310501_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

[I ype of vmn:: W comp nce inspection v vperanon Keview V structure c,vaivanon V ieennicai Assistance
Reason for Visit: outine p Complaint O Follow-up O Referral O Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: _ C� County: Region:
Farm Name
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: rl en r—e Integrator:
Phone:
Certified Operator: Certification Number: Z02-7D 4
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Longitude:
-! 1 1 Yl'ild
�. •:541
1 t 1 l.! '•r 111 f r' 1
,�5 1 4 ;a x• ,5 >I w.4
n -M & .11 H 5
+ N
�S"`'S,'rit d !..,.11
s4 ,
A ! k b'.r„'� M -5..�
s�,r �+, i r .'ram
� Y �...P
f.
d. .:Ati� p', 11
i5 C
1 e
a n,a
''Z=
Y y , 1 4, ..x ¢�"M wl:alA�1t1
5R•;5`5
9 �p 1 I �1��ys1?
4s
�
'1 " 1
�S
lAga
1151-4� n'v55' 1.aa'
�51
W
Form,".
Epi
t 1
,
qq
11
■
i 1 - 1 -
--
Yti
A.e
Mir
1
.J
1 x x.,
■
1 :.
,SIaS
E1.1
roal
t,1
Yl�y�y
s i lY`lr^�.
H® f 4T4
y, kyW
l31 t w
IPA nl 1~
Ad Plx.
1. xd�l\gut
■
--
9:p,„d�
Z.
Y 5
i 5 1.ijV�iv,
Is:
i M iLti� `ll! N 5Y1� 1.
lMl
y;. O Ii ,8�
4; ,0. .11.A ix d
YSi
4�1
ii.
ii
■
1
--
Ip,S
1M�
51
5 l ; 1i�1►
1N 1 \
� i} U k 4l ' S` �
y115
0. .Alps 5�14 T--}W?d1Y 441
ytb `, � F,i �yS 1,�yyY � It �IRx.
j41
•
--
''�'t
■
,
-_
ti..
xi
lair: ,la- Ilh .;,i liMn13S:l!
wvh"i1VH�n .k4M`x, a `Is.'n1
.■
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
❑ Yes [] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Page 1 of 3
21412015 Continued

Facility !Number: - S Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �2o 0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes No NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes LG'vo li 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 F;Ko ❑ NA ❑ NE
maintenance or improvement?
11. 1s there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes 0 "'0 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E3 off-❑ 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
❑ g-0 ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
I_ 4o ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
❑'No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfait ❑ 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
NA
�Noo
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
NA
❑ NE
Page 2 of 3
21412015 Continuer)

Facility Number: 3- Sol
Date of Inspection: 2
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
23: is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑'Now❑ NA ❑ NE
Ergo (❑ NA [] NE
❑ 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 ❑ NAA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑.PEA FJ 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes PAo EE] NA
❑ Yes No ❑ NA
❑ Yes
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o ❑I
❑ NA
No ❑ NA
iVo ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature: Date: r l7
Page 3 of 3 21412015

Type of Visit: (;�CoZuti�ne
' inspection O Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: O Complaint O Follow-up Q Referral O Emerizency O Other O Denied Access II
Date of Visit: / d
Farm Name:
Arrival Time: © Departure Time:�J County: Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
/
Onsite Representative: r' I{ t"n r Integrator:
Certified Operator: Certification Number: e3--' 3
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Da signmor'r-enjyj
Swine Capacity Pop.
We to Finish
can to Feeder
Feeder to Finish Z S
Wet Poultry
Layer
Non -La er
Capacity
Pop.
t
Cattle Capacity Pop.
DairyCow
DairyEll Calf
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Farrow to Finish
Dr, P.oultr� C►a aci l;o
'Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other
Turkeys
Turke Points
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �o ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ONE
❑ Yes rNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: Date of Ins ection:
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ED-9-o—❑ 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 totheintegrity of any of the structures observed? ❑ Yes [no ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E No ❑ NA
❑ N E
(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 [2rNo ❑ 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 re-1—No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0*-No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes 0-No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [I -No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes EjNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio3No
El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - jDate of ins ection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ 9o_ Q NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(cs) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑'No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ Pd7r" ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes [D'R-o ❑ NA ❑ NE
❑ Yes ❑15oo ­ ❑ NA ❑ NE
❑ Yes []—Nor— ❑ NA ❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
�] Yes
[D-No
❑ NA
❑ NE
❑ Yes
�_
❑ NA
❑ NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/ 015

So
(Type of Visit: (j Co Hance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2° / Arrival Time: Departure Time: �0 County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �.c `� tr i t r1 n y
Owner Email:
Phone:
Integrator:
Phone:
Certified Operator: Certification Number -
Back -up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Region:
Design C►anent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. C*attle
Wean to Finish r airy Cow
Design Current
Capacity on.
an to FeederJJLLJNo�nLayer
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current Da Cow
q rTyl Poaltr, C:a acit P.op . Non -Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Boars
Non -Layers
Puilets
Beef Feeder
Beef Brood Cow
Qther
Other
Turke s
Turke PouIts
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 Rilli ❑ NA ❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
rNNo
[] NA
❑ NE
Page I of 3 21412015 Continued

Facility Number: - S o Date of Inspection: 2n I
Wlrste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed Freeboard (in): t3�
Structure 2 Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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?
❑TI o ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No ❑ NA 0 NE
[:]Yes, No ❑ NA ❑ NE
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 �o ❑ 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 DNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EINo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2fNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
11 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
5No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
64o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ONo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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
16No
❑ 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
j�
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA ❑ NE
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
eNo23.
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facility Number: J- Date of inspection: z �
24'"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 ;],Ro ❑ 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 ❑ NAB ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No C 'NA D NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E rNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes No ❑ NA
❑ Yes No NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature: —-o/ Date:
Page 3 of 3 21412015

{Divi-sion of Water Resources
FaciliUm e 1,31 - Srj 'O Division of Soil and Water Conservation
0 Other AgeEncy l�
Type of Visit: Compliance Inspection Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / Arrival Time: ® Departure Time: � County:
Farm Name: �� �N� Owner Email:
Owner Name: 9tLj 4A( I iEiyNG b (A Phone:
Mailing Address:
Physical Address:
Facility Contact:
�IR (3)41C-e(Z r
Title:
Phone:
Region:
Onsite Representative: Integrator
Certified Operator: / awN E Certification Number: C>r-.)
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
ILayer
Design
Capacity
IDairy
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
Non -La er
Dr> P.oultr.
Layers
I
Design
Ca aci
C►urrent
P.o P.
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Feeder to Finish
/
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
IOther
Turke s
Turke 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 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 x No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[]Yes
❑ No
❑ NA
[]NE
[]Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412014 Continued

Fadili Ntwnber: ->5 Date of Ins ectiow
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ^16bN
Spillway?: G
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.) IP
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 10 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 �X No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s). 156 f� 6V_
13. Soil Type(s): 66y ouc- _-
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 111� No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes �kNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
QWUP ❑Checklists []Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �5(No ❑ NA D NE
0 Waste Application 0 Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ Waste Transfers 0 Weather Code
0 Rainfall ❑ Stocking 0 Crop Yield 0120 Minute Inspections 0 Monthly and V 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 9
No ❑ NA ❑ NE
Page 2 of 3 214120,14 Continued

Facifitv'Nuynber: --s'l - qn / I I Date of Inspection: 1 / /;5tt4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ 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 �n No ❑ NA ❑ NE
33. Did the Reviewer/inspcctor fail to discuss review/inspection with an on -site representative? []Yes C4 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes V�No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional reeommendations or any other comments'.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: Phone: (1-�%�e3QU
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2014

Type of Visit: OTompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:J Arrival Time: Departure Time: County:,
Farm Name: bt K ry%N Owner Email:
Owner Name:. .
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
gk's:%� 7)L. &Allor_
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:66
Design Current
Design
Current
Design Current
Swine Capacity Pop.
letPoultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
er
DairyCow
Wean to Feeder
Dai Calf
Feeder to Finish
TNon-Layer
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
P,aultrF
a .acity
'.pa
P.o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes eNo
❑ 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 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 e-6 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes 2TNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412011 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )allo ❑ 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: Lj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan? r
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 � T4o ❑ 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)
9. Does any part of the waste management system other than the waste structures require ❑ Yes FXN0 ❑ NA ❑ NE
maintenance or improvement? 7T
Waste Aaulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes - 2rNo ❑ NA ❑ NE
maintenance or improvement? T"
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J�fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PTNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
LZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WrNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
[] NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
\23.
❑ Yes
6 No
❑ NA
❑ NE
If selected did the facilityfail to install and maintain rainbreakers on irrigation equipment?
g❑
Y es
[;]'No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

so
acili Number: - Date of Inspection: - 4-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes XNo
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? ❑ Yes 2fNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes KNO
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �No
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 0No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No
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 K No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes m No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE.
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 25) - 3 41- 2acb
Date: ) P I f ` e3_
21412011

Division of Water Quality
)(±acility Number - ® MOM vision of Soifanfia—fle—rlGonseriva
tion ✓�
�+ Other Agency
Type of V!sit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 'X Routine O Complaint O Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: / Arrival Time: Departure Time: County:/Y Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative:��N ]�E� Integrator:
Certified Operator: �(�l �n� ��tCN r Certifieation Number: Q of 3y
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
DairyCow
Design Current
Capacity Pap.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design C►urrent
D Cow
Farrow to Feeder
Dr, P,uult . Ca aci P,o ..
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream 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 XNo ❑ NA ❑ NE
❑ 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 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 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: l - 50 1 Date of Inspection: 9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L F
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 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 [3? x Yes No ❑ NA ❑ NE
waste management or closure plan? T�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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) TT��
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 j/V No
❑ NA
❑ NE
maintenance or improvement?
]�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes j No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
0 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?
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.
❑ WUP ❑ Checklists ❑+ Design' r❑ Maps ❑ Lease Agreements
❑ Yes V No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [k No
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers
Q Rainfall ❑ Stocking E] Crop Yield Q 120 Minute Inspections Q Monthly and 1" 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 F No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Q Weather Code
0 Sludge Survey
❑ NA ❑ NE
NA ❑ NE
Page 2 of 3 21412011 Condnued

lFacility Number: - p Date of Inspection: all FP4=
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
[] NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yee 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 anyYE.S answers and/or any additionalyrecommendations or any, other comments _ '4 i
Ott �.
Use drawings of facility;to better explain situations:(use additional'pages as necessary)
".
(_911g11a , L9 -
4tilo 9.0
n )0� D1��
Revicwer/Inspector Name: P V(),7 G'41 / C S
Reviewer/inspector Signature: -�
Page 3 of 3
Phone:
Date: �11(D �C
21412011

Divi"sion of Water Quality
Facility Number 3 I - $d I Division of Soil and Water Conservation
© Other Ag UM
Type of Visit: Wompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
9�IIY W
Date of Visit: M= Arrival Time: tS Departure Time: County: Region:
Farm Name: f E�N�J)—+* OL 6L6// Owner Email:
Owner Name: a j , . 1` Phone: 310 - 99R - R I gL/
Mailing Address: �] (} }C.Q- pl %f �C l� i { C _ , A/C
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Ea_ I oqlv e1V1Vr� Integrator:
&O l 1 n L1
Certified Operator: � R.1 41-4 � iC �/VNE� � Certification Number: a D� � -7
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
C►attle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
I
iNon-Laye-r
I
Dairy Calf
Feeder to Finish
/
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, P,oult .
Ca aeit
P,a P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Arf
Turkeys
Other §
Turkey Poults
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 DWQ)
❑ Yes IX
No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [] NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes g ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facilit Number: - O Date of inspection: 21497711
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
f
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LACOCVY
Spillway?:
Designed Freeboard (in):S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., 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 No ❑ NA ❑ NE
❑ Yes *No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes /� 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 P� 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? 4
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
.SC,
12. Crop Type(s): 1,
f(Zi.r t/) ._.,. ...
13. Soil Type(s): / y6{1C M"__
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
/,� I No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ANo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
Q WUP ❑Checklists Q Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers 0 Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1" Rainfall Inspections 0 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? ❑ i Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: —3 1 - jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 7❑� No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes *o
❑ Yes 4NO
❑ Yes No
❑ Yes '
❑NA ❑NE
❑ NA ❑ NE
NA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft 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).
W•r,•
� l��►I�r � . o
�CplV `i f GAT S C.ctiQGf Sct(LUC F-c) a0i l
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Division of Water Quality /
F,Wci1flRV]N,WM—�r3 -� Division of Soil and Water Conservation
Other Agency
Type of_Visit gCompliance Inspection 0 Operation Review. 0,Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i/ Arrival Time: ® Departure Time: County: UA/ Region:
Farm Name: CAQjM Y` Owner Email:
Owner Name: KE NNE 11 (A Phone:
Mailing Address: J'� A E1J V 1 %y LIL ,,_/ �C OR 5�0— _� S
Physical Address:
Facility Contact:
(� ` Title: Phone No:
Onsite Representative: 1J5C r__H/VC tl� �_k Integrator:
C FFN . jC6"YN&b polo
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = 6 = Longitude: 0 ° ❑ ` = `d
Design C►urrent
Design Current Design Current
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
1110
Layer
1
❑ Daia Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Daia Calf
ER Feeder to Finish 119MLI
1,900
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
El Layers
❑ Beef Stocker
Gilts
❑Nan -La Non -Layers ❑ Beef Feeder
FBoars
❑ Pullets
Brood Cow
❑❑Beef
Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes )kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
*0
❑ NA
❑ NE
12128104 Continued

Eacility+Number: 3 1 —
Date of Inspection i[
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
Identifier: 1-4020/V
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 No
❑ Yes No
Structure 5
❑ Yes X No
❑ Yes P(No
El NA El NE
❑NA [I NE
Structure 6
El NA [I NE
[I NA El NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. []Yes ANa ❑NA ElNE
El I xcessive Ponding ElHydraulic Overload ElFrozen Ground ElHeavy 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 types) &LFOL�
A
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
KNo ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
*o ❑ NA
❑ NE
'FID ® c ',.� � 1.#d
Comments (refer to question #): Explain any YES answers and/or any rxecarfimn i dations or�any other�'�commentsj
' Y gt
Use drawings of facility to better explain situahonsi (usc additronal pages as necessary): „ i
y, .'' i,
AL
T
Reviewer/Inspector Name 1 =
<Yl/}l pA` ' '. %t1F SEA/>F.; t ,x;z, Phone:
j
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

11 Facility`Number: 3 Date of Inspection
Required
Records & Documents
t9.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
Cl NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
No
❑ NA
❑ NE
the appropriate box. 0 WUP El Checklists 0 Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Xste Transfers
E;Al(nual Certification
0 Rainfall ❑ Stocking 0 Crop Yield El 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
J4 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ 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
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
14 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
'�
❑ NA
❑ NE
29.
Did the facility fait to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
Additional Comments and/or Drawings:.
ylSlrc� !• Co
C_ra _r6e4 7IoN DEC �G11
Page 3 of 3 12128104

Type of Visit 'Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit XRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /�,� Arrival Time: y Departure Time: C� County: U� Region:
�-- Farm Name: q al
&x t\j`(�m Owner Email:
Owner Name � �___ J 1�Ciir/1� Phone:
Mailing Address: 1 �X] Vi9 E,` �1 %1��� HiLLO./yeIf
Physical Address:
Facility Contact: Title:
(�
Onsite Representative: l .,j jq lV 1Cr_—.A/ ylE T_'A_k
Certified Operator: �� �' EN.u.is�:N
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: «da3
Back-up Certification Number:
Latitude: = c = 6 ❑ Longitude: = ° = , 0 "
Design Current Design C►urrent Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
Feeder to Finish o7�-
❑ DairyHeifer
❑ Farrow to Wean Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑Beef Feeder
❑ Gilts ❑ Non -Layers
❑ Pullets
❑ Boars
❑ Beef Brood Cow
❑ Turkeys
©tier, 11:3 urkey Poults
❑ Other ❑ Other
Number of Structures:
Discharees & Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
)� No
❑ NA
❑ NE
❑ Yes
P[.No
❑ NA
❑ NE
12128104 Continued

.ti
Facility Number: 31 — S ]
Date of Inspection MWEI
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: t-4gC0AF
❑ Yes 'KNo
❑ Yes rC No
Structure 5
❑NA ❑NE
El NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in): 19.5
Observed Freeboard (in): 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 'b(J 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 El NE
maintenance or improvement? R
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
o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
, \
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12.
Crop type(s) �i Q�(LL}1
13.
Soil type(s) NQ(� �GLL
_
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 #) i l�:xplam any YES answers andor any/ m^mendat ous or any other comments. *'
Use drawings of facility to better explain situations: (use additional pages astnecessary
3/177
Reviewer/Inspector Name
r4,.. 4
` " Phone. • 9/0-45&-�3a
Reviewer/Inspector Signature:
Date: Mi /aQ
12128104 Continued

+'Facility Number: 3 -- f 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 �(No ❑ NA ❑ NE
the appropriate box. 0 WUP El Checklists El Design [] Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
S Waste Application C] Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Yste Transfers ❑ 7AAnual Certification
0 Rainfall 0 Stocking 0 Crop Yield [] 120 Minute Inspections El Monthly and 1" Rain Inspections El Weather Code
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ANo
❑ 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
V NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,] No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
g,No
❑ NA
❑ NE
12128104

°Division of Water Quality
Facility Number O Division of Soil and Water Conservation
O.Other Agency 1
Type of Visit 16 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: 1 /9$0 1 Departure Time: County:
Farm Name: (� Owner Email:
Owner Name: '�J+�-ti�Iy 1< a/V^/rz Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �St2114N 1CP_/y q6 nK
Certified Operator: N E /N/VQ
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Region:
Operator Certification Number: � J _S�C�q
Back-up Certification Number:
Latitude: E:j 0 0' = Longitude: = ° 0' 0 "
Design. Current Design Current Design` Current
Swine Capacity Population Wet Poultry. Capacity Populatititi Caft[e CapacityPopulatton ':
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
I 19,9Y
1 1
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -Layer
Dry Poultry.
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElStructure ElApplication Field ElOther
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Daia Calf
El
Dairy Heifer
El
Dry Cow
El
Non-Dairy
ElBeef
Stocker
El
❑
Beef Feeder
Beef Brood Cow
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �"o ❑ NA ❑ NE
El Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Faeility.Number: 1 —sal Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
kNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: L#fi00N
Spillway?:
Designed Freeboard (in): • S
/�
Observed Freeboard (in): '7 R
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
XNo ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
'KNo ❑ 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
INNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ZLNo ❑ 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?
It. 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
krNo
❑ NA
❑ 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 acre determination ?
❑ Yes
_R No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
,RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EYZ4o
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments r
Use drawings of facility to betterex lainsituations.. use `additional pages, necessary
g t3 A P g y)
Reviewer/Inspector Name I yt� fj r S. Phone: y�Ci•�O—�slo�i
Reviewer/Inspector Signature: Date: g1 /3 3
Page 2 of 3 12128104 Continued

Facility Number: 3 1 — Date of Inspection z a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes]` No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes 4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes §9No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
$iNo
❑ 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
ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q(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
KNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31:
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
ElNA
ElNE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
Page 3 of 3 12128104

n
Facility Number
0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit VRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /d (m Arrival Time: Oa Departure Time: County: DIAM Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No. -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e =' = Longitude: = ° 0 l
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stockei
❑
Beef Feeder
❑
Beef Brood Co l
i
Number of Structures: EJ
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structare ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2 No ❑ NA ON E
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes El No ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 i — ��J Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2fNo ❑ 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: L4 &0"J
Spillway?:
Designed Freeboard (in): JS• S'
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 EI No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes � El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes C3/No 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 ❑4 o ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0<o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes E2 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
Lk o
[INA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
NNo
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
,,3
E?<o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ENo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
lJ No
❑ NA
❑ NE
IComments (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): I
41&Fn fd 0" J o a rig_ SI UD6,6
Reviewer/Inspector blame _ 0 ij Phone: 70 b — T3
Reviewer/Inspector Signature: Date: d e.
l9/7R/1}d !'nnliHuoil

Facility Number: — Sbj Date of Inspection l Q o
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I 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 V
Rain Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
LJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
IJ No
❑ NA
❑ NE
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?
El Yes
VN
❑ 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
ETNo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[Woo ❑ 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
EYNo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
<No
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?
❑ Yes
o ❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Y
Division of Water quality,`
Facility Number tij ® 0 Division of Soil and Water ConservationW.,
Q Other Agency;
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit x Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 2n Arrival Time: 2 %�jr eparture Time: ,� y: At'OeZzJ Region:
Farm Name: Owner Email:
Owner Name: i1 ' %nlnl�- V Phone:
Mailing Address:
Physical Address:
Facility Contact: fJ Title: Phone No:
Onsite Representative: dAry r\ /�nl/1/�.�L/ Integrator: f�
Certified Operator: (J %1 2/ 1%1A1 i0`Z Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o ❑ 4 Longitude: = o = 1 = 6f
F
Design Current, Design Current r M Design a Current
t
Swine. Capacity Population Wet Poultry Capacity Population Cattle Capacity.Population
❑ Wean to Finish I
ji ❑ Layer +
❑ Wean to Feeder I
1 10 Non -Layer
r
LX Feeder to Finish 2
El Farrow to Wean
Dry Poultry
❑ Farrow to Feeder
❑ Layers
ElFarrow to Finish
❑ Non -Layers
❑ Gilts
❑ Boars
;
❑ Pullets
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
J 10 Other
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
q �(
x
Number of Structures A i EE i
Y . EZ � gtJW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes14 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: — U Date of Inspection O Q
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? El Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
C2c
5. Are there any immediate thre is o t e integrity of any of the structures observed? Cl Yes X
o El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) XNo
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes X
No ❑ NA [INE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA El 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 ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes X
No ElNA ElNE
ElExcessive Ponding [IHydraulic 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. Croptype(s)
13.
Soil type(s)p
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?
❑ Ye
❑ NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
,No
/!( No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
XNo
[INA
ElNE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
[� No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
r5� f 2�30�°5 Soo, -7;_ -6: �,E a2r -5#044)40 �J'f�f� `� i1/-AOVn/C__
Reviewer/Inspector Name �� ' Phone: 1'Di(!�l9- — S SZ3
Reviewer/Inspector Signature: Date: 4'Zyp
Page 2 of 3 12128104 Continued

MI . '4
Facility Number: — Date of Inspection
Rectuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes dNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�No ❑NA
❑NE
ElWaste Application ❑ Weekly Freeboard ❑WasteAnalysis ❑SoilAnalysis ElWaste 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
No ❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o eyNA
❑ 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
RfNo ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
/No ❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
❑ No XNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes P(!No
ElNA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
[I NA
❑ NE
If yes, contact a regional Air Quality representative immediately
Y
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes �[J No
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes zNo
❑ NA
El
33. Does facility require a follow-up visit by same agency?
El VNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Y5 �fGC, �,�tnJ7q-�
Z�l� 25� GJz�� /✓cf� T ��fl,�f ,B y &OC r � 2ao�
Page 3 of 3 12/28/04

(Type of Visit 12f Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit )Z5 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access iI
Date of Visit: Arrival Time: 31% Departure Time: Q ounty: PuPe_z� Region:
Farm Name: Owner Email:
Owner Name: &t/jV-2w Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative:rJv_alz_D_-
Certified Operator:
Back-up Operator:
Phone No:
f
Integrator..
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = I = q Longitude: = ° = i. = is
yiI Design
Current
Design C•urren't
1Poultry
Design Current
Cattle
Ctipaci�ty
Population
11611 Opacity Population
Capacity Population
f
❑
Wean to Finish
❑ Layer
❑Dai Cow
❑
Wean to Feeder
❑Non -La et
Dry Poultry
❑Dai Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
Feeder to Finish
Zvi
❑
Farrow to Wean
❑
Farrow to Feeder
e,
❑
Farrow to Finish
#
❑ La ers
Non -Layers
El Stocket
❑ Beef Feeder
❑Gilts
❑ Boars
❑ Pullets
❑Beef Brood Cow
El Turkeys
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
' +
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
;KNo
❑ 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
1VNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes A No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Q Date of Inspection %� D
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:
Spillway?: 0
Designed Freeboard (in): ,5,
Observed Freeboard (in): 30
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 P 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 2� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ;Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs []Total Phosphorus ❑ Failure to Incorporate Manurc/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of ind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�ZNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination❑ Yes
JZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JF3 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JZ No
❑ NA
❑ NE
Reviewer/Inspector Name f �� ^ ': '�" �� Phone:
Reviewer/Inspector Signature: Date: 311
12128104 Continued

Facility Number: 31* �j Q� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Pen -nit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
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 ONo ❑ NA ❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 2rNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the pennit?
❑ Yes ETNo
❑ 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
Z NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes VNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ,❑ No
❑ 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 2f�o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes &No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes_2'No
❑ NA
❑ NE
Additional Comments and/or Drawings:
ArplzS ..
2
���/,� r GA�✓I✓��- � �jcrJ.ZTCir�- �iv �� �s�fi- 78/+5 �O� .
O�NF.��< L l�d %�2zTZG� c 7T4n1 Avo
�i�C 0�20 jN 0,02O eX�e
_
12128104

Type of Visit XCompliance inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit xRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number O Date of Visit: 3 Time: 3 ws
Not Operational O Below Threshold
PermittedxC�eArtified © Conditionally Certified 13 Registered Date Last Operated or Above rThreshold: .........................
Farm Name: .....1.AZZIJ....L..�.�1!.Ll...................................................................... County: .....ID...4,iP�!l�l........................... .......................
OwnerName:.... .l r� ......................... �. WAtl..................................... Phone No:.......................................................................................
MailingAddress: ................................................................. ................................................... _................................................................. ................. .........................
FacilityContact: ..................................................__...``......................... Title:................................................................ Phone N.o1:...................................................
Onsite Representative: ..B. AKfF..l......!!.W.k.W............................................... Integrator:....L� . /!�1X..a...............................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 44 Longitude • 4 «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 9fNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes J rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes R(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: .............I................................................................................................................................................................. ....................... ...........
Freeboard (inches): (p
12112103 Continued

Facility Number: 3 i -So I Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes YNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes RfNo
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 VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 96No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes VN0
elevation markings?
_Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes U(No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ONo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Sw% #jA . r.A Aswa Ov CK Sf_" . (k-Ar W C4 ( N
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
b) Does the facility need a wettable acre determination?
❑ Yes
73'
c) This facility is pended for a wettable acre determination?
❑ Yes
15, Does the receiving crop need improvement?
❑ Yes
16. Is there a lack of adequate waste application equipment?
❑ Yes
o
Odor h sues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes V�;o
liquid level of lagoon or storage pond with no agitation?
18, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
i"' Y°,,,,<h..Hr y§:; i;y.n,:a.;:iS!'"°..isi?i t+?4, .�ri�zai. s+- ,,;;,,3! : w14 - E1 ;8,'a &i...:[. ,i .:i.`i ?i - """ ,t i F.: eS if;ltS=6ii, wE3i - •.a "'•• .:� s me at. .<� sst€! n� si r � n •a��r nt Y„< :rltsi t � ;t � !s u*�,�° x! �4`� .5 r s,=ei ,.t �4 � �»s :'s,"
Comments(refer,�to�questian{#) �Expla�n�aay,YES answers and/gr any*recominendataoas orany�other.comme�ts , ;.�:q�� �,�f; �, € g � j,
i' t �.�• Ssi"�P :,n. a _�I:a ay 1 -:�.[ s; E3 � tf �«s•
Use z awtc�gs of faculty toabefter�expin sit�atroas. (use`.dditaonal pagesEas necessary), 4aipEi ❑Field Copy Final Notes
':'�i 9 r4tii�.i1kS,{�;4 r •n, _- r, �j,'y ".'Oat
�h µa t�^y�• 5.+ €, i�il' rti.:,�; 1 a i". ` -U. �1x' C-"r1,'�" yyf-�e,.N(''ya :i. 4 try �i;�. r' �at 1s �4${�•,j�.it44 Y-�{4 °Ar f4{{.� r • p�. . ¢ .. • s �..Zt ..a ��n• :<t.,- i . }.• ,{F i'c}'�?Y i
sa.�I ,..f�.ii_$?.6f!,-id . T'H„�ii �a x-}eEfw� :�s..31! t .'J �v4:k O.3tiF�.m4 'F si i�> ai.�xi � .tek: ;k�€e.:s i �9- E6'Stv�i ?t.�t1Ft F�:K�?? I� !$g:t�:nu4 {V1�i .;Pc' F0,°;s' t �ii�!�tt? e�� Y�vt.OEn
�Etp2�.S L oot�6 v � Goad. •
CL.EAti 00 i3h.l=M OC LAC60a) wA�.
j i€v •m- of e-',•j` 1t' >.•s ,'13"Sii 4ii•'•"".g"t 4sf 'r �.» xt stT"rF i '�q s ryi,rPi<"i �„�;' [ in -("" Y° !f t S r C t ; �€ a.n ..........
Reviewer/InspectorName
Reviewer/Inspector Signature: Date: p 6y
IL/!l/u f Lonanuea

Facility Number: I —6611 Date of Inspection
Required 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?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss 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)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ AnnuaI Certification Form
❑ Yes JNO
❑ Yes iNo
❑ Yes (p No
❑ Yes 7NO
o
❑ Yes
❑ Yes Zo
�
❑ Yes
❑ Yes 20
❑ Yes :'No
❑ Yes O'No
❑ Yes Z1111
❑ Yes�Nro
❑ Yes Uf No
❑ Yes 210
❑ Yes �No
12112103

,�.i��•�a ����,si !i§6i;t�43-.'a,�S�; i...�€�€,} �. �.s y it 3�a _" E a°�. , .� ,� ; � E€ €, „a d8 y �. q „f� ,. � i` ,' i.: i5 ',
s sl�iVlSIOA of,Water Qnaitty St r W: ! a rs�t, , i E
1 Q;Divlslion of 5oil.and Water Coaservatiop I >� , +
iExt s a b' #I� €p. [ s•4�b;t ! r t 3 I q'- i i ! q �. ( 9i N s S !4 9 t o{f q I[ ai
tT YoOthei it,
T.
Type of Visit crCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification .O Other ❑ Denied Access
Date of Visit: �Time: Z '
Facilit- Number
rO Not Operational Below Threshold
0 Permitted 13 Certified [3 Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: �' re `r'' ` f County:
Owner Name: S ire% `Sr"t '' Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: e''� `�r`'' ' �1"` Integrator: �r��'> S G C4,0 f,•n
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 66 Longitude 0a 04
;Design.
Current lid, Design „3Currents' r ` . - �! 4'=3 , E! ,!Design ,a=Current ,E
Ca acity"
EP i
Po �utatton, a 1?oulirv'achy „`1?oulation` ;Cat#ie, :'I'. I Ca acttn'' fo alstion
Layer Da' i"
N�
EE�J€' ❑Non -La er] Non-Dai a,
❑ YI
3 g Other I 3 3; � � •� 3 �Epe # i, Ei � � a �,�, ! 1
Total Design Capacity 3#
t 3'!E t if gl.Ifi'�1 € M FEE ii
" i Number of Lagoons' ll .� {; ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area �E
` loldQ,r0onds I Sobd �i'i'aps
j� , ❑ No Liquid Waste Management S stem
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:]Yes ❑ No
Waste ollecti n & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: J
Freeboard (inches): Z
05103101 Continued

Facility Number:.3
Date of Inspection O a Z
5. Are there any immediate threats to the integrity of any of the structures observed?-(ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not 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 markets with required maximum and minimum liquid level
elevation markings?
❑ Yes ONO
❑ Yes ZNo
❑ Yes ,dNo
Yes ❑ No
❑ Yes ONO
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
ONO
12.
Crop type Sef ­ Ie{cy Co^4 eol 4,-a e y jG r., L �/ d Ha H 5 v—xcd ( C? r^Ca ►'�
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
JZ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
ffNo
b) Does the facility need a wettable acre determination?
❑ Yes
fNo
c) This facility is pended for a wettable acre determination?
❑ Yes
o
15.
Does the receiving crop need improvement?
❑ Yes
�Z`No
16,
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ZrNo
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 ,rNo
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes E�No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,ENO
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 ONO
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? []Yes ONO
24. Does facility require a follow-up visit by same agency? [:]Yes ff No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ETNO
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comritents `refer to' Question #) € Ez` lain lolly ,YES answers alydlnr any recann�tendatioe n`r anvE uthercoiriwiments. ';i'
o J
-. >,!� €
,�".- 3 € .:)€ i.. }J, ..��' 9 i FJE . E 9 - i p
k9se drawings of [acillty to better explain situations.' {use additional; pages as necessary) ,fie: EE ❑
d �.
- 4 �� °I ❑ Field Copv Final Notes
€ e
E, E E Er �; € E }4• ,. _t- €
.. - z• _., . �r k- ., .... t: E. - 49 a 1. V�<, I . � .: t . ,. �€ i F
1}-. Elie !q)ry�^ r�vc( sL�e�zald 6e (owe✓eOf r� q ,r'esPovts�'6!e-�,'.-•�-te!%
AL
--I V-1n4e� �o w,e-.
51vo-aye-Fo- I'kje -,.-fi
�p�au�de
fv-k;4ty Soll�S -��a-� I'VIrt54;4"o+� �vnLIJ4N S�vG� tC�SI wee ,+V
• r/!, S4
a,S�J'ralyy,r� (�/0. e 1�i C✓G
YI� \e f�1reC4tO✓1. Necc,-ySO✓ ! c Cc4;e �S 4O
�.ns �e �6�es✓ APe�q- ,'ato or Ttte q vn ska L i te �e- �ZL�� 1-1 �r; - I'd n way .
J ,� I
(� d��>•n wed �
E M _Mi._n -{ - Y •-ry t 'j-+
.. ' ] 1 3
Reviewer/Inspector Name 6r►eW r
Reviewerfinspector Signature: Date: B
05103101 Continued

Facility number: Date of Inspection /4 0
dor 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?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ] No
❑ Yes No
❑ Yes/ No
❑ Yes'z No
❑ Yes -ErNo
❑ Yes �No
❑ Yes ❑ No
Additional Comments andlor:Draiimgsi! `.
/►'�� 9 S' kave A Ve+"� n)60d C-0Ver(-ADC n� PC, AgL/Ot6L
-T7�e ,rG'Co/`�(S �'✓'� (rlQji kd�i . TGIe nece) q✓,c L4 X,5;(
hortse ,'s Well n�alr�Ficure�.
05103101

r IV
c;
uonservatinn !i=w
Type of V1s11 )DCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit $6 Routine O Complaint O FoHow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Z / p Time: M IJ
Q Not Operational Below Threshold
0 Permitted 0 Certified 3 Conditionally Certified 13 Registered Date Last Operated
/or Above Threshold: .........................
Farm Name; ...........................j................................................................................................. County: .}LI.Gt-l"
.........................................................
Owner Name:.t%>J�,!—� rz......'�!........... /l� T�........................... Phone No:
FacilityContact:............................................................................... Title:................................................................ Phone No:..................................................
MailingAddress.....................G.................................. /............................ ..........................
OnsiteRepresentative:............................................ Integrator:..,QIGI!........................................ ...............
Certified Operator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ����
Design Current
ru wauun:
❑ Wean to Feeder
IffFeeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Cnrn
Poultry_ ',"Ci aci , Population Cattle .:Ca aci Po 'ula
❑ Layer ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
1
❑ Other
j 10;:
Total Design Capacity
Tonal. SSLW
La aoa Area 5 ra Field Area ''}
3 Number of Lagoons ` ❑Subsurface Drains Present ❑ g ❑ p y t
]H0 , gP0ids/SoH&Tra0s'j No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
C. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes PNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J� No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;2rNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................... .................................... ................................... .................................... ........................................................................
Freeboard (inches):
5100 Continued on back

i TW
Feeility Number: � f Date of Inspection 1_2/ D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not 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?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application?
` ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop hype .l�ERM !/,0q C lYf>? !� } 14Al- ��/alZ/J 1�6e Ela4 --
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 wehaoie acre determination I
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?
Renuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
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?
0.. iQ•Yiorptioris'Or. f tfjejetn�ies -*N� 0000- 0(069 tbjS*VWAt; - Y:O way tftiye 00 futft
icorrespozicience about this 'visit
fi4L �-ff&Za5 /V & C_'-U % ,BE ��%i F/J /'S _SW/v
� ��� � ,�� � r P�� ter✓ � ,�F �✓ G� goo ,� /�'1� � K F
�S �/�'GrFi ,� /v �J�i2✓hC� ri'�iJ %�,evu T f�Ac��-/��- ��l�I %i��Rkr-�
❑ Yes 0 No
❑ Yes 0 No
❑ Yes gNo
❑ Yes 0 No
❑ Yes PfNo
❑ Yes V(No
❑ Yes 0 No
❑ Yes 9No
❑ Yes P(No
❑ Yes No
❑ Yes �No
❑ Yes F1 No
❑ Yes jo No
❑ Yes PfNo
❑ Yes 9No
X-Yes ❑ No
❑ Yes O No
❑ Yes �No
❑ Yes 9No
❑ Yes ONo
❑ Yes #No
❑ Yes_ XNo
Reviewer/Inspector Name
Reviewer/Inspector Signature: k, Date: I '!�? 5/00

il . TT
Facility Number: — D Date o#'Inspection � Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes j No
liquid level of lagoon or storage pond with no agitation? /
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes /11 No
AAditional Commentsand/orDrawings:
�2 � >�� �� �L/�/n P f.� � E /7 % din P �i�GG'f� �sy�.rED -�•rJ
A14 p YAAUO�5,4 MW,0+1 . AvWFi2- rl'54t A7;?,,4dk IUs5rc
AF
5100

i-
3-
ADivision of Watei'QiWity
Q Division of Soil and Water Conservattoa
QEOther;Agency:���
Type of Visit kcomplianGe Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine Q Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Date of Visit 'ri�nc: ' Painted an: 7/21/2000
Facility NumberI—ZTD—C —�-w Q Not O erat' nal Q Below Threshold
Permitted ❑ C r fi d ❑ Condditiona11 Certified 0 Registered Date Last Opera Above Threshold:
Farm Name: ��`' .l.T...:.1�. .. County: �!..lr....................4 /..:........ ..
OwnerName: ....... ... . .. ...��. .............�i.,(...T'.`"..................... Phone No:.......................................................................................
FacilityContact: .............................. ................................................Title:................................................................ Phone No....................................................
MailingAddress: ....................................................................................................................................... .................... .............. I...........
Onsite Representativ . .. ..... ... ....�....T........... /...r!�..7.......`............. Integrator:...... .. ..,J....................................................
Certified Operator:...,. .............. /�.............. Operator Certification Number:..........................................
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 44 Longitude ' 6 «
Design." . Current
$Wlne GannAft PonMatinn
Wean to Feeder
Feeder to Finish
Z
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
Boars
Design ' Current Desiga Current
Poultry Ca aci Po ulation Ciiiado, .. Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design, Capacity'
Total; SS M:
Nflmber oi'Lsgoots ❑Subsurface Drains Present [I Lagoon Area ❑ Spray Field Area
Hoildiitig Ponds L Solid Tiwaps ❑ 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 [ISpray Field [IOther
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed• did it reach Water of the State'? (if yes, notify DWQ) ❑ Yes ❑ No
c. II'discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... �2
.......... �....f................................................................. - ... ............................. I ......
...........................................
Freeboard (inches):
5100 Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obs ved. (ie/ trees, severe erosion, ❑ Yes [No
seepage, etc.) �`N�
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes kNo
(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 par[ 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 )S�No
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes NNo
11. Is there evidence of over application ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type Z:k :�'j
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/]nspector 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?
:Yiolatio�s:or- detjcie q.pe were- pa(ed. O(wifig �hIs:visit; • Y60 HI •r. eeeiye Rio: fukfte • : •
corres} 6fid6ce: abouti this :visit. "
ElYes No
❑ Yes
❑ Yes 04Io
❑ Yes �Wo
Xyes ❑ No
❑ Yes j(No
❑ Yes JNo
❑ Yes PeNo
❑ Yes �KNo
❑ Yes �o
Cl Yes �Vo
❑ Yes
❑ Yes
❑ Yes
❑ Yes Xo
Comments (refer to4uesti6n 4): Explain any YES aniwers and/or any: recommendations or any Ether coiiritnents''
iUse drawings of facdlty to better explain situations. (use addrhonal pages asmelcessary):
4AL
Vt 4; 0, AD
1AL
vt� K V�C-�(,yv /V0
(
k
i� � � D �- s �- 4aA �o �
VvJ �,,SeLv-
��It _
Reviewer/Inspector Name
Reviewer/Inspector Signature:
s 11 U /'41
�,,,� �.dtyko, _ , O , �� . '
5/00

I
Facility Number: 75J I Dute of luspection 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 kNa
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes J No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or , l\
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes JNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? / ] Yes ❑ No
Additional Comments anifor Drawings-
.
r
y/L//L
/JS.l V\./L f!

3 ,1j, - E ¢ d I E E - , 3e = 'E "I ; a , .E .. , e _ � : 3- 1 x ] < F r l..
i kI f_ r ¢ pAa� t: Q_DYV'ision of Water 06aliiy
O Division of Soiltand Water Conservation r '
I f '. iz I� �� �� ' E
.gency.- (3 `Y I t 3 �. { t }
0Other A
Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint Q Follow up Emergency Notification Q Other ❑ Denied Access
Facility Number '3 Date of VIsit.: 1a— —576 'lime: 1 13 ao I Printed un: 10/26/2000
Q Not Operational Q Below Threshold
© Permitted © Certified( 0 Conditionally Certified © Registered Date Last Operated or Above Threshold: .........................
FarmName:.... ` .5.....sc'-`5 ............................................. County:........... ......................................................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
Facility Contact: .............................................. .......... :..................... .I`itle:................................... Phone No: ..........................
............................. .........................
(Mailing Address:..........................................................0 w� ,.-......................:.........................
....
..,...........................
... ..........................
Onsite Representative. ��.. !^-t. P Integrator: d�
Certified Operator: ................................................... ............................................................. Operator Certification Number:...............................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * 6 •i Longitude • �� �64
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I JE1 Dairy
Feeder to Finish ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JEI Subsurface Drains Present ❑ 1,agoon Area JCI Spray Field Area
Holding Ponds, / Solid Traps JE1 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 observed, was the conveyance man-made? ❑ Yes k�No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes gNo
c. if discharge is observed. what is the estirnaled flaw in gal/min'? h /ti
d, Does discharge bypass a lagoon system? (if yes, notify DWQ) 9Yes ❑ 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 (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
SWULAurC I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......................................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Number: — Date of Inspection �_J Printed on: 10/26/2000
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? ❑ Yes [:]No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste AURlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
I I. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ 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 ❑ No
b) Does the facility need a wettable acre determination`? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination! ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment'?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Q yi0 aigris'o ftrica haiD wire noted d�rring 3h�s:visit} Yo}>F will �ee�iye rio fut�t�tgr. :
Corres pride'& about. this visit: -
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
'Comments,{ ,.q i F her comments
refer to uestion #) Ex' an YE5 answer's andlor any recommendations or;any of
Clse drawings of. facility.to better explain situations. (use additional pages as necessary).
GIle� n
A6
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: �'� ka� G 0
z,
5100

©'DIVItiIOn,OfS611 acid W4cer ' i�servat�on'= Opeiation•Review
��y > ,.
©;Division of.Soil and Water Conservation - Conipli:ince Inspection,
Division Of' Water' Quality-Complianc�c Inspection j
Oth'erAge ncy"- Operation Review-
Jo Routine Q Complaint Q Follow-up of DWQ inspection O hollow -up of DSWC review Q Other
Facility Number 31 SbE Date of 1nspecti(11)L- - - f $ 9$
Time of Inspection t- 24 hr. (hh:mm)
© Permitted Q Certified © Conditionally Certified ❑ Registered 10 Not O eratiottal Date Last Operated:
Fartn Name: G�)....14aA-40r1..... 5-r^........ .zr.................... .................... County: .... �4fltiri........................................... .......................
Owner Name: Nbv....................................................... Phone No:....t l G1 2�i8`...$:�q............................................
FacilityContact:..............................................................................'Iitle:................................................................ Phone No:...................................................
MailingAddress:.............................................................................................................................................. ..........................
Onsite Representative t 1 Integrator ................
Certified Operator: ...................................
Location of Farm:
................ Operator Certification Number:..........................................
...........................?h...ea ........Sl.tu...3..........a.lZ.. uo..............................................................I........
............................. ............... ..
Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer_ ❑ Dairy I I —::]
® Feeder to Finish 172 ❑ Non -Layer JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
El Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present JJEJ Lagoon Area JE1 Spray Fietd 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 (If yes,. notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Ficld ❑ Other
a. ]f discharge is observed, was the conveyance man-made"
h. 11' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If' dischan, is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there 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) less than adequate?
Structure I Structure 2 Structure a Structure 4 Structure 5
Identifier:
❑ Yes RNo
❑ Yes
No
❑ Yes
No
N�..�
❑ Yes
No
❑ Yes
[ No
❑ Yes
9 No
❑ Yes ® No
Structure 6
Freehoard (inches): 2�&...................
1/6/99 Continued on back

Facility Number: 3[ — 501 Date of Inspection
5. Are ihe're any immediate threats to the integrity of any of the structures observed? (ic/ 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 top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? `❑ Ponding ❑ Nitrogen
12. Crop type ..........GC !^....... „ ...... .P ......
ET EIJE
rlYes ❑ No
❑ Yes 1;9 No
❑ Yes No
❑ Yes No
❑ Yes QO No
❑ Yes R No
❑ Yes 92 No
n.U.t a. .. ............ SmA [t.... 11! ra... ...............................................
I ........................
I.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ElYes No
14. Does the facility lack wettable acreage for land application'? (footprint) Yes ❑ No
15. Does the receiving crop need improvement'? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Required Records & Documents
17, Fail to have Certificate or Coverage & General Permit readily available?
❑ Yes P No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ® No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
U1Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes [ No
IV
21. Did the facility fail to have a certified operator in responsible charge?
❑ Yes 0 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ 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 same agency`?
❑ Yes WNo
Njo.violations-tir. deficiencies .we're rioted, du.ri'n'g.th'is:visit:. Y:oti -v.viJl.recceive'tar Mrtlier .:.
bd respotidence' abbitt: this visit.. ' ....... .. : .
:Comments (refee to question'##): Explain any YES answers and/or any, recommendations or any other, comments ,, ,
Use awings of to explain situations. (use additional pages as ne`cessaryL);,, , i `l' dr
.Tec�e v �u5� ..Sl.cult} be t•eM.OJtC} Od rii14r�� • CanG1 �,5�;c Su�� +
1. 4W acFtA)p 1 K �� lfJ� [Ol�r �irJGT 1k 1(Z CA .
FCC`f1 +M/mri�S ar.c} Gn.CV�-o- CS Sh�f! � G�y-i �i'2 d h9t � C l�S 2'" �a . S�1J� ltzCCH�S Z�lp,1�fJ ��.
�� yw��aw.ccs ►
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
116199

y `�•
�r �
❑Division of Soil and Water Conservation ❑Other Agency
�' � '�`
{�,
®Division of Water Quality
�'�
�,�
' - Sk - :R' 'Nc...
�nx'
• ,lf r _: _: :^t^..n`. + i:i4'.:
f Y.. k3=:Ef =-. �
: ,�k '!
Routine O Complaint O Follow -tip of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection ' 24 hr. (hh:mm)
© Registered M Certified E3 Applied for Permit 13 Permitted JC1 Not Operational Date Last Operated:
Farm Name: h #Zn County :......... D:V j*1:T6 ..........................................................
OwnerName: ....................... ! !n............... ...... &Y—lr..:................................................ Phone No:.....� Ri�?�..�4�$ ����.� .........................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: -
3Z .......1�ai�.... y ,........................................... ............. ........ ........ ....: Y .....�...lt.........t..N....4......................... a .z.....
Onsite Representative: ........... �....kn.......................................................... integrator: W4:;5.........................................................
Certified Operator; ..................................................
Location of Farm:
Operator Certification Number; .....................
I: ID 1.... a..:. ...M;;.6;...... a .
.... ...... .
Latitude =• =' =" Longitude =' ' "
Design
`. Current
_`+
Design CuirrentDesrgn Current+
Sv�me
Ca "actt
p Y
7pa elation
_., p
Pbultr Y
Ca acit Po uI tion' (.tittle„
p Y p- Capacity Population
_; :, ❑ Wean to Feeder
I0 Layer I
❑ Dairy
.....:" Feeder to Finish
7,
.. ❑Non -Layer
❑ Other
10Nan-Dairy
#:
N
❑ Farrow to Wean
❑Farrow to Feeder
.
Toial Design Capacity
FX.arrow to Finish
❑ Gilts
-
Total SSLW
❑ Boars
tuber of Lagoons / Hotdtng Ponds❑
Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area j
x
.........
❑ 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
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
[RNo
c. If discharge is observed, what is the estimated flow in gaUtnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
1p No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
50 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[N No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
(P No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

Facility Number: �4 —
S. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons.11olding Ponds, Flush• Pits,, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
Freeboard (ft). ............ eZ
Structure 2 Structure 3 Structure 4
10. 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?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes [ No
❑ Yes No
Structure 5 Structure 6
...............................................................
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 DW�1Q)
15. Crope ................. Loxvu......... &A ........ 5o —erg- .................!�l�?t.1P1 ua ................5
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onh:
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0, No'.violations,or. deFic 6de's.were;noted,duritig this:visit: Y.ou4411 ireceive•Ro:furi er,::
:. eorrespoti<dekci6 out-this:visit:::.:: :
❑ Yes q No
❑ Yes [p No
❑ Yes No
❑ Yes ® No
❑ Yes RNo
..........................................
❑ Yes
No
❑ Yes
No
0 Yes
❑ No
❑ Yes
jD No
❑ Yes
® No
❑ Yes.
0No
Yes
❑ No
❑ Yes 'P No
❑ Yes 1p No
❑ Yes No
t- &--owk skOA h¢- V n•1m, (J, PC-th * vojUV V_Lr- C�Mves s fjo"Jr be- rto ovJ -A-Qds.
�� . trO,r,,,,e..e,�` ��� S�•oul� �-` +Ei.jne�.t,t� a+L s�1�-a.-� h. �orti5 . i� e`ei n�1+r,i�.erS , y� W tJ� sko�l�
Gl u 4� . u�aatW waskc S+c
7125/97
Reviewer/Ins ector Name
p r�:
Reviewer/Inspector Signature:
Date:

❑ DSWC Animal Feedlot Operation Review '
J.DWQ Animal Feedlot Operation Site Inspection
10 Routine O Complaint O Follow-up of D%VQ inspection O Follow-up of DS1VC review O Other
��� Date of InspectionEn
Facility Number""`l? U l lTime of Inspection24 hr. (hh:mm)
© Registered ® Certified [3 Applied for Permit E3 Permitted 113 Not O erational Date Last Operated:
Farm Name:... ......... ......' A..±1.5..�}-7o..�n.......`�-vs. r.w�...... ...Z............... Countt :... .. .t.t.... ,... ............................
. i.i... .�
Owner Name:........ ...........................' a.►.?..i. ..r-................... Phone No:.4.p.3.... 2..q.4...`.Z.&I-1.....................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress* .....,��`�........[,....1..,............................................ ........�4-c........................
Onsite Representative: .....�x-,V—... ..............tJ S..tR.+!4................. ........... Integrator :......$.Y-a.�u..✓L..S...............................................
Certified Operator;.................................................................................... . Operator Certification Number,....................
Location of Farm:
�}.va...... s.i.�4..R ....a......o .R..]."IDI y.....-0,.�..: .a..» ......... ..0.r.2—..S.....r .:............5:..ti. h.... .. ^:...,....
....................................................................................................................................................................................... PV
Latitude Longitude
Design, Current
Swine Capacity .Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons 1 Holding Ponds
e:
Poultry Capacity Population Cattle Capacity;:; Pol
❑ Layer F
Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity C
Total SSLW �—
❑ Subsurface Drains Present ❑ Lagoon Area 10 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
No
Discharge originated at; ❑ Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance main -made;?
❑ Yes
99-No
b. If discharge is observed, did it reach Surface Water? (If yc:s. notify DWQ)
❑ Yes
BNo
c. If discharge is observed, what is the estimated flow in Leal/min?
cf. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
❑ Yes
® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
5d No
4. Were there any adverse impacts to the waters of the State other than from a discharge'?
❑ Yes
@ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
13 No r�
7. Did the facility fail to have a certified operator in responsible charge'?
❑ Yes
MNo
7/25/97
Continued on back

U
Facility Number: 31
8. Are there lagoons or storage ponds on site which need to be properly closed'? ❑ Yes E9 No
Structures (Lagoons,Holding fonds, Flush Pits, _etc )
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes E�No
Structure l Structure 2 Structure .3 Structure 4 Structure 5 Structure 6
Identifier: '
Z.
.........................................................................................................................................................................................................
Freeboard(ft):.......................................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes ® No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes No
12. Do any of the structures need maintenance/improvement? ®-Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ®. No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ®,No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
...........�tr - 1..i..�g rr-rL.;..Y,...................S�.y.-a--.:...... .-,...cr�!.�n-ot'f...... 15. Crop type .... ............................ i
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 9 No
17,
Does the facility have a lack of adequate acreage for land application?
❑ Yes
EL No
18.
Does the receiving crop need improvement?
10 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement'?
E.Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
®,No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
IRNo
®• No.violations 'or' deficiencies were -noted during this;visit..You.w'ill receive no ftirther
correspondence about this:visit:
C6rttmei6 (refer toaquestton #). Explai any YES answers and/or any recoµmmendations or any other cotninents
Use drawings of facility to better explain situations (use addititmal,pages A& ecessary)
�Z. Lv t' w�g4.fe a ., avvk t♦ o tD0In
6 • W a r 1G a 1,- .S Q ✓• r-V- G {' i Nam+ �i + n +' •---t�
Z2. C %,L c y is fit. vv+ 4 r-e
a ►c ¢ s v 1-4- 6 r, e t S o I 1 s n�,..- P (e ! ,� I�-e...� -P„�-�(l
bv,.L� i_t , S'3LG t- t a o �-e-dL q ce
V
7/25/97
Reviewer/Inspector Name.
Reviewer/Inspector Signature:
t L;•_ A, ,
Date:

•
•
11
Site Requires Immediate Attention:
Facility No.?7�
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: '$ "23 , 1995
Time: G
Farm Name/Owner: LY ab ) r m
Mailing Address: -1 &624- US'dM& Q4_ A41C A ll LC 28S22
County: _ D ri o
Integrator. _ -5 -- Phone: 3(000
On Site Representative: _ Phone: C1 10- ZR8- 4S50
Physical Address/Locadon:
Type of Operation: Swine �� Poultry Cattle
Design Capacity: _421 «po Number of Animals on Site:
M 5
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ;7¢ - 51 ' 6042- Longitude: 1") ` � ' 27.7� 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) Sor No Actual Freeboard: —a_Ft. O InchDNO
Was any seepage observed from the laavon(s)? Yes o o Was any erosion observed? Yes o
Is adequate land available for spray?( �es or No Isle cover crop adequate? es or No
Crops) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es r 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 i o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? es r No
Additional Comments:
L.
Inspector Name
cc: Facility Assessment Unit
A-PL,
Signature
Use Artachments if Needed.