310432_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: Wompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: KRoutine Q Complaint Q Follow-up Q Referral Q Emergency Q Other 0 Denied Access
Date of Visit: 1 I I Arrival Time: 0 Departure Time: 1D County: ,Le) Region:
Farm Name: (ir-c-e.{L Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: vy
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: 10 (Z2
Certification Number:
Longitude:
Swine
Wean to FinishL
Design Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop,
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
311
1 ov
LLa
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
.
D F. .
Layers
Design
Ca aci
Current
P, o -
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
`l'urke s
urkey Puults
Other
Beef Brood Cow
Othe
Other
Discharaes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
e. 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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ElYes 9No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: - 2 jDate of Inspection: Jtj
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 25
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 9No ❑ 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Appllcation
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
X,, 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
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
[3 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
KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Repaired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
o
rNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0�No
❑ Waste Application Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
[] Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
21412015 Continued

facility Number: - Z Date of Inspection:
I
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA
NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
'KNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i,e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
5wLd_P_ iw� cry P'eqds
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
(A
❑ Yes )] No ❑ NA ❑ NE
❑ Yes �1Yo ❑ NA ❑ NE
❑ Yes �6 No ❑ NA ❑ NE
❑ Yes 9No ❑ NA [] NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
,No ❑ NA ❑ NE
No ❑ NA ❑ NE
Phone: Lp 3 Q
Date: +
2/4/201

hype of Visit: rp compliance inspection L.J operation Keview V btructure tvaivation V leelinteal Assistance
Reason for Visit: routine ❑ Complaint Q Follow-up D Referral D Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time:" County:
Farm Name: Ir' Owner Email:
�r
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �M�d
Certified Operator -
Back -up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:y.�
Certification Number:
Certification Number:
Longitude:
Reglon:l.V �'
Design Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Wean to Finish ILayer
Design Current
Cattle Capacity Ppp.
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
EEJ
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
❑ I'oult . Ca ac€ Pop.
Da Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
I
L]
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 L3+No ❑ NA ❑ NE
❑ Yes [;J'No
❑ Yes ;;J-No
[} Yes 0 No
❑ Yes 2'No
[]Yes [' No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 2/4/2015 Continued

[Facility Number: - pate of inspection: 1 2-1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
21 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
EfNo
❑ 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
Oio
E] NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
FNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ZNo
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[;a 10
❑ 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 2rlo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 2YNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 2''10 ❑ NA ❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑"No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ;E "❑
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
0 Yes oNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes -E:fNo
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 0"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 E!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 oNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [ )No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 o. f 3 21412015 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �allo
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:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 12" No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �❑ ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes qo ❑ NA ❑ NE
and report mortality rates that were higher than normal? T
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes �o ❑ 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 Elio ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
[] Yes trio ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes C5,Mo ❑ NA ❑ NE
33. Did the Reviewer/]nspector 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 C;?I�o ❑ NA ❑ NE
omments: re er: o°ques on xpoa.n any; ;answers an nr any a t ona :recommen at ons oany of ert.comments:.
•;: :..e[. '.r ;.:q;.i=i:"zsa.iia s-,
$:::�:. :. -!. i:..
Use drawings of facili : t&bitter."ex 'lain..situatiori_q (me .addltianalf ages'as � w :-
Reviewer/Inspector Name: U
Phone: G ;16 7_12
Reviewer/Inspector Signature: ] L.
Date: AJ97
Page 3 of 3
4/201 S

I)iVi5i0n of Water Resources
Facility Number - �� Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit: (D etimpliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q Routine Q_ Complaint _ Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: T Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: C4..5 "Cz
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
Boars
Other
ether
Phone:
Title:
Latitude:
Phone:
Integrator: 1*)7 Zj
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
Pullets
Poults
Design Current
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Daia Cow
Dairy Calf
Dairy Heifer
DIZ Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow —
[] Yes +❑i ' No ❑ NA ❑ NE
❑ Yes No
❑ Yes '�_'�o
❑ NA ❑ NE
❑ NA ❑ NE
d. roes the discharge bypass the waste management system? (If yes, notify DWR) [] Yes -[2Ro ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ,rNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes eNo [] NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facilit Number: Date of Inspection:
WastS 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
,�{'
� 1 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �^
Spillway?:
Designed Freeboard (in):
7 r
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 P No ❑ NA D NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes PNo ❑ NA ❑ NE
R, Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 7No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes 7No ❑ NA ❑ NE
maintenance or improvement`?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
.If
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 al components of the CAWMP readily available? If yes, check
the appropriate box.
❑Yes
ZNo
DNA
❑NE
[:]Yes
�T No
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
0 Yes J?j No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
[:)Yes P N❑ [DNA ❑ NE
A ❑ WUP ❑Checklists D Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ MonthIy and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. 1f selected, slid the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes;� No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Coneinued

Facili Number: - Date of Inspection:
24. Qid•the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ;2� No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes e No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or 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 Ej No ❑ NA ❑ NE
❑ Yes ;'No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes C2rNo ❑ NA ❑ NE
❑ Yes &No
❑ Yes ❑
7�
❑ Yes §No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
OWN
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Type of Visit .CrCompliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for visit -Q•Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I(� Arrival Time: r�� Departure Time: CountyRegion_
Farm Name: _r �rn� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
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
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = j ❑ 11 Longitude: ❑ ° ❑ 4 = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_ ❑ Layer
IYCXQ I ❑ Non -La et —
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & 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 fleifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures:.
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 /v No ❑ NA ❑ NE
❑ Yes ZNo
❑ NA
❑ NE
❑ Yes ,B No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes 6No
❑ Yes ATNo
❑ NA
❑ NE
❑ Yes ti10
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Ins ection:
Waste Collection & Treatment
4, Is storage Capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2J No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes J�2] No ❑ NA ❑ NE
waste management or closure plan`?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 26 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 [7No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs, ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E5No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ff No
❑ NA
NE
acres determination?
17, Does the facility lack adequate acreage for land application?
❑ Yes
Z No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2TNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
2!rNo
[] NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZfNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes � No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 2fN0
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PKNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 2.1412014 Continued

Facility Number: - V,3ZJ Date of inspection: LoAV
24, Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes Z No [:]NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 7 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
ff No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�3 No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ef No
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
[Z No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Z No
❑ NA ❑ NE
11
Reviewer/inspector Signature: Date: (, 10 l
Page 3 of 3 4/2014

Type of Visit PlBompliancenspection D Operation Review D Structure Evaluation Q Technical Assistance
Reason for Visit 4"Routine ❑ Complaint Q Fallow up a Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: df Departure Time: County:
Farm Name: 2 a- 3 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:. Pf�
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
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Regior�
Latitude: = o = s 0 Longitude: Q ° =1
Design Current Resign Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Puults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
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)?
Number of Structures:
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?
4
❑ Yes ;�TNo ❑ NA ❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
[;I -No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ff No
❑ Yes
oNo
❑ NA
❑ NE
❑Yes
P.Ko
El NA
❑NE
12128104 Continued

Facilit Number: 54 - Z Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the struct res 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
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes �No
r2-No
❑ NA
❑ NE
R. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes LErNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Arc there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application`? If yes, check the appropriate box below.
❑ Yes 12'Fio
❑ NA
❑ NE
❑ Excessive Pending ❑ I3ydraulic Overload ❑ Frozen Ground D Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes EfrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes J�rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes E] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J2'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes ONo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ER -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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes gNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection: _'7*
24. Did the facility fail to calibrate waste application equipment as required by the perm ? ❑ Yes No
A 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 to provide documentation of an actively certified operator in charge? ❑ Yes/a No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes .M No
Other Issues
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ;-No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes -r] No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes j2j to
❑ 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 C1 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [E!f`No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes E!� No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes FJ'No
❑ NA
❑ NE
Comments;{refer;to questlon ft:Explain .any:YES;answersrarid/or;any^additidrial ry�e.g. xd.iitimeridatioi s or-any+other'corriments.
Use drawings of facility to Hefter expialn situations (use `additional pages asdnecessary):. : & kmrfl.:,
�ir/x "� /rcofC§
�ls�iy G- 3c �
v-3� 3
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: �Q �-
Date
4,1 014

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
12eason for Visit:.0 Routine O Complaint ❑ Follow-up Q Referral O Emergency Q Other Q Denied Access
Date of Visit: I Arrival Time: Departure Time- County:
Farm Name: r r �rjd� ��s-i Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: YYl I/-j
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Qesfgn
Current
Design Current
Swlne Capacity Pop.
Wet Poultry
Eapacity
Fop.
Cattle apacityPo Cp,
Wean to Finish .
La er
Dairy Cow
Wean to Feeder
Non -La er
Daia Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Ds. 1?oult .
Layers
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Soars
Pullets
Turke s
Beef Brood Cow
Other
Turkev Poults
Other
Other
-0
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ],No
❑ Yes F;IrNo
❑ Yes ONo
❑ Yes No
❑ Yes No
❑ NA ❑ NE
[DNA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facilit Number: _ - Date of Inspection:Z 2,120
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
J] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ---
Spillway?:
Designed Freeboard (in).
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
VNo
❑ 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
ZNo
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
L2rNo
❑ 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
pr'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes'ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ;;�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window D 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
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 )allo ❑ NA ❑ NE
❑ Yes ZNo [] NA ❑ NE
❑ Yes J2190 ❑ NA ❑ NE
❑ Yes Pno
❑ Yes �No
❑ Yes No
❑ Yes 0No
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [ZNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [� N
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
o
Page 2 of 3 21412011 Continued

Facility Number: - Uate of inspection: jzl7ig
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
,EyNo NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes jEENo ❑ NA ❑ NE
the appropriate box(es) below,
C] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Nan -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 'P-11�o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes �o ❑ NA ] NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes _La'No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes�No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes �] o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
T
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [;j"17qo ❑ NA ❑ NE
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): 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).,
T:r� d--
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:©e7
Date:. 2
2112011

Type of Visit: Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint Q Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name:C, Owner Email;
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: -� I
Certification Number:
Certification Number:
Longitude:
Region:
i
Swine
Dc ign
Capacity
Current
Pap.
Wet=Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
R
ean to Finish
La er
Dai Cow
ean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
❑r. P,oultr
Design
Ea acit
Current
P,o .
❑ Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Other
Other
Non -Layers
Pullets
Turke s
Turkey Pouits
Other
Beef Feeder
Beef Brood Cow
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 [DNA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 7 - Date of Inspection.
Wste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
6 s
❑ No ❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: r
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
2f No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus D 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
VfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�Np
NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PrNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
W
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN
❑ NA
❑ NE
Required Records & ❑ cuments
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
24. 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 I " Rainfall Inspections ❑ Sludge S;N5
y
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No NA
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA E
Page 2 of 3 21412011 Continued

Facility Number: N19D Date of inspection:
24. Dfd the facility fail to calibrate waste application equipment as required by the perm? ❑ Yes ❑ No ❑ NA
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No ❑ NA 6CJ 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 Io [DNA ❑ NE
❑ Yes <o F] NA ❑ NE
❑ Yes 21'No ❑ NA ❑ NE
❑Yes No ❑NA ❑NE
❑ Yes No ❑ NA
❑Ye o ❑NA
Yes ❑ No ❑ NA
❑ NE
❑ NE
❑ NE
(Comments (refer to question 0): Explain any YES answers and/or any additional recommendations or any other comments. 1
f Use drawings of facility to better explain situations (use additional pales as necessary).
4 J d- 3q), Sp iv►.E AS 31 - i $3 0v 713Ii3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 uj3
Phone: 7 �d I 3 g
Date: c3
2/4 11

I'ype of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: jg�-Koutine Q Complaint Q Follow-up a Referral D Emergency Q Other Q Denied Access
Date of Visit: Z Arrival Time: /�Q Q Departure Time: County �L
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region: "/
Onsite Representative: �'�U Integrator:
dim
Certified Operator: Certification Number: ' 1 �L
Back-up Operator:
Location of Farm:
Latitude:
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)?
Certification Number:
Longitude:
❑ Yes XNo ❑ NA ❑ NE
[:]Yes No
❑ Yes No
❑ NA ❑ NE
❑-NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [ZNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes YNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ZNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/20I1 ContinuedContinued

Facilit Numher: - Date of —inspection:
L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes � No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 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 ONo
❑ 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. ❑o any of the structures need maintenance or improvement?
❑ Yes Z 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 ;EfNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes eNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes eNo
❑ 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 PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes P No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes 0No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes A�J'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes )2]-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 [Ej^No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes. ff No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 010
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r
Facili Number: - )date of Inspection: j/ Z
24. Did the facility fail to calibrate waste application equipment as required by the perm ?
❑ Yes tNo
[3NA
❑ NE
25. rs the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes � No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question #):Explain any -YES, answers and/or any additlonal recoinmendMions;er;any othrer;cornmen s = a
... i. n.. <;. •. ...• . _,°.; :,:':'#:�7.i"'.5.'i �.x:S Yi .. ;. '.� :Y .':�.w.lr,-:..Si+;�7 5 . `...1:-
Use•drawings.of facilit ,to better'ex lain situatlons (use;addif/Deal"'ages.as.necessary).•y; •-;.:_:�1.:,:,. R: ��;,A,-I..,::. ;,- :: �, "
11)14 .�✓ I P Q_
CGt L fo
.,:.:, .�. ::
2 -leif-
'2—'7'/' 0 r (.) �
Reviewer/] nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: %1 t
Ma 6I

Type of Visit-ercompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint Q Follow up Q Referral Q Emergency ❑ Other ❑ Denied Access
Date of Visit: 1 M691 Arriv Timc: Dcparture'I'ime: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I'itic:
Onsite RepresentativesUsa
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 ='
= « Longitude: = ° =' = «
Design
SwInc Capacity
Current
Population
[resign Current Design Current
Wet Poultry Capacity Population Cattle Capa`ity Population
❑ Wean to Finish
❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑Non-1 a cr
❑ Dai Calf
❑ Feeder to Finish
❑ry Poultry
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ La crs
❑ Farrow to Finish
❑ Beef Stacker
❑Non-[ a ers
❑ Gilts
❑Beef Feeder
es
❑ Pullt
❑ Boars
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Pot
❑Other
Number of Structures:
Discharees & 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 impact or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes ff No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
Cl NA
❑ NE
❑ Yes ZNo
❑ NA
❑ NE
❑ Yes 11dNo
❑ NA
❑ NE
❑ Yes �eNo
❑NA
❑NE
Page 1 of 3 112/2VO4 Continued

Facillt 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
Structe 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !7C
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes )ZNo
❑ 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 closuro 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 �2r'No
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ZNo
❑ 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 �LJ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes M'lo
❑ NA
❑ NE
maintenance or improvement?
l l . Is there evidence of incon ect land application? If yes, check the appropriate box below.
❑ Yes A!�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 ZI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,2y'oNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes fENo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 0 No
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes oNo
❑ NA
❑ NE
Re [tired Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes ZNo
❑ 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 J;;,M0
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes eNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

3 l H Y,3,
Type of Visit el Gfompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit EMoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denled Access
Date of Visit: r C Arrival Time: i Departure Time: County: Region:
Farm Name: ❑caner IJmail:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: s" 4 zaZIcZ
Certified Operator:
Back-up Operator:
Phone:
Mime No:
Integrator:
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: = 0 0 ` = `i Longitude: 0 ° = g 0
11
Design Current
Design Current
Design Current
5►vinc Cap cii#y Population
Wet Poultry Capacity Population
Gattfe Capacity Population
❑ Wean to Finish
I
I
113Layer
I
I
❑ Dairy Cow
❑ Wean to Feeder
I
❑ Non -Layer
I
1
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
ElBeef Stocker
❑Gilts
❑Non -La crs
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Broad Cow
❑ Turkeys
[]ther
❑ Other
❑Turkey Points
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes tilo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
[3 NE
❑Yes
;�Ko
❑ Yes
El
ElNE
ClYestN
❑ NA
❑ NE
Page ! of 3 12128104 Continued

Facility Number: — Date of Inspection
W.f Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �,O No [I NA El NE
,LI
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Struct re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PKNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0"No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes ?(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 El Yes PrNo ❑ NA El NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RNo ❑ 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 types)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
7No
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
�f 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
i No
❑ NA
❑ NE
Cifrntnents (refer. to. quest€qn H): Explain any, YES. an§iVers,andlor any..rccommendat�ons. or any. atlier.;. comments:.;'°'}
Llse drawings of facility to' b.rtter explain situations: [vise additional pages as riecessar`y): Q
r sa4 <
z ''� iFr P•']`. C, :"i��,�
�p
`;' ��. �viri si���=; s���a, ss Fw ��PSa. h„i3.�.
�i.J �� V I fr �Q! V FV �V ,.• J • � s� �
�
7
._-Yx?-"-: �.:-:i�:.t �:s`r -i "'r: �'�,: •. �•�.. ,�.
Reviewer/Inspector Name ',�.<, �.Y. af'=x::':...3s.;...t:
�" Phone:
Reviewer/Inspector Signature:
Date: 7
Page 2 of 3
12128104 Continued t

Facility Number: — Date of inspection
$equired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes PrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �YNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E:Mo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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?
El Yes
0
[:1 NA
I--] NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
No
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
V o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge`?
❑ Yes
(ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes '
21 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
IL1 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 concerts?
❑ Yes
f
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
VNo
❑ 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
ZN o
Cl NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9'No
❑ NA
❑ NE
Additional Cnmineritts:andlnr`1]`ra►vin's�z>::`�
g. t: ...
��Ja�� wil
OW a� Ia - -7-Z
0/G.3
0/63 e,G3 6.�-�
0,67 r a
l ,�9
0.. 7(
a/ '�'r
3 sire % �Pa
yy
0, �4 &
6.050
So l J� .�e 54
-C&C 0-,d 16
Page 3 of 3 12128104

Type of Visit 9-Compliance inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit �outine D Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: I 11-AArrival Time: �� Departure Time: County: e Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: ,_,
Back-up Operator: —
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number -
Back -up Certification Number:
Location of Farm: Latitude: =O [= 1 011 Longitude: 0e =1 =
it
17.'" ; .�' pax • :,
Swinc'c ` ^Ca
g•�ti.a
��.
Design Current
-pa tyP�apula ion
1]esign Current Design Current
Vet Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ DairyCow
❑ Non -Layer ❑ DairyCalf
❑ Uai Heifer
Dry Poultry . ❑ Dry Cow
❑ Non -Dairy
❑ Layers
❑ Beef Stocker
Non -La ers❑ Pullets❑ Beef Feeder
❑ Beef Brood CoA.❑ Turke s
PaultsOther ❑Other Number of Structures:
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
[Lh
Gilts
Hoars
er❑Turke
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
.1R<0
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 �<o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
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 5KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �kNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `1
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P�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 ;2rNo ❑ 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 7No ❑ 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 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 Z1 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes LQ 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 o ❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes o ❑ NA ❑ NE
— F4,ew--% ,4- Aco'elpeloc7c,
Reviewer/Inspector Name ! =r.F. ' r� Phone:
.fly' [` i%_.::;yis.°af rd'ii=A'ai. I
Reviewer/Inspector Signature: Date: r'
Pnu,0 2 "f 7 17 RI Canyinnod

Facility Number: — Date of Inspection E0*
Renulred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1;Xo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JE No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? [IYes � N ❑ 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 W10
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes �o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
_p4ro
❑ Yes 2<o
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [;*o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
-Zo
30. At the time of the inspection did the facility pose an odor or air quality concerti?
❑ 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 trNo
❑ 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 2<o •
❑ NA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes id'No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit A6
ompliance Inspection Q Operation Review Q Structure Evaluation ❑ Technical Assistance
Reason for Visit x4outine Q Complaint ❑ Follow up Q Referral ❑ Emergency Q Other ❑ Denied Access
Date of Visit:
Arrival Time: r �
Departure Time: I$� ounty:
Region: 66VI O
Farm Name: {���ff.;
� Y,f 7tY�
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Ons€te Representative:
Certified Operator -
Back -up Operator:
Phone:
Phone No:
Integrator:fl!
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 ` =" Longitude: = o = 4 = "
Design Current
Design Current
Design Current
Swine CFP-2c1 P—1 tion
Wet Poultry Cap ty Population
Cattle Capabity Population
UP Wean to Finish
Laver
❑Dai Caw
❑ Wean to Feeder Q ❑ Non -Layer I
El Dairy Calf
no Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
El Farrow to Finish
Layers
❑ BeefStocker
Gilts
❑ Non -Layers
El Beef Feeder
EBoarsEl
Pullets
Beef Brood Cowl
[--]-Turkeys
Dther
❑ Other
10 urkey Puuets
❑ Other
Number of Structures:
Discharges & Stream impacts
l . Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
10
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the Statc? (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
1Z
XNo
❑ NA
El NE
other than from a discharge'?
Page I of 3
12128104
Continued

Facility Number. — 2 Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier: % Gw
Spillway?: I�
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWp
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA ElNE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 10
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 10
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0No ❑ NA ❑ NE
maintenance/improvement?
11, is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;ZNo ❑ 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 ElEvidenceof Wind Drift ElApplication Outside of Area
12. Crop type(s) &41� r f S-+ Q[�t�5 n j� t¢ 4 zE /Srluc
13. Soil type(s)
0
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
9No
❑ 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 ?
tZ
❑ Yes
;Z No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any.recommendations or any'othen;comments.'
Use drawings of facility to better explain situations. (use additional pages as necessary):
15)
2 me /L,�,dG o
Reviewer/Inspector Name I ' As*Phoneolv
Reviewer/Inspector Signature: Date:
Page 2 of 3 12118104 Continued
1

Facility Number: — Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes ZNo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 0No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes )ZNo
❑ 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
ElNE
23.
if selected, did the facility fail to install and maintain rainbreakcrs on irrigation equipment?
ElYes ❑ No
NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes �No
////❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[--]Yes ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes0-No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes ❑ No
PNA
❑ NE
Other Issues
29. Were any additional problems noted which cause non-compliance of the pennit 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 reviewlinspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes'VNo
Cl NA
❑ NE
❑ Yes )z No ❑ NA ❑ NE
❑ Yes 7No ❑ NA ❑ NE
❑Yes No [I NA El NE
Additional Comments and/or -.Drawings:
C ��//'' Mkt ' ` •.
��� �� G�r Ty � r• s
Page 3 of 3 12128104

Type of Visit �mpllance Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visit routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency
Date of Visit: 4—,07 '12 -a rrival'1'i re: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: '57+(GJ.
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
Phone:
0 Technical Assistance
0 Other ❑ Denied Access
Phone No:
Integrator:
Operator Certification N er:
Back-up Certification Number:
Region: ZzAeo
Latitude: = 0 0 I= Longitude: = o= i j
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
71,; a 766 10 Layer
II 10_Non-Layet
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?
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Daia Cow
❑
Dairy Calf
❑
Dairy Ileifei
❑
Dry Cow
0-Non-Dalry
❑
Beef Stocket
❑
Beef Feeder
❑Beef
Broad Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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 .L3No ❑ NA ❑ NE
❑ Yes
❑ Na
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes )F No El NA ❑ N&
❑ Yes 2No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection
W�k—
Wa 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?
Strut re 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): a 5 rye
Observed Freeboard (in):
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 21slo ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P' 4o ❑ 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 P4o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PW6 ❑ 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 SoiI
❑ 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 �o ❑ NA
15. Does the receiving crop and/or land application site need improvement? ❑ Yes "No ❑ NA
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes O No ❑ NA
17. Does the facility lack adequate acreage for land application? ❑ Yes 9 No ❑ NA
18. Is there a lack of properly operating waste application equipment? ❑ Yes jT<o ❑ NA
Reviewer/inspector Name ee. �.
"'.:a.. Q .a, Phone:
Reviewer/Inspector Signature: _ f Date: Q
❑ NE
❑ NE
❑ NE
❑NE'
❑ NE
Continued

Facility Number: Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes L3'fqo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes j2rNo ❑ NA ❑ NE
the appropirate box, ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
[:1 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] 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 _J:�-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
❑ No O NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
❑ No )2'NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit'? ❑ Yes
❑ No
j2NA
❑ NE
26.
Did the facility rail to have an actively certified operator in charge? ❑ Yes
2No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes
❑ No
❑ NA
ti1E
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
P<o
❑ 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
❑ 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
r o
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application}
32,
Did Revicwer/Inspectnr fail to discuss review/inspection with an on -site representative? ❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by some agency? ❑ Yes
to
❑ NA
❑ NE
Additional Comments and/or Drawings:
o"
cll-e_ 6
0A- fro / errs
r�
1212VO4

IType of Visit Q(Compliance Inspection a Operation Review O Lagoon Evaluation i
Reason for Visit outine Q Complaint 0 Follow up O Emergency !Notification O Other ❑ Denied Access
Facility Number Date of Visit: lD Time-
Facility
Not Operational 0 Below Threshold
❑ Permitted Certified P Conditionally Certified ©Registered Date Last Ope oAhor a Threshold:. — . » ..».....».
Farm Name: »....»,C » ..�.1C1� ....» f_ •?-� __._ ..._ ___ County: _. �.
Owner Name: _ ............. ...»_.._._......_......._».........»» ».» ..».».».. 'Phone No:
MailingAddress:...._ ..» .. »...........»...» .» »..... _.... » ...»....» ......._ .._ _ __ _
Facility Contact: ..».». ............... ..».». Tide:. » M__._ ..__ __.. ... _.».» Phone No: _ _..._ ..»..._ ...»... »..». »
Onsite Representative: Integrator.,
_. _......._._. _ ... Integrator•.
Certified Operator:...___ . »............___..... __....» ....»..»».. »......»».» Operator Certification Number:.__.._.__ .................... —
Location of Farm:
❑ Swine [] Poultry ❑ Cattle ❑ Horse Latitude a ` " Longitude • 0` «
Discharges & Stream Iranacts
l . Is any discharge observed from any part of the operation? ❑ Yes 2 Na
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ 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/rain?
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 ,two
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 12 No
Waste Coflection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes rcwo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ _ .» _____
Freeboard (incites); � �^
12/12/03 Continued

Facility Number: 3/ -- Date of Inspection y
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes'evo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes C;-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 Eno
8. Does any part of the waste management system other than waste structures require maintenmce/improvement? ❑ Yes Eo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ; No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes M-No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ,24rb
❑ Excessive Ponding ❑ PAN Q Hydraulic Overload ❑ Frozen Ground Q Copper and/or Zinc
12. Crop typer? C f I . • �-� //�C��'�J"r�G r I K 7U/7/tt C r-1 �_.._..
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,Er No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes '12'No
b) Does the facility need a wettable acre determination? ❑ Yes PNo
c) This facility is pended for a wettable acre determination? ❑ Yes ONO
15. Does the receiving crop need improvement? ❑ Yes of4o
16. Is there a lack of adequate waste application equipment? ❑ Yes 5'No
Odor tssues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Zi+io
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JaRo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Rio
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 E3-No
Air Quality representative immediately.
as ,TY)?; ti ❑ Feld Copy ❑ Final Notes
Reviewerlfnspeetor Name°1, .
.YTS•,
Reviewer/Inspector Signature: Date: /C _ f
12/12103 Continued

Facility Number: Date of Inspection rJ ♦''
Reuuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ,@go
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ETNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ,8'No
❑ 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?
�
❑ Z Yes No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes .- Q
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes o
Oet discharge, freeboard problems, over application)
_0-3C
27. Did Reviewer/Inspector fail to discuss reviewTmspection with on -site representative?
❑ Yes 0-9,0
28. Does facility requite a follow-up visit by same agency?
❑ Yes E1'Na
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Lallo
NPDES Permitted Facilities
34. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes �o
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
I© No violations or deHciencles were noted during this visit. You will receive no further correspondence about this visit. 1
121IZI03

Type of Visit ID -Compliance Inspection ❑ Operation Review 0 Lagoon Evaluation
Reason for Visit (& Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number bate of visit: Time:
Operational r
Permitted 19 Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
���
Farm Name: 7CZz JJ �'r e-e [ 1� —�^ County: gL
Owner Name: c� rd v9 V rr Phone No:
Mailing Address:
Facility Contact:
Onsite Representative: [lGt>h,f!:, :__
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator:&�
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude r 6 46 Longitude "
Des€gn
Swine Ca aci
Current
Pn ulatfan 1Pvultr
Resign Current Design Current
Ca aci Pv ulativn Cattle I .Ga aci Pv elation
® Wean to Feeder 3 ZQ
10 Layer
❑ Dairy
EJ Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
[I Farrow to Feeder
10 Dther
�.:.
Total Design Capacity
❑ Farrow to Finish
❑ Gilts
Boars
Total SSLW
Number of Lagoons10
Subsurface Drains Presen# La oon Area
Spray Field Area
Holding Ponds 1 Solid Traps
No Liquid Waste Management System
Discharges & Stream Impagil
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 galimin?
d. Does discharge bypass a lagoon system? (if ycs, 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 CColivet€vn & lCreatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes C,No
Structure 5
Continued

Facility Number: JT1 — SF3� Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �3 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? [I Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes tR No
8. Does any part of the waste management system other than waste structures require mainlenancelimprovement? ❑ Yes ES No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes MNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over JJapplication? ElExcessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes El No
12. Crop type 64J? i'� [ yt r.0 U i
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ZNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 21,No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes ANo
15. Does the receiving crop need improvement? ❑ Yes ® No
16. Is there a lack of adequate waste application equipment`!
❑ Yes
ONo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
RNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
K No
(ic/ problems, over application)
23. Did Revicwcrllnspcetor fail to discuss review/inspection with on -site representative?
❑ Yes
ElNo
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
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
C6iinirfents'(refer,tg;question.0). p Ei 1aiA.ai%YES,Answers a-n'd/or'any, re —co i .me.ndatlons'prfany:other comments.
drawings.of facility to better explain §ituatlnnii. {use additional pages as necessaryr.}: ❑Field Co>)v ❑Final Notes
Z,,Use
q.,,.
"•^C.�'[ w"ri:. k.'i :e'Rn %..lk]in'
-���{7r��fl I•�r-.
wer/ins ector NameP
E
wer/Inspector Signature: Date: 3 L
05103101 Continued

Facility Number. — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes F] 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 4No
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
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 O,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 Ca No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JNJNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ONo
Additional Comments and/orDrawings: ;
i
T
M
5100

•
,. - 1.
Al..- �.. Division of Water Quality
a z
`: �� ^ � -• ,:• � ° , . Divisiair,of Soil and Water,•Canser'valion
0.0thei A .
$C11Cy r `'
Type of Visit ArCompliance Inspection ❑ Operation Review Q Lagoon Evaluation
Reason for Visit T Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Printed on; 7/21/2000
NNot Operational ¢ Below Threshold
AS Permitted [3 Certified ❑ Conditionally Certified 0 Registered Date Last Operated
]or Above Threshold; .........................
FarinName: ...4 QiFi.....k...� �.......... rl?.............................. County: ..... >LAPL....................................... ........... ............
Owner Name:.....,, 1 .fr.................. �5?,tP..O. .. Phone No:....................................................................
FacilityContact:.............................................................................. •Title:....................................................... ......... Phone No:
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite Representative:... .. ...... ...r,Q0..4,6................................... Integrator: P!y ..................................................
Certified Operator; ................................................... ............................................................. Operator Certification Number:
Location of .Farm:
MI5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �` �" Longitude �• �� �«
i �`" Design Current Design Current Design Current
:.: C.
` a� Poultry ulation Cattle Ca .c Pa ulalon
Capacity ,.Po aladon.Capacity Pop ?�pFarrowtoFeeder
Feeder p Layer ❑ Dairy
Finish ❑ Non -Layer ❑ Non -Dairy
'fixo Wean
--v
!, nOther
o Finish Total Design Capacity
Total.sst w
Subsurface Dra s Ln r•nn Area Spray Field Area
g " ' :Ni4uileir. at' pope ❑in Present ❑ a ❑ P r
.,5�� � ��1r,�,4'�"�y:k,'�l•:'1r,S.';�i�5,. £ .r.:Y''S.. I.: • :. ;i - .. �� _€.•
HoMitisg P0 ID No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �Vo
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 tltc State? (lf yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated now 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 pan of the operation? ❑ Yes ErNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes f�No
Waste Collection & Treatment r
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes )8'No
Structure. I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...........................................................................................................................................................................................
Freeboard (inches): 3
5100 Continued on back

y r r
Facility Number: — Date of Inspection 2 1
5. Are there any immediate threats to the integrity of any of the structures observed? {ie/ trees, severe erosion,
❑ Yes
ja"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
ONO
(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
PI!
8. Does any part of the waste management system other than waste structures require maintenance/improvemcnt?
❑ Yes
P�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
Po
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over ap ication) ❑ Excessive Ponding AN ❑ Hydraulic Overload
❑ Yes
10No
12. Crop type I R
'Z(No
13. Do the receiving crops differ with those esignated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
0No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
VNo
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
A No
15. Is there a lack of adequate waste application equipment?
❑ Yes
F(No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
PNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(iel WUP, checklists, design, maps, etc.)
❑
E(No
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[AO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
VNo
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
PNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
P(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
['No
i'i ►� s:a# � ���e�+�� V re I� �d �14H`� > {his' s t• e i q 00
cor'res aricYenc� about this Nisi/: ................................
Comments (refer to question #): ° ExplaJn any YES ninswers and/or ainty'recomn mndntions or. any other, comments:' ` s
Use di�iairaiiaq�p pf facility ta' better"explaip site ttians. use addidnnai pages;as:aecessary
Lop_ `
�Rm �S oaD�
rA4T

::
�. ,... ;•t a ,.ti :.y''r{. (•Witter Q ` �...as n°Y:�= 'k 6i,.. °ti •g;
q.,. �Divlslon"o uality�`::.•; `�� .*.
D•Divtslati'of Soii and•Water Consei►ation'
D Other: Agen'
cy +' °. t' 1
, .:
�� �I • r.i •j' •c r r.. F.�r. r s ' . � .-i �•'.•: ��.^,k�-k��
R1 r .,.�': �..r r ��: rG•.• ��: Ass; y^�
Type of Visit Compliance Inspection D Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Fallow up O Emergency Notification O Other ❑ Denied Access
Facility Number
I)atc. of Visit: Q a 'f`itnr : : �� Printed on: 7/2112000
3
❑ Not Operational D Below Threshold
0 Permitted 0 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .......................
Farm Name: ..............r4jLl..�,-:C .....` , Il i ...........................�I............... I.......
Owner Nrtmc:..........,,��11I L. ............. .. fw.�...... .( ...............................
Facility Contact:
Mailing Address:
Title:
County: .. ............................................................
Phone No: ........ 1 Q......a✓5,6.Z/ ......................I
Phone No:...-..
Onsite Representative:........................................................................................................... Integrator:..............1..l.V.it '•''q-
Certified Operator:,,,,,,,„1,,,, .S.�Cwl. I(....Operator Certification Number:
Location of Farm:
17.
14 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude I.ongitude �• �� ��[
Design Current
Swine Canacitv Pnnulatinn
Wean to Feeder
1 209
D
❑ Feeder to Finish
❑ Farrow to Wcan
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ I.ayer ❑ Dairy
❑ Non-i,ayer 10 Non -Dairy
❑ []lher
Total Design Capacity [
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Uignon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps J 10 No Liquid Waste Management System
Discharges & Stream ImpacLS
1. Is any discharge ohserved from any part of the operation? ❑ Yes JXNo
Discharge originaroci at: ❑Lagoon ❑ Spray Field ❑ Other
a. If'discharge is ohser.ed, was the conveyancc man-made? ❑Yes .21�No
b. If'ciiscltarge is observed, clid it reach Water of the State`? {Ifyes, notify 1]WQ) ❑ Yes RNo
c. II' discharge is observed, what is the estimated Ilow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes EjrNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes C N0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Stl'Uelure 2 Structure 3 :Structure 4 Structure 5 Structure 6
Idelitiker: ............................................ ...... ......... ...................I....................I..........................
Freeboard [inches):
5100 Continued on back

Facility Number: 5 r q5zVale of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
>(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
b 'No
closure plan?
❑ Yes
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DW'Q)
7. Do any of the structures need maintenance/improvement?
❑ Yes
8�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VKNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
8rNo
Waste_ Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
C�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
0 No
12. Crap type ss
l3. 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
ONO
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 irprovement?
❑ Yes
[ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
I�No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
4Na
18. Does the facility fail to have all components of [lie Certified Animal Waste Management Plan readily available?
❑ Yes
t No
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[J No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
[A No
22. FaiI to notify regional DWQ of emergency situations as required by General Permit?
(ie/ diseliarge, freeboard prohl ems, over application) ❑ Yes Q� No
23. Did Reviewer/Inspector fail to discuss review/inspection will) on -site representative'? ❑ Yes IgNo.
24. Does facility require a follow-up visit by same agency? ❑ Yes j No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NdHa 141�tri00S'ot- ftf i; xndes were ;ngt;ed d%tring fh js;visiti Yoh ;wild >i �eeiye 46 further ;
coiris oridence. bo' ut. this :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):
F1
Reviewerllnspector Name
Reviewer/Inspector Signature:
Date: 10-Z7-05100

'agility Number: —Lf3 Date of Inspection Q -Z7-a Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes �(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours'? ❑ Yes �No
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes [� No
roads, building structure, and/or public property]
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ] No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blades), inoperable shutters, etc.) ❑ Yes { No
3I. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J No
32. Do the flush tanks lack a submerged fill pipe or a per-manent/temporary cover? ❑ Yes j No
Additional Comments and/orDrawings: °>
Ak
5/00

y�
Division of Soil and Water Cortservatton -Operation Review
`, 1a C1 Division of Soil and Water Conservationr.ComplIAnce Iiispeetioq
:a. Division of Water Quality : Comlliaiace Inspection
th er Agency.ratiwe Revrt U = Upe
Routine QCornplaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of inspection
Time of Inspection 24 hr. (hh:mm)
[J Permitted 0 Certified 0 Conditionally Certified 0 Registered 113 Not Operational Date Last Operated: „•••
Farm Name: .........A .....����.►�........,...L...,,k......)Gren............ County: .....
kilo. IL.nrl ..................... C0 ..........
Owner Name:........ Ame;.5....................... ...... S ......................................... Phone No:..... ��',%.���...�.�.�i... �.�7r.�j�......................
FacilityContact: .......................................................................... ... Title: ................................................... ............. Phone No:..................................................
.
Mailing Address: �J�
....................... ...,................. s..r�►.� ........ f reL.. .........................r n, ...x......p .. ...........,. "3.....
Onsite Representative: ...
-ua-*n.,fr%6......................r.�� k��al�,.j........................... Integrator:........ z.......................................................,..
Certified Operator:......4...1.G.t1!J�1. P.j............................ -h.�........................ Operator Certification Number:..........................................
Location of Farm:
J_
.................. ....................................... ............ V
Latitude Longitude
Design Current
Swine' C:anucitv Ponulation
Qj Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population '
❑ Layer ❑Dairy
❑ Non -Layer I Irl Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdixig Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [3 Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. [[discharge is observed, did it reach Water of the Smic? (If yes, notify DWQ)
c. If' discharge is observed, what is the estimated flow in gal/min?
d. Dues discharge bypass a lagoon system? (Il'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
SITGCture I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: (i _a C)
Freeboard(inches): Z I ...................Z................. ...... .......... .................... .... ............................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
❑ Yes No
❑ Yes [A No
❑ Yes 0 No
4114
❑ Yes /W No
❑ Yes % No
❑ Yes 0 No
❑ Yes 0 No
Structure 6
❑ Yes 14 No
Continued on back
3/23/99

Facility Numhcr: z-- Date of lnspection
6, Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan'?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
I0. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do (he: receivirk crops dl/ffer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
h) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (iel 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`?
(iel 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?
l'Vo yiirl gts'o 0OCicienges rare i�ofpd• d4rring 4his'v1sit, • ;Y;op 'i1j•r. eeoiye lid furl ft
CQrresh ondence', abaut: this visit. ........ .
Commen s.(irefer to question`:#). .Explain.ariy YF.$'itnswers andlor any recommeridatians nr'any other comments.
Use drawings of facility to.bettir explain situations:. (use a llditianal, pages as:neeessary):
rq) Glp1 le &; I �[ s,s apd Wij4 Sys:S. &z wee k
❑ Yes X No
❑ Yes No
❑ Yes No
❑ Yes M No
❑ Yes " No
❑ Yes 0 No
❑ Yes r'�_-r No
❑ Yes ❑ No
❑ Yes ❑ No
EK Yes ❑ No
❑ Yes g No
❑ Yes A No
❑ Yes kNo
❑ Yes No
Yes ❑ No
❑ Yes No
❑ Yes j No
❑ Yes X No
❑ Yes [q No
❑ Yes ® No
❑ Yes Dq No
J �e
Reviewer/Inspector Namer
Reviewer/Inspector Signatur _14L_,p,(1,_. ?')% r,,, Date: 11_/7­1!j
c �� �1I0 ��s�tL� 3/23/99

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
No
28.
Is,there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30,
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken Fan blade(s), inoperable shutters, etc.)
❑ Yes
*No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
X No
32,
Do the flush tanks lack a submerged fill pipe or a pertnanent/temporary cover?
❑ Yes
fio No
Additional Comments -and/or Drawings.
All
3/23/99

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality ^'°°'°..:".!?5:..... :.. �„---......-....�..,. :Fi F { F s .e.1 { v.
.� . .. ......
..........
RRoutine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspec(ioll
Facility Number
Time of Inspection 24 hr. (hh:nim)
13 Registered ED Certified 13 Applied for Permit 13Permitted - 113 Not Operational Date Last Operated: ... ......................
Farm Name : ................. E.1 �.C.y Ck".CJ;? ...... F.;,x.xv . . ...... ......................................... County:........ \41 ................ .......................
.14
Owner Name: ........................... ).0A ........ ...... t...... .................................... Phone No...Ina�.Arlj."n4 ............................................
FacilityContact: ......................................... I .................................... Title . ................................................................ Phone No:
0
Mailing Address:..... .................... ...... ......................................... ....
. J.t5 .......... ......
Onsite Representative:.........
................................. Integrator:....,Axrt.�+r ..............................................................
Ceirtified Operator;.............. ................................ .... ............................................................. Operator Certification Number:.........................................
L'ocation of Funn:
Latitude Longitude
-.!;Current,' '- Design .,:Current :
Currenit
a'i.: Swine ; .;Cpii:P6pulationPoulky Capacity Population Cattle Capacity ,-Populaton
[23 Wean to Feeder
0 Feeder to Finish
0 Farrow to Wean
0 Farrow to Feeder
El Farrow to Finish
0 Gilts
El Boars
N'­ �6 '.'%"-f Lagoom] Holding Ponds,il
. ...............
UTZ ."Tj€
EJ I❑ Subsurface Drains Present
V Lagoon Area JE1
----- - - ---- -- - -------
Spray Field Area
d Waste Management R� riqui Lys—tem--i
General
I. Are there any buffers that need maintenance/improvement?
0 Yes
No
2. Is any discharge 'observed from any part of the operation?
[J Yes
EP No
Discharge originated at: El Lagoon' 0 Spray Field El Other
a. If discharge is observed, was the conveyance man-made?
0 Yes
N3 No
b, If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
El Yes
1P 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)
D Yes
No
3. Is there evidence of past discharge from any part of the operation?
C1 Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
El Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
0 Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
0 Yes
[P No
7. Did the facility fail to have a certified operator in responsible charge?
0 Yes
51 No
7/25/97 1 Continued an back

Facility Numher: gf — t.( Z
8. Are there lagoons or Storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding Ponds —Flu shPits. etc.)
9. Is, storage capacity (freeboard plus Storm storage) less than adequate?
Structure 1 Structure 2 StructU e 3 Structure 4 Structure 5
Identifier: ....... O A....
F reelmard (t'tl: ..............
10, Is seepage ohserved #'rout any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12, Do any of the structures need nt:tinten:tncelimprovement?
(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"
WasteApplication
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 ............ �� �.s,.......... .......... 5xlx,a 1A....tn................................... ................................... .................. ..............
16. Do the receiving crops differ with those designated in the Animal Waste Manageniew Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application'
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20, Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
Eor C'ertir"ted or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit''
0 No.violations or deficiencies were noted -during- this. visit. You. will receive no further
correspondence about this. visit. ;
❑ Yes [�No
❑ Yes 0 No
Structure 6
❑ Ycs I No
❑ Yes 1�3 No
® Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes M No
❑ Yes No
Yes ❑ No
❑ Yes No
❑ Yes E& No
El Yes ®No
tP Yes ❑ No
❑ Yes 0 No
❑ Yes q.No
❑ Yes M No
Cnrttments.(iefer to question #j; Ex; plain any:YES answers and/or'Any recomme6dations or any 61her 6nini66;
Ilse W.drawings of facility ; , better explain situritirrns,'(tisr additional pisges as necessary
f.'
I z • $wry- awtac o y- agoor, j : y, w itl �, kljl
1K. Ce4iptva- eQ6,(� 6 V"fyrre
hlrr+�cr• +'^4 i r. 5"
v ccr�x � `�nL �r�lo e S�a 1�d �� W: -�.. +r w. +re�tkr� y. Ar c6�7 ; �W Lr
L n Ur6€+V.1 D r. G,c F•
WO *IQI IV DC me_ 41441
7/25/97
:i; ..e=. .. f i `FR`«... ••N• n:�.: •..fie ..Sfex.rvi..ii.ervFu;
is F
Reviewer/Inspector Name '.:.e:
G..:
Reviewer/Inspector Signature: _ �, �,� �� Date: 7 1R1411

ID Routine V Complaint 0 Follow-up of D= inspection ■ Follow-up of DSWC review p Other
I III �I wn
Facility Number 31 432 Date of Inspection 1/21/98
Time of inspection 1130 24 hr. (hh:mm)
0 Registered ® Certified [] Applied for Permit © Permitted Not Operational Date Last Operated:
Farm Name: ELder..jCxeeR.lFltrM....................................................................................... County: 1).Up tl................................................ !'. JR0.........
OwnerName: datmm...................................... Sir.quid.j.r................ .................................... Phone No: 29.G->iS64,.................... ,.......................... I ..... I.............
Facility Contact: d.B,..S1 r►.ud...................................................... Title: .Owt1.et:................................................. Phone No:
Mailing Address: 315.M.StrAudRd............................................................................... NUguwia... N.c......................... I ..................... ,....... 28453 ..............
Onsite Representative: a,.L.Stx.o.lit................................................................................. Integrator: lY urVhyfAMUyfgr7u5...,,..................................
Certified Operator:Jalma, ............................... 51r..aud............................................... Operator Certification Number:18161 .............................
Location of Farm: _
On smithrast cide of SR 1922_ gnnrnyinnntety ti_25 milpc nnrthnct air with R112 1909_
Latitude 34 a S4 ill 46 Longitude 78 ' 011 45 «
Design Current
Swine Capacity Population
® Wean to Feeder
3120
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1 is
Boars
Design Current Design Current
Poultry :.Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 3,120
I
I ;Total SSLW 93,500
Number of.Lagoons I Holding Ponds �", ❑ Subsurface Drains Present ❑Lagoon Areu ❑ Spray Field Area
❑ No Liquid Waste Management S stem
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
❑ No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
❑ No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
❑ No
maintenance/improvement?
G.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
❑ No
7/25197
Continued ors back

Facility Number: 31-432
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures LagoonsBolding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier: ................1.............................,................
Freeboard (ft):.............. 1..1T.............. .............. 1,.1z.... .........
10. Is seepage observed from any of the structures?
❑ Yes ❑ No
Structure 3 Structure 4 Structure 5 Structure ti
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
W_nste_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.................................................................................................................................................................................
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?
24. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted F cilitie.' 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?
13 No violations, -or deficiencies.were noted du-uring this Asit" -You will receive no further..:
correspondence about this -visit, : .:.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
done as a follow up for freeboard. Freeboard is still out of compliance. Will send a Notice of Referral to DWQ-WIRD.
dons are tied together.
7125197
a '��Y . iY .'; <� O..,;; .1",`;
i 4. .iF.;q :. .; i, €•- •y -, •T•
Reviewer/Ins ector Name John M. Fitxp'eraldr{:
°
Reviewer/Inspector Signature: Date:
FarilitvNnmbpr: 'it —dig I nafanrTncnaPtim% nl�tioQ�

■
............. . ....
.
Division of Soil and Water Conservation Other Agency [3 D
Division of Water Quality
A..
10 Routine 0 Complaint 49 Follow-up of DNV2. ins [,action 0 Follow-up or 57VT review 0 Other
Date of Inspection
Facility Number
I Time of Inspection �: p 24 hr. (hh:mm)
[3 Registered 0 Certified [3 Applied for Permit [3 Permitted JE3 Not O eratinnal Date Last Operated . ..........................
Farm Narne. ....e.1.r tv. ...... ........................................ County..... ..............................
Owner Name: ......... ................ ... ...... Ty ............................. Phone NO: ... .... . ......
FacilityContact: .............................................................................. Title: ................................................................ Phone No:...................................................
Mailing Address:..... ...... ..... K&AAL ...................... J..
..................... ...
Onsite Repre9entativc:..J-n,.y)M.9.& ...... ................................................. ...................................................
Certified Operator ...... 1; ........... ..... . ............................ Operator Certification Number-, .....
Location of Farm:
Latitude Longitude 0 =4 ©sc
t . .... .. ..'..Clotrent �. — .. . .......
"D 6
�Pe4gn'; 1,curreih Msigir esip Curren', �je . ;.:.
ca0dw opulat6n ,,;Cattk apacity'; P0 4Swine XapaO P C
.�Np�ulafi.on Poultry:��,. . ........
0 Wean to Feeder
20
0 Feeder to Finish
D Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
0 Boars
s.�E=i,,10 Subsurface Drains Present JIMLagoon A a
10 Spray Field =Area
V s. r MI.
Isein
P�N]o Liquid Waste Management System
1. Are there any buffers that need maintenance/improvement?
El Yes
El No
2. Is any discharge observed from any part of the operation?
0 Yes
El No
Discharge originated at: El Lagoon El Spray Field El Other
a. If discharge is observed, was the conveyance man-made?
[:1 Yes
❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
D Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
.d. Does discharge bypass a lagoon system'! (11 yes, notify DWQ)
0 yes
El No
3. Is there evidence of past discharge from any part of the operation?
El Yes
0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
0 Yes
El No
S. Does any part of the waste management system (other than lagoons/holding ponds) require
EJ Yes'
C1 No
maintenance/improvement?
6. Is facility not in compliance with any applicable ,setback criteria in effect at the time of design?
0 Yes
ONo
7. Did the facility fail to have a certified operator in responsible charge?
0 Yes
0 No
7/25/97 Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
❑ No
Structures (Lagonns;Holding Panels, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Stnlcture 6
Identifier: 2.......................................................................................................................... ....................................... ...................................
Freeboard(ft):.......................................................................................................................................................................................................................
10, Is seepage observed from any of the structures?
❑ Yes
❑ No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
❑ No
12. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
❑ No
`Vas_ to ,ipplirptirin
14, Is there physical evidence of over application?
❑ Yes
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15, Crop type....................................................................................................................................................................................................................................
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
❑ No
18, Does the receiving crop need improvement?
❑.Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
❑ No
20. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
21. Did Reviewerllnspector fail to discuss revi ewh n spe c 6 o n with on -site representative?
❑ Yes
❑ No
22, Does record keeping need improvement?
❑ Yes
❑ No
ForCertified ,or Permitted Facilities Qnly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
[3.No.v:1OijtiOns'Qr deficiencies were noted_during this'visit.� Ydu. 'Will recei'Ve itv-further
correspondence Aout this visi#.:: "
1
Camiiien (refer tn_questinn #) :Iaxplata iriey�YES,`answers undlarF'atiy recumirtendatiiins or any'other" ciririett
Usa'iit^ArvinIN ot. facility tri" better exnwn,siti a6: hs• Use tidditionwriece:;,1�
...iiE- F'?•. i..t: 4iii3.-e::: .t� ,e �' ;.:...
� F e-• v f e� S f.. I �-d u c t wash �► ... 1► a t+i V .. � { �., . rt a r d[ ct f� E� h a c K p.' h
P. t- �� �� � u e t 1 � J 'x J a � j. �-.•-�. �..,,,., a R;
d��e.i1 �v.e0.r 11;+�1es� h tk iwt-Q la�ppr►pr ap Fro x:� Z. l.dv� �►ti-e.l' �a
sti•e w a I�.r- tk a v cl a d i i o f i' a w n+-d 1a w.-e e,l-9..•r� a I t-UA u y, SO
�;wd cx yrult•i-) W4i a [,xr1 . � o w. Q Ge Ct tic a e
�+ �¢ a l o +tie c1 rr� ;�''jt d �t [ .tee w„� 1n . = a t� k o w +.v..Q-•r� ttiu Ls a {-e.r n
tea. r. W p 1 e1 Inv. ti fo .1 ., .�-� r t-sl b a c tt , L a o V-. out- of •N,i
11 !! 1 I a44 , t� p.y�. -1
fj O w 0. J }� 1 v,
1► i ;~ w In r n c1 � �- � k to j c er k t, i� ra � o,r a � l w l-�•+r av ., � ►•. t e li � ti ' l y ' q �,
The wt
syC w ed� orNor a S��t. ib,�g t
o r e ., w a. W 0 t it-i v d Q t eM V,-, n� t-h 9-L e t a. F+ a jl� ►- •' -1 •l' r k c 6 J 1,� A l
I.s'[ lAI A - La A �1 CY iAnA. T i_�._e �. R1.1a_ J.., LuROY Q.� f-i.L A.. -....._ter
,...,, ...._p :,....,....�.-.,
Reviewer/Inspector r Nslr ,i;,;_ ecto n _ 1
z ;, , :.... ' is
i ,; ..aa SS
i . �i ,� q
Reviewer/Inspector Signature: �,,,,_,t a y,-- 1 - Date:

r
FHcility Number: .3.1....... •—... .2,r UHte of Inspectlowl i 1
Additional Comments and/orDrawings-
o
c a ,r� a-4 f-v+.c d� , -o� ti '� '`� a u t Lam. a E s 7 4 a
4/3 0/9 7

.... .. .. .. ... .... ..... ..... . . .... ..... . ... . .. .. ...... ... . . .. .... .. .... . . ... ........ . . ... ... ....
DSWC Animal Feedlot Operation Review
E§ DWQ Animal Feedlot Operation Site Inspection . . .....
0 1(outille 0 C01110"int 0 Follow-up of DW12 inspection 0 Follow-up of DSkVC review 0 Other
Date of Inspection ij m q
Facility Number 7
I ... Time of Inspection =It] 24 hr. (hh:mm)
13 Registered MCertified 13 Applied for Permit E3 Permitted 10 Not Operational I Date Last Operated: ..........................
FarmName:... .......... ....... ............................. ...................
Owner Name: . .......... . ............... .... ....... Zr . . ...... I .... .. ....... Phone ....... I........"...,
Facility Contact:
Title -
Mailing Address:... &1's ......
S-1— -a..,. &10-104 ................................
Onsite
Certified Operatol ........ Ja-,-,r. . . ....... S ......... ................................
Location of Farm:
Phone No: ....................................
. .................................. ..zx4.S..3 ...
Integrator: ... tA.U.W..r.k. I.......................................................
- ..... * ........................................... *
Operator Certification ......
.. . . ....... ... . ---- . . .. ... .... ---
----- - ---- ... ..... ......... ...............
Latitude
Design Curren;-
-Swine Capacity Population
MWean foFeeder SIZC)
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
0 Boars
Longitude 0 1 it
Design Current Design . Current
Poultry Capacity Population 'Cattle capacity Population
ry
Layer ❑Dai
Non -layer I ❑ Non -Dairy[
�therj I
Total Design Capacity 10
Total SSLW 0
Number of Lagoons 1 Holding Ponds JE1 Subsurface Drains Present
JE1 No Liquid Waste Manager
General
1. Are there any buffers that need inaiiiien-,itice/iiiiprovet-neiit?
2. Is any discharge observed from any part of the operation'?
Discharge originated at: El Lagoon 5& Spray Field [I Other
C� C
a, If discharge is observed, was, the conveyance mar -made"
b. If discharge is observed, did it retch Surface Water? notify Ify D-WQ)
u, If discharge is observed, what is the estimated flow in gal/111in"
I
d. Does discharge bypass a lagoon system? (Kyes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge'?
... .... ....................
Lagoon Area
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
G. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
El Spray field Area
El Yes 0 No
Yes D No
El Yes 0 No
El Yes C3 No
❑ Yes 0 No
Yes 0 No
El Yes 19 No
9 Yes 0 No
0 Yes K NO
0 Yes 0 No
Continued an back

Facility Number:,?) —14.3
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
&No
Structures_(Laeoons.Iioldinu Ponds, Flush Pits, etc.)
,
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: 1
Freeboard(ft):............... ...................................................................................................................................................................................
.....................
• 10.
Is seepage observed from any of the structures'?
❑ Yes
® No
11,
Is erosion, or any other threats to the integrity of any of the structures observed:'
❑ Yes
® No
12.
Do any of the structures need mainteriancelimprovement?
Yes
®s
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14.
Is there physical evidence of over application?
® Yes
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type.......................................................................................................................................................
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
® No
19,
Does the receiving crop need improvement!
® Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
O No
20.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
21.
Did ReviewerlInspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
❑ 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
❑ No
24,
Were any additional problems noted which cause noncompli:uice of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yos
91No
0 No. viola'dons or deficiencies we re" noted•dueing this:visit. ; .You.wiII receive no further .
0er6:p6nde&e about this:visit
CvduI' ri6U {refer to'ques(ion #)-"Explain any;'YES;w ansers andl6ri any'recoinmendatiions or'any !� other. tf►r
Use drawings of facility to better;ezplain situations. use additional pages as necessary):::-,
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Y 1 Y► w N�,Rs.�w
�t is o t]
1A1 .
ReviewerlInspector Name
ReviewerlInspector Signature:d_• _j e,„_r Sf `j _ �J n�[ . y_� Date: t y

Facility Number .Z)....... --.A.3 �gr Date of Inspection: I t r Z
Additional Comments and/or`Drawm&- %: ...
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4/30/97

T,
WC Anima . ..... ... . ... ....
E3 DS l';Fe6dl6t..OP,6eition'..R,�*ii6w
V . ......... .
....... ...... ... . . ... ...
SS
mpett0
VIM,
.4.13
Routine 0 Complaint 0 Follow-up of DWQ inspection
0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection I L 24 br, (hh:mm)
Total Time (in fraction of hours
Farm Status: El Registered [I Applied for Permit
(ex:1,25 for 1 hr 15 min)) Spent on Review
XCertified El Permitted
or Inspection (includes travel and Brocessinj
[I Not Operational Date Lost Operated . ...... . ....
.................... . .......... ......... . ........ . ..... . ............... . ...... ........... . .... . ........ . .....
FarmName- ..... . .... ................... ............
............ ........ County: 34w'i . .. ............................. \AhIRD ...
Land Owner L-511.911Sd ..... Z.r . ..... . ................. Phone No: . ..............
FacilityConctact . ... . ......................... _ .............. . . .............. . .............. Title . .................... . .... . ............. . . Phone No:....................._.........................._....._.
Mailing Address:.__31.5 --- . ......... I ... . ................ . ..... ... . . ............... . .....
Onsite Representative: ......... . .... . .................. .............. Integrator; ... Mvr�?, ... y ..................... . .......... ...............
Ij
Certified Operator: ..... ................ . ........................ . . ........... ...... . ........................ . ............ Operator Certification Number: _!.Y.14.2 . ..................
Location of Farm:
A.114 . ..... . ...... S.t_1..LZ_2
.................................... . ....... . . . . ................ . .................. ..... ..................................
Latitude 0 1 44 Longitude # 4 96
Type of Operation and Design Capacity
...... . ...
.'Current 'INT Miil��
eagn, W
. .. ... ..... esgn rrent
.... .. . ...
11�?. e. Paull ry � !: i ,� Cattle
.............
a 'P6"6 �i�c Pa Calme ....Po Callacitv "Poi6,61mion
t
Wean to Feeder i 7v cla— 10 Dairy I I
]QEXj
Non -Layer Non -Doi
Feeder to Finish
.... .......
W
Farrow to Wean
�, 4� P:­ .11 .6
Farrow to Feeder.
_y
M'
k;' V
Farrow to Finisb
13 el
01:
iE
P�10 k.,
j ffdldlfig"F:Po'n D Subsurface Drains Present
l
�"tn 'r
:"mi�igl[Lagoon Area osprayFielq AeaM&� j�iM
- - ------------
-Gel]ergl
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
- Discharge originated at: 0 Lagoon [3 Spray field [3 Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
[3 Yes M No
0 yes -M No
0 Yes
PS No
0 Yes
L9 No
OkA_
• Yes
qNo
• Yes
E[No
0 Yes
0 No
0 Yes
0 No
Continued on back

Facility Number:.3.1.....
6, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
J&No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
&No
S. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
KNo
Sfructufes (Lag ons_an fgr Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
RNo
Freeboard 01): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
2.
10. Is seepage observed from any of the structures?
❑ Yes
® No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
0 No
12. Do any of the structures need maintenance/improvement?
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
P9No
Vf' ste ulicution
14. Is there physical evidence of over application?
❑ Yes
RNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... .....................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
RNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
RENo
18. Does the receiving crop need improvement?
❑ Yes
O No
19. Is there a lack of available waste application equipment?
❑ Yes
PS No
20. Does facility require a follow-up visit by same agency?
❑ Yes
O-No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Faciliti Only
❑ Yes
PjNo
JEoLCertit%d S
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
9[No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
9No
24. Does record keeping need improvement?
❑ Yes
allo
omments- re er to question #): xplam
`a'ny YES answers an or.any recommendations air any other comments. "
f.
Use drawings of facility to better explain situations;.(use additional pages as necessary}:., E,
.�:' •;S t :4' i SE3. 1 .4 d .31` ..}; K.
lZ . A I i 1a c•-r-� a`^�.a�S p +-E .y o 'ej %L L l S L► 0 .s L� ip v'9- 3 �- tL �}
S .
V
Reviewer/Inspector Flame ' K:. yy°
'1<`'1 l'Ir�
Reviewer/Inspector Signature: - Date: 7 1 30 l q
cc: Division of Water Oualin% Water Oualily Section. Facility Assessment nil 4134197

Post -it" Fax Dote 7671 case � �S pa°gssE 7�-
7o pram x \.V
Co.fOept. Co'
Site Requites Immediate. Attention:
Facility No. 31-- 4 3 Z
phone p
Fax" , 1 „'
NTAL MANAGEMENT
y SITE VISITATION RECORD
DATE: •'� a �, 1995
Time: i :; o
Farm Name/Owner: k cksr C.rtaV, N b r �.r � = a -V 4;i rvwa►
Mailing Address: S* -r • N C- F 3
County: v `
Integrator:--* [�'lk��lyr�...,.�.. _F..�,,,. , Phone: �►e - Za; z�� t
On Site Rtpreserttative:' �.5 -y4 . 's #' ,."A Phone:
Physical AddresslLocation: 3 .i, . 5 �-'#t,'k 5y. «--7
kAt SR 1 W5I a Ir • Z - M+ is It:,c6 '------�- —
Type of Operation: Swine X Poultry Cattle
Design Capacity; Number of Animals on Site: ■
DENS Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° Longitude• ° "
Circle Yes or No
Does the Animal Waste Lagoon efficient freeboard of 1 Foot + 25 year 24 hour ' storm event
(approximately 1 Foot + 7 inches) Yes r No A�Freeboard: __ 3 Ft. Inches
as any seepage observed from the l n(s)? Yes or a as any erasion ob till? Yes ar
Wadequate land available for spray? or
or No Is the cover crop adequate? Yes r No
Crop(s) being utilized: �bve
Does the facility meet SCS minimum setback criteria? 204 Feet from DwelliENT
ry Ye or No
100 Feet from Wells? I Na
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o 0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue L ne: Yes or TVo
Is animal waste discharged into water oP4 state by man-made ditch, flushing system, or other
similar man-made devices? Yes ork,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: r n
IL 0-k
V114 C.L.
Le. ., d
Tvi14 L,aa1 W+46kc.r
legectar Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.