310466_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: Qf C anee Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for VIsit: . Routine Q Complaint 0 Follow-up Q Referral ❑ Emergency Q Other Q Denied Access
Date of Visit: I 5 7 Arrival Time: 4n Departure Time: T 6 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
N ITUT
Onsite Representative: 6L-I ` 41 L' ti ( p
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Numher:
Longitude:
Design Current
Swine Gapacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Gapaeity
Current
P.
Design Current
Cattle Capacity Pap.
DairyCow
Wean to Feeder
Nun -La er
DairyCalf
Feeder to Finish
Dr. P,oult •
Layers
7Nonimers
Design
Ca acit
Gurrent
POP.
DairyHeifer
❑ Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Beef Feeder
Boars
Pets
Beef Brood Cow
Other
Other
Turke s
Turke Puuets
Other
Discharges and Stream impacts
i . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure El Application Field ❑Other:
a. Was the conveyance man-made?
h. Did the discharge reach waters of the State? {If yes, notify i]WR}
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 [201o"~❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑Yes ❑No ❑NA ❑NE
❑ Yes �No
NNANE
❑Yes ❑ NA ❑ NE
Page I of f 3 2/4I2015 Continued

Facility -Number: - ybj jDate of Inspection;J rn &P
Waste Collection & Treatment �-
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑' No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 25 2 f s0
Spillway? -
Designed Freeboard (in):
r
Observed Freeboard (in): & {
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ET 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
�o ❑❑ 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 th eat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q'1q0o'__C:] NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. hoes any part of the waste management system other than the waste structures require
❑ Yes
❑K❑ 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
[2fo'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
C]t*Co ❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[: ►Wo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ErN❑ ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
L? 1yo ❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
Q,bia ❑ NA
❑ NE
Re uired Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Q-IQb ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
[a�NU" ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps 0 Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [2-Ko1 ❑ 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 [2-t tv ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Vo� ❑ NA 0 NE
Page 2 of 3 21412015 Continued

Facility Number: jDate of Ins ection:
p
�4.'Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
DeNoNA
❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
w❑
P41 ❑ 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
o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No KA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e,, discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or OAWMP?
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-
a<01"11 NA
❑ NE
❑Yes
10 _❑NA
❑NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
ff No ❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
Efr90
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Co.mments,(refen,to,(gn1. estion #)1Explaip any,-jYESfgngwcrs end/or.any,,ndditlonnl:recnmmendatlnns;ar�nnysather;cnmments Ag r .
Use:clira►+ingsjof facil[ �to;6etter ex�xla! 's[tuaiiuin`s [use dditidn l' a He's as ne�ess r t' `' ' 1f,r °g �_ "' o
t3[ d p P R Yl� � i�. , 0.` I�..1's" ? Y.e,
5.0 0.,C, f4tX60 4s 4_�,C'W e-ft,(-&I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1Ot
Date: 2�
21412015

Division of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation
d Other Agency
Type of Visit; ompliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint a Follow-up Q Referral D Emergency Q Other a Denied Access
Date of Visit: Arrival Time: 0 r eparture Time: 0ounty: � t. Region6
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ..MGV Integrator: M la
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Nan-L
Pullets
Other
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 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
❑ Yes J2rNo ❑ NA ❑ NE
❑ Yes ,fNo
❑ Yes 6 No
[]Yes 12No
❑ Yes .!fNo
❑ Yes E5'�No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA C]NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 Of 21412011 Continued

Facili Number; 171 - Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes FT'Ro ❑ NA ❑ NE
Structt�ure 1 Structu Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): +�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes •[j No
❑ NA
[.] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ff No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ;3*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 �'o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Ara there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect Iand application? If yes, check the appropriate box below,
❑ Yes O'No
❑ NA
❑ NE
[3 Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN 0 PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drib ❑ 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 Jallo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes J21No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes,,[�JNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E2►1Qo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes •� N❑
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ZNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L1 iyo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

'Division of Water Quality
Facility Number ! Q Division of Sall and Water Conservation
Other Agency 11
Type of Vls
Reason for
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Compliance Inspection Q Operation Review Q Structure Evaluation D Technical Assistance
outine n Complaint Q Follow up 0 Referral Q Emergency Q Other ❑ Denied Access
Ar
rival Time: arture Time: I� County: Region:
Owner Email:
Facility Contact: Title:
Onsite Representative: ff,661 164-6-y-
Certifled Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
LI Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Finish
Gilts
Boars
Other
❑ Other -- - --
Latitude: n°
Phone:
I PP]hone No:
Integrator: I "
Operator Certification Number:
Back-up Certification Number:
0 « Longitude: 0 ° Q ' 0 «
Design Current Design Current
Wet Poultry Capacity Population Cattle Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure. ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E-31
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Z. 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 PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
FelNo
❑ Yes
Zf No
❑ NA
❑ NE
❑ Yes
Z1 No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number:,31- Date of Inspection:
Waste Collection & Treatment
4. Is•storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structu 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard {in}: � J
5. Are there any immediate threats two the integrity of any of the structures observed? ❑ Yes [�Na CD NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) T
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes
❑ NA
❑ NE
12fNo
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No
❑ NA
❑ NE
maintenance or improvement? 111iii������""""'
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 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 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 rail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes ;2 No ❑ NA ❑ NE
❑ Yes �Iti10 ❑ NA ❑ NE
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes Z�lo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements [3Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes ;;]^No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes &No
0 NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3
21412011 Continued

Facility Number: 1— date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structur 1 Structure 2 Structure 3 Structure 4 Structure Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any ofthe structures observed? ❑ Yes �dNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes I'YNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ?,No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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/i m pro verve nt?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes JdNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Ovcrload ❑ 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 ff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0 No
❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment`?
❑ Yes
;NNo
❑ NA
❑ NE
.Comments (refer to question'#):: Explain any YE&. answers and/or any.recommendatinns:or any `other.eomments.. '.
Use drawings of facility. to ex situations.'(Use situations.(use additional , a es as necessary
g Y P P g Y)�.
AL
Y
Reviewer/Ins ector Name `• 4 "
o Phone: 7` a-
3 €:� g
Reviewer/inspector Signature: Date:
P 2 1248104 Continued
age uj

Type of Visit 'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I Arrival Time:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Time: County:
Facility Contact: Title:
Onsite Representative: . l
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone Not
Integrator:
Operator Certi cation Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: 0 ❑ = 6 = " Longitude: = ° = 1 =
Design Gurrcnt
Design Current:
Design Current
Swine
Capacitty
Population Wct3Poultry
Capacity Population
Cattle y
Capa eity Population
❑ Wean to Fistish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non-1-a er
❑ Dairy Calf
El Feeder to Finish
❑ Dairy Heifei
❑ Farrow to Wean
Dry'Poultry
❑ D Cow
El Farrow to Feeder
. ""
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cond
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structu'res:,
Discharges § Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes 2TNo
❑ 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
O'No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes,
NNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
PNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

facility Number. Date of Inspection 7
Waste Collection & 'Treatment
,�,/
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[I,1GI 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: /f
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
vo El 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
2`No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
1plNo
9. Does any part of the waste management system other than the waste structures require
❑ Yes
P*o ❑ NA ❑ NE
maintenance or improvement?
//
Waste Application
14. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
P No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
;2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > l0% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifi ❑ 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
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone:
Reviewer/inspector Signature: Date: 3" d
1212&0 Continued

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

0
Type of Visit 0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up • Q Referral Q Emergency ❑ Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region: w/'
Farm Name: !�� Owner Email:
Owner Name: I�l./%�►��+5� ��-� Phone:
Mailing Address:
Physical Address:
Facility Contact: �/] � Title:
Onsite Representative: ! Ln4je I /f"axQ S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:ZV
���
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 j= Longitude: 0 0 =1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
QD DO Nan -La er
❑ Wean to Finish
Wean to Feeder
Feeder to Finish
o
Farrow to Wean
t7
farrow to Feeder
ElFarrow to Finish
❑ Gilts
ElBoars
Other
❑ Other
Dry Poultry
La ers
Non -Layers
Pullets
Turkeys
El Turkey PonitS
❑ other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [IStructure ❑ Application Field ❑ Other
a. Was the: conveyance man-made?
Design Current
Cattle Capacity Population
ElDair Cow
El Dairy Calf
❑ Dairy_1leifej
El Dry Cow
ElNon-Dairy
❑ Beef'Stocker
❑ Beef Feeder
ElBeef Brood Co
Number of Structures:
i
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

1�
Facility Number: — Date of Inspection(G n
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes t O No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '110 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
X No
ElNA
ElNE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
f
❑ 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
VN❑
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
A No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
ONE
Other Issues
28.
Were any additional problems arrted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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
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
VNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;Z No
❑ NA
❑ NE
H.... � y
AdditivriaE' otnrnetits itindlar Drawin s:�A` 4 +� .,. �,.� •_y� ',YY1ii •� '':' �sY� .
s � . � �.i`�- �:`�;�'f3.u'.' :'�� r•. 1� • �i: s.i;r?►R?Z�►1:L'J.4d xor,�Si�' N:�.[1-:�'�w�ar Ls.t.��?iaaL�'+'
12128104

Facility Number: 31 Date of Inspection
S. Are,there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El Yes
0 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑yes
No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes;XNo,
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
12 o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
Nv
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type V L &' -�; o
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�No
b) Does the facility need a wettable acre determination?
❑ Yes
❑'1VO
c) This facility is pended for a wettable acre determination?
❑ Yes;No15.
Does the receivin cro need im rovement?
Yes
16. Is there a lack of adequate waste application equipment?
❑ Yes
2<0
Odor IKsues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ yes Nv
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
19, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes o
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes �o
Air Quality representative immediately.
Field Covv ❑ Final Notes
�ai►►� ( tLCAA} - UP h�1C�C dd 6A(A< S, d D�l� WAu.�
IZ C. 0 a ; f t1a/c
itr + E Cur ZYC; S ootJ T-o Au.00 fSE muoA Qra pvi
Reviewer/Inspector Name!m
Reviewer/Inspector Signature:
Date:
I2I121u3 Continued

Type of Visit ? Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit SD Routine O Complaint O Fallow up ❑ Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
Permitted [3 Certified 0 Condit' nally Certified r] Registered
Farm Name: S
Owner Name:
Mailing Address:
Facility Contact: 4 Title:
Onsite Representative:�_
Certified Operator:
Location of Farm:
Time:
Date Last Operated or Above Threshold: _
County: 1)YLIZ_ �)
Phone No:
Plump No:
Integrator
Operator Certification Number:
Swine []Poultry []Cattle ❑ Horse Latitude 0' 6 H Longitude 0' 06 0
Design Current
Design Current Design Current
Swine.
Capacity Population
oultry
Capacity Population . Cattle capacity Population
Wean to Feeder
I 12e?o
I 1
0 Layer
I
❑ DairyI
i
Feeder to Finish
Non -Layer
❑ -Dairy
::J;
Farrow to Wean
Farrow to Feeder
❑ ether
Farrow to Finish
Total Design Capacity
❑ Gilts
El Boars
Totai SSLW .
F
:; ..,:. Number: of.Lagooris ❑ Subsurface Drains Present 11EILagoonAres iMiray Field Area
='Bolding l'orids`I Solid Trapsx ' No Liquid Waste Management System
0 ❑
DJscharges & Stream Impacts
1, Is any discharge observed from any pan of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d, Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any pan 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 & Treatmgrt
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Styr c�ture I S cture 2 Structure 3 Structure 4 Structure 5
Identifier: .7 it/ �_A go_q
Freeboard (inches)' 3 I'I
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
)ZNo
❑ Yes
INo
Structure G
05103101 Continued

Facility Number. T— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, Cie.)
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
El Yes�No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
Cl Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste AL!L!lisation
10, Are there any buffers that need maintenance/improvement?
❑ Yes
A, No
11. Is there evidence of over application? [IE ' essive Pon g ❑ PAN ❑ Hydraulic Overload
❑ Yes
XNo
12. Crop type
13. Do the receiving crops differ with those designate in t e Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Nv
z
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
f'/No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crap need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
RequIECd Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc,)
❑ Yes
❑
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ YesfNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yeso
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
7fV/1�
23, Did Reviewer/Inspector fail to discuss review/inspec(ion with on -site representative?
Elo
24, Does facility require a follow-up visit by same agency'?
❑ Yes
No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Eamments.(rePrr to;questinn #)::::Explain any YES answers,and/or:,any° recummendatiuns.'orany.. otl eracRi invents:
Use;drswinga ofrfacility"to better expinln situatlpns.,(use'additional pages. as neceasa"ry]:r '';, , Field Copy ❑Final Notes
`F?'
i .:r.• : r
_`..1
DMA" f�F��
4o
H
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

•
Facllity Number: Date of Inspection
Qdnr Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29, is the land application spray system intake not located near the liquid surface of the lagoon?
34. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc,)
31. Do the animals feed storage bins fail to have appropriate cover?
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes No
❑ Yes �No
r
ElYes No
❑ Yes PfNo
❑ Yes No
El Yes No
AdditionalComments and/or Drawings:: rr,
43/D3101
43/D3101

Date of Inspection I L'IZ
there any immediate threats to the integrity of any of the structures observed? (iet trees, severe erosion, ❑ Yes 3ING
seepage, etc.)
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ONo
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ,2 No
B. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 'E2No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes .00Nci
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ;2440
11. Is there evidence of over application? ❑ Excessive Ponding J'PAN ❑ Hydraulic Overload ffyes ❑ No
12. Crop type lge--wtt/44 611~i2R1 144A400.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,ET10
14. a) Does the facility lack adequate acreage for land application? ❑ Yes .EfNo
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.) -
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certif-ted operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
i yiQlatSi r�s'o deficjenmpjo -rv-(�rp pg#e • id(9 s;vstp wig ree iye tilti f. thigr ;
Torres bridence: ab0 this visit. • . .
❑ Yes O'No
❑ Yes ONO
❑ Yes J'N10
❑ Yes J'No
❑ Yes JR'No
❑ Yes JZ'No
❑ Yes 9 No
❑ Yes �no
❑ Yes Z No
❑ Yes PNo
❑ Yes eNo
El Yes ONo
iRTYes ONO
Cammeiats (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):'...'
r • 7tte-�—WQs Je GTtl 5 4 r- inn o4e re 1 4k,1, Z� ��5, r � 1�1 !-r�4 � Fit'J'r ��.c
1� Vc3N✓Gary �►� ftrt.�Gr �0lf / T.5•J Its P4N,3'q Af PWA//��^•�
r1 [nct r*r;s l'' r� �,rf'I►c4 4e y,:�fd Fv11 [ , F[4 3 Fv�j3l
r;rIel 3 f5l VI/q, F;,: (ef I purl'7 rr-`�rc-; q� -
zS. 7hEee wee P4'er ��w< <t� L��rf �'� �l�� Cr�C' r-td r.�t• 1 cg11 ��.
iNG��c � jlih re-1 � ple's
jrllSjtCr . � �Ct UIL,► r iri ���Y' j,t%ll� � ��� �' -
rr
Reviewer/Inspector Name'hT A C P%t-111
Reviewer/Inspector Signature: Date: 6 01 5100
+1

% . �,.,:.:.;.�. ,.::.. •,, :;,�d. :....:::i.:=: s:.:.'::.:.^::;'+ ':r..k.'i:iY,.I .'.;": :r.;r.-. a�. "rqVill
'i
AA
Rt� �i4 _ I�:ii� i,u.., .ir.
Dirisian of Soil atdd Water Catai. .......... .
s
w
jTypo of Visit 4 Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reagan for Vlslt-'Ohoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: 17 Time:
Facility Number
10 Not Operational2 Below Threshold
0 Permitted 0 Certified 13 CCo�onditionally Certified 0 Registered Date Last Operated or Above Threshold: .......................
Farm Name:.....`.�a'''ds.........�f�►'t........I..................I........ .......I..........I........ County:... 1� �:........,................................................
r-AOwner Name:....... e I .....I....I�.Grn-A� �� fr!S.. Phone No:
..0
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: .... �a. ..1 .!. is 2.:*.�........................................................... Integrator:.• r [v �` .....................................................
Certified Operator:................................................................................................................ Operator Certification tuber:.........,................................
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ■ ° 66 Longitude ' 6 «
Design Current
C'snsrity Pnnniatinn
Wean to Feeder
Z 0 tJ
Q
Feeder to Finish
Farrow to Wean
L $'p
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Desiga• Current;''
Poultry Capacity, Po ulation Cattle CapacityPo iilatloi
❑ Layer I 1 1[] Dairy I
❑ Non -Layer I I Non -Dairy
❑ Other ii ;
TotalDesign Capacity J.
Total SSL W
Number of Lagoons ❑ Subsurface Drains Present JJC3 Lagoon Area JE3 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System ` :,' n, ;, ... ` , i'
Discharges & Stream Impac
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. Ii' discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier 4 ...Fe n_1S c „
.........................................................................................................................................
Freeboard (inches): 2-9 49
C/ n
❑ Yes XNo
❑ Yes Jallo
❑ Yes ZNo
� j4 -
❑ Yes /rglNo
❑ Yes ONo
❑ Yes P`No
❑ Yes Z'No
Structure b
/'nwhinrrad nn A"01-

Facility, Number: 1 [ — Date of l.nspection
*5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erasion, ❑ Yes �NG
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ONo
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health ur environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 'ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes )25lo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ,0140
Waste ADMication
10. Are there any buffers that need maintenance/improvement? ❑ Yes P No
11. Is there evidence of over application? ❑ Excessive Ponding PAN ❑ Hydraulic Overload ,fYes ❑ No
12. Crop type -9e e r►% y4et 6/eka? zmn'i UA ..,.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 'Mo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,ErNo
b) Does the facility need a wettable acre determination? ❑ Yes ONo
c) This facility is pended for a wettable acre determination? ❑ Yes ff Na,
15. Does the receiving crop need improvement? ❑ Yes j2 No
16. Is there a lack of adequate waste application equipment? ❑ Yes ,PrNo
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ,0`No
19. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ONo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes JZNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes FeMo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes )ZNo
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes Po
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes eNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ONo
.S
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? 0Yes 91240
:4�+*Wptiodis pr- 004eienp rare 1 oW. 0#wiog i�ls.vWt; ►vii1.tecvJyq Oo fOtthO� . .
carresporideh& ahottt: this visii: .........................................
Comments (refer to question #): Explain any YES answers and/or any Hers mmendations or Gray ot6i cgnu ,Rtsk' n'r "`�} ; ; s;: a
Use drawings of facility to better explain situations. (use additlonal a ear as tteces i 3 F k € '
It. Tate Wots4e c1f411s 4Q r ho 0-tore 4ka4, Za lbs. p4AJ �e be i f f4e4 Ah
[7q" nVu 2_w 415.5As Pl/u� ?9.� ld.( P1aiA/,�b1
t6.f 12� N a�td � . jbs } N 4 f f lie4 46 �►-erd ! i°ulj r � _ e[d .3 Pvll3)
r !d 3 Pull4/ r;,c1d q pvJ11l reX,4,7e
ems, vfr
2-S. -TAeee 07ee hie e e. d-aw-r41 44e PISIN -A e y c D G c, .ud w,*A6 r/ ►t 6?)I k
"AAe 417 15 err ►'tvesce Y 001 S, �04 Sel VP far 9I6 F►,iJ1we WhAe, r�pG i,•
w4rk wkn C !.Foy ;•z Ish�r .
Reviewer/Inspector Name ` - .... 1.
o i 1
ReviewerfInspector Signature: Date: g/pp

Facility Number: 3 j — 6 Date of Inspection 2'T 01
Odor Issues
25. 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 0 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ''No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes J2rNo.
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 ZWo
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes P No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional ommen an or ra ngs: j
T
5/00
J

1i acility Number: 31 — � Date of Inspection i z � nD Printed on; 7/21124fJ0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,QrNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancehmprovement? )9Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ;ffNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 95 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes )UNo
11. Is there evidence of over application`' ❑ Excessive Ponding ❑ PAN Hydraulic Overload ,®"Yes ❑ No
12, Crop type 6 e f ►ti7 t1 A Cra ze j M f':LJ V A _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑
Yes $ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,® No
b) Does the facility need a wettable .acre determination?
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?
Reguirerl Records tic Documeas
17. Fail to have Certificate of Coverage & General Permit readily available?
i$. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc,)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & sail sample reports)
20. Is facility not in ,compliance with any applicable setback criteria in effect at (lie time of design?
21. Did the facility fail to have a actively certified operator in charge`?
22. Fail to notify regional DWQ of emergency situations as required by Gencral Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance ofthe Certified AWMP?
yi la> itjns :or.. rjclefJpN Were nofej- 0(teitng 4;his'vlsatt • Yoo will-r' eeoh cy fia f0 t�
caries oric�ertce: about. this .visit. .. .
❑ Yes IgNo
❑ Yes &No
❑ Yes j2wo
❑ Yes &No
❑ Yes J*No
❑ Yes $ No
)9 Yes ❑ No
❑ Yes ®'No
❑ Yes JffNo
❑ Yes J9 No
❑ Yes Jf No
❑ Yes �No
❑ Yes W No
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)::
2. 81v)de.nGe 4r<SG6"rqG --Par'A r10.54 4- h k W.t3 vbseeued • Jqkro�
J
ivat.54e i.f ondrA b-,'^ltnfezih hp9hvv eS d ve jo reeen4 j .rj,A,✓ e -�rp q
601t." I- ��eiq arcs f ljje 11146 vi P1 KO M 1;k7e PO4Wa)l �att�e �
gCGO?'O�twG� fe i'j'Iarrh V. r
r7. �d�-If6r{ VG���6i�r"an —f��Ue WW►kg �n ,Sew/a�v'^SG+^y f�t�jdoh wfe Gf�r�W
-for iv,sp�c-}�vn, 1 v
11 • -rh e ee A' ►' o been SAn', Q yd npr �l, c auer'r�.+ +' n� - r*A s�
Reviewer/Inspector Name
Reviewerllnspector Signature: Date: 2 C9 0 5/00

Facility Dumber: 3 — Date (it' Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 03 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes D�No
Waste Atrplieation
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ I'AN ❑ Yes No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes J j No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes X No
15. Does the receiving crop need improvement? ❑ Yes W No
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
24. Is facility not in compliance with any applicable setback criteria in effect at the titne of design?
21, Did the facility fail to have a actively certified operator in charge!
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yiplal�igt;s;oir d Feie� ie v► re n tiet • c (whig #;his'visit; • Y;or w01- ' 0*0 ci #'utth
carres� oridenke. Ao' u' f this visit.
❑ Yes 0 No
❑ Yes Do No
❑ Yes 4 No
AYes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 4 No
❑ Yes No
❑ Yes No
❑ Yes No
,. r
Comments (refer to question #): )l;xplain any Y)ESansvieirs;'andlnr any recommendations orf uny;other cgnntnnents..;,
Use drawings of facility to better explain .situaiivk(tisc'idditional pages as necessary}:, " is1.'.
is ,.
i;t
n..
-47 ..fXff-let 10aw{ {'G�( (Cda*44
{1Q4
Reviewer/Inspector Name i''
Reviewer/Inspector Signatu jJ� Date:
3/23/99

. .......
....... ........................ ............................................... ..... ... ......................
.. .... .. .
$ ❑ DSWC Animal Feedlot Operation Review =°ji •°g. _ `..jI7777$) °"?M lilgp
.'.::.. .; (Tiff F •: `ij=e'iit %'I:
i DWQ Animal Feedlot Operation Site Inspection;!€!iii`;;;;
4 ll�l,ls
11:
IQ
Routine Q Cum saint O Fullow-u t of I)%N"( itxs cTtit)tt O Follow-u of DSWC revic►+�•0 0tthherr
Date of Inspection
Facility Number
Time of Inspection 1 ZjQ D 24 hr. (hh:mm)
© Registered 9Certified © Applied for Permit © Permitted JE3 Not ❑ erational Date bast Operated:
Farm Name: .. saab County: ........ 1..l3,?�14\.................. I .................. ........I........1,
0caner Name: Y 4v.- 1 ...................... Phone No: ................
Facility Contact: ..... ..IQ ...... ...s` tA)2& ................................. I'itle:....111lrk►..A_�UC................................ Phone Nn:..�����.Z�.'��.�.!.............
MailingAddress: :........ P.0.... Box....7 1....................................................................... .......R.5 fr..........................................,
Onsite Representative:...... Ape ....... Gai!;t...................................... Integrator: ........ .....Ak. , ,fit. .........................
Certified Operat.ot................................... ............................................................................... Operator Certification Number;.........................................
Locution offarm:
Latitude = • =' =11
Design Current
Swine • Capacity Population
Wean to Feeder
1406
Feeder to Finish
® Farrow to Wean
5 i
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
t-.a.....1..V.r....1.�,.� :.sxn......#
...i'?Ir....lid-- .�....
6n #e slirillq. rttl+- ► e' fit ❑r'
Longit ude ■ 'Mt1iq, Itirrn ri are , }a Ilk [M. �" � s
1�
Design 'Current _ 5 Or, " .Resign Current ...
Poultry Capacity Population Cattle Capacity Population ,
10 Layer I I ❑ Dairy
10 Non -Layer ❑ Non -hairy
❑ Other I
4.
Total Design Capacity
Total SSLW
Number of Lagoons 1 Holding Fonds ❑ subsurface Drains Present JJEI Lag4xin Area PSpray Field Area
❑ No Liquid Waste Management Systern «=
General
1. Are there any buffers that need uinintenancelitnprovernent? ❑ Yes �XNo
Z. Is any discharge observed from an}' part of the operation`? ❑ Yes (3 No
Discharoze urioinatrd at; ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made:' ❑ Yes KflNo
b. If discharge is observed, dui it reach Surface Water? tff ves. notify DWQ) ❑ Yes No
c. I1 discharge is observed, what is the estimated flow in gallniin?
d. Does discharge bypass a lagoon system? (it' yes, notify DWQ) ❑ Yes Q] No
1 Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
4. Were there any adverse impacts to the waters of the State tither than from a discharge? ❑ Yes [3N❑
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
mai ntcnanceli m prove[nent?
6. Is facility not in compliance with any applicable setback criteria in effect at the time ot'design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes qNo
'7 V) 4 KV?

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoon-Ololding fonds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: `
C)t�k................... .......'r..................................... ..............................
.....
Freeboard eft . ..........Z- Z
la. is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed!
12. Do any of the structures need maintenance/improvement?
or any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify I]`' Q)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste AV14icatim
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...........cf;a�a.�M.A... .......k7err#1tJaa................................................. .
❑ Yes
5P No
❑ Yes
P�No
Structure 5 Structure 6
.............................................. I................
❑ Yes
�& No
tRYes
❑ No
R'Yes
❑ No
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 fallow -up visit by same agency?
21. Did Reviewerllnspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 Nwviolation� or deficiencies were n6l:M-during this:visit..You;will receive ho further
Oire06fidence dtiou.lt this. visit'.,,
❑ Yes IR No
❑ Yes %No
❑ Yes KNo
❑ Yes JR No
❑ Yes 12 No
❑ Yes FR No
IR Yes ❑ No
❑ Yes ® No
19Yes IdNo
❑ Yes R1 No
❑ Yes R No
❑ Yes �tNo
Comments (refer to question #): Explain any„Yf;S answers andlnr: any recQrnnnenclutions vr;any othe. .. .... nts.
Use'drawings of facility to better explaitl situation.5 (Use additional pages as nccessary) ;,€ <'I€i„=€iiF
I I2. Eros;rn crews aP- tr,rur c v, ov4r wAl1 of I A,N«r•[ba uclwc�� s,jvu d liet -14 wi C "awed AL
44v_ � lejebh skid he e€cf�t�de) 64�} 4. e, �eJ aree, Uace .A,1W a
wccOedQ� to t e nn {�i
[.(a.� � vt. ,Cejd- %,c.. Arta% on 1:c,' _ S �G� i s[>¢��c} e r,cse�er�, ,� t t( WaAs d f IAy�w
skod 6e 4wed Us.) eo 4fC", ft�>,avfr3. Co+��Lk 0o i ax,�'Wg Q,- rts�sst �� � set �e�n
0. No ev�r ma_ o� o�ex� �t litA��n . &L� - S � k I 1 ko rLns, On
hoeAr- v-vns .
Iz- U�aa � ��+ &kj bj0.S�e_ Sajtpit- Ailaf�5i3 S IOUJf be- 'in �10n. �_ATan
�" t k& laver � eG `I� Gw i fa � R ]f7a�Dr u7/25/97
l7. Ptah t �3 S Geis �U 2ehita�c rvno� tto E �t
Reviewer/Inspector Name
Reviewer/Inspector Signature:

Site Requires Immediate Attention:
Facility No. 3 1 — 4 o �.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERAJIONS SITE VISITATION RECORD
DATE: , 1995
Time:
Farm Name/Owner:
Mailing Address:
Ci1'1fp �� eS F
ILA--Y Vntu-
County: D'4446'74
Integrator: � ✓ Phone:
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine .-v1 Poultry Cattle
Design Capacity: Number of Animals on Site: , b 6
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:,-, 6 - 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 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. _L_ Inches
Was any seepage observed from the lagoon(s)? Yes o<�? Was any erosion observed? Yes or io
Is adequate land available for spray? Yes or No Is the cover crop dequate? re or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No '
lad Feet from Wells? Ye or No
Is the animal waste stockpiled within 144 Feet of USGS Blue Line Stream? Yes orO�
Is animal waste land applied or spray irrigated within 2S Feet of a USGS Map Blue Line? Yes 00
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes org If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector N
cc: Facility Assessment Unit
S ignature
Use Attachments if Needed.