?:
Designed Freeboard (in): 31
Observed Freeboard (in): Z ,
No ❑ NA ❑ NE
No ❑ NA ❑ NE
B,Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
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 D<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ��
9. Does any part of the waste management system other than the waste structures require Ele Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 11J No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) %cm^gv " % 1 S�
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
,��No'
L� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El
VV0
El
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
4� ZO7 oC .StP0—T 'PvM? UVEL OESM6d f(wf" '55
w 2.` PLUS .7" �ol-i. toT AL, 14 3 f nnAn1L SCT
OE;6n TO VP O A TE ASAP,
P-0 �— S`� E �G�'�'s RE cac�.ns S «� vt.� S N t, E VCnrrSt �T� Zq (� RS
S 0 rt✓"-m' THxS Pa ev LJrs 14 u m fLf t�S CA L0JL4V&W S
Reviewer/Inspector Name ,Tt1 jJ A.(t,�JF,�� ":' Phone:( 91-0 3500 X 13
Reviewer/Inspector Signature:
Date:

Facility Number: e3— Date of Inspection 16 05
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes jNo ❑ NA ❑ NE
Rl Yes ❑ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
El NA
❑ NE
�No
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
L� No
0 Nj A
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El No
E NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
�A
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑4'o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
VNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes EKo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[3 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Eilfo
❑ 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
DO<
❑ 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
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit R Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: / Time: =
Facility Number
.�10 Not Operational Q Below Threshold
© Permitted 0 Cextifie 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: (/Jl ' L.J_F _ /yi ) County
Owner Name: / ' it3/�L' i" Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
�f Phone No:
Integrator:
Operator Certification Number:
[Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 6 " Longitude 0 6 OK
Wean to Feeder
Feeder to Finish
- -
_
— _
Li Layer I I AU Dai
❑ Non -Layer ❑ Non-
Farrow to Wean
►;. ::.::. ,. .
❑ Other
? T:ntal IilPciian %annei
Farrow to Feeder
Farrow to Finish
Boars
Number of Lagoons Ll Subsurface Drains Present JLJ Lagoon Area1Li spray Field Area I
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management S stem
Discharges &. Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JZNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes FINo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

r-4
Facility Number: — 3 `V 21 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not property 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 Aunlication
10. Are there any buffers that need maintenance/improvement?
11. is there evide
12. Crop type
13. Do the receiving crops differ with those designated ifi the Certi
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 or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes INO
❑ Yes VNo
❑ Yes J&No
1yes ❑ No
❑ Yes PNo
❑ Yes Al
No
ElYes �SNo
U Yes 10 No
El yes No
❑ Yes ❑ No
❑ Yes ❑ No
Cl Yes No
❑ Yes XNO
❑ Yes No
❑ Yes �No
❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes XNo
El Yes No
ElYes XNo
❑ Yes �No
C] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,�-:. a;.. .r - "" , ..:- 4 r . '" -- . - f< s d`§ ax yy..,.,
Comments ((refer fo"questtan EXpl, n any YES answers and/or any recommendations .or any o er comments :' r
Field COUP Final Notes r r
g X. _ .' )
Use draRtn `s of facility to better explain=situahon`s. (use addihonal:pages as,neeessa„ry)
. . , ¢
%1IF,E,OS rp
DGfr
7o' te-3E ;6Ar
N7,o,vzo Ara 11,41110 f�oF �s �u [��� �✓
Reviewer[Inspector Name
Reviewer/Inspector Signature: Date:
05103101 %__ Continued

Facility Number: 73S Date of Inspeetion J
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes o
❑ Yes No
❑ Yes WNo
❑ Yes $No
o
El Yes
ElYes ❑ No
Additional Comments and/or Drawings::
rj
to
r o�go
45
O5103101

Type of Visit )Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ?16 Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Dale of Visit: ^(a E3 Time:
S
Q Not Operational 0 Below Threshold
O(Permitted 0 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..� . �.. .» ....
Farm Name: .....`. ..................... County:......�� �1..............._� ... .....» .� . �.
OwnerName: ...............................................................................:........................................... Phone No:..............................................................
Facility Contact:
Title:
Phone No:
MailingAddress: ..................................................................................................................... ................................... -.............
Onsite Representative:. t^. ....1� 1� ... ....................... integrator:......(.... R..........................................
._. C _ .._
Certified Operator: ................
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude ' 1 44
Design Current Design . Current : Design : Cunt
Swine -. aaiPuaton Puty Catte c;.Ca aiti Po iaialfon
❑Wean to Feeder ❑ Layer 10Dairy
Feeder to Finish a Q ❑ Non -Layer ❑ Non -Dairy
El Farrow to Wean
❑ Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity
Gilts
❑ Boars Total SSLW
i Nnmbeir'of Lagoons s ❑ Subsurface Drains Present ❑ Lagoon Area , ❑ Spray Field Area
`Holding Ponds 1 Solid Traps . ❑ No Liquid Waste Management System
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P,(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a: If discharge is observed, was the conveyance man-made?
❑Yes
❑ No
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ)
❑ Yes
❑ No
c. I-I'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(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
�fNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:........................................................................ ................................... .................................... ....................................
.......................... ..........
Freeboard (inches): q3
5/00
Continued
on back

r .
Facility Number: —3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? - ❑Yes �No
{If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ,Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 12 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes I (No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes OtNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes MNo
12. Crop type h n , c C„
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
V No
b) Does the facility need a wettable acre determination?
❑ Yes
gNo
c) This facility is pended for a wettable acre determination?
❑ Yes
MWo
15.
Does the receiving crop need improvement?
9Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
gNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
00o
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
aN
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
) No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
]!(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes tM
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes RNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 2!rNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes jj, No
yioioii0s;o� ftfjeje)icier -*'re pQted• OiWing thjs'visit! • :Y:ot will •teegiye OQ fu�th r
correspondence aYwut this .visit
Comments (refer to;questton #) " Explaeu any YFS answers'and/or quay recommendations uc any other comments.:_'
Use drawings of facility to better e5cplai situatioes: (use additional pages asnecessai^y)
0,CQ3Slt ve
C7r '7 ��t�-,-e A. ►'��-.�e,� � ►-tee 4 ' ` [
��,�._-,� w—ct"�1�� � .�\t`'"� �`�'tC . lyQ Q�. � c r H-•��R 4�
�.es
IV
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5/00

Facility Number: — 3 g Date of Inspection o
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below KYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 0No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 9No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 6 No
Additional: Comments an or rawings::
I r
i
l-pig�
R
V4
5100

Division of Water Quality
Q Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit )KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 s 3 Date or visit: I I t 1Do Time: 1 Printed can: 7/21/2000
Not O erational Q Below Threshold
Permitted [3 Certified E3 Conditionally Certified [I Registered Date Last Operated or Above Threshold: ..................
A
Farm Name: QY .�!lr1.... ............. ........
............ .— � � �w.�........................ County:.....: �A�'�............ �....
OwnerName:........................................................................................................................... Phone No:.......................................................................................
FacilityContact:.............................................................................. Title:.............................................................. .. Phone No:...................................................
MailingAddress: .................. ................................................................................................................ ..........................
IVLOnsite Representative:.... .. E.......... ..Irs� R'1.�. Integrator:... ....... ....../.. {. s....................................
Certified Operator. Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 i Longitude • ` 64
Design Current
Swine C'anneity Pnnnlation
❑ Wean to Feeder
[weeder to Finish
J {e U
❑ Farr - to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer [��❑Dairy
❑ Non -Layer I JE] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ ILagnan Area ID Spray Field Area
Holding 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. li'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 dischar�,e is observed. what is the estimated flow in galhnin?
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
,f r.
Identifier: ............... !rf..,�........ .............. ........-............ ....................................
Freeboard (inches):
5100
❑ Yes [ (No
❑ Yes ❑ No
❑ Yes ❑ No
�y#-
❑ Yes ❑ No
❑ Yes TNO
o
ElYes
❑ Yes ,�No
Structure 6
Continued on back

F25ity Number: —3 g Date of Inspection pe7 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obse ved? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes a No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ZkYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes M0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes {� No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of o erplication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ®No
12. Crop type I, S 4. ,
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)
21 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?
P. _1o•yi6latioris:or- defcienctes -mere n6ted• during this:visit; • VoU'Wtl•reeeive tn6 further
...... ........... ...,
correso&ideirce. about: this visit:
❑ Yes KNo
❑ Yes gNo
❑ Yes R No
❑ Yes A` No
❑ Yes XNo
❑ Yes R.No
❑ Yes j(No
❑ Yes VNo
❑ Yes JTTo
❑ Yes C�No
❑ Yes XNo
❑ Yes �No
❑ Yes kfivo
❑ Yes [9No
❑ Yes [ ZNO
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
OLo lw VQ 0adtj ve- c ,s 44,z, CIF i- sP -� .1 �'L�,,-� W I
`p,n,,�..r� G,tn„vvw•� %DIGS titS��o�t L�� iv` mS-� 0-f rteai.l— aiSt?
less 1v a� �.�� tam
rav✓v" 1 VAS KI c t<
kok IOLArPlir- LPt1d A,nan FiLwat�t� t rr n�� AA'J -4... �9-f' 1-#t��� c ate.. r �v A
A.
Reviewer/Inspector Name ►
Reviewer/Inspector Signature: o_ PAIf ./, Date:

Y
Facility Number: ; —3gj Date of Inspection D a Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or hclow ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JANo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1N0
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes WNo
Additional omments an orDrawings:
•
5100

7 - Division of Soil and' Water Conservation' O eratlOn ReYIE{V ?' -A '-
a
a xrt Q. DiVISiOII Of SOLI aAd atel' COnservatio# COmpl aliCC �IiSpeCi7on
t
=Division of Water Qt�altty ,Compleance Lspeehon = A s e
O'Other. Agency Operation Reveal t m
1% Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection J
Time of Inspection 24 hr. (hh:mm)
® Permitted © Certified [3 Conditionally Certified [:] Registered JC1 Not O erational Date Last Operated:
Farm Name: �Ca-a�f ySLV i''l C i".r........................................ County:......-...-..... ......-.-...-.........................
OwnerName:.....b.r ' ..-... !� .......................................................... Phone No:.......................................................................................
Facility Contact: ..............................................................................Title:.......
MailingAddress: ......................................................................................................................
Onsite Representative: e e f n
CertifiedOperator: ................................................... ................................
Location of Farm:
.............. Phone No:..............
................................................................................... ..........................
Integrator:... Pf-C A e..........
Operator Certification Number:...........
r.............................................................................................. ............. ............ ......... I ...... I ..........
i 3
Latitude �• �' �•' Longitude
"Design Current r_ _. Design Current R Design _ Cu°t rent
Swine _
Ca acit Po alatton Pgultry Ca aci Po ulation Cattle Capacity" Population.-
Y p ty, P
❑ Wean to Feeder
Feeder to Finish
2 j &40
Z
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
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 J5 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ff No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �M No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6 I Identifier:
Freeboard (inches): ..........
....... 2.�.......................................................................................................................................... I................. ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

Facilky Number: 3/ — 35,7 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 04 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? C9 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenatice/improvement? []Yes H No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 18 No
Waste Anolication
10. Are there any buffers that need maintenance/improvement?
kzj Yes
❑ No
11. Is there evidence of over plicatiion? ❑ Excessive Ponding ❑ PAN
�JJ
❑ Yes
No
12. Crop type 17 �(7
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
29 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
29 Yes
ElNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
0 No
Re uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
10 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
;R No
19_
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Dff No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
8 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
12 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes )9 No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes JR No
24. Does facility require a follow-up visit by same agency? ❑ Yes J'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �Vo
0: �'Vo violations of clefciencies -were noted- d0itig this:visit. - Y:oik :will reeeiye iid furth6e
comes• ondence: about: this :visit. : :::::
Comments (refer to question #) Explain any YES answers and/or any recommendationi.or any other commeiitts: ;
Use drawings,of facilityto�better ez lam situations. use additional a es as necessa )_ w`
� p _
7• art*;n vC , 1 1
C c,�{p r� s -�p V t�i �•tC� a �a�1 r'G ft►�'Cr4s oil 1 j e 0 h A,
10. Ftnc a Cat,,)$ MA4 W Creek Area. Ca h ]e^v c C rasSin� k1*0
-'oe Golds • Con4;lwe aAfo s 4d S4gb;11z.e eroded q.'[.A negr
1S, T Qeed MAVk4O/,r7
IfIM4 needed iyl S49AIC grcas W r'e'&'►vdu s�vrti.
n �;�l�s-'ire eoct tangy; f1Qvy ove�Rl��1J ��J�
• A�{v;scDt e'O fa Y !h �e4✓' Ftr�vr>c rt AfG � dsfi bI P t'.�lST L✓C�T�+:
F(viewer/InspectorName 1. C-M'ne.h� iC, �¢ ewer/Inspector Signature: -- Date: IV if
3/23/99

FaciH4 Number: _7 _ 3 [)ate of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[]Yes
$j No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Yes
❑ No
AAditionat-C6 t3 an or. rawings:
3123/99

Longitude
<°Design :' Current ?Design
Poultry Capacity., Population Cattle., Capacityl
13 Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
M-Routine O Complaint O Follow-up of DWO Inspection O Follow-up orDSWC review O Other
Dale of Inspection
Facility Number
Time of Inspection GU 24 hr. (hh:mm)
©Registered M Certiled © Applied for Permit © Permitted JE3 Not Operational, Date Last Operated:
G+y� �t"�t� County. V ..,�
} �.Farm Name: --....q...�.....q�.`�........./...................................................
Owner Name: ��2 .. Phone No:.......\.�.. l J� �..........................
Facility Contact: ....................................................................... Title:.................... .... Phone No:
Mailing Address: ,1....1....... .,1...... 7`�. .............. %W ...��.`'����......7W �bS............................. ..........................
Onsite Representative:.aL�tc-,c---'-!; �e` -' .............................. Integrator: .... `...Y :.
Certified Operator:............................................................................................................... Operator Certification Number:...............................------....
Latitude �• �� ="
Design' Current
Swune _ :`Capacity Population
❑ Wean to Feeder
Feeder to Finish
0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes allo
2. Is any discharge observed from any part of the operation? ❑ Yes (g No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes N No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min? N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. is there evidence of past discharge from any part of the operation? ❑ Yes t4No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ('No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
. maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes N No
7/25/97

P.
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holtiini! Ponds, Flush Pits, etch
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Stmcturre 2 Structure 3
Identifier: 1
. ......................
Freeboard(tt):...........�.:.i................................ 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)
❑ Yes No
❑ Yes No
Structure 5 Structure 6
15. Crop type Ix...,... J'.........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
.......... .............................
❑ Yes
I... ...
No
Yes
❑ No
Yes
❑ No
❑ Yes
bg No
❑ Yes
CO No
❑ Yes
EdNo
❑ Yes
No
Yes
❑ No
❑ Yes
WNo
❑ Yes
tff No
❑ Yes
JgNo
❑ Yes
i9 No
❑ Yes
No
❑ Yes
No
❑ Yes
M No
[]: No.violationsor. dercieitcies'were:noted-during this:visit.-Yoii.will ireceive'.noAirttieT;
eorrosPOI UO shout #.his.visit:
A,
VLANC) h .
7125197
Reviewer/Inspector Name
Reviewer/Inspector Signature:—�JL _ _ __ _ Date:

❑ DSWC Animal Feedlot Operation Review` °r a
t=
® DWQ Animal Feedlot Operation Site Inspection
IG Itaiutine: 0 Comnlaint 0 Follow-un of D%VO insncx:tion 0 Follow-un (if DSWC review 0 Other
Facility Number
© Registered INCertified [3 Applied for Permit © Permitted
Farm Name: .... .... .....j ......
S.u�l..l.-X.h'........ ..................
Ovmer Name:..........[ . ............... .................
Facility Contact: .............................................................................. Title:..........
Date of Inspection
Time of Inspection I c4 : I.S 24 hr. (hh:mm)
Not Opera Date Last Operated :..........................
- pI1
County: .....P..'j, ..1.v ..........q....I............... t� ....1`tJ
........ Phone NO:...lr...R..... .......�o.,..t1......1..�..l...7.�............
...................................... Phone No:............................
f �1 I,
Nlailing Address :.....L.�. ....,, D ..._ N.!r.�4. > ..... ............... .!kAlt........U....i.LYs-�.`......�l.L..�...............
Onsite Representative: .... t .,c.�J.
............ . .a.�..-......... Integrator: �..3...1........................ ........... . -..Certified Operator;--,j--U4.k--- .-......... ......... .... ... Operator Certification N�imber;.,.�„g.�),
p
Location of Farm:
�...... 0......�.. � ... ......t.....a�t..�.Y�.� t �.a.................0.�.......x.V......�>.£..i..h.....o ....... ...✓...-.......
Se-.t:. :.i Q ✓} ..-.tn? `.... ., .7 zn............................................................................:......................................... ........................ T
Latitude 0 L .9 Longitude EH�D• ®` �.9
Design Current
.........
Design Current
--------
Design ' Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
10 Layer
❑ Dairy
Feeder to Finish
❑ Non -Layer
I
I
I[] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
: z 1 6 0
❑ Gilts
Total SSLW
Z q 0
❑ Boars :::E�
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Fietd Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes JR No
2. Is any discharge observed from any part of the operation? ElYes C'No
Dischar�,e originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes KNo
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes :9 No
c. If dischar-e is observed, what is the estimated flow in-al/min" �]
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes I1No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,KNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes IlM
7/25/97 Continued on back

f
IlFacilitYNumber:,si— 3d3
8. Are there lagoons or storage ponds on site which need to be property closed? ❑ Yes ® No
StructuresiLaeoons,IfoldinU Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Dd No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(fty 31........ .? ......................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
0 No
It.
Is erosion, or any other threats to the integrity of any of the structures observed?
91 Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
EK Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
KNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
P9 No
(If in excess of WIMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .......a.��...►t.a a�.................................................................sVVS-A %.�.,..q..111-"". ..�!►
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
R ❑ Yes
9 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
,KNo
18.
Does the receiving crop need improvement?
KYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
IRNo
20-
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
R No
22.
Does record keeping need improvement?
❑ Yes
9 No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
IR No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
•I?KLNo
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
& No
No violations or deeciencies.rvere noted during this visit. You.vvill re. a no further
' correspondence about this:visit:-.�
.. ..............
Corrtments (refer to question #) r=.Explaiti' any YES answers and/or any re'cotnrtnetidattons oraany other conunents. `
Use drawings of facility to'better explain situations. (use additional pages as necessary)
I z. A tx_x j *^-a
�! �--
in 0. yC..2 Q . ►.� vi o ► - t 0 h Q �l �, S Q O.v R u-S LL r -2-e�,rl� .
i W p r i= 0 +1 C -O 'r v�-G �� t v. vwv pt a r
12-b - a w t •' A 14 o) ,�. '�•► , . e.,ro c ; n ►-� J ; w tw l aL. 6-e C. 0 0 CU
o v.1•n v--si L_a f t-t-e, �.2�,,, c_e_ a " o a., (}
1- V V 0 r r- 0 , % A- 0 ✓ .r�Q-C. G 1 �v-a ( 1 6 �V P C CA ✓ Y4��/ b� S Jj 42 V,
C adJ a c.w. f i 7/25/97 _
Reviewer/Inspector Name = �;
Reviewer/Inspector Signature: Date:

CJ
0
r
Site Requires Immediate Attention:
Facility No. 3 — 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERA072
SITE VISITATION RECORD
DATE: _ , 1995
Time: 3,2249
Farm Na
Mailing
County:
Integratc
On Site Representative:
Physical Address/Location:
C
_ Phone
Type of Operation: Swine Poultry Cattle
Design Capacity: Z D Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number:' ACNEW
Latitude: ° �' Longitude: 79-° —o �" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have
(approximately 1 Foot + 7 inches)
Was any seepage observed from th
Is adequate land available for spray?
Crop(s) being utilized: 4
cient freeboard of 1 Foot + 25 year 24 hour storm event
No Actual Freeboard: f— Ft. - Inches
z(s)? Yes Oro Was any erosion observed? -Yes o. To
ar I�o Is the corer crop adequate?,Oor No
lec—
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings e or No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or09
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or�
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop) . Yes or No _
Additional Comments: i3Z/i
Inspector Name
�?6.5
41
cc: Facility Assessment Unit
Use Attachments if Needed_'