310459_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

ivision of Water Resources
Facility Number a -;j O Division of Soil and Water Conservation
p Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: "Outine 0 Complaint Q Follow-up Q Referral Q Emergency D Other Q Denied Access
Date of Visit: jJJ'J,,td 11 Arrival Time:—�-�-l� Departure Time: County: Region:
Farm Name: ��nn���� I d�►'! j'
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: actA s �,'yt6k Title:
Onsite Representative: [ [
..r� Certified Operator: l J 'NI tleJ`
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finisha
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator: ' 6 -6j `~�
Certification Number: '79 -7 j 2 3
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Ga er
Non -La er I I ��]
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop,
Dairy Cow
Dairy Calf
Dairy Heifer
❑ Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Im acts
1. is any discharge observed from any part of the operation? ❑ Yes No ❑ NA [] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No [ 2-NA ❑ NE
b. Did the discharge reach waters of the State? £yes qte%e_j�RMXffl,?
WR)❑ Yes ❑ No E1 A 0 NE
c. What is the estimated volume that reached waters of
d. Does the discharge bypass the waste management Urtep[[1I1?,(L�? , notify DWR) ❑ Yes ❑ No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? 11 ❑ Yes ZNo ❑ NA NE
3. Were there any observable adverse impacts or potential !►� ra ios ecKKn
' waters ❑ Yes []"No ❑ NA ❑ NE
ti
of the State other than from a discharge'? Wilmington Regional Office
Page 1 nj'3 21412015 Continued

Facility Number: 3 - Date of Ins eetion: WL-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[D_Ntf ❑ NA
❑ NF
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
B 1 -A
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spiilway?:
Designed Freeboard (in):
Observes! Freeboard (in): 2-©
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
❑ 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
❑'IGo
❑ 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
E15TIo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ffNo
❑ NA
❑ NE
(not appI icab le 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
3<o
❑ NA
❑ NE
maintenance or improvement?
Waste A10plication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
D-No
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
<0
(DNA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs, ❑ Total Phosphorus ❑ Faiiure to Incorporate
Manure/Sludge
into
Rare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s): - ci co 15 „ . sto 0 -� C.1►�tr. +C
.,,.
13. Soil Type(s):e7 Cy
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
❑�Ko
❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑Yes
EJ'No
❑NA
❑NE
❑ Yes
E No
❑ NA
❑ NE
Required _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 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
❑ N E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
No
❑ YesgNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facilit Number: I- S Date of Inspection: Z ,-G
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [21,40
25. /;,the facility out of compliance with permit conditions related to sludge? 11'yes, check ❑ Yes E�Ko
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 [EN❑
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o"N0
Other Issues
29. 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 faciI ity require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes D"No ❑ NA ❑ NE
❑ Yes 2No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes [�_No ❑ NA ❑ NE
❑ Yes EfNo
❑ Yes [fNo
❑ Yes %f No
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
Comments' refer to uestion!4 :iEx Explain! :1,YFSianswers'andJariat� 'additlonRl recommendatinns'ar'ari :hother;catnments.;
( an ,? py .,z, �' -,;: • ,..rN � . ,, .,,,,� Y .,, n::r.
"r"HI?lilt"'I1HjirEl:';illiusllEjE€. ....I ..I=.�! ..,t .rR€€i$i lfit}FtlfElfl111fF{jFkitE€!!€:li.r€l,lti:'�1,€ i 1, �!'E lflr�l .I Fr ii •, p sir• ,.. �f .;r; • !s:i" jrlliyN, i,
[.Iae:drawin of Melli .4obetter, ex lain,$itnallons.(use,additionai; ages as;necessa )�;4,�;,��!Fl! ;!:1'i' r�';I.i. ,;(j ,' f , ,ryaf, 'GL"r
Reviewer/inspector Name: ' j3al Vw Phone:% 3.133 {
t
Reviewerllnspector Signature: ti Date: ��17
Page 3 of 3 21412015

Type of Visit: ❑ Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: p Routine D Complaint Q Follow-up Q Referral Q Emergence Q Other 0 Denied Access
Date of Visit: I IVI YIIP_1 Arrival Time: Departure Time: County: b� e
Farm Name: /W Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: 6,& Isc f-L! 1 C%T_ Integrator: %YL //'49
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Region:
❑esign Eurrent
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
G It—VIEROP.
Cattle Gapacity Pop,
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Design
Current
Dairy Heifer
Dry Cow
Farrow to Wean
Farrow to Feeder
D • Eouitr.
Ea aeit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes � No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ET No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
[} NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: IDate of Inspection: /G
T
Waste Collection & Treatment
4. Is jotorage Capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
® No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[a -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
❑ 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? 0 Yes �] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
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?
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?
Reaulred Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ Yes
ZrNo
❑ NA
❑ NE
❑ Yes
L1 No
❑ NA
❑ NE
❑ Yes
[ "No
❑ NA
❑ NE
❑Yes ©No ❑NA ❑NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes �2rNo ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes P� N
o
Page 2 of 3 2,1412015 Continued

Facilltv Number: 7_1� It F- C71 IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA ❑ NE
25. t5 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
P No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ONo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes jo No ❑ NA ❑ NE
❑ Yes 7No ❑ NA ❑ NE
❑ Yes E6 No ❑ NA ❑ NE
❑ Yes PTNo ❑ NA ❑ NE
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 [ZfNo ❑ NA ❑ NE
Coininents• {refer�ta uestion'#};:1Fit la1ri: itri : jVES answers-and/or:;any addltlanal'recommendations"or anyiuttter comments . '
•4:,= :�..Yt. i£i t, =.. z9" A €' 8• (`y
F . '. � i `. .,ti • .. ' ;=1 !.Wi :.� ..X•�e!'. :.�� t
Use tlrawin` s:af;faeili , to;betterlex lain:situations;(use.:addltional a es:as:necessa ).,.Y�. s;.�. � �• �% =:s:t���,�k.,.�`�:�` � �; ; �
�' �a lyri r I'Q c � r��S ��`o ►�
Reviewer/Inspector Name: MOO
Reviewer/Inspector Signature: k _
Page 3 of 3
Phone: /0 7,323
Date: �f
21412015

pr�
!vision of Water Resources
Facility Number - Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit: omplianee Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: JQKoutine Q Complaint Q Fallow -up Q Referral a Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: ft�Q Departure Time: County: Region: (.._j Z&m
Farm Name: %fJ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Airyr�
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:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
FTLayer
Non -Layer
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)?
d. Does the discharge bypass the waste management system'? (If yes, notify DWR)
2. is there evidence of 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dair Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E7M ❑ NA ❑ NE
❑ Yes-61No ❑ NA ❑ NE
❑ Ycs/[No ❑ NA ❑ NE
❑ Yes,,P-No ❑ NA ❑ NE
❑ Yeso ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of inspection:
Waste C,pllection & Treatment
4r is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �o [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: 2—
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Q-No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes eff 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 La"No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ETNo
❑ 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.,,0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O 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(%):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes -No
❑ NA
❑ NE
15. floes the receiving crop and/or land application site need improvement?
❑ Yes PMo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes .[fr No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes pAo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑•No
TT
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes rio
❑ 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.
_C;�No
❑ WUP ❑Checklists ❑ Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J:�No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes .ErNo
❑ Yes I .}-5n
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 oj3 21412014 Continued

Facility Number: - ❑ate of inspection:
24, Did tjre facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 'L2''No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,❑ErNo
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [] No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field. [] Lagoon/Storage Pond ❑ Other:
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
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. additional recommendations or any other comments.
Use drawings of facility to better explain. situations. (use additional Pages as necessary).
i
, /'4V4 kcaH�
r C
� `z Cvc•.8 �I 7 1���
a Carol
Reviewer/Inspector Name:
Phone:
Reviewer/lnspector Signature: Date:
Page 3 of 3 2/ 01

Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine Q Complaint ❑ Follow-up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time:County: p Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: ,
Back-up Operator:
Phone:
Phone:
Integrator:
Certification Number: 994127
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design Current Design Current
Swine Capacity Pop,
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer er Dai Cow
Non -Layer Dai Calf
El
Dairy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Die —sign Current Dry Cow
Farrow to Feeder
D . P,ou[t . Ca Belt P,o Non -Dairy
Farrow to Finish
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Co -
Gilts
Boars
Turkeys
Other
Turke Puults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes Z' No ❑ NA ❑ NE
[:]Yes Po ❑ NA ❑ NE
b, Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes 4No
[DNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[:]Yes Ef o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[-]Yes WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faeili Number: 1 -4 Date of Inspection:
Waste Collection & Treatment
4. is heavy less
ZNo
storage capacity (structural plus storm storage plus rainfall) than adequate?
❑ Yes
❑ NA
❑ NE
a, If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: + -c
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33�_T�
5, Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
jEfNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
VfNo
❑ 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
�TNo
❑ NA
❑ NE
8, 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)
TT
9. Does any part of the waste management system other than the waste structures require
[:]Yes
rNo
❑ 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? 7
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 7"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc..).)
0 PAN ❑ PAN > 10% or 10 lbs, ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box,
❑ Yes
?T2No
❑ NA
❑ NE
❑ Yes
No
"''''
❑ NA
❑ NE
❑ Yes
TTTTTT'''"ONo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
Zf No
❑ NA
❑ NE
❑ Yes
�fNo
❑ NA
❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 4N
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [3 Soil Analysis ❑ Waste Transfers
❑ Rainfall O Stacking []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 ����G" No
o ❑ NA ❑ NE
0 Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: jDale of inspection:-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes if No ❑ NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �5`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 KNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
VTNo
❑ 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
Fr
❑ 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
7rNo
❑ 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
0"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
6 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o
❑ NA
❑ NE
lComments (refer:to question #) ;Explairr any YES answers andJor any."additiotal recoinin"eridatiuris+,ar any�other'commer►ts c i ;°
tw6 ngs of facility}to lietter explain situations (use additional pages as necessary}: � y ry ; s �:,P g
Fes+ 4Ae f;4 5c4x4 I i per. Rti-Sp�� aot5.
Reviewer/Inspector Name: ► Phone: 5
Reviewer/Inspector Signature: r V Date:
Page 3 of 3 21412014

k
Division of Water Quality
Facility Number ®W � a Division of Soil and Water Conservation
a Other Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint p Follow-up Q Referral Q Emergency p Other 0 Denied Access
Date of Visit: IT'0"M
I I Arrival Time:
Departure Time: [j=
County:
Farm Name: .5'.x&6
a 44S
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative:
Certified Operator: E
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
Latitude:
Phone:
Integrator:
Region: VIKU
Certification Number: Iqya1)
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
JRL: er
1 N o n- L —ay er
Z
Other
Poults
Design Current
Discherees 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
0 Yes E!fNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes ZrNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: -L45A jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
JZ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[4 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
ZrNo
❑ 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
,U No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[]Yes
ONo
❑ 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
2fN❑
❑ NA
❑ NE
maintenance or improvement?
Waste AmAlcatlon
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
g3 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
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
❑ NA
❑ NE
18. is there a lack of property operating waste application equipment?
❑ Yes
V No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
4 No
❑ NA
❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
VjNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ L.ease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ETNo
❑ 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 Zf No
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 21412011 Condnued

"ram
Facility Number: -_HS Date of Inspection: �-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 6 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes KNO
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
❑ Yes f No
❑ Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes fff No ❑ NA ❑ NE
❑ Yes
no
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question 0): Explain any YES answers and/or any additional recommendations or any other comments. .
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
ReviewerlInspector Signature:
Page 3 of 3
Phone: a ^
Date:
21412011

t 91, GJ Division of Water Quality
Facility Number 3 - 0 Division of Soil and Water Conservation
Q Other Agency �/ I
Type of Visit: 7Routine
pliance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint Q Follow-up Q Referral Q Emereenc_y ❑ Other Q Denied Access
Date of Visit: G Arrival Time: Departure Time: County: 7UPtZ$J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish 3G od 3tAoo
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Title:
Latitude:
Phone:
Integrator:
Certification Number: 116 7-0
Certification Number:
Design Current
Wet Poultry Capacity Pop.
±Non-LaXer
a er
Design Current
Pullets
Turke►
Other
Poults
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes O No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N [DNA NE
❑ Yes No ❑ NA ❑ NE
❑ Yes E/No [DNA ❑ NE
Page 1 of 3 21412011 Continued

[Fac!!q Number; - Date of Inspection: 4
Waste Collection & Treatment
No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑
❑ 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: GDruV t LA c,,dA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 j
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
[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 enviroumenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes (o [DNA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) f
9. Does any part of the waste management system other than the waste structures require ❑ Yes En No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ (No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E(No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes u No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes F3/N o ❑ NA ❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E(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 IVo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes E_'No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit Number: jDate of Inspection: ye
2A. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
WNo ❑ 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
o [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Yo ❑ 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
N ❑ NA ❑ NE
permit? (ix., 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?
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?
drawIigs nflfac(Iityi4We` tier;'ki
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[:]Yes
Oo ❑ NA ❑ NE
[:]Yes [No ❑ NA ❑ NE
[:]Yes [ No ❑ NA ❑ NE
iicwa re:a nil Inr-on. I oil it i fI A n o I f ran nrii m en'A o H r nc 4n r:"iAnhl.o.=: rinmi-"
,jj4g)y g4ewHN t
Phone: l 914)) IfG - 73 o p
Date:
21412011

'Type of Visit: (�3 Colfipliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ?OT& GIB rysj to
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 1162y
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pnp.
Cattle Capacity Pnp.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La cr
I
Dairy Calf
Feeder to Finish
o
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr I?oultr.
Ga acit
Po
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Pouits
nthcr
ether
Discharges and Stream Im acts
l . 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 EZ /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
[:]Yes g
❑NA ❑ NE
❑ YesNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number:31 - Date of Ins ection: iD
!
Waste Collection & Treatment
4. Is rprage 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: L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
o
❑ 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
Vo
❑ NA
FINE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes eNo ❑ NA ❑ NE
S. Do any of the structures 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 E3"'No ❑ NA ❑ NE
maintenance or improvement?
Waste ApRlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [I] No ❑ 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? Vyes
es No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes ZNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Eko
No
[DNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[/]
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
[J
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
5<0
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes CZNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection:
24. Did the facilityfail to calibrate waste application equipment as re required b the permit Yes NA NE
PPq Y P ❑ ❑ ❑
25. Is tie facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes�zo ❑ 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 �Io ❑ 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
E34o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
INO
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ 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
To
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ffN0
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
YNo
❑ NA
❑ NE
Comments (refer to question 0): Explain any YES answers and/or any additional recommendat€ons"or any.'otherpmmcnts: :
Use drawin s of facllit to better explain situations (use additional ages�as:necessary)r ":.;a.
' 'r-<;r ;Yr
t s) AI&Yj f 96M A/e_- CAe WW1 Rar �6�, ►�JFr-n re 00. pv6U
e o I016 �``'�IZ- S/i > E0 1l / SATE .
Reviewer/Inspector Name:
dW 1144r.L,
Phone: 010,
Reviewer/Inspector Signature:
Date: 1 _0
Page 3 of 3 214121911

Type of Visit 0 Cam nce Inspection Q Operation Review ❑ Structure Evaluation Q Technical Assistance
Reason for Visit outine Q Complaint Q Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ,97
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = ` 0 " Longitude: = ° = 1 =
tl
10
Malesign
it
Current
Design Current.r
pacity
'Aopulation
. Wet Poultry Capacity Population
Cattle Capacity Population
an to Finish
❑ Layer
❑ Dai Cow
an to Feeder
❑ Non -Layer
❑ Dai Calf
eder to Finish
vV
Z.$ 4
❑ DairyHeifer
rrow to Wean
l]ry Pao. ul�try
❑ D Cow
row to Feeder
❑ Non -Dairy
row to Finish
❑ Layers
❑ Beef Stacker
ts
Non -Layers
❑ Beef Feeder
ars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
Murkey Poults
❑ Other
❑ Other I
Number of Structures:
Discharees & Stream Imnacts
I . Is any discharge observed from any part of the operation?
❑ Yes
E No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation'?
❑ Yes
9�No
El
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

;il.jPacility Number: pate of Inspection Y
'■ 'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Structure 2 Structure 3
Identifier.
(4ana G
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Z
Structure 4
❑ Yes ['No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,..�
6. Are there structures on -site which are not properly addressed and/or managed El Yes E I 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? El Yes EdNo ❑ NA ❑ NE
8. Do any of the stuctures 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 6No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes 6No ❑ NA ❑ NE
maintenance/improvement? ,
11. is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ff No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 1 fl% or 10 lbs ❑ Totat 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
0 No
❑ NA
Cl NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or Operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,E(No
12No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Carnments (refer to question #]:.Explain any YES.answers andfor, any. reenmmendations.or, :any othericoggmments:;
Use drawings of facility to better explain situations. (use, add€tidnal pa'ge§ as necessary):. _ : wR a . "Z A.
x1► &R f u Al&,eox 7j 13r &A16 Z k1CC kT LR r6.
Of 4vitor
Reviewer/Inspector Name f a 3"+`R..
Phone:
Reviewer/Inspector Signature:
Date -
Page 2 of 3 12128104 Continued

+rt
Facility Number: — g Date of Inspection
i_
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,_,,(No ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElFJ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Lather
21. Does record keeping need improvement? If yes, chec the appropriate box below. r-1 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application El Weekly Freeboard rJ Waste Analysis ❑ Soil Analysis [:]Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�o ❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ICJ No ❑ NA
❑ NE
dyes
26.
Did the facility fail to have an actively certified operator in charge?
[_—]No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ff'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[l"N❑
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
MIND
❑ 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
dN o
❑ 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
dNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
I2128104

E
f Visit 7Routine
piiance Inspection 0 Operation Review ❑ Structure Evaluation D Technical Assistance
for Visit Q Complaint Q Follow up Q Referral Q Emergency a Other ❑ Den led Access
Date of Visit: S z.'j o Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: foMMfM 113AR49642 Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = ` 0 " Longitude: = e = , El
11
'
Swlne
Design
Capacity
Current Design
P�lation Wet Pnultry Capacity
Current Design Current
Ppulation Cattle Capacity Population
❑ Wean to Finish
Layer
❑ Non -Layer
_3000
ply Poultry
Layers
❑ Non -Layers
Pullets
ues
❑ Turkeys
❑ Turkey Pouets
tither
❑ Dai Cow
Wean to Feeder
❑ Dai Calf
Feeder to Finish
UM
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Farrow to Finish
❑Gilts
❑ Boars
❑ Beef Brood Co
Other
❑ Dther
01
Number of 5truetures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
, ��
L( No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made`?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[,I No
[I NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LI No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

s
1*acility Number: 51 — Date of Inspection r o
MAuste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier LA 69M� 2.
spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2�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
ONo ❑ 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
E� o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[IYes
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
E2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
/
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Z
El NA
El NE.
17. Does the facility lack adequate acreage for land application?
El Yes
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
L o
❑ NA
❑ NE
Comments ('refer to question #): Explain any YES answers and/or any recommendations ar any ether comments.
�llsee rawings-of Ifeillty to b0ter explain situ.atians. (use additional pages as necessary):
1 s ;) mow► i/b 5 G- a F"t- -1 J VJXP E ,D z le u aq
f '''' � Phone:
Reviewer/Inspector Name :. _ - -- t'- TT �'x <,�
Reviewer/Inspector Signature: Date:
Page 2 of 3 1 f12128104 Continued

cility Number: — Date of Inspection
RJguired Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes, check
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes E� o [3NA ElNE
❑ Yes No ❑ NA ❑ NE
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Z1No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�K
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
R(No
❑ NA
❑ NE
27,
Did the facility !'ail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other Issues
�
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElE Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ENo
❑ 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
CJ 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
ElYes
E No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El
�f
I!J N
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
El
No
❑ NA
❑ NE
Adnitiunal.Corn tenivandloi• L]rawirtgs: = " "a s i . ,` .;, :r
tam
w
Page 3 of 3 12128104

L
Facility ,~;umber 3 5
t
Type of Visit
Co pliance Inspection
Q Operation Review Q Structure Evaluation
Q Technical Assistance
Reason for Visit
,Routine Q Complaint
0 Follow up Q Referral Q Emergency
n Other ❑ Denied Access
Date of Visit: [1 [ Arrival Time: 3 Departure Time: County: Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: (�D`2 O �>AtL=� _. Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0= 0=44 Longitude: 0 n 0 4= u
Design Current
design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Eapacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
10 Non -La er
El Calf
® Feeder to Finish Gob 00
❑ Dai Heifej
❑ Farrow to Wean
Dry Pnultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Layers
[I
Non-I.a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes L,G No ❑ NA El NE
Discharge originated at: ❑ Structure El Application Field El Other
a. Was the conveyance man-made? El Yes ❑ No El NA El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes El 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) El Yes [I No [I NA El NE
YJ
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No El NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State El Yes V No ❑ NA El NE
other than from a discharge?
12128104 Continued

Facility Number: 3 1— s
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
❑ Yes E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA(m nI L A 6nWrJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 56 Z�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes LJ No ❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ 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 tFjxeat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes O(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
g. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
1 l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes .PNo ❑ 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
ENo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
EfNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[NIo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as necessary):
►S;.) CoMT.IMV C 'ia UUIt-1Cr oN (3EiLmU:0 f'{ s vAm_ Pua LC- 5 GA L�- F� a - I SM L ,
f jjA_ oP(j.l; re S vijobti F"CA! r ore , E �° e�P of Wa22EO 4C >\/ ► r N
At o OS A SCUD
Reviewer/Inspector Name J At/ t;LL_ Ark gCLPhone: NON -, 511
Reviewer/Inspector Signature: Date: I
r 7r7AMa r•.,..r.. —d

- , I V,
Facility Number: tl — jJ Date of Inspection a
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the approprrate box, ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes ZNo
o El NA El NE
El Yes ❑ NA ❑ NE
21.
Does record keeping need improvement'? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E No
❑ NA
❑ NE
24.
Did the faci lily fai l to calibrate waste application equipment as required by the permit?
❑ Yes
E5'Np
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
6/No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?[Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LJ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
KN
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
Yes
ElI
iv❑
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency`?
ElYes
Z
El NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water Quality :.
=Fadlltyumber Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit
Compliance Inspection
Q Operation Review Q Structure Evaluation
a Technical Assistance
Reason for Visit
UY Routine 0 Complaint
Q Follow up Q Referral 0 Emergency
0 Other ❑ denied Access
Date of Visit:
Y 6
Arrival Time:
I)eparture Time: County: n�&rAl Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 'rR6h!A_I3e41V-ZE.LYI
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' =" Longitude: =)
=' 0 "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[--]Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
{
❑ Farrow to Wean
❑ Farrow to Feeder
❑ farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
Pullets
Pouets
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity Population
❑ Daia Cow
Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
El Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cn
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes N ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
12128104 Continued

Facility Number:31 — 4 Date of Inspection b
Waite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
U 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?:
_
Resigned Freeboard (in): 7 • S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which arc not properly addressed and/or managed
Cl Yes
N❑ ❑ 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 notify DWQ
threat,
7. Do any of the structures need maintenance or improvement?
El Yes
ILI No ❑ NA ❑ NE
8, Do any of the stuctures lack adequate markers as required by the permit'?
❑ Yes
dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
dNo ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ICJ /No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2 f % ❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > IU% or l0 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil typef s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ErNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
El No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] yes
Id No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
CNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Vo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
15-i �Nr�>vU& wdr�c .N ,BE ►�A J AlQ ►os
40&aee G9• 7 1/610- -
Alap nz►fl_� , rmwC12 1 t^,
24,) a Cr G r u�tc hl��p�D• 45*1 4_
ON&*X.AJG , I/SC PNFiLs v1✓T.�L
�ESQLv�, SEND �Pi b �= dam. C�lxlrl �
AN+>' �A7���S C� �k►+rf6. f o D�,IC�
VAV LAran E'�
Reviewer/I nspector Name f �WAewlv (,
Phone: C� L — 73 a d
Reviewer/inspector Signature:
Date:
12128104 Continued

Facility Number: — Date of Inspection
Required Records &_ Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ff No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If s, check es El No El NA El NE
the appropirate box, ❑ WUP El Checklists ❑ Design [I Maps Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ENo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LI No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
J?j No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
2fNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32, Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes WNO
o
El Yes
❑ Yes M No
❑ Yes U No
❑ Yes LI No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
12128104

Type of Visit o fiance Inspection D Operation Review Q Structure Evaluation O Technical Assistance
Reason for Vlslt Routine ❑ Complaint Q Fallow up Q Referral Q Emergency Q Other ❑ Denied Access
gate of Visit: 3 '1/4G 1 Arrival Time: do departure Time: County: 1 %++'Q ! Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 11OYa Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =1 0 " Longitude: 0 ° 0' = "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capaty Population
Cattle Capacity Population
❑ Wean to Finish
❑ Laver
❑ Dai Cow
❑ Wean* Feeder
❑ Nnn-La er
❑ Dai Calf
® Feeder to Finish N.
❑ Dai Heifer
❑ Farrow to Wean.
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
Gilts
❑Non -La ers
El❑ Beef Feeder
FEI Soars
Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
L1 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge mach 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)?
71
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
�Zo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 31 S-
Date of Inspection 7 e
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identi Fier: CA 6-0 ° 10 1 CA 6r=R Z
Spillway?:
Designed Freeboard (in):
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 C" No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ff No ❑ NA ❑ NE
❑ Yes L7 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment71tcat, notify DWQ
❑
7. Do any of the structures need maintenance or improvement? Yeso ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Lam! 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 [,3No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
la. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ 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) Q OLW1OVA C is ) 3 Go cta s f!-:6 W u
13. Soil type(s) A }�'
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
E} No ❑ NA ❑ NE
V, jNo ❑ NA ❑ NE
Ld No ❑ NA ❑ NE
VNo ❑ NA ❑ NE
VNo ❑ NA LINE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other. comments: �;a ::<'».
!� Y P ( P g . ryj' ..... k, i......: ... ... .
Use drawings of facility to better explain situations: use additional page's as`necessa :; .; �, �.
tit EU.) Ce tiTCA_ ?rvfoT o N U t.It r-TC;,p 0 E tr D -n 6,6T N W
t..i pu mar Fuewp
+
r+tr�• ? LAU t To fl-P-3 P " (3 c a-M va w MW Sp R_t�,1 6.. c ew
tt.P Cog Lee 4hW0-- L. Qt--t .� .I-tiv (,K EkJ
rf. i Al
Reviewer/Inspector Name ���''y��A�.....�. ._ ...
1 Phone. 9/a 71 Gn 12 .�
Reviewer/Inspector Signature:
Date: 31��
Page 2 oj3 12128104 Continued

Facility Number: �j S Date of Inspection o.
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
❑ Yes iNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ NA
LINE
[:]Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
WAnnual
Certification
❑ Rainfall Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and i"
Rain Inspections ❑
Weather Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 No
❑ NA
❑ NE
/o
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WN
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
L o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[3/NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
lZJ NNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
Lr 4
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
L7 Nc
❑ 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
N
❑ 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
N
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

e, f
Type of Visit 10 Compliance Inspection ❑ Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Visit ❑ Routine ❑ Complaint 0 Follow up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: Arrival Time: Departure'rime: County:
Farm Name: Owner Email:
Owner Nxmp. Axo Phone!
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:17 Z"U
Certified Operator:
Back-up Operator:
Location of farm:
Region:
Phone No:
Integrator: d�P__
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = ❑ s Longitude: Q ° 0 =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ji j[__1 Non -La et
i
Fcederto Finish
El Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑
La ers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Stricture ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heife)
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: a
d. Does discharge bypass the waste management system'! (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
YN o
❑ NA
❑ NE
12128104
Conlinued

Facility Number• —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
ructure I Structu re 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: C�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan? III
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 9NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA NE
maintenance or improvement? 14
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA XNE
maintenance/improvement? ,_ ,(
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes ❑ No El[J NA ) NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) J
❑ PAN ❑ PAN > 1 Q% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable CropWindow ❑ Evidence of Wind Drriif�i ❑A�Ap�pli�jtion Outside of�
Area
12. Crop type(* G22A !fnr-4 h17.6-11 4V I �%]f�L�L�`�'GIthN !f+'� ►'0� J,G `C�,E��
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No
15. Does the receiving crop and/or land application site need improvement? 02� Yes ❑ No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes ❑ No
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No
':.":•.4'�k�''.� c.z;.. ... .l�rQ,,, .�..- �..;.._.. .,fix
/� ?� :�_ �:r;'� cti�,;. s M•i e'k �n..dr^r�t5�=,��+i� �'�;�.0 r�.mi!�'�F.
/rv��► �,P =��T DNf ry ��r9L��1-?F �rl�r�4�9 S�Af�Ii]r
Reviewer/inspector Name
Reviewer/inspector
Phone: Z/�
Date:
12128104
0." S8
❑ NA X INE
❑ NA Flec-
I
❑NA NE
❑ NA NE
❑NA �NE
Continued

Facility Number: / Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA/Z NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA /NE
the appropirate box.
. ❑ WUP ❑Checklists ❑Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
1;6
❑ NA NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA NE
27.
Did the facility fail to secure a phosphorus loss assessment {PLAT} certification?
❑ Yes
❑ No
❑ NA NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA/1" NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA � NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
,�{
ElNANE
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
ElYesNo
X
❑NA ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
/Z No
❑ NA ❑ NE
33.
Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA ❑ NE
Atldltioinal'Gomments'andlnr' prawn ` s� '.�'• ,:r: + � : �:'c •;_.::�r�� ,,.:.; � ,; . .. � R Wa
erE�I��I,G' I drrl)
A-� LSD •� /� /a �'G�. f c•1E vs �a
-
/1;4
�r�•�Y N� �
V74A
15
f1D
l
12128104

(Type of Visit grCompmance inspection Q Operation Review 0 Structure Evaluation D Technical Assistance
Reason for Visit 0Routine Q Complaint Q Fallow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: %!j Arrival Time: � Departure Time: i I Cnllnty, Region:c vt_ i9
Farm Name:`Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator -
Phone
Phone No:
Integrator: &Cya'o3
Operator Certification Number:
Rack -up Operator: I Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Latitude: =o = = Longitude: =° 0 =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
T ❑ Non -Layer
Feeder to Finish
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ !Jilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers'
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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
❑ Daia Calf
❑ Dairy ileifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
c. What is the estimated volume that reached waters of (lie State (gallons)?
Number of Structures: ®1
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 0 No ❑ NA ❑ NE
❑Yes ❑No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ON F
❑ Yes ;zNo ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0No
❑ 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: 1-41 h��
Spillway?: 0
Designed Freeboard (in):
Observed Freeboard (in): Zf 5 20
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Z 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
ONO
❑ 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
ONO
❑ NA ❑ NE
8, Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ NA FINE
(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
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 Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
15. Does the receiving crop and/or land application site need improvement?
12rYes
❑ No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
[1 No
17, Does the facility lack adequate acreage for land application?
❑ Yes
P?No
19. Is there a lack of properly operating waste application equipment?
[]Yes
ONO
❑ NA ❑ NE
El NA El NE
❑NA El NE
❑NA El NE
El NA El NE
�1�IQOf�.Gs'/1�F—�� �,Cfyfl�ZCu�Y� �,n��- S�i9l►Io �5� �
�v19Luf�7 ��1,0, Wp[16D Ll,k4. IAY 10!'F-v 4Ac
`,... a.r r
Reviewer/Inspector Name Phone: 4
- .� ;s �}'�' � -� � �� ?�% �• a
141'
�d
C4
Reviewer/Inspector Signature: /_.�07,�f%4-h % �%r Date:
12128104 Continued

Facility Number: V Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [:1Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. VYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers of Annual Certification
❑ Rainfall ❑ Stocking 0 Crop Yield 71 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections 9 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes `� No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit`? ❑ Yes ❑ No ❑ NA A NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA 9NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes J� No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA ANE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes V1 No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 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
YfNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Yes
2to
❑ NA
❑ NE
�[frr ., pp
Addltional Comments.and/ar DrawinS `ns: `:: °, 4
..: .. .. ...... a .. .�• ..: •�s ...:' gee ::, "C;."�' .d::ti,w.�a.�S:�°.w!'1f�•a .8��':�%,K �J
G 4 I-VU0hp ► V2 Fz6._0 ���,3�oy .�� rsr ASTgo) tlevo- �apvap
ccJ�1 �r
��03
IPA

',�' r ..x'...:>•. ;..:1. ! .. N. . •11 . •- T :ii: .. ...,...:. ••r_.,:�sl, :i !.:.:tss...:3:::. •::...€;tF' i'ir i
r =' .. 11 .,.�:..� pp.. p.r S .m.,lr.,, �i'• 1 � .. ....: ,x'::'; _, t :: €a::e :,`{.-t€i::?d €a€�€..:= 3z;'•.rli.-;.. r: €. .'[:i N' ...{.,. ;.i -
j . '! .. ># if., i m' •k 3=i1� '; i'sili::: :.,,::� 3 y, f: .'.+�u t .it i
S E i Di►+isioa
..F 4r. d, .I ��lil. i.F .:I? �4:'�S.'33::'"'-•-] .11 '':i d"� r •i'�:�:t r•i�' '� .L .11. .. ri.iii r'!f�
!D1VlSlOt1 ,Vj i.f" ?} �. lf =13ti1. yF ' llf .5F'!'! �. ��Y�IW�d .� M i,l ..I:: .s•.. ^E .S-F-:i, i.; :!ii�' N.:
# r:
i
ri
.i+� �`� . Iry : ^i : §£' 'a =:;3;:«.......! ....::,:•4,s
y
..j:t€':::'R':..«..t•:,':�:"::,' :°;s°'i� :: 1 3€d,.,�€.l.: , . ;1 . ..... �:r :11':. i . r . .... ... F { - .., s,... ....$€:��.. ..! ; ,..Y.. F,.''�^�
jType of Visit j0 Compliance Inspection Q Operation Review D Lagoon Evaluation I
Reason for Visit PRoutine D Complaint 0 Follow up a Emergency Notification D Other ❑ Denied Access
Facility Number date of Visit: 3 r Time: �
Q Not ❑ erational Q Below Threshold
Permitted dcertiried 13Conditionally Certified © Registered Date Last Operated or Above Threshold: .....................
FarmName: ......... .�i�. e.!................................................................................... County:........ !2! PPk.AFL.)............................ .......................
OwnerName: ................................... . .............. .... .......... ........... . ............................... . ........ Phone No:.................................r...............................................
Mailing Address:
Facility Contact:.r..............................................................................Title:...................._.......................................... Phone
t No: ...................................................
Onsite Representative: ....... i!1!► M t»... .... ...................... Integrator: ..... &AkudlS................................... ... ..... ......... .
CertifiedOperator: .............. r............r............................. .... r.......r...... ... .......... ................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry
❑ Cattle
❑ Horse Latitude
Longitude �• �' �«
.. 1 Ir;'...
! .,i i,'.:i;.']Deslign
I
..
''I Gurreat ;i1 s `;! ; , :, ; py r..
# ! 1.
f Current"t " �. = Design - Current ,
5[kF!(1
SWrner'?1.,. "A'. ,;'•
Ca :SCt
wii :
E is r i€ f"w
�PD' 6 afiorl: 'i.'Poul�'Y. _sF.''.a`- Ca" Ci I.Po ulatton."' ''CattlE A ' Ca aCl Po ulabOII
l
❑ Wean to Feeder
:V ❑ Layer
❑ Dairy
• Feeder to Finish
g�: Non -Layer
,�:Non-Dairy
i le
-• Farrow to Wean
.:. Ali j
�;;,.... ! ,....,....;,......
i ��� Y . ;`, •s;,��' J�,i
,..;;:.t';a'
❑ Farrow to FeederR,.s::�_,:
Other
Farrow Finish..,.
°'
! Y
❑ to
Gilts::
I, f =`,; wy. ,
6til Design Capacity
1 n
❑ Boars
Q f ti� ` ` i
.r.':
' x SSL' W''
.rl.. s
A.ro"41'7:"'k b:..s .:eu`I :i
oTatel
{�,. �i.r � F'.1. ... 'Z �: k: 1', ,c iI
f.,Numi a ofI.agnnns t '' t'''
Discbaraes & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ❑ No
Discharge originates! at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, disc it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaumin?
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 CKo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes U<O
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 2 O
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 5
Identifier: j ............................ Z............ ..... ..................... ..... ... ....... ........................... .............. .... ........r.............. I .... ......................
Freeboard (inches): Z 3 Z
12112103 Continued

r Facility Number: y — Date of Inspection 3 a
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
— immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper
//and/or Zinc
12. Crop type Hi ,rry %,u OVc fL Cu CC l 6y C 5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes 24
[]Yes '(No
❑ Yes [�io
❑ Yes 7No
❑ Yes
❑ Yes o I
❑ Yes W
❑ Yes dN
❑ Yes Wo
❑ Yes ❑.<0
❑ Yes
❑ Yes �No
❑ Yes fff Z'
❑ Yes 2<0
❑ Yes 0<0
❑ Yes �No
�- "RI!.ti':.T4nlc'Mt-MI . yyir... :�Atl .n..riL'-X-1 ::.:E..i: ....., e: s....:::. Y--.r ..,...;.. .. .. .
Cnmments,(reter.,lo quest on'#yc Explain any�,Vm sidluir any;recom&b4atioi;ts or aay utlier.ramm"en r.
answers a _ _
•nH•: = i'IV.}}] yi. ;,:..Nyy: � a iN' � �,. e�.: :..q. [' '%ffiiE^i�N ... S!� iii •�:f.:i3Fi ::Ck ..:V�� .:...{P.i �: :..
,
L1se draiviags af. i�ieility to' l�ctter' explain sitq tiotts. (use additional; pages ins necessary}:` ❑Field Co �] Final Notes
n! 1 j::Sii Mt f: Ssf n a.f Copy
h. l
�.Nl��i1� !�:,..ti,�a,.:s{�a,,.,,���a�� :.r: �!!�..�• s�,�:�;,.�.. � 4,.�'.�•. _�,��. ';�'��:..E.:,��: `.E,�F.��: �u�
a3 T-x- SA meL(L k)d E 0 Or us-fu R(coPLDS. SAMPL(c SC W
off 'GSUL-�s POT 13ACk. '�ti,
O&TAW-) Sko c_,�,W er viz -am
A�AUAL- �,rs1rS�AT3.�� ;AJv\ P
h so o G( S u�1 E'; aE pwJ & e
CA,Z1SgAT:f ZiO Tb X o-Wf-
�a
rMR5WWOcw F±6_� Uoy- NrGG ,
T?J ; 6 z,�T4a, AtiD IW-p (of y WTI jLt
605 To U SG&�T
' AM . Z�'-
APB, Z-q-V'
jDoNE ASAP,
7•-
Reviewerllnspectar Name :; ` ' :i7#-� i 1 =i 2'` ,
Reviewer/Impector Signature: Date: 31Oq
12112103 Continued

Facility Number: !j Date of Inspection 3 c3
F
Re uired Records & Document.
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appr riate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
GO discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30, Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35, Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ S oectionsVArnualckingForm ❑ Crop Form ❑ Rainfall [IInspection After V Rain
12U Minute InspCertification Form
❑ Yes ONo
❑ Yes No
[Yes ❑ No
❑ Yes ❑ Yes��O
No
❑ Yes No
❑ Yes IJ �Q
❑ Yes I<o
ElYes
E Yes ❑ No
❑ Yes [ �N0
❑ Yes
❑ Yes ❑ No
Vyes ❑No
s ❑ No
12112103

r
4i
Type of Visit XCompliance Inspection Q Operation Review a Lagoon Evaluation
Reason for Visit .0"Routine Q Complaint Q Follow up Q Emergency Notification ❑ Other ❑ Denied Access
Facility Number 3 J 5Gj [late of Visit: 02" Time: /0•' 2-0
Not O erational 0 a to
0 Permitted 0 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: -S�e; V-Ce4t Ea r- "r S County: D Vic
Owner Name: __ t7 �'�� ' r�)�� Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator: rc'..rnS Or t_Angl tnq
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' 0" Longitude ' 0' 0"
=' ' Desi n
:. g
F;Efnei'.T,,
Current
RQesi"n Current
Dcs€ n Current
g
, Gapaeltv
ronjulation P,aultr
Ca aci Pollulation Cattle Ea aci Po ulatinn
3r•
❑ Wean to Feeder
10 Dairy
❑ Feeder to Finish
❑ Farrow to Wean
IQ Non -Dairy
❑ Farrow to Feeder
❑ Other
Farrow to Finish
Tt►tal Design Capacity
❑ Gilts
❑ Boars
Tptal SSLW
Number of Lagoons
❑ Subsurface Drains Present ❑ Lagoon Area
Spray Field ,area
Holding Pands / Solid Traps
0 ❑ No
Li uid Waste Management System
Discharges &. Stceam Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flaw in gal/mid?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2, Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Trcgtmen
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure S
Identifier:
Freeboard (inches): x Z •05103101
❑ Yes )No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
121'No
❑ Yes
E2�0
❑ Yes
PIo
Structure 6
Continued

y
Facility Number: 3/ — Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 2fNo
❑ Yes XNo
❑ Yes ❑ No
❑ Yes 0"No
❑ Yes [Z No
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes ANo
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes j2o�o
�
12. Crop type 'Be .�+� jel el 1 gy I Are"V of coe,-Lf,I R_SCye Sati ed 1 6­,; In 61/cV >Ced
r,r ilw
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 ZNo
b) Does the facility need a wettable acre determination?
❑ Yes 2'510
c) This facility is pen tied for a wettable acre determination?
❑ Yes ZNo
15. Does the receiving crop need improvement?
❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes j2rNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Penn it readily available?
❑ Yes ONo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
El Yes ,ZNo
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes ❑ 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 XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ONo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes of o
24. Does facility require a follow-up visit by same agency? ❑ Yes ;2fN0
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? 0Yes ❑ No
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain 4N. ES ans*Vers'and/or..: A'ny, recommendationi r. 'any other a rimehts::.
bi[ 'drawings of.facility to better explain situations. {use udd[tiotial pages as:ner�essary
. ❑Field Copv ❑ Final Notes
7. bleed 4o cie4 crass cave&- Oh �r�,ers c,(' kj000l 1; rya )I0� r►.tow
grass no c loseli qs ,4 i S A,-r cat VS;� 9ro%3s 4o &jo� rot,./ rn 44em
be-11,jeen
F4AC-C f M A ; f'1�al / a� rtt 3 S Z'*a 3 ; ►, 64e r A,,,d 19 i vck e-t ,
IS_ rF_iGIo( 2—t)43 6ce,, G IQA--eol -1 p I Amv1e4 -4 P be r10''; )J Cp� -560P, ..1
r %cr o V%n ev-►e �d vs i ►1\1 � y e 1 h -��; 3 I i e I pt a s ct rec h m � r) y r G"r ,
Z,a ve n P\ a m e hA e rj add e 4 To r 1,q {o r � : r -� de,4 A o r f 1,'r' r
Wel
e-d eat r,-C,w,. 9��,�d art �,.,r,c -� ►}s ��
Reviewer/Inspector Name r^ . ar�ec wti f ►1
Reviewer/Inspector Signature: Date: 3 O 2-
05103101 Continued

Facility Number: J -14 Date of I nspection 3 D 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 ❑ 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 O'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? []Yes ,ZNo
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 J21No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes A No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
A.d.ditional Cornments an orDrawings:
I . -T Ile r reec
3a', -�es4 rej VJ}�S"; h']r�S�-�f.e r'd .rxcyi rz,e lillezf Ae 4loarl or�
004 Gr--t col 7'�,e -fl-ee baA1Of ficeevo4-1 sA�w. 1 R� o0h 11 7
i „1+r r� C' o h Z-��,1 �1 1— q ►� 4t } 2. ; h GIt@ S 0 h '2-111 01 b �
s i„ -t� e reco re s
E d p rQ.f,Pdrtp� �D � �; S �!"d P� i�7,r • �J c► r�I � � ! �Gi + GA��Rf 7 �Ot� �A C
-P,-eebI�E1 -,d )eve-1 1'<<A !'UVe been r''60r�61d P7 9!01\00', Be -SV-r4
fQ use L►lc�s- G q "1�1 s: S p�ci�Ga� [r,► ►"- 1'�, d� r evei74'
4e C41Gu1l4e 4-ke 17,4rp�en a1910
Av
zS. M -e. &ee rglof s ys4d-, O� {fie ems►-�l�►a�+ ; a Wc.-j
des: ped; Lie U se-< a t u-le; ftee 0l 4o hA ve -+6e - eA 4 i GA J
Sfeci a~Vs4 ezi d Aiq a.-.,d ev,,inC.n+-W1i-tli .spec;{scs 6tj Sy.s-�e�
S 4,0 be B fa a r4-t�d w i 44 A i -qa /vi 4 ✓11, Z2. lei -
Alse'.� )wd 4e ct vql ;d IQftSe q r�2r'+]�►� Irv,,
w�.: c�, i s' �eQ.se� �►� a� *' cenl fm- w�.s �' 'q�'�
041,e ' _ mo, ne.&W ti-aeve , -the vrAci 1 jI Ot ld cevfs Offea,
J
5/00

.p ... -�:r :..fir.,- �.�`�... yT c1��"��� �� 'h�i - -.r" _ .� .. ti:iv--•,'4., .��-•
.,�. �' '�:Di►ision'oFWate� �uality;�s'f '�:�
''?
.. �"e:. ,�Y:.�h Jf:
,.
�:�.• ;;i;..� n�"�.
` s}: ,a�° �;' •
-
- .F:;'
`r •' 1 C
`M 1." `'�' y DiVlSlon of Soil and:Wat�r-ConSerVBtlon
w g y,.
^
t'
- �. fir
��..
.y •�: F•1 r- ...-
:i ":._�.'--i?� ��t�. f; ''�• -
__. ___.
_.__.. _.. r..�
Type of Visit 0 Compliance Inspection D Operation Review O Lagoon Evaluation
Reason for Visit O Routine ❑ Complaint O Follow up O Emergency Notification O Other © denied Access
Facility Number rJ 'lute of Visit: 1 Time: �Printed on: 7/21/2000
❑ Not O erational Q Below Threshold
1$ Permitted ® Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Fartn Name: A. e�f1......F.? MK ................ County:......klu.Prr 1nl...........I...I............................ ----.......
....... ...... ..................................................................... Q
Owner Name:.....t?.pYD TtfON4$ ..... Plf lt� .. Phone No: !........................................f`r5..//,;1—.......
................. ................I........
FacilityContact: ..............................................................................Title:................................................................ Phone No:...................................................
Mailing Address: •, Z. .$UM...!��f4lr!nl.....�rQ_ASS.�o.9D S � ..... .T... � GI l� �i� ..........................
............. ......
tj
Onsite Representative: Integrator: i7li o W
........................
..............................................
Certified (]perator:.. ( ....... ?�? � .................................. -......-........ Operator Certification Number:........L;, .........................
SGoZ
Location of Farm:
I SGG MgP _ �ASr- oK 5'gL'ear-A So u T-H 51D6 6A� 5►KI70a ;{. 101 Le5 From .,
[a�SS2aAb5
14 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 3 • ®� ®i` Longitude ? 7 • ®' �7 "
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer 10 [wiry
Feeder to Finish 60 10 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity ;� d ❑
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-nn Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If' discharge is observcd, was the conveyance man-made? ❑ Yes ❑ No
h. if discharge is observed, did it reach Water (if the State'? (if' yes, notify DWQ) ❑ Yes ❑ No
c. 11'discharge is observed, what is the csliinalcd llow in gal/rain''
d. Does discharge bypass a lagoon system? (If yes, notify ❑WQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes &NO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freehoard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
19
ldcritificr: ........... ...1.......................... ' ..............................................................................................................................................................
Freeboard (inches):
5/00 Continued on back

Facility Number: — 5 Date of inspection 11 Z OQ 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
closure plan? ❑ Yesll,�No
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) i
7. Do any of the structures need rnaintenancelimprovement? ❑ Yes )j�No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes )�No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes P(No
Waste Application
VNo
10. Are there any buffers that need maintenance/improvernent?
❑ Yes
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes *No
12. Crop type t`zc 6L� 0"AA4 5G. pd C Vj► Se F rSr^� e-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes LNo
14, a) Does the facility lack adequate acreage for land application?
❑ Yes �K No
b) Does the facility need a wettable acre determination?
❑ Yes A "No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
❑ Yes 1�:No
16. Is there a lack of adequate waste application equipment?
❑ Yes E�No
Re(wiretl Records & 1)ocuments
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes XNo
18. Does the facility fail to have all cornponenis of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes P10
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes EyNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes [N1V0
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes 9No
(ic/discharge, freeboard problems, over application)
23. Did reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes )�fNo
24. Does facility require a follow-up visit by same agency?
❑ Yes JS(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes KNo
i yjo aidgs.ojr• iirr#iciencie� were !noted.00-ttng (his'visiL L. Y:oo )vflI-teeeive 00; fpfft
cnrres taric�enee. abouf 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):
! tAo,v AeooNn 0-Z L-Adoo r- ReFoA►RL oe r+ w A.
Go C T9 r r na tr.r� b p �t+'r►+1 IA w �ra� lid"1-6 — I] a-S- it!;' G meta
LU f! ��� rr7T�er► L a rn ►ur n rr.S a tG� TR ►'rrirr^ t 3 Cw
�oC ~
�^ f,.,' .� Ao*te we.�U �:.#` 911 ct `T 3 3-603
pw�.c..r�,�;� Go►t�i�� - �►+�'� �� toFarm�.�-��-►► `�o ,
� f1� a n+-u� Sal � r�►+t-�j$r5
Reviewer/Inspector Name Per G D41P_RCTi
Reviewer/Inspector Signature: Date: 1l r2 f 2 5/00

F�ciflty Number: 3 r - S9 Date of Inspection i1 2 saa8 Printed on: 7121 /2000
" Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge M/or hrlow 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 XNa
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, 0 Yes PVO
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 N60
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes .Io
32. Do the #lush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes P7`bL
[,�Odifional Comments and/orDrawings:
K6►4AtJ5V1 C-
Tt'4
J
S/00

l j. �] Division of Soil and Water Conservation •Operation Review
Division of Soil and Water Conservation -Compliance Inspection
Division of Water Quality Compliance Inspection
Oth'er.Agency • Operation Review
1(7 Routine 0 complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Intipeiiiris) 3
I-in►e art' Inspection 24 hr. (hh:mm)
© Permitted 9Certified [l Conditionally Certified 13 Registered JC3 Not t} erational Date Last Operated. ..............
Farm Name: Larrntr ..............................
�. arm..........................f.-.j.................................................[l�>...................................
Owner Name:...,......&yr ............... p,r~ .t'll1............... Phone Nu:...�
FacilityCorttact:..............................................................................Title:................................................................ Phone No:...................................................
Mailing rltidress:......s?.� �......S..V.. .......C.t'Ouvok 5... ................... .............. .:........ Q{fit_f�....... N.0............................ ..223.i..�
OnsiteRepresentative: ........................................................................................................... Integrator:......-''.t?f! 1......................................................
Certitied Operator: ................................................... ............ ................. _............................. Operator Certification Number:..........................................
Location of Farm:
.......... ...1i'1.OQ.. i�...tni..5......PFS.........A..f......+f f.
r�......... ,...............................................................
................ ...I......... .......................................................................................
Latitude �' �� 0« Longitude
Design Current
Swine Capacity Population
❑ Wean to Feeder
Fcedcr to Finish
)
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
El Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity 1440
Total SSLW
Number of Lagoons ❑ Subsurface Drains Prese-n-t-110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps IQ No Liquid Waste Management System
Discharges k Stream Impacts
1. Is any discharge observed From any part of the operation (if yes. notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
�i. IFdischarge is ohscrvcd, was the convgarce man-rna(le?
1). It'discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge is observed. what is the estimated Ilow in gal/min?
d. Docs discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were thcrc any adverse impacts to the waters of the State other than From a discharge'?
Waste Collection Treatment
4. Is storage capacity (freeboard plus storm storage) Iess than adeyuatc?
Structure I Structure 2 Structurc 3 Structure 4 Structure 5
Identifier:
Freehoanl(incties):.....................................................................................................................................................................
❑ Yes [A No
❑ Yes M No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes ® Na
❑ Yes P No
Structure 6
I /b/94 Continued on back

6614,Number: Date of Inspection 3 !b q
5. Are there any immediate threats to (tic integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 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? Qa Yes ❑ No
S. Does any part of the waste management system other than waste structures require main tenancelimprnvement? ❑ Yes ® No
9.
Do any stuctures lack adequate, gauged markers with required lop of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
® No
Waste Application
10.
Are there any buffers that need rnaintenancelimprnvernent'?
❑ Yes
® No
11.
Is there evidence of over application? ❑ Ponding ❑ Nitrogen
❑ Yes
® No
12.
Coop type .............. 6Y..1'!7,ulo................ `�!{!�►ill..l�ll4rl.h................. ................... .... ................... ................................... .......... .....................
.............................
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
Docs the facility lack wettable acreage for land application? (footprint)
14 Yes
❑ No
15,
Does tlic receiving crop need improvement?
❑ Yes
j No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[RNo
Rcuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certifier. Animal Waste Management Plan readily available?
60 WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (icl irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[P No
20,
Is facility not in compliance with any applicable sethrtck criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as requires[ by General Permit?
(icl discharge, freeboard problems, over application)
❑ Yes
® No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24, Does facility require a follow-up visit by sarnc agency'? ❑Yes No
l.... .. I . ns o. . ... i.rides :were rioted .... :this viisit:: YQu wiyl.re�ceive no Nrtfier
• egrr0060de> 07 iibotit'this 'visit.: - ; -
Comments (refer to question #): Explain any YES answers and/or any reconnmendations or any other comments.;
Use di• Wings;of.facility to better explain situations. (use additional pages as necessary):
14. ra.rw• �Ag b�e� talk 1 ltd tPr (Aj1 , ad�YY►�ino.�l4r� .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: {,
ITG7CIM

[] Division of Soil and Water Conservation ❑ Other Agency
:.... .
P_
Division of Water duality
nyH;3 t •t'
Routine OComplaint Q Follow-u of DW ins action D Follow -tip of IlSWC review 0t�heerr
Date of Inspection �--a
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered © Certified {© Applied for Permit © Permitted JE3 Not Operational Date Last Operated:
Farm Name: ................sxsL.r~Vrs.,...„CmS-.....................i1........ C:ounty:........ ir�.............................................,.....,.............
Owner Name: ................ .....,...............................,... Phone Na:...4fci�LR :.: 1L.......... ,............... ......................
FacilityContact:...............1............................................................... Title:................................................................ Phone No:...................................................
Mailing Address: ........... A`iA....... umrq� r. l�►.,I..� :YA S.Y.a�.c�s..... }.......... ............�i :,... AGIs.1. ur.r........I......................... .M.361r.........
Onsite Representative:......... ...... ............................ I ........ I........ Integrator:.......... ........... -...... -...---................ .................
Certified Operator................................................................................................................ Operator Certification Number:.................... I....................
Location of Farm:
................. .....&..... k1:L.l.. s.....CA5't...o...... 1.. r......................................................... ..............
I....................................................................................................................................................:......'................................................--............................................................ �r
Latitude �• �� �6� Longitude
Design Current ... ,Design Current Design.:
Current
Swine ... Capacity Pnpula#inn Cattle:. opacity
Y:Po" ulatian
P
❑ Wean to Feeder ❑ layer 10 Dairy
Feeder to Finish jt44o ❑ Non -Layer. I I[] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish _ Total Design Capacity
❑ Gilts ;
,;
❑ Boars Total SSLW
T
MO.. her" f Lagiions I Holding Punds _ - ,_; ❑ Subsurface Drains Preents❑ Lagoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes 5a No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes 1P No
b. If discharge is observed, did it'reach Surface Water? (If yes, notify ❑WQ) ❑ Yes 1p No
c. If discharge is observed, what is the estimated flow in gaUmin? NJ 4
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ) ❑ Yes M 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 [A No
m ai me n a n celi m pro ve me nt?
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
7/25/97

Facility Number: 3 t —q
8. Are there lagoons or storage ponds on site which need to be properly closed?
Stn;gjijm I,a oon. II ldin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier:
Freeboard (ft):............. L'.4...............
.
10. Is seepage observed from any of the structures?
❑ Yes ® No
j] Yes ❑ No
Structure 3 Structure 4 Structure 5 Structure 6
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(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?
Wastg 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 ................'kmwl.................. .........%malk... �C:►n.....................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or rVirmitted 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.vio'lationsar de tdencies:rvere.ntited-during this,visit.:You,wi11 •recei ve'- h& further
Ofrespundeke 6 oitt this'visit:• : :
❑ Yes ® No
❑ Yes [Q No
N Yes ❑ No
❑ Yes 0 No
❑ Yes W No
❑ Yes 19 No
❑ Yes q No
❑ Yes J9 No
❑ Yes 10 No
(Yes ❑ No
❑ Yes No
W Yes ❑ No
❑ Yes ® No
❑ Yes 1�9 No
❑ Yes ® No
utrtments`{ref+er tq'gveslion #) Iaxpiain ally YESanswers andfor any recommendations or.any. other. caiiiiment �1 A
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7125/97
Reviewer/Inspector Name ; u,:.....
Reviewer/Inspector Signature: Date: if

DSWC Animal Feedlot Operation Review";::
e { i
.f
�DWQ Animal Feedlot Operation Site Inspection
,
0 Routine Q Complaint G Follow-u of ❑M ins ectiort a Follow-u) of [)51tiC,' review D other
Facility Number Date of Inspection lD
Time of Inspection Hnn 24 hr. (hh:mm)
l] Registered ® Certified, © Applied for Permit © Permitted JE3 Not Operational I Date Last Operated:
Farm Name:.�..t�.r.,lr-.��'.......�P-.y.+�'^ �.................... ('ounty;.�..fi.�..►k�.................................... ... LJ.i.i;—Q-
.
t.)v►ner I<amt.:... .a.�,A.... irL.�:vna t..... ar l-.�t�.................................... Phone No: ...�.`�.i..`i),.... G.,gx..z.r.,1�..1-1z.......................
Facility Contact:........1................................. ...... Tit le:................... Phone No:..,...........
Mailing Address:... .. .r{ ....... .u..vx►.-f[.(.,n......
lV,tiraS�. et.�lS.. � R......�1 ......L2..[.�.�t ..l....ls, .., 24.'s.cs.
Onsite Representative: ..... 'f�-v..v�!sra-:'........� 1.4r..a[ ..................... ] ntrt;rator:.-. �.�.►�►I.�rr.i-................. --..................................
Certified Operator; ...................................... .- Operator Certification Nunther;....... -...................
Location of Farm:
fl.rx..�.t..u.. 41...rS..1.. A ...... Z.( .1 .......SI.�.. ..! i..F-[.�!'►rx. 2—n.z.. .....,rv�-�..i ...,L.4.�J.... ..............� ....... A
s. i.C.,n.......W.a. rf?..i....
Latitude ' ° it Longitude �"�• 4 «
Swine
Design Current
Capacity Population
to Feeder
P*an
eder to Finish
rrow 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 I IF -I Non -Dairy
❑ Qther
Total Design Capacity
Total SSLW
Number of Lagoons) Holding Ponds 10 Subsurface Drains Present 110 Lagoon Area 10 Spray ]hietd Area
❑ No liquid Waste Management System -
General
1. Are there any huffet:s that need tnainten:inceliiiiprovement? ❑ Yes KNo
2, Is any discharge observed from any part of the operation'? ❑ Yes F 'No
Discharge originated ate ❑ Lagoon [ISpray Field ❑ Other
a- If discharge is observed, was the Conveyance man-made? ❑Yes No
b. 1l' dischar�c is observed, did it reoch Surlace Water? (II yes. notily DWG)} ❑ 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 5jNo
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 HNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 9No
mai ntenanceli mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the tirne of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
7/25/97
Continued nn back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (LaQoons,ilolding Ponds, Flush Fits, etc..)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l
ldcntif-ter:
Freeboard (ft):
Structure 2
10. Is seepage observed from any of the structures'?
❑ Yes &No
❑ Yes ®, No
Structure 3 Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15, Crop type ..� .................. ......................
16. Do the receiving crops differ with those designated in the Animal Waste Management flan (AWMP)'?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19, Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certibed 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 Certif-:ed AWMP?
25, Were any additional problems noted which cause noncompliance of the Permit?
0 No. violation's or deficiencies Were noted dutring this:visit.-.You.wi11 receive no further
cyrrespundettce about this'visit:
❑ Yes ® No
®►•' ►M
.Yes ❑ No
❑ Yes f@ No
❑ Yes 19 No
❑ Yes M No
❑ Yes 19 No
❑ Yes O No
❑ Yes ® No
❑ Yes 9[ No
❑ Yes gNo
Yes ❑ No
❑ Yes K Na
❑ Yeti ® No
❑ Yes XNo
Comments oireTio question#}; .Explain any YES:iimwers aid/or' any recoinmendations.or anysother comments.
Use..drawinga ot:fucility to better eaiplaiii'situations;:(use:additiirnul,pages as necessary):
XS t t a•r 1-4 r.-wr CL
t�
7125197,
Reviewer/Inspector Name
Reviewer/Inspector Signature: _1�„j- 4'1 .
�� hate:

•
•
•
Site Requires Immediate Attention:
' Facility No. 3,J
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANMA.L FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: r
Farm Name/Owner:
Mailing Address: Q� .� PEA k— 1'> 1I,- V C Z8 5-T2
County:
Integrator ro
On Site Representative:
Phone:
I-Cf 3 - 3(aw
Prone: RV_
Physical Address/Location: r-rO If Ur' t 1v ' Qn t Uri
Type of Operation: Swine V'-" Poultry Cattle - 41 --=A 1 /7A
Design Capacity: � Number of Animals on Site: 1--�
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:
34 '_' [7 4- Longitude:�'� Elevation Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) &or No Actual Freeboard; Ft. Inches
Was any seepage observed from the la oon(s)? Yes or No Was any erosion observed? Yes o No
Is adequate land available for spray? es or No Is e cover crop adequate? Yes or�
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? re or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or T� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irritated on specific acreage with cover crop)? &r No
Additional Comments:
Inspector Name
cc: Facility Assessment Unit
Signature
Us-, Artac:hments if Needed.