310384_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
II

ie'
ivi'sion of Water Resources
Facility Number 31 - ®MENEM O Division of Soil and Water Conservation
� Other Agency �
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �toutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ,3 c7 Departure Time: �'�'J County: - ; •-� Region:
Farm Name: ,a� f�.t� Owner Email:
ff
Owner Name: A De K Fi0 �/T x's T;Y Phone:
Mailing Address:
Physical Address:
Facility Contact: �� �rr1`� /��f>r� Title: 2&lA Vie- Phone:
Onsite Representative: _f-IT_,
Certified Operator: `��„�.r p}
Back-up Operator:
Location of Farm:
Integrator:
Certification Number: �-_6fy
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
F
Design Current
Wet Poultry C**opacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
INon-Layer
I I
Feeder to Finish (, i
Design Current
D , P,aultr, Ca aci P.o .
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation? ❑ Yes CEI-No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [DNA ❑ 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
1K No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
_allo
Page 1 of 3 21412015 Continued

` Facility Number: 3f - ldr& jDate of Inspection: — a--/
Waste Collection & Treatment
•' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (A -No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1—�) H--5-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): le-117 �f -
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes MNo ❑ 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
R[No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ,M 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): `/,'�/yr�r � 1041
�1y�dl
13. Soil Type(s): jV
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes E.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [:]Yes J' No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes C'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[X No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1!�[ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑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 Jallo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes M Rio ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

• Facility Number: I/ - 11 Date of Inspection: --
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E -No
�1 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E.No
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 3❑.No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes B No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes C, No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
[—]Yes No
[:]Yes No
❑ Yes CR�No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Cotnments .(refer to question #): Explain any YES answers and/or any additional recommendations'©r any other comments.
Use drawines of facility to better egnlain situations (use additional Mies as necessar-0.
J Y��'. � �s�l�O�i-� �r? ->! / ✓`�x �s �-err-� %�T ���'��
j x cc - -r-dT— G'� J ---�
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:
Date: S` 9Z
21412015

type of Visit: omptiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
2eason for Visit: 0 Routine Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: L± tz_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity P,op.
Design Current Design C►urrent
W. ,et Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
W to Feeder
Non -La of
DairyCalf
eeder to Finish 3 9 VS
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Design Current Dry Cow
D , Poultry Ca aci P,o Non -Dairy
Layers Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1, is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
N
❑ NA
❑ NE
El Yes
YNo
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: 3 - Date of Inspection:
.24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [] No
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
❑ NA Ea' Elm
❑ NA CP.KC
❑ NA NE
fA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ No ❑ NA
❑-N>r
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
❑' f�❑ 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 pernut or CAWMP?
❑ Yes
No7 NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
]Yes
o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ErNo ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
7
Use drawin¢s of.facility to better explain situations (use additional pages as necessarv).
�0t4� I
a^ t l A^ �4/�` A.0/1 f �to� le kO e
Q /-'- �ac h o°'-e4
Reviewer/Inspector Name: q, v! !J I ��� crTnL't Phone: i +¢i-��
Reviewer/Inspector Signature: Date: /G
Page 3 of 3 21412015

Facility Number: ' ] -3 L jDate of Inspection: 1 t�
Waste Collection & Treatment
•4.
is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
4],"" ❑ 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: 1 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1
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
E: � 1❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA [frNE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA LJ E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA Ej"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 ❑ No ❑ NA L1J E
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 ❑ No ❑ NA 1J 'NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No ❑ NA
❑ Yes ❑ No ❑ NA rNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA E j
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA KNE'
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 [3 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 ❑ No ❑ NA Q NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA [frNE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Inspection: ,
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J�o
❑ 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): 0Z C
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
F-1,No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �10 ❑ NA ❑ NE
waste management or closure plan? `T
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 ;2-'go ❑ NA ❑ NE
8. Du any of the structures lack adequate markers as required by the permit? ❑ Yes ;2Ro ❑ 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 'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yesj2<o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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 po"o
❑ 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
❑ Yes Pj-go
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes _f: "o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ;].No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes �o
❑ NA
❑ NE
the appropriate box.
7
❑ 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 ❑Vo ❑ 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 21412014 Continued

Type of Visit: () Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Q Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: GJ//Z0
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: l�/tQ, Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Capacity Pop.
Finish
IF!
Design Current
Wet Poultry Capacity Pap.
Layer
Design Current
Cattle Capacity Pop.
airy Cow
Feeder
r7FFeeder
Non -La er
airy Calf
o Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D , Ploultr, Ca aci P,o .
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Dischary-es and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes pr<o ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes No
❑ Yes 0 V(No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: % _ Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes JZNo ❑ 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 stmeture(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
0 Yes
E;,No
❑ NA
❑ NE
❑ Yes
[�fo
❑ NA
❑ NE
❑ Yes
[;?No
❑ NA
❑ NE
[—]Yes PNo ❑ NA ❑ NE
❑ Yes 2�No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
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 o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �No ❑ NA ❑ NE
Comments (refer to question=#): Explain any .YES answers and/or any additional recommendations or- any, other comments:
Use drawings of facility to better explain situations (use additional pages_as necessary)., : a
N r d' - re, ct7 '� 16111`�_
Reviewer/Inspector Name: Phone: ,
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015
_ ��

Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: ;ky,(11(Ey1/�\ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
Integrator:
Certified Operator: �,lA,;n
;��'_
Certification Number:gab
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pap.
C►urrent
1ft"r-031
Wet Poultry Capacity P_'o_P-
AM
Layer I
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,oult . Ca aci P,o
Layers
Dry Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes PNo ❑ NA ❑ NE
[:]Yes
[?!rNo
❑ NA
❑ NE
❑ Yes
FeTNo
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes g No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes Ef No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes VNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Ifacifity Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Vr$io ❑ 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 VNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes j2TNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FTNo ❑ 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 KNo ❑ NA ❑ NE
maintenance or improvement? h
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? to
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2rNo ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes 0 No
❑ Yes 21 No
❑ Yes wr No
❑ Yes VI No
❑ Yes eNo
[—]Yes P No
❑ Yes V'No
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )6 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 9No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [;eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ WE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

' ill Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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 L' No ❑ NA ❑ NE
❑ Yes Of No ❑ NA ❑ NE
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes [;],No ❑ NA ❑ NE
❑ Yes Lallo ❑ NA ❑ NE
❑ Yes
(7 No
❑ NA
❑ NE
❑ Yes
�j No
❑ NA
❑ NE
❑ Yes
17 No
❑ NA
❑ NE
❑ Yes
5'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 naees as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�J yc,n Phone:j-.FjT7
Dater
21412011

Type of Visit: (p Cgtnpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: V[ Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 Zo 3 Arrival Time: ® Departure Time: JI S County: Region:
Farm Name
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: DiXVXbWu L_-n1M_( ecco_ K 6 a Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
C>apacity Pop. Wet Poultry
La er
Design Current
Capacity Pap.
Design C►urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Nan -La er
I
Dairy Calf
X Feeder to Finish
38 '
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr. P,o_ultr,
Layers
Design Current
Ca aci. P,o
Cow
Non-Datry
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other J L___L0ther
Turkeys
TurkeyPoults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes CJ 1" ❑ NA ❑ NE
❑ Yes rNNo DNA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: -3rigly jDate of Inspection: 3 !
,0
Waste Collection & Treatment �
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L�J i4o ❑ 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: LAGt&J I (A 6,100 Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 119
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
6 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
E�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[?fNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[:2�o
❑ 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
E: "`o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of 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
�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�40
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21<0
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ENo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3No
❑ 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
ff No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

IFacWty Number: - Ds ection: 1
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 ON. ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge Ievels 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 d No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes 0"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ff /No ❑ NA ❑ NE
❑Yes IlJNo ❑NA ❑NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
dNo ❑ NA ❑ NE
�No
NA ❑NE
❑ NA ❑ NE
Reviewer/Inspector Signature: 44VA Date:
Page 3 of 3 21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Vtoutine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: job Arrival Time:
^ Departure Time: County: Region:
Farm Name:1'+iL1Vl S /,Yt- Owner Email:
Owner Name: �V 1 w+ C_Ll E}ih S �7AfLMS 1J4/L Phone: 91C�-53D -W6F Cyr EA01
L� Mailing Address: �,_L.1 , 010
Physical Address:
Facility Contact:
Title:
Onsite Representative: C �,%i MoN .e
Certified Operator: �'6 A 0 l 1*_'i l& , LA—� W A tK % _
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
C�'ficicat a Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Eop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
11 Non -Layer
E�J
Da' Calf
Feeder to Finish
A
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
to Finish
POL�a
Non-DairyFarrow
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Other
Other
Turke s
Turkey Pouets
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes INO
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facility Number: Date of Inspection:
1, Waite 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:
O�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -37!> I
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 pufilic health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes j 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): � G-1
13. Soil Type(s): /V 6(('F0LA(_
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 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes No
❑ NA
❑ NE
the appropriate box.
QWUP QChecklists QDesign Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
0 Waste Application Q Weekly Freeboard Q Waste Analysis ❑ Soil Analysis Q Waste Transfers 0 Weather Code
Q Rainfall 0 Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and 1 " Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes OdNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: / - Date of Inspection:
24. bid the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any Iagoon
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 0 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
WA
❑ 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
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes Mi No
❑ 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).
�Ug�1�bw �u� aa1
w-a . // / —,> Sly
3j/// ��_ J. 9
(i�l ,0/ 11 6.e)b & /) 6 -,> j 0// 0
u115
. L��►C014 %�K-E # NEEDS rn� ECLOS)o� conrr2o�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�'
t3C�nl NCB �
Phone: !36
Date: —3 1 j
21412011

ADivision of Water.Quahty
FFacifityNurnber Q Division of Soiland Water Conservation.—"n
v_ O �✓
Other,,Agency
Type of Visitj Compliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Compliance
0 Complaint Q Follow up 0 Referral O Emergency Q Other ❑ Denied Access
'NDDate of Visit: ® Arrival Time- rDeparture Time: County: u Region:
Farm Name: DAv Cam, LZ r,fYi S FR�ZrY1S )JV C Owner Email:
Owner Name: Dau1� ��(LL169MS MS _ &Ca Phone:
Mailing Address: j__1t`I wl LL / Ar t S ►t-O { _L / Y t-11
Physical Address:
Facility Contact: Title: Phone No:
�/],
Onsite Representative: �V`t%�� 1 " +�of'g- Integra or:
Certified Operator: D�� Q W - � S Operator Certifcation Number: -/ "' S4b0Q
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: = o = 6
Design Current
Design
Current " Design Current;, .
Swine
Capacity Population
- Wet Poultry -.Capacity:
Population- Cattle ;capacityPopulati n
ElWean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
" ❑ Non -La er
❑Dai Calf
Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
El Da Cow
❑Farrow to Feeder"'
El Non-Dai
❑ Farrow to Finish
:
❑ Layers
❑ Beef Stocker
❑ Gilts
❑Non -Layers
❑ Beef Feeder
❑ Boars
El Pullets
1 ❑ Beef Brood Cowl
I
❑ Turkeys
-
�u
Other
❑ Turkey Poults
❑ Other
�'
❑ Other
Nu r of, tructures
Discharges & Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
to
❑ NA
ElNE
ElYes
❑ NA
❑ NE
Page I of 3 12128104 Continued

-acility.Number: — f
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: ) ___5 L- 5
Spillway?:
Designed Freeboard (in):in
Observed Freeboard (in):
Structure 4
❑ Yes r PNo
❑ Yes ❑ No
Structure 5
El NA El NE
❑NA ❑NE
Structure 6
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 puhlic health or environmental t reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No El 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) ,�6c1'OL4C
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes '
No ❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
El
No ❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
El
No El
El 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?
El
o ❑ NA
❑ NE
Comments (refer to.question ft Explain any YES, answers and/or any recommendations or any other comments w* , F
Use drawings of facility.to better explain situations (use addttronal pages as necessary);
,. .
Reviewer/Inspector Name
.°z Phone: 6)
_
Reviewer/inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents `,_,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes •`�LI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. 0 WUP Q Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No El [I NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis El Soil Analysis 0 Waste Transfersinual Certification
EIRainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections El Monthly and V Rain Inspections /❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
. No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,.,(
j� No
❑ NA.
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ 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
�No
El 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
jo No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
do
❑ NA
❑ NE
Additional Comments and/or Drawings:
g4ZF�i row �)LAJF�
h4 00(X 1 C-C'- PAV4?//V()-
A(eli;b Cc-7je Z GQ SS7CCjQr6aAC(E 4N Ct46QG1,V b) KE
Page 3 of 3 12128104

Type of Visit ACompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit A Routine 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:Mual Arrival Time: Departure Time: County: 1 Region:
Farm Name: "UQ U l4.') LA-2�1> LL-1 14m S i-47-04. /NC. Owner Email:
Owner Name: L AL)) f) W) C_L1 A+t'� 5' ACL OA_ JNC , Phone: 9/0-S39-9ME- El-cr a (e
Mailing Address: ,�"1 ��a c—� I RM 9 �i�-d VF ��E }-�lc �l /VG DEy� 8�S 1
Physical Address:
Facility Contact: Title:
Onsite Representative: _Mooe-E
Certified Operator: Q440 tAj • w+ U...I A#o r�
Phone No:
Integrator:
q ` (5_5(o 02
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [= o[= 6 0 Longitude: 0 o Q& 0
it
Design Current Design
Current
Design Current
Swine Capacity Population Wet Poultry Capacity
Population
Cattle
Capacity Population
❑ Wean to Finish[E]Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish
Dry Poultry
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers_
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Beef Brood Cowl
❑ Boars ❑ Pullets
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharstes & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes qNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes 10 No
❑ NA
El NE
Yes , to
El11!
❑ NA
[INE
12128104
Continued

Facility Number: Date of Inspection !�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
/ Structure 1 Stru re 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: c
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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
maintenance/improvement?
❑ Yes t� No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes !�J No ❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El 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)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
10 No
❑ NA
❑ NE
15.
Does the receiving'crop and/or land application site need improvement?
❑ Yes
PrNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
IT
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers and/or any reco me das o a tionny other comments
. e . _.. , . : � _ ..,.. _ r _.. ,� ,.c=* : �,,. t a �:k
Use drawings of facility to better explain situations. {use addrt�onal pages as nei essary) . , ,}
6&A-T ION O� 6 CC)41 b
Alp SQ C cAAt ED -- Ai o vSj 1,V rFe_ PL4AA-PIA/ C
ReviewerlInspector Name
Phone: -
Date: 7
ReviewerlInspector Signature: LkYrQyytCt�Q h
12128104 Continued

Facility Number:. Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes X No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis [3 Waste Transfers ❑,tnual Certification
El Rainfall ❑ Stocking ❑ Crop Yield 3 120 Minute Inspections El Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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. Did 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?
Otiher lssues
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 ANo
❑ Yes 4 No
❑ Yes )kNo
❑ Yes ❑ No
❑ Yes bi(No
❑ Yes ❑ No
❑NA ❑NE
❑NA ❑NE
❑NA ❑NE
❑ NA 'N NE
El NA ❑NE
XNA ❑ NE
❑ Yes KNo
❑ NA ❑ NE
❑ Yes 'No
ElNA ElNE
ElYes,,D�'N1 o
❑ NA ❑ NE
❑ Yes .PrNo
❑ NA ❑ NE
❑ Yes �No
❑ NA ❑ NE
❑ Yes �No
❑ NA ❑ NE
cipditio alC�o�ments and/or Drawings:
�]l�]�� , t a M
CM
sutZ u& �fZcz cotLDs
E Lb FOB9
El
12,128104

IType of Visit V Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit x Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Arrival Time:
Departure Time: County: Region:
w
Farm Name: AU 1Z�
wl LLI
4A,- S r 4
I
AA-S &e-. _ Owner Email:
Owner Name: +�/ i� �)1C J A/A� V-s 1`i4R��VI�3] )/JC. Phone: J �}
Mailing Address: J 3 CS1 r 0 � L.J-1Ntp 1 �-L:_ 1wS 141 LL • / Y C- aD% Y 5
Physical Address:
Facility Contact: Title:
t2 �� 1 '
Onsite Representative: G P(� yd0QLC—
Certified Operator: N_'14 U I w w f L" R Ms IL
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 4 9 0=,.> (_0a
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = ii Longitude: 0 0 = j = ,6
Design
Swine Capty
Current
Population
Wet Poultry
Design Current
Capacity Population
Design
Cattle Capacity
C•nrrent
Population
❑ Wean to Finish
❑ La er
❑ DairyCow
❑ Wean to Feeder
❑Non -La er
❑ DairyCalf
Feeder to Finish
❑ Farrow to Wean
DrY Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
- ❑ Turke s
❑ Turkey Poults
❑ DairyHeifer
❑ D Cow
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Non -Dairy
❑ Beef Stocker
Gilts
❑ Beef Feeder
FE] Boars
❑Beef Brood Co
Other
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes x No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes] No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes �No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: -may Date of Inspection to
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 l Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
p {
Designed Freeboard (in):
Observed Freeboard (in). 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
I l
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 'K 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
6"t' 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 ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[ No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
�jNo
❑ NA ❑ NE
nts (refer to.'queshan #) MExplatn-any Yi S answers and/or an
Petter explain situations. (useaadmonal.pages as necessary ; n
Reviewer/Inspector Name Phone: Jjg"� jo1�
Reviewer/Inspector Signature: Date: )Q
Page 2 of 3 12128104 Continued

Facility Number:3) �i Date of Inspection /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 CA WMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard El Waste Analysis ❑ Soil Analysis B Waste Transfers ❑/nual Certification
0 Rainfall 0 Stocking 0 Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes]
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NA
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
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
Wo
❑ NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
O
32.
Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

6 Division of Water Quality
Facility Number 3 '� �� Q Division of Soil and Water Conservation /
0 Other Agency `t!
Type of Visit 4 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit �§ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: LAW Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative:'04toa) W 1 LLI*MS Integrator:
Certified Operator: Its AV 1 L� W • U') kLJ—4I +ks � 5�— Q Operator Certification Number: ` OL^) s9
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
�o
Latitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer Ll
1— ❑Non -La et
. I E�]
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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?
Longitude: = o ❑ i
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Eli
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 KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
4No
❑ NA
❑ NE
❑ Yes
[ (No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2//}} Structure 3 Structure 4
Identifier: LACa CO M R
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): n}
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes O(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes gNo ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes i%7r El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes allo ❑ 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 IV ❑ NA El 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 oNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drill [:]Application Outside of Area
12. Crop type(s) S Nl G t2A W , & C—e m(k1>A
13. Soil type(s) _ /y43(Z F-o L lC
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
J'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JP -No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
kcrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
-allo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name pwvwG'7 Q4 me S Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: —'3�y Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C9,No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes JXNo ❑ NA ❑ NE
the appropirate box. ❑ VVUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes EANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ONo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
r-7t No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
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
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[� No
El 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
1WNo
❑ NA
❑ NE
12128104

Division of Water Quality
Facility Number ?, g Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: /Z'Z4QO Departure Time: ' ounty:
Farm Name: �/� Owner Email:
Owner Name: ✓ f t/ Phone: _
r
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone No:
Onsite Representative: a� Ci��� d0!!_L' , 4 0w �'" Z� Orator: •QIyS�f�C
Certified Operator: Operator Certification Number: Z4'�3 Z 12-
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Back-up Certification Number:
Latitude: = o ❑ 4 0 Longitude: = ° = g 0 «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Other
❑ Other -
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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dr
y Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: EEL
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
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes 11
No ElNA ❑ NE
❑ Yes �No []NA ❑ NE
12128104 Continued

Facility Number: 31 Date of Inspection / O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA [INE
a. If yes, is waste level into the structural freeboard? ❑ Yes i ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L3 15L 5
Spillway?: n% tip
Designed Freeboard (in): 5�
Observed Freeboard (in): �aj2 3Q
5. Are there any immediate threats to the integrity of any of the structures observed? ❑Yes I El 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 [I 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? ElYe 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 ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)tea,
13. Soil type(s) �p (� ,
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
ZT
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
�
Xyes ❑ 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
Cl NA
El NE
18. Is there a lack of properly operating waste application equipment?
[I Yes 2fNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
/ems.e6,0,�
�irl �in P2o r/f,
Reviewer/Inspector Name Phone: 10
Reviewer/Inspector Signature: Date: & 0J
12128104 Continued

Facility Number: ,j ;j Date of inspection / O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes /VNo ❑ NA ❑ NE
El W
the appropirate box. UP ❑ Checklists ❑ Design El Maps Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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
gNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Q1'No
❑ NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
/�No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(((((( No
�
El NA
El NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
X
❑ NA
El NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
p
[/� -iP�E��1�Q
i
X Z��10 �aSG �� 7� WE�D.er �E
0114C,17
`� D � T !ri»i Cam' ✓� �
12128104

Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
— - Q Other Agency
Type of Visit fjj Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: ,j /� Arrival Time: r Q Departure Time: unty: Region: C�
Farm Name: AAA=~' Owner Email:
Owner Name: AaAo 1 + Phone:
Mailing Address:
Physical Address:
Facility Contact: Title.
Onsite Representative: 6"-W
i
4" -
Certified Operator:Gz
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = ° 0 ` =
CA
/,
Design . , Current Design Current ti Designs Current '
'GAS
SwrneCapacity Population Wet Poultry Capacity Population` ..Cattle , {.,Capacity Populat' .
�..:-
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
12
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La er
Dry Poultry
❑ 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?
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[!] No
❑ Yes
ILl No
❑ NA
❑ NE
❑ Yes/
No
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of Inspection S /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ 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: /—,3
T"
Spillway?: 0 NO
Designed Freeboard (in): Ig, 5
Observed Freeboard (in): T� 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )ZNo [INA [3NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No [INA [INE
through a waste management or closure plan? 0
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 PINo ❑ 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 I,Q No El NA ❑ NE
maintenance/improvement? /_,(
IL Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes P No El NA El NE
❑ Excessive Ponding El Hydraulic Overload El Frozen Ground [I Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or_l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) d
13.
Soil type(s) /149
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?
/�fNo
XYes ❑ No
❑ NA
❑ NE
W
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 XNo
❑ 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):
S I err- o c%E
'61'wly) ao'i
Reviewer/Inspector Name l�A A Phone: Am
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 ' Confinued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ElNE
the appropriate box. ElWUp ElChecklists ElDesign ElMaps ElOther
21. Does record keeping need improvement? If yes, check the appropriate box below. 9yes ❑ No [-INA ❑ NE
ElWaste Application ElWeekly Freeboard ElWaste Analysis ElSoil Analysis ElWasteTransfers ❑ Annual Certification
❑ Rainfall oi&ft
❑ Crop Yield ❑ 120 Minute Inspections 9Monthly and I " Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
oil,
❑NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yesyr-
No
El
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LQ No
❑ NA
❑ NE
Other Issues
%
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 1VNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes [/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 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 [VNo [3 NA El NE
General Permit? (ie/ discharge, freeboard problems, over application) !!
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes /0No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑'No ❑ NA ❑ NE
Additional Comments and/or Drawings: '
!/ N
C/--c -
2,9 C ✓� ( 4 R-41,1
A,��,�5�
Page 3 of 3 12128104

Type of Visit
Corn nce 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: Arrival Time: L L.� Departure Time: County: LdPL4tr Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �� ti.i� t.A fy►S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
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 [= i Longitude: = 0 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
. ❑ Layer
I _1 JE1 Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
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
El NE
❑Yes
❑No
El Yes 9Xo
❑NA El NE
[I Yes LV ❑ NA ❑ NE
12178104 Continued

Facility Number: —
Date of Inspection !�
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
S
Structure 5
Structure 6
Identifier-tA660N l fo LAG-oa ?
Spillway?. -
Designed Freeboard (in): ! S
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
El NA El NE
[(VNo
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El 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
7. Do the improvement?
environmentalth eat, notify DWQ
Zo
any of structures need maintenance or
El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
�/No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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
[;No
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) 26KAANvDA ( 4 ) CwJ
13. Soil type(s) do A
me
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L1 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
9/Yes
BKNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
❑ Yes
O No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ErT o
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
;No
❑ NA
❑ NE
rA
ovm1c. 7b-) a-ekL wpa, 6vsAEW—1
Reviewer/Ins ector Name v 1'16) 7 t — '] (ot
P 1i� Phone
Reviewer/Inspector Signature: Date:

❑ Yes
o
El NA
El NE
❑ Yes
7No
❑ NA
❑ NE
Facility Number: Date of Inspection a n 5
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
LJ
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
[I 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
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
,KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
Zo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El"No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E�<o
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 N'o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�,/
'
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
7No
❑ NA
❑ NE
A'ddltlonal Comments and/or Drawings �A,�'e i " aYax r tisX T
12128104

Type of Visit OYCongfliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit OYRoutine O Complaint O Follow up O Emergency Notification O der ❑ Denied Access
Facility Number Date of Visits Time:
Q Not Operational Q Below Threshold
Permitted Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: _ 0 W �a:M_s_ zat= County:
2.- 4y fop �d
Owner Name: .�._._.................. - -• Phone No. ......
Mailing Address:
Facility Contact: __ ._ W ...... ---- -Title: WWPhone No:
Onsite Representative: PAg;w 1iz_ .C1S_---- �[Z _ Integrator.p _
Certified Operator:. --
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude • it Longitude • 6 44
Swine -
Design DeQga Currr�t r Dga Cnri
ai�acity Po lion Poaltr9' "Cat�aci-Ponnlatton, ._Cattle Capac�t�;=Ponullation
= Wean to Feeder =i ❑ Layer 71nDairy
Eff Feeder to Finish 36,75 ❑ Non -Layer I I-- Non -Dairy
Farrow to Wean
Farrow to Feeder Other T
Farrow to Finish _ - ;i
Gilts s x - Total
Boars ,. Total SSLW .
Nu
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2- Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: __ f
Freeboard (inches): 31--
❑ Yes p'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 3<0
❑ Yes To
❑ Yes L'T No
Structure 6
12112103 Can inued
Nu
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2- Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: __ f
Freeboard (inches): 31--
❑ Yes p'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 3<0
❑ Yes To
❑ Yes L'T No
Structure 6
12112103 Can inued
Structure 6
12112103 Can inued

n;3ity dumber: 3 Date of Inspection I ?Sl lbw
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes O/No
seepage, etc_)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or D Yes [/No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes eNNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes E No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancefimprovement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes �No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.. Crop type A CSC
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 91�co
b) Does the facility need a wettable acre determination? ❑Yes [�
c) This facility is pended for a wettable acre determination? ❑ Yes 7N9
15. Does the receiving crop need improvement? El Yes 16.Is there a lack of adequate waste application equipment? ❑ Yes [ o
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below C] Yes 0<0
liquid level of lagoon or storage pond with no agitation? / 18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [JNo
19. 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) 20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes
Aar Quality representative immediately.
Comments (re€er tu:gass�n.#} �Expiamauy�YES�answers andlur ury' or sny�oih_eroaa�_e_ats. -�.� - -�
Use dravvn�s�of#aa'>lry two bettu���� � {cf n�I,pages as'}� - Feld Copy D Final Notes
C-LC-AR- i3Qc.k_s:AE of I.AGoorJ %',AAL U4 Qti11S�j,
Wp*srr ► C(=V -tb, 3&c r►<e+l43�►�bs� '
�ts,�r/Sb�nlp// �p�j
PAPS COFL AftrM 1-ULA_M. t�VK7� �PT~` `6 r co00- AJC0.1��G. ;%J LJY�-�`-'Z.
PAP
USE
3S.} UPOp,t& (.ri.oP YSEo
.Lu t �.flA L i�F T(,ti. t �i fZA sli .
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: a 64
12112103 Continued

�I'acility Number: 31 _38 Date of Inspection 1.1p o
I
iecinired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Doe record keeping need improvement" If check the appropriate box below.
Waste Application ❑ Freeboard Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewfmspection with on -site representative?
29. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for DES required forms need improv ent? If yes, check the appropriate box below
❑ Stocking Form Crop Yield Form ❑Rainfall Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes [(No
VYs [�
❑ No
❑ Yes CT No
❑ Yes 2<0
❑ Yes L7No
❑ Yes ONo
❑ Yes to
❑ Yes ?o
Yes ❑ No
❑ Yes 31410
❑ Yes Lr9a
❑ Yes L<o
❑ Yes �R�O
❑ No
12112103

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit to Routine O Complaint O Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: f - O Time:
10 Not O erational 0 Below Threshold
0 Permitted [3 Certified 0 Co�ndi�tionally Certified r[3Registereedd ,,�D/�ate Last Operated or Above Threshold:
Farm Name: �4J �JZ,p 1.�/� LL'��}n' i'AR/'h`� V 1�+1� County: DLA
Owner Name: Pei rm Phone No:
Mailing Address:
Facility Contact: `t '. Title: Phone No:
Onsite Representative: �W
yZQ '1::7L1.Zfl lVVS „ , ,; Integrator: R CS'fA0-�
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 u Longitude 00 4
Design
Current
Design Current Design Current
Swine Ca aci
P..o ulatiorr POUltn3 ,
Ca aci P,o ulatlon Cattle Ea sci Po ulation
❑ Wean to Feeder
I ❑ Layer
110
I JQ Dairy
Feeder to Finish 1,5 to r75
E Non -Layer
I 1 11 JEJ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder
=
❑Other
❑ Farrow to Finish
TOtaI llesigin Capacity —�
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons © ❑ Subsurface Drains Present ❑ La ooa Area ❑ Spray Field Area
Holding Ponds OWN
❑ No
Li uid Waste Mana ement S stem
Dischaa ees & Stream lm acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection && Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Stnicture 2 Structure 3 Structure 4 Structure 5
Identifier: _ # �if,
Freeboard (inches): T 2?1
❑ Yes l6 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
VNo
❑ Yes
WrNo
❑ Yes ZNo
Structure 6
05103101 Continued

• J I
Facility Number: —3 Date of Inspection I G/
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes [p 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 VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes m No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ElYes ILI No
_Waste Application
l0. Are there any buffers that need maintenance/improvement? ❑ Yes VfNo
11. Is there evidence of over application? _ ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes [{'No
12. Crop type AN5
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?
t 6. 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 PTNo
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes WfNo
❑ Yes ONO
❑ Yes A No
❑ Yes ONO
❑ Yes PrNo
❑ Yes VrNo
❑ Yes ONO
❑ Yes
❑ Yes
❑ Yes
❑ Yes
ONO
No
PINo
VfNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coiitments (refer to quesbori Ezplam any YES answers andlor any recgmmendahons or any'a her comments
Use drawings of faces ty to better ezp am situations (use add_ itional pages$as `oeressary}
El Field Copy El Final Notes
_ _
�
1.5 yqV AA�S 1 & eo Jro AA /QFir� D t1f-O /�i�4 /i�i � �Z"�L �
qW
k ,,• `.
Name ector Reviewer/Insp r
Reviewer/Inspector Signature: Date: d
05103101 Continued

0 . .
Facility lumber: 3 Date of inspectimi
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there anv 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?
-Additional. Comments. a nd/or°Drawings:IV
dw
69,_J
y �.►2 >z�► 6cT .�
OMAU/i
V / iy4"71 S
2T�
05103101
❑ Yes 'V No
❑ Yes PfNo
❑ Yes P1 No
❑ Yes Rf No
❑ Yes VNo
❑ Yes EfNo
❑ Yes ❑ No

Type of Visit orcompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I
Date of Visit:
E3 Permitted 0 Certified .0 Conditionally Certified [3 Registered
Farm Name: Z�GtVIAZl/s�IiGlms �ff,��►�-
Owner Name: 5) z` v , ; I f ► G"W1.SF�"Y-"Is ^T G
Mailing Address:
Time• �� U
Date Last Operated or Above Threshold -
County:
Phone No:
Facility Contact: Title: Phone No:
OnsiteRepresentative: Oa V A t GL�s Integrator: �S�Aeki
Certified Operator: Operator Certification Number:
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 4 Du Longitude ' 6
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes dNo
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 ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 2-
Freeboard (inches): 30 Z
05103101 Continued

Facility Number: 3 — 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 2fNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or /
closure plan? El Yes �j 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 'ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes //❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Cl Yes XNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes )2j'No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes .21No
12. Crop hype A,rrnydyt b4,,, y , Go" jkf hoof Sa j bey. �
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes ❑ No
16.
is there a lack of adequate waste application equipment?
❑ Yes ZNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
'XNo
(ie/ WUP, checklists, design, maps, etc.)
21ryes ❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Oyes ❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ,16 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes ' �o
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ZNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes &No
24.
Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_ 4acility s .,ess�a' ry,) . ' ❑Field Ca
py ❑inal Notes
to betteplatn situat�on5.(ueaid�honapagesas ne
..
S, P;r 4hct-f 9oes Aetos-S creek 4o .sprcL hers e ree Rcl1/e-,x oCrass
l4 pn 44,e 5;de e f 41,e Creek *GAIN-54 ho j hotevjes . M. Sgio{ l)ekiv
na-t vseeWh:s P;1e_1 t ►)n R Ian .{..;.►.e U4 1easl 3 J.Ti,;s
;s fe1 „.eeat qs r14 "1 rs Gt�frem7l wr;44en . lveeef 4ip ensvre 4h + f> e
is in+a C'4 and[. frZiperl Time rQrefenCed4 r;,e]G, GeuI dL be
�r�;n
.4h;s ►^1v. 4 &e wr$ .e,,j ;x146 livas-,e -plan . sjvs4rlan� Carnrt"1ke�t�tar b2�z�s lh l,r
Reviewer/Inspector Name LOWeWA aE"}hIts
Reviewer/Inspector Signature: % Date:
05103101 Continued
qr?epi!�( otCvosS Gi l c1S I �t=1 )-s G v �r�v'1- (� W /' ri72+'1 ' 4 -

Is T-i'yP Berl-1 11 Act -/"; e Id 11 ox-- been ss ra ed w,46 k e,- b ;Glo(e 4. .�s 11-5
So t/V, vna ble -Fe , ove►l :�rvxa s4 f �a v%e'v t✓r�p .
._ f.1cee! -f-a ns�re -j h �h� s sv Y
ct you Sand r,� v ah C01 a
Facility Number: 3 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ 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 ZNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ld(o
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 P'1(l0
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 0"No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanenthemporary cover? ❑ Yes ❑ No
1q . Some at,(-4k-, LvOU e Acres i►'1�DI a'! �6Y1 is vnGlear. Twp h yd+an-F�
41\e be.—m"A� -tieW fti/has rve h +^an-�j ih +� �l{'e lakdkd
� oin he '-a i -� he, s no Gal ctJl�-�� 1°°`�� Fa r �l,e ►..�e�od
��1[s. Also �ddoe
-¢�,ese �wg � -�'�e acrea5e -fir -�hc �.
ov![ in 4ke re�'e,-e►-,,c r,, ;s shown aj 3.�Z ac�cs ol�l
f cv1�+-i pan sl,ee-� l;,,I�,; fe hndtp Sl,ot�1 � --� aGres� need[
A�lst;rePanc� clep,red Vf. A1r0, 4i e 7:1'R2-Z Aoea Ps 4a mol
phAach 41 e wei9eA Azwos IUeed 4o el.', 1,-,A4e
e-lf 'r'a►-�G�`�1-FrQr'l We�I,CA Aefes 1rl4Pt^-G;f10h ti;fh4vl?
�t.rt. Ii-F;,ed �oerle � vvtci �e Avld doGvr�e�� w1.Dd ;�cq. � ►a`'` te Lp, rtQek 4o & wr,4en bf.sed on we.fla bJO acres e ;h�a
Was
Ol✓1G�1,Z aG>rPo ►r)eBOls �p CO�f2SDOnd -JoL.vy�abl� aCl�]�G
J (J'd D G v MP r►t-f-a-i i �h �o C i7�T � �'"s .
lg, Need I � �a�, des ► � h ,•�Far,�-�-� ter,
)R. yo0 t.v ���'1 ay[ reed 4o vPda-le t ,OL4 e f'.�ld �lo�l�caoh re-""Of�4 ler
do{ijy
sl��-� ney ,d 4Ae4e) o,nd Wh-'C-k pvll was
.I
rv'Me G,ad m04 we 4l e*A d0w►, eYita( 43e ieS o,r v1 rvtnde for
g111,0 ��,�,( g11116 Z eve4-h Vn4;l �'nsfeCv; -fn . 41sp l e nd 4iIves
were n04 reG-'rde-d an record rer -2,001 a���vl� c�,-�; o� Sf 3rd
Ip„r4y ewl-fv14An+ 11eed endere of "A ..�';�e ovn -T zl-s &eenseet
ass vied rYy7 �;rn e !'►'! r . W ;11!; awtS
Asa) neeA 4v be sv,re --o recore[ treeboafd week;
-(fie rc Are nD -Freeboard r'eUorG� S befit cn ��iZl a z Rcro1 3%�z�oZ
and 3/Zg4v 411110 Z . Me , Lv ,11;awt s Sq seo-v i ce rat h
11�e�� keeng --�h, sl &v+ h4,. , l.�/ ► ll ; am r .sue 1w ; It 54-t"4 do; ,�
Alta) 4he re �vess no wa.s4e a pnq! a : s w;fh;h &ei d4 s a
, -%Q le4e pv9gaol l;Gp�-�;o� j MU54 h4vt anal :sad
l2r W 4 4/! in �jlJ �aS G�t9 ® 1 i ] o+N C1l�'1�} s .
d.S sLrdw a Ogle i'16Lt d rer,n ,lagooh wid an
�ker`c G1,r2 h4 Cp✓'reS�p7e�
a�1�GC�-I ion reoerd:��. ��/�ll�al s.���--th;l ►r -hc resvl-1 c►�' er�a� to
05103101 re 41Avge evr\4 ree a, -A keep,'c,
9
�n. �✓%✓. lilf,!r�Ll�hi ;►��i �ed �'}c
�rav; P UUk �o`lre a�G&,Ireq e, wa� y0o.- h; I�' 4e read ctv e.rv4h

Drv�sioti of Water Qiva
¢ DiAsion of Soil and Water Conservation
Q
4 Q Othet A epic ` -
� y
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit jarRoutine O Complaint O Follow up O Emergency Notification O Other [IDenied Access
Facility Number 3 J Bate of Visit:Jr Q 'rime: 76 QS 1 Printed on: 7/21/2000
Q Not Operational Q Below Threshold
[] Permitted 0 Certified ❑ Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .........................
Farm Name: a V ......................... d �J r..s Yc,,/.r-,Sj h L. County: j P,(1..n.........................................................
.....................................�...........................................
Owner Name:....... a ✓ �......... h!_,:rr.i G ^L S Fe,T►"-. S nC Phone No: ................................................................................
FacilityContact:........................................................_..................... Title:........................... Phone No
MailingAddress:..............................................................................................-........--................................-_.........................-........-............................
Onsite Representative: --_ +"/ t? j (t: � Iutegrator:PresA.................................. r..1 ...................I..._...I.......... ........................................................................
Certified Operator:...................................................................................-_.......................... Operator Certification Number: .................................
Location 'of Farm:
I\
'016wne ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 14 Longitude • 4 «
Design ' Current
Design Current Design Current
;5 `:Ca ci Po elation. Poultry
Ca aci Po ulation Cattle Ca ari :. Po elation
Wean to Feeder ❑Layer
❑ Dairy
er to Finish 3 ❑Non -Layer ❑Non -Dairy
-_ Farrow to Wean
Farrow to Feeder ❑Other
- Farrow to Finish
Total Design Capacity
:x Gilts
'i Boars
Total SSLW
, l�Wlfi�Cl- Vi LB�OOnS rr -_
-. .� �.
Subsurface Drains Present ❑ Lagrxm Area ❑ Spray Field Area
i. HolldLug Pond; /Solyd;Traps ;
No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ON-0
Discharge originated at: [ILagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made? ❑ YesANo
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? h 7A
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 _0"No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:]Yes O'No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................ ......_................................................. .................
Freeboard (inches): T
5100 Continued on back

Facility Number: �� - B Date of Inspection z Q Printed can; 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes XNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? XYes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes,,O'No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Ej"No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes )�fNo
12. Crop type Cdrh,W h--0 , 5-0ybC.yt1sj 13er-r,U441 H-Ay
f f
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. Fait to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: N,O •yiQiatidiis'ot- deficiencies were ngted. during t, s.visit'. • Yoil Will •re ieiye ii© further.
correspondence. about. this .visit... . -
El Yes _I
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
'Iffyes ❑ No
❑ Yes, �No
[]Yes j2r,�o
❑ Yes o
❑ Yes /�No
❑ Yes Yes
❑ YesNo
❑ Yes P1Vo
❑ Yes'-Ipmo
❑ YesX o
❑ Yes A�fNo
%. Ljork �v b4c., e5---I61, rt �jra�s cove,*'- � 0% 16 JO q'1 2-,
—rtie► e 15 sOrhe y 4 caq s.4) ),� fie ! 604,0 cJ>rii l d f bu+ &41,ee
9`�P-5 k)eeat 4, �e eI;vn,4,,ated anal c.,���fal ����6t;sG��d ;x
Reviewer/Inspector Name o he >' Y� i = c " E' "
Reviewer/Inspector Signature: Date. SCIZ S S/pp

Facility Number. Date of Inspection ut D Printed on: 7/21/2000
Od6 Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid Ievel of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes fl-No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ YesAff'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 ONo
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
omments:an or Drawin
gs:, gs - - _ -
5100

R
d ^ i. i '.-.'
-. L - -ham rj}�'7',+'•,� y�_.y},!
v�sEon of Water Quality , '
an
o d Water Conservation
x �r
Qi Other. Agency ,
aL
l F
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Atoutine
O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: Q Tfine: Printed on: 7/21/2000
Facility Number
_ 7%�.
Q Not Operational Q Below Threshold
[�rmtttedjUertmed © Conditionally ertined LiRegistered Date Last Operated or Above Threshold.
Farm Name: ![ll.<.�. A/z,a�..,Y.� County :............ ...._ ....... Owner Name:�Ll�.....114.l /..�1..!�[ ���P S Phone No: .........................................
FacilityContact:.............................................................................. Title: .... ............................................. Phone No:
Mailing Address:... ........ ........................................'...... .
Onsite Representative:! /{ . %C--•..................
Certified Operator:
Location of Farm:
................ I .................. ..............................._. ................ ..........
/ ,/
Integrator: ....... I.-... v
Operator Certification Number: ............... ..........................
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� �' Longitude �• �� �jc
Design Current Design Current Design Current
Swine Capacity Poj2ulation Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Weeder to Finish JE1 Non -Layer I I❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JE1 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag -on Area 10 Spray Field Area
Holding Ponds / Solid Traps 1 10 No Liquid Waste Management System
Discharges & Stream Imaacis
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made''
h. If discharge is observed. did it reach Water of the State'' (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/►nin?
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?
SdMcturc I It
Structure 2 Structure
Identifier:
y
�4- .l,e(
Freeboard (inches):
r6
❑ Spillway
Structure 4 Structure 5
❑ Yes KNo
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
❑ Yes KNo
Structure 5
Continued on back

t
Facility Number: — Date of Inspection ���] Printed on: 7/21 /2000
5. Are there any immediate threats to the integrity of any of the structures obs ed? 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
closureplan? ❑Yes K 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 ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes `�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level '
elevation markings? ❑ Yes ZjNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes _KNo
11. Is there evidence.4over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes IZNo
12. Crop type U-W J
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes <NNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes o
b) Does the facility need a wettable acre determination?
❑ Yes P�No
c) This facility is pended for a wettable acre determination?
❑ Yes
15.
Does the receiving crop need improvement?
❑ Yes
16.
Is there a lack of adequate waste application equipment?
`;o
❑ Yes A r1
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes gNNo
18-
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
(ie/ WUP, checklists, design, maps, etc.)
'KN-0
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes -,FfNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes kNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
El Yes DNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes L�To
24.
Does facility require a follow-up visit by same agency?
❑ Yes WO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes `�No
/
0: io•violatioris:oi- kficiendbe •"rb, ngted-di&ifig this:�visit:-Yoix will -receive iio: l'urtht>tr
corresporideni ce:abautthis:visit:::::-:•:-.-.-:•:•............:.....................:•:-.-.-.-,.....:
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):
W�
Reviewer/Inspector Name r�����
Reviewer/Inspector Signature: �� _ ,�_, 6 ��//���� ,�^ Date: 4
5100

1.
Facility Number: — Date of Inspection G7i 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 atfor below
❑ Yes
4No'
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
JNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
, Vo
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
I<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
5100

-(3 Division of Soil andWater _Consei ahon-= OperatEon Review
- ' - .._ _._.. a
D Division of Soil and Water Conservation: -,Compliance Iiispect�on
�.11ivis on of Water <juAity-:Compliance1nspecti©n
a.
r �
[] Other Agency --;.Op': tl d Rs
esew Y
14PRoutine 0 Com laint 0 Follow-up of DWQ inspection' 0 Follow -tip orDSWC review 0 Other
Facility Number 3 3
Date of [nspection 8
Time of Inspection FT27 /5 24 hr. (hh:mrn)
© Permitted ® Certified © Conditionally Certified © Registered JE3 Not Q erational Date Last Operated:
✓/ W! f 1 L- County:.... 3 n
Farm Name: ................. �'�.._........•-................r.7................f .. �........................ L....
Owner Name A V% ► f I�S otWLQs �Z"e J Phone Na: l `5 32
FacilityContact: ... ............. ..... ........ .�J.................. Title: ................................................................ Phone No: ...................................................
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative: ...... lJlc►/ 1'1. J............L.4�...y.j...... .�.t 4 ....... Integrator:.. .e. .T..........................................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude ���°�• Longitude 0���°�
Design Current _. Design_ Current.. Design. Current
Current
Capacity tyPo ulab0Ppulatin :Cap pulatronS;Mn'e 'Poulty CaitP
❑ Wean to Feeder
tff Feeder to Finish
3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of Lagoons - �.J ❑ Subsurface Drains Pres; I0 Lagoon Area ID Spray Field Area
Holding 1?onds�/ Solid Traps [] No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated al: ❑ 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. Dues discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes A No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I Z
Freeboard(inches): ........3...`��.............. ..3 ....................................................-
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P1 No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date of Inspection s
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes PC 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? 19 Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance improvement? 1KYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes M(No
Waste Aonlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? !� ❑ Excessilvef Ponding ❑ PAN ❑ Yes ANo
12. Crop type G
13- Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes R 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?
XYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
K No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
1KNo
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
1K No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
WYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JgNo
21-
Did the facility fail to have a actively certified operator in charge?
❑ Yes
1KNo
22-
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
J4 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JKNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
)KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
El: Rio •yiolati1 j) is _oir deficiencies •mere noted• during this:visit: • Y:oir wi11-teeeiye iio further
corres�6fidence. ab6 ' this visit:.. . . ... _ ... :.......: :. .
Comments (refer.to question #) _Eatplam any -YES answers and/or -any recommendation's or any'othercomments
- --
Use•drawings of facility to better.explain situations (use additional pages ag n_ecessary);. -
�o �.A oBh G S�c yt �d lg 40h l,Ja� Oind bnl e -i -ertf �
S!wa14 be V e-��►t� ro Gam" —a) sS GoVG>r
Lageort Z-- Alow we.e-ds o1n 10t ae
g . �4e� li[ w e�p( .� o t,� -•�1.-, ; Yl C �LJ S � � i cl � .• � 4 G r4 �p j s
I - ad here, U w Y?'-r :Ole o d d C o t-✓ G r! Y-b4il
r � tit 5 e ! � � � 1 Oyl
GrcGo d t�+ f� w fI,qr)
Reviewer/Inspector Name' ' Q.•' �n -jam
Reviewer/Inspector Signature: Date:
3123/99

Facility Number: j — Date of inspection I ii/ j/c�r�ll
" 6dor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
2q Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Z No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
9 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
FfNo
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
0 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
JKNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent temporary cover?
❑ Yes
KNo
Additional Comments -and/or Drawrn s v
)5 Cor��inUe ���`of�"S -�o eI i�y;A-4e cro/h. Goa�S�4�
And e54 1 I A eoe.sfnl an ri ll e4 ;n f 4 ar'eq .
Ale S,r ►^ rJe A
fe r W e e'S.
lgq 7,
rh:d-
C; vr'r^�nt t,vGl s�e �n�t CTs s needed) 1a51 rervllk4ed/
etc lie q j e s
j11 r Iled i©� � 4�e 5,� k, ;14p4ch ur
3/23/99

4 �5.
� - y
❑ Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
m r.
outine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
D Registered OCertified U Applied for Permit E3Permitted
Farm Name: X. S ...
Owner Name: . l
Date of Inspection
Time of Inspection 3 4 24 hr. (hh:mm)
© Not Operational Date Last Operated :..........................
It
Count .......................
........ Phone No:..c U�....S.�.rt2.......�.�G�.... �..... d�...3[�
FacilityContact: ..............................^.......t.............. ...... Title: ............. Phone No:......................................
( ��,, j( '�Q �[ Q � l 1
Mailing Address:......!. ....1..... �) � l Gti+�..i':...iN. 1 `�.3 ��.'tY (�� �, ��,5�
... .............. ..................................................
0...
j [ 1 �7
Onsite Representative:._-�S%- .. g aVt �... .. ..........
Integrator: S.................
Certified Operator, .............
..---, Operator Certification Number,
Latitude ' 0' 0" Longitude • 6 46
❑ Wean to Feeder
_
Feeder to Finish
,.
❑ Farrow to Wean
❑ Farrow to Feeder
71.
❑ Farrow to Finish
❑ Gilts
❑ Boars
Cattle
Non -Dairy{ J }'
� x
apa&t
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 19 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes [21 No
c. If discharge is observed, what is the estimated flow in gal/min? IA A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes N No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
[XNo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
t&No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
IgNo
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N�No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
9No
7/25/97

.t IFacifity Number:31 •--3Y
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes [(No
Structures (Lagoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes E( No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: -
Freeboard (ft) Q
10. Is seepage observed from any of the structures? ❑ Yes KNo
1 1. Is erosion, or any other threats to the integrity of any of the structures observed? 0 Yes ❑ No
12, Do any of the structures need maintenancelimprovement? ayes ❑ 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 gNo
Waste Application
14. Is there physical evidence of over application? ❑ Yes 1allo
(If in excess of WIMP, or runoff entering waters of the State, notify DWQ)
15. Crop type h... ............. 0O v'`•ti........................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? Yes ❑ No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes NrNo
18.
Does the receiving crop need improvement?
gYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
KNo
20.
Does facility require a follow-up visit by same agency?
XYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
allo
22.
Does record keeping need improvement?
N(Yes
❑ 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
KNo
244,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
D(Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
O—No.vio'hitions-ordeficiencies.were notedduring this:visit: .ou:W'i11 rece'ive•no°ftirther-:
:-:-c6rrespQndehceaboutthis:visit:•:•:�.��-:•:•:•.-�•:.-:�:-:-:•:..�....:.:.:.:...-..-.�.:.....:.....
1114
ROA
w
Reviewer/Inspector Name
IReviewer/Inspector Signature:
Date: I() Vac I `y

A
a
im
3
0

❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site Inspection J
a Routine O Complaint O Follow-up of MVQ inspection Q Follow-up (if DSWC review Q Other
Date of Inspection
Facility Number � aS
Time of Inspection 1 to : l 5 24 hr. (hh:mm)
E3 Registered 0 Certified [3 Applied for Permit © Permitted JE3 Not Operational I Date Last Operated:......
u. 1...�.................... Farm i4ame:..D..�..L.l�S....... .t.�.�..�..k�.�^.r.�.S..............!�.�1�..:..-......................- Gountv:.�i f.. ...............,�.,...�..(�
Owner Name: .............. .t+.�1..t.-..............L1�..x. .;..�,.,�-�.i.................. ....... Phone 'so: ...
.� .1.b......5.. . z..`..y..�.. ...1..... !.ii.Yk�
Facility Contact: . Title: Phone No•
i4lailingAddress:... �. ..., ......�.t,.u.tl..' f................................... ......................... .z�.`3. S.�...
Onsite Representative:... 0- ..1.t ...111J..t.-.1<�-i.e _z 3.................................... Integrator:-...P. x �.. xti q.iL................................. .............
Certified Operator:............................................................................................................... Operator Certification Number-, I ----..... A...
Location of Farm: t S
�,�+...5. t.. ....j.....m, ..F..,- ..........�:...................I..... . ................. ......w....y.t
................................... ................................ :............... .............................................................................................. ..............................................................I.........................- .... .
Latitude 0 9 64 Longitude ` `
Design Current
Design Current
Design , . Current_
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑Dairy
Feeder to Finish
U
10 Non -Layer I
I[] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
3 {i 75-
❑ Gilts
Total SSLW
❑ Boars
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area ,.
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes (LNo
2. Is any discharge observed from any part of the operation? ❑ Yes RNo
Discharge originated al: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes (LNo
b. if discharge is observed, did it reach Surface Water" (If yes, notify DWQ) ❑ Yes q No
c. if discharge is observed, what is the estimated flow in al/inin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ' ❑ Yes allo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
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 El Yes A No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes IR No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ®'No
7/25/97 Continued on back

t'
Facility Number: 31 —
8. Are there lagoons or storage ponds on site which need to be property closed?
Structures 1Lagoons,lloldina Ponds, Flush Pits, etc.1
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..... 3 '............. ........H-. -.. 0........ ..-...........-......
Freeboard(tt)...................................................................................................................................
10. Is seepage observed from any of the structures?
1 I. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .................... +.-*-a... t t ..........: .ua , .1.� ... 1 .L.V-............
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 ReviewerAmpector 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
KNo
❑ Yes
®,No
Structure 6 ,
❑ Yes
allo
®' Yes
❑ No
I? Yes
❑ No
❑ Yes
JR No
❑ Yes
KNo
KYes
❑ No
❑ Yes
2(No
0 No.violation'sor de' icieincies.were-noted during this'v_ isit.:You'Mill re'ceive'no ftirttier
correspondence About this'visit. ;
.Yes ❑ No
❑ Yes ® No
&Yes ❑ No
[I Yes ® No
® Yes ❑ No
❑ Yes El No
❑ Yes R] No
❑ Yes ® No
Com nents''(i efer to question #): Explain any ;DES: answers and/or.any recommendations ur any o. ercommettts.
Use drawing"s of facility kQ better explatti situations {use addtfiana.pages.as ;necessary)
it-1 iz - Bn-� ei✓Dd i0.1 G"-S to t Pir.-,�-d_ o o v s�Ja_Ll t G 064�L It-2— L zU
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��,�
W 0. A o 1 d 7� ( �i v a (. , c~� '7 F K �Y►•• � 0 0 �+ W It. � � d.
16 � + Peel
t4 11 V t t
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a
a 5 S Se tYJ Lwcs PA-Lso, .Ji r[Z3 p SotZt} vd`4. tz . Ca 1 -v 1.r�r (-E, ppOJ : } r-+� e ,. 1. QAO- ••-.c-R• &_„ L v-ac_o Y vL t oc-4 44 o+- jc� � e �+ s 44-10 1 rVA
4 131 �C� fi4 1i(-" r-1 �NLC.e•f neti t l04 c w.... f- �-.t .- o v-a i i i r% vt U. An ... e., 11. . i
ecto Name me _t . ;t
Reviewer/Inspector Signature 50., ". S y] - )�i a _L__1011 Date:

Site Requires Immediate At �0
' Facility No.I—�54�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
,� Time: �
Farm Name/Owner: 2>A✓1y !� k,tIAl-&7 5� _ ezy,7
Mailing Address: r �' �� 0.L-l%" UC-
County: �l/, 4,1 /V --
Integrator: / P_&.frA6Tr,_ _ Phone:
On Site Representative:
Physical Address/Location:
/�iQ1l',� Phone:
Type of Operation: Swine V Poultry Cattle
Design .Capacity: 99,0 !�' Tap Number of Animals on Site:
DEM Certification Number: ACE DET%4 Certification Number: ACNEW
Latitude: ;41° 419' Longitude: 78 " 49? ' 03 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche Ye or No Actual Freeboard: 1�_�Ft. Inches
Was any seepage observed from the lagoon(s)? Yes r N Was any erosion observed L5 No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: 3 4e -14`S'7-Az_ LJ A'
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings? es r No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS .hiap Blue Line? Yes or No
Is animal waste discharged into waters of a state by man-made ditch, flushing system, or other
similar tnan-made devices? Yes r No 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: ��ln� � J4 / W04 MO S_1dl/ Carl✓ A&--eX 1 b�C
cite
Inspector Name Sig tore
cc: Facility Assessment Unit Use .attachments if Needed.