310502_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qua!

Type of Visit: (D Co ance Inspection U Operation Review O Structure EvaldvAion Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
'Date of Visit: Arrival Time:Departure Time: I_S County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: 5-0
Title: Phone:
Onsite Representative: J 0 n�-i� 'i°� Integrator:
Certified Operator: Certification Number: i / Z,)
Lf
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
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Discharees and Stream Imaacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [?No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes [_ Io ❑ NA E] NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: 113ate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 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 to the integrity of any of the structures observed? ❑ Yes .E3-N­o_"L] NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental rest, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes FNo�
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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?
l . Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes 0 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
QZo-'_-❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
�❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
��N ❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ff No ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
rNo❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the 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
❑ Yes
eNo" ❑ NA
{] NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, [] Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections PSludge 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 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of -Inspection: �7
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes az Q NA ❑ NE
25. Is theiacility 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
Eon -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 ❑'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
DNo ❑ 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
C o ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[] Yes
0 No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No D NA
C] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑J NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No ❑ NA
❑ NE
Comments,(refer to,,question#) Explain any�YES answervind/gr any additlonal''recomnnendati6ns or�any ntlier commentsz �I€� f4
Use drawings of facility to,better: ex Fain-situations,(use+additiatial, a )..,.r, K,.,,�x`
es.as necessa
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ��7�0,
Date: A>
21412015

(Type of Visit: (' CCopliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint- 0 Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time:
.-"`t"`-----� Departure Time: County: 1 U t Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative:
Certified Operator:
Sack -up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Capacity Pop.
Wet Poultry
Capacity
Pop.
C►attle Capacity Pop.
Wean to Finish
La er
airy Cow
7Swine
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ltr�
Layers
rNN
Design
C•.a .acit
Current
P,o
Dry Cow
Non-Dair
Beef Stocker
Gilts
ers
Beef Feeder
Boars
Beef Brood Cow
keys
Other
Turkey Pouets
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
[] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ 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 1 of 3 21412015 Continued

Facility Number: - Date of Inspection: )�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
'+ a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
D NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L-W_,-00W ( UQ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�NoD
❑ 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
[3/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 environmen al threat, notify DWR
7. Do any of the structures need maintenance or improvement? D 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 E3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired 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 ❑ Maps ❑ Lease Agreements
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
R/No
❑ NA
❑ NE
❑ Yes
<o
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
�dNo
❑ NA
❑ NE
❑ Yes
[%'No
❑ NA
❑ NE
❑ Yes
E/N o
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge'? ❑ Yes � o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Ins ection: 5
24.sDid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25,,Is the facility out of compliance with permit conditions related to sludge? If yes, check zyes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
No ❑ NA ❑ NE
[-]No ❑NA ONE
ENon-compliant sludge levels in any lagoon C
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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes IJ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes Or 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 No
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 ZNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes LJ N
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E 6
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [No
Reviewer/Inspector Signatur
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
0 NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Date: i
2/4/2 15
Page 3 of 3

Gr
Type of Visit: Cf Com lance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: rutine O Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 1 12,6 . Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �� �%! f"Ll-EA
Certified Operator:
Sack -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: Certification Number: 1 /7
f� 3Y
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Design Current
1)rF P,ouItr Ca aci P,a
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
Turke s
Turke Poults
10ther
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)?
❑ Yes No ❑ NA ❑ NE
[]Yes [:]No
[:]Yes ❑ No
❑ NA ❑ NE
[DNA ❑NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesZv�o
❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yeso ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection: j
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
12fYes
❑ 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: LAG-ow
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes16
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme l 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
[ZNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
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 ❑ Maps ❑ Lease Agreements
❑ Yes
[ o
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�Xo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
No
❑ Yes
�
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis []Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ZNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facilit Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes. O/No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
E�Y/e s ❑ No
[] NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
E(Non-compliant sludge levels in any lagoon
date first indicating Old Tz
List structure(s) and of survey non-compliance: 11 M
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
❑ 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?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #) Explain any YES answers. and/or "any. additional recommendations or any other comments.
Use drawings:of facility to better explain situ ations'(use additional, pages as�necessarv).'
r j k)AS Ya7-4C6D 9 AX,l o ����.�1� �z�� r"c- &Aari
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wm, T 6,6 CdMPLTAPT B
ICE W -P Foo i,/. dzC14 r96(6oAAP Nz-C-9 Lv&(,
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
Pho[�e:
Date:
21412015

n
Type of Visit: UCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: County: tj%J Region:
Farm Name:
Owner Name:
Mailing'Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: 00 PJ A -r p1q d 1 ►'! -]'� _ Integrator:
Phone:
Certified Operator: Certification Number: 4T L 3Lf
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Wean to Finish
I
I
I Layer
DairyCow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
1
Dairy Heifer
Design Current Dry Cow
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ 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
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Zo
❑ 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

Facility Number: -
Date of Inspection: t
V�aste 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
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 1/ Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:j%
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No 0 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 dNo ❑ 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 o
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �10
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes fNa
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L No
❑ NA
❑ NE
Re uired 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 LJ 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 YNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes '
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes e
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili *Number: - 6 Date of inspection: t�
24.,6id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ 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 hTo DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �' o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [] NA ❑ NE
[:]Yes 0--No ❑ NA ❑ NE
❑ Yes No
❑ Yes N
❑ Yes o
❑ Yes ❑
❑ Yes ' ]No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑NA [3 NE
[DNA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments. ..
Use drawings of facility to better explain situations (use additional pages as necessa ). ,
q. ], �.1�� W H w I)OAS , 6. -�j
1
Reviewer/Inspector Name: " r� rAfl4etu Phone: (%22%
Reviewer/Inspector Signature: qt j,,9V
Date: 1-1/1
Page 3 of 3 214,12014

(Type of Visit: (D rRoutine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1/0 I.D7173 Arrival Time: ® Departure Time: ® County: f)9 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �oulaTNA"J Y&"[1, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 17 2,: jj
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current Design Current Design Current
ou
Pop. Wet Pltry C*apacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
x Dairy Heifer
Design C*urgent Dry Cow
D , P,oult C•.a acit P,o Non -Dairy
Farrow to Finish
I 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? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes I No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facilit3,Number: I t - Date of inspection: /b 10
Waste Collection & Treatment
�No
41s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: L)k&04,,4,j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
10 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
dNo
❑ 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 environmen I threat,
notify DWQ
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
WNo
❑ 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
C2/No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes rl�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:]Yes []No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E3 No
[DNA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the 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
❑ Yes
[DNo
❑ NA
❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
U No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E/No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - '6 Zi Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ' ❑ 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 o ❑ 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
E�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
LE 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?
❑ Yes
gNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Reviewer/Inspector Signature:
Date: lb �0/
/4/2011

Type of Visit: 0 Co piiance Inspection Q Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: Z Routine O Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: 119 &UZI /1-1 Arrival Time: Departure Time: ® County: �t.� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J_o�,+mkqtjM-[._LJ�-&.
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 1-7 a 3
Certification Number:
Longitude:
Design Current
Dcsign
Current
Design C`'nrrent
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity P.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
1�
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr, Pooutt .
Ca aei
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullcts
Beef Brood Cow
Turke s
©then
Turkey Poults
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes [:]No
❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes VN ❑ NA ❑ NE
[:]Yes 90 ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CA 6-VV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� r
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑Yes
No
❑ NA
❑ NE
waste management or closure plan?
hreat,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmJNo
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[7�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 YNo
(❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records &_ Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[3 Yes
Yes
E� No
❑ NIA
❑ NA
❑ NA
❑ NE
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes )No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Ll
Facility Number: - Date of Inspection: 47
24, Didthe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes yNo ❑ 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
❑ NA
❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
VNo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
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:
!No
❑ Yes NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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
C�rNo ❑ NA ❑ NE
❑ NA ❑ NE
o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any: additional recommendations or any other comments r1 r71
Use drawings of facility to better explain situations (use additional pages as necessary). ; 4
Coed �� T Ck6T
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:r✓
21412011

50
Type of Visit: Q Co> pHance Inspection U Operation Review U Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 20 Departure Time: County:Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: L jOWATi4A n% 61 ILIA&
Certified Operator; J&'
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine C**specify Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
06
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P■ouItr,
ILayers
Design
Ca aci
Current
P■o P.
Gilts
Non -La ers
Boars
Pullets
Beef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
DischarPes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes V�No o ❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
[:]Yes ZNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Dumber: - 01 7 Date of Inspection: G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No [DNA
❑ 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: t,+ &t4k) LA&V Y
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�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 or7Yesonmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
o ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
YNo ❑ 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 Z] No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P/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?
es
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yyes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
F/T� o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
[3NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Yo
❑ NA
❑ NE
the appropriate box.
❑WUP [3 Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes o [DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes �Z) ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of inspection: 9 ,�-
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 1�fNo ❑ NA ❑ NE
the apt ropriate 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? 0 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
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:)Yes ENo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [2'Ko ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Q No
❑ Yes rNo
❑ Yesa/No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments ,:
Use drawings of facility to better explain situations use additional pages as necessary).
'7.) F �d6� Al Ina 6�c sd wo EXi� i,�Au
S LjJv6-k 5"'L E
,-T;ty 4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: % 7t4
Date:
2/4/2011

6-1,
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit C> Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: Departure Time: County: IP 4�� Region:
Owner Email:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = f = 4f Longitude: = ° = 6 = {1
Design Current
Design Current Design Current
Swine
Capacity Population
Wet Poultry
Capacity Population Cattle Capacity Population
❑ Wean to Finish
JEI Layer I I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer I I
❑ Dairy Calf
Feeder to Finish
❑ Daia Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers ❑ Beef Stocker
❑ Gilts
❑ Non -Layers ❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
El Turkeys
Other
❑ Turkey Poults
❑ Other Number of Structures:
❑ Other
Discharges & Stream Imoacts
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 U No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes El o ❑ NA ❑ NE
Page 1 of 3 .12128104 Continued

Facoity Number: — Date of Inspection t /
;r Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LK Cr�s� [ A (46-6L)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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?
2 Yes ❑ NO ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA [I NE
[3 Yes L� No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltheat, notify DWQ
`? El7. Do any of the structures need maintenance or improvementYes o ❑ 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 ❑ E Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes D < ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop types)
13. Soil type(s) ,.,d�
14. Do the receiving crops differ from those designated in the CAWMP? El Yes LNg ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[3N [INA ElNE
❑ NA ❑ NE
IJN El NA El NE
o El NA El NE
}:. yi"f .' E a '. d.9'!�"�a5 !' i. eA Az' S ri� �j -q o.
Comments (refer to question #) Explain any YES answers and/o,'r anyrecommendations or, any�other comments/
k 3•x R.4 , , t. •� burr JoN''i �•ey l k -¢.�J� - F 7
Use drawings of facility to better; explain situations$: {use additions[ pgag'esi'as.�nece/sysary) , ,, r � t Rq y 3 tzyTV �p , y ,
4i�. $.}'. .z?} FVSh:"I. 1_`.-r�k: u 1"f a¢. iJ �e a.l ..ii' . .y �i"ilE� i °.��?.Y mr F .,cS `":a t/' Y'rY.fiR :'#1:.
d /cam �6[ 1�yv1 uDA PA40
Reviewer/Ins ector Name ,��"� c n
P � ; �' � �'i�it:a �i ;�.�'� Phone:
ReviewerlInspector Signature: Date: jv
Page 2 of 3 1212810 Continued

FaLlility Number: — d Date of Inspection 6 rz
%`Bemired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ld No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
❑ Yes N ElNA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ElNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes N ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 1C.1 N ❑ 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
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Zo ❑ 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
QNo ❑ 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? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
�No
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additional Commenti and/or Drawings: r<� �t='e'r;"I'tF,t;�
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit Co pliance 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 G Arrival Time: Departure Time: County:_ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: '-TOWFITkAd
Certified Operator:
Back-up Operator:
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 6 = « Longitude: = ° = 6 =
Design Curren)TEON
Design Current
Design .11gent
Swine C•ap ��ity PnpulatiWet
Pouf#ry Capacity Population
C•att[e Capacity Popula#ion
❑ Wean to Finish
er
❑ Dai Cow
Feeder
-Layern
❑ Dairy Calf
Feeder to Finish W-11 -1 1,4v+5
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
El Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ 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
ENo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
;,2/No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 31 — b Date of Inspection I lo 1.7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA<,- a?.J I LA &mW 'L-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2_7 Z
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes O/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes L'I No ❑ NA ❑ NE
❑ Yes L/J No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, 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 dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes !J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ErN ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LJ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E o ❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
El
[N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Noo ❑ NA
❑ NE
.,..._13�y
Commc"nts {refer to;queshon #} �xptatn, any Y11S,ranswersYandfor;any�recornmendatio so any other comments' .,
y.-3A y; r e �s.ir i a as :r✓y � x�?�'� tk .�.Y:b ii�"-�� :;�nw' A�. a _ ,�t,.r'��_i
Ilse drarvtngs of facility to better explain s�tuahons.(use,addttional pagesJrasnecessary).
,+i p r". ra � d r� s� '1` F..�gJ".t` ": . J " b d1 w+ FJ✓ i� k' a:..k x.ri.'s'n3`.r AtM��.. �-i?�3F'i��"�_.L.: a 'x3 �Yt :...1i.�F' .�+s 1 �.S ��. �. R`..'�ie�.
A,
Reviewer/Inspector Name r E c s e a�'r� -;�' �" Phone i� K� 73g�
Reviewer/Inspector Signature: Date: 1 o
12128104 Continued

Facility Number: 1 —,�Q Date of Inspection
I d o
` Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,�, ONo El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes hd'No ❑ NA ❑ NE
the appropriate box. ❑ W ❑ ❑ ❑ WA
UP Checklists Design aps Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
3 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 °
Rain Inspections El
Weather
Code
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
eNo
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
b No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O/No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
YJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[�4o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
[ Flo
❑ 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
[I/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
I212&04

roll
Type of Visit 7compliance Inspection O Operation Review Q Structure Evaluation /O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency 4z Other ❑ Denied Access
Date of Visit: !! / G Arrival Time: /Ord Departure Time: County: & Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Phone:
Integrator:
Phone No:
Certified Operator: I Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: e ` �" Longitude: = ° "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C*apacihy Population
Cattle Capacity Population
P'Wean to Finish
❑ La er
❑ Dai Cow
Wean to Feeder
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
ElNon-Dairy
El Farrow to Finish
Non -Layers
El Beef Stocker
❑Gilts
❑ Pullets
❑ Beef Feeder
❑ Boars
❑ Turke s
❑ Beef Brood Cow
Other
❑ Turkey Poults
❑ Other
ther INumber
of Structures:
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (1f 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 RNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ o El NA [I NE
❑ YesZo
❑ NA El NE
1
[]Yes ® NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — d Date of Inspection I I 6
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structur 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: i� uy 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 24 f�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
(_j/ 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
WNo ❑ 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?
C3 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
El�
/
L� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
O No ❑ NA ❑ NE
maintenance/improvement?
1 L is there evidence of incorrect application? If yes, check the appropriate box below.
Cl Yes
,_,/
L1 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E(No
❑ NA
❑ NE
❑ NA
❑ NE
�2/No
L���No
❑ NA
❑ NE
Zo
NA
❑ NE
❑ NA
❑ NE
F` ld�Y rl'&%d 'Ali Yadm: �_
Comments (refer to question'#) Explain any YES answersband/orsany recommendations or. any other comments.
Use drawings of facility to better explainsrtuattons:(usead�d�pp�t�onalpagesa[[s,necessar}}y};
`l� SfA��i✓t SGG Yos a �c5 1^ Ga�rte,- �go6� /. R r s w�C� s�' 4. tp�! i
I
a�+>, �a�lc� kan,ny anel .4o4 �dA2 Q�rcr,��1y ,
10�-ha ✓t., ✓�Dlc! re n� 1,zvd-,eol C Wi '+fie ,
eviewer/Inspector Name - s + ` a'
LPhone:
eviewer/Inspector Signature: Date: 11d o
t 12128104 Continued

1 1
R `
Facility Number: Date of Inspection ►1 Y 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 7eNE
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 [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA dNE
❑ 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 ❑ No ❑ NA L"J7NFt
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA L 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA
25. Did the facilityfail to conduct a sludge survey as required b the permit? ❑ Yes ❑ No ❑ NA NE
g Y q Y P _�
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ElLJ NA NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA LINE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
lE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
❑ No
❑ NA
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
LJ 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
ElE 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
ErNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
NE
12128104

W
- Division of Water Quality
FaeElit�y Number 3 S b L O Division of Suit and Water Conservation
w 57ther Agency
Type of Visit ,Co pliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ; Routine Q Complaint 0 Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit:
T�
Arrival Time: ®
Departure Time: County: Qt/�� Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: �� Title:
Onsite Representative: J_4uJA Alj r `�/j C�C�L�_
Integrator:
Phone No:
Certified Operator: Operator Certification Number -
Back -up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: e = = Longitude: = ° =
Design Current
Design Current Design Current
wineOR
Capacity Poulon
Wet Poultry Capacity Population attlu
Ce Capacit Po lation
❑ La er El Dairy Cow
El
Wean to Finish
]
Wean to Feeder
❑Non -La er
El Dairy Calf
ILE]
Feeder to Finish
Z
f7
❑ DairyHeifer
Dry Poultry El Dry Cow
❑ Non-Dai
❑ La ers
El Beef Stocker
❑Non -Layers
El Beef Feeder
❑
Farrow to Wean
❑
Farrow to Feeder
3
Farrow to Finish
El
Gilts
Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
❑ Turke Puuets
❑Other Number of Structures:
EEe
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ 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
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: —So 2, Date of Inspection G o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA'A-gya1J 1 -2-
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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,�No [I NA ❑ NE
El Yes I .� No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental 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 0No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
P � C $ Jv^"p
Fa
❑NA
ElNA
❑ NA
VN
❑NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Name D Phone: 3 gg
Reviewertinspector Signature: Date:
Page 2 of 3 12128104 Conlinued

Facility Number: 31 —Sa Date of Inspection !d
V Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L!J N El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes No ❑ NA ❑ NE
the appropirate box. ❑ WDp ❑ Checklists ❑ Design ❑Maps ❑ Qther
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑-IVO
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ 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
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
9o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[19'o"'
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9Z❑NA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑yes❑
NA
ElNE
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
LJ Nc ❑ NA,
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
No ❑ NA
❑ NE
Additional'Comments and/or'Drawin s ';`` ?"'s ,+«, ism°
i
•
Page 3 of 3 12128104

Division of Water Quality.
Fumbers' 4:
d `� Q Division of Soil and Water Conseryatton
E _ Q Other Agency
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Iqs Departure Time: County: v�t`i� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Y I f� lTitle: Phone No:
Onsite Representative: .nll4��i� ct.[JvC� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = o ❑ 4 ❑ Longitude: a ° = ` = +`
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population
❑
Dairy Cow
❑
Dai Calf
❑
Dairy Heifer
❑
D Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures: F7`
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 El"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
[�,No
❑NA
❑NE
El Yes
2/o
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: + A 'L.-0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
Oe/ 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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
El Yes 0/1 El NA El NE
❑ Yes WNo ❑ NA ❑ NE
if any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t cat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [INA ❑ NE
L/J No
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑
9. Does any part of the waste management system other than the waste structures require ❑ Yes JZINo ❑ NA ❑ NE
maintenance or improvement?
Waste Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Z7No
o ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
I4. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[f El NA ❑NE
No ❑ NA ❑ NE
o ❑ NA ❑ NE
LAN ❑NA ❑NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or. #ny other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
►� r( b)9 oA) Err To4mN , slwLer urU cA6o-) Tr s�Nns
R 2r'' FEEB°A4d,
�Z1,) UJ°NPi=
Reviiewer/Inspector Name
Reviewer/Inspector Signature:
Pape 2 of
Grp T6 Lb,
Phone: W M --
Date: 9 Z. ,� `
12128104 Continued

Facility Number: - Date of Inspection
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes eNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAW P readily available? If yes, check �s ❑ No El NA ❑ NE
the appropriate box.
Elkli WUP ❑Checsts Design El Mans ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below,
Yes
❑ No
❑ NA
❑ NE
❑ Waste Applicatiop, ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall tocking rop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
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
CTNo
❑ 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
Q A
❑ 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
0 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
❑-151'o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
[I Yes
,�
Ehgo-
❑ 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
Q<o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit AQf Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit ,0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 66 rrival Time: Departure Time: County: Region: __4L11Zd
Farm Name: r Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: /2 d
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Pho a No
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ 6 ❑ {I Longitude: ❑ ° ❑ 1 0
11
Design Current Design Current Design C►urrent
Swine Capacity Population Wet PouCapacity PopWation C►attle Capacity Popul
MEMO
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder110
Non -Layer
El Dairy Calf
Feeder to Finish--b
❑ Dairy heifer
El Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑Gilts ❑ Non -Layers
Feeder
❑❑Beef
Pullets
❑ Boars
❑ Beef Brood Cow
❑ Turkeys
Other ❑ TurkeX Poults
❑ Other ❑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?
Page 1 of 3
❑ Yes ❑ 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

Facil'lty Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'Yo
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments s'
Use drawings of facility to better explain situations. ;(use additional pages as necessary): P i'
AL
ry
Reviewer/Inspector Name — - - - - -� - Phone: 7
Reviewer/Inspector Signature: Date: g
Page 2 of 3 I2/Z81U4 Continued

Facility Number: e5l 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. ❑ W-Up ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit'? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
[I NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes ❑No ❑NA ❑NE
Additional Comments and/or Drawings:
AL
(�J,4 1/ 1
-
-7 �y a, 6
;�Lo
3 a! p (v A
3-S'`
1 15W ��//
/K �k Ivov be l�u.I
5'
IL Page 3 of 3 12128104

31 H S0 Z
Type of Visit 0 TRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Z off' Arrival Time: I Departure Time: County: pew-�`� Region:
Farm Name: (,/l;=Ttjd 6q fK _ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: V ' Title: Phpon?e� No:
Onsite Representative: l.F_nf'� I�--NtjZgy Integrator:") fiy
Certified Operator: cjlt� o-t KEn1�E.0`� Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑ o ❑ d ❑ Longitude: ❑ ° = ' ❑ "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
1 ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stacker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes rZNElNA ❑ NE
ElYes ❑ NA ❑ NE
12128104 Continued

Facility Numher: �) —,$'� t Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E5No ❑ 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: 1Z K l Zjc I,
Spillway?: 1J0-M
Designed Freeboard (in): 19
Observed Freeboard (in): l Gi 24.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'?
❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA ❑ NE
. maintenance/improvement?
11. is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop type(s) CIS W 13 ea-w)✓on S G'b
13. Soil type(s) (A V S
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:]
Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
lci,) G,P`I' a& C(--f�Li zFXc-ATE,*F 6-o1azA& rwb Pc6Ljvr_�r WITH
-ra,AoasfEat, LAG-rO4 Cf-uEc,s fib ojct,J F6
�ZEG�YtDS
Reviewer/Inspector Name n <„ Phone: 910 3'15" - 39co 103
Reviewer/Inspector Signature: Date:

V --;.
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 14vs ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections Weather Code
22. Did the facility fail to install and maintain'a rain gauge? ❑ Yes 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 VN
A ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes YN
o A ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes 0 VN
A ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No A ❑ NE
Other Issues dv
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ElYes ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes LJ No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E I 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 ldNo ❑ 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 LGNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes V N ❑ NA ❑ NE
Additional Comments and/or. Drawings:
12128104

Date of Visit: �� 4 Time: 2 rioh
Facility Number / Z
Not Operational Below Threshold
Permitted 13Certified O Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: le!5' A/ - �C i n rn GCounty: _ _ ___Vi to/!,' el _
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: ��e '0/���2 e iC. "A e.'40�✓
Certified Operator:
Location of Farm:
Phone No:
yPhone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0• 06 0" Longitude • 6 11
Design.
Current Design Current Design Current
Swine Capacity
Population " Poultry C21DRCitV Po ulation Cattle Capacitv Population
❑ Wean to Feeder
❑ Layer ❑ Dairy
® Feeder to Finish
JEI Non -Layer 1 1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
❑ Gilts
Total Design Capacity
❑ Boars
Total SSLW
Number,of Lagoons
;; ❑ Subsurface Drains Present 110 La oon Area 10 Spray Field Area
10 No Liquid Waste Management S stem
Holding Ponds / Solid Traps
Discharges _& Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ LaRoon ❑ 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 ❑ 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 AL 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: %i
Freeboard (inches):
05103101 Continued

Facility Plumber: & — r7Z Date of Inspection ! LL 6
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? E'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
V1'aste Anplication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
I2. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA'ArMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for Land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment?
$eguired Records & Documents
) 7. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewiinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
O;Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
'Comments(ref&t6f uiW6E 'Ex larn.an- Yi!!Sfanswersandlo anypecommtiti ationso a��
<,. qry �i• � Y, y
!�: � ,, � . , �t,���� �try..w.,�::a,=�.._,...
Use drawings of;facil�tty to better ezplasttsttayattons.(use additional pages as necessary) ryp�, ..�] Field Copv ❑ FinaI Notes 6N
Auto v-- 1�4/; ►,` .r✓crf)oA rare- /f a 0 j,a 1#7f Awfe sr 0 —ZA�AOAI do ieof
AL
/ZIZ3/O3. 4A/ will AA& //oS4 s< As 11'a;.?s'2 pel
/tsrc l� 14,- 94 4 50;/ $AmAic 4ee l/ l•Cr%ier i`n At-Alte
,fa
Reviewer/Inspector Name a, '`" r ` ; _ M ? L • >' } f '�_ �"
p f #t mti... A . i u 11 tK7^� s.. Ji�a kF_F Li «' : , 9
Reviewer/Inspector Signature: Date: / ?�
05103101 Continued

Facility Number: 3 / -4'O7_ Date of Inspection 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there 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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments and/or D„rtMngs
AL
05103101

-=-•-i - r ::a. T f _ - T _ _ r,;�x-. r'�r r
Type of Visit I& Compliance inspection Operation Review Lagoon Evaluation
Reason for Visit 9-Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
6Z
FacilDate of Visit: Time:ih, Number Z
L 1QNot O erational Below Threshold
® Permitted ® Certified [3 Conditionalk Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: W t°' rin County:
Owner Name: Phone No:
Mailing Address:
Facility Contact: J//� Title:
Onsite Representative: �d L.1101R //J� c-
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �• 0" Longitude 0a 01
y, Design., -Current,,; :. _'Design,, ;,Current = ..Design Gurienf
Swine ;. Ca ach.P
y a' elation Poulr _
Capacity..Population>_� •Cattle, _ : ;Capacity, FPopulation.: ,
❑ Wean to Feeder
® Feeder to Finish
IZ142JL
❑ Farrow to Wean
' ❑ Farrow to Feeder
❑owFinish
❑ Gilts
❑ Boars
❑ Laver
s ❑ Non -Laver
�� ❑ Other
1.7
.
Sui
No
u uan
[Ellon-DaiTy
. �.1.U1711•LC���llyt..7;1171t.�4f' -, -�
ice Drains Present ❑ La oon Art
id 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 ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify D WQ) ❑ 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 KjNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes W o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes C,No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i 7__
Freeboard (inches):
05103101 Continued

Facility Number: — 2
Date of Inspection �'1 `-7` �•_
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste .f nWieation
❑ Yes
ij2Na
❑ Yes
No
❑ Yes
No
❑ Yes
nNo
❑ Yes
SNo
10.
Are there any buffers that need maintenance/improvement?
❑.Yes
® No
11,
is there evidence of over application? Excessive Pending ❑ PAN El Hydraulic
❑ Yes
IMNo
12.
/Overload ' I
__ \❑
Crop type ,it' (T�'G1 �/�.f� �d9��Yot Clsr4 �N/1 Y ?,t(-
/4' lZ
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
(8 No
c) This facility is pended for a wettable acre determination?
❑ Yes
�INo-
15.
Does the receiving crop need improvement?
❑ Yes
T No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
(C1No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
f.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
[WNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
®.No
20,
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[�g No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes J�j No
10 No violations or deficiencies were noted.during this visit. You will receive no further correspondence about this visit.

Facility dumber: W —OV Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours7
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 �5Na
❑ Yes ER] -No
❑ Yes g No
❑ Yes JO No
❑ Yes B-No
❑ Yes ®No
❑ Yes W No
05103101

r
Facility Number Oa Date of Visit: 0 --U Time: ��
Q Not Operational Q Below Threshold
Permitted 13 Certi�f-ied 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
FarmName: ..... ......,�,.`�`'!�........................... County:... .. II.` ......................................................
OwnerName:........................................................................................................................... Phone No:....................................................,...................................
FacilityContact:............................................................................... Title:................................................................ Phone No:...................................................
MailingAddress: ..............................................Q�......................................................
Onsite Representative:. '-i3... .............................................................. Integrator:.... ............. ................... I.............................
Certified Operator:................................................................................................................ Operator Certification Number:................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' 66 Longitude �• ��0�s
De3ig11 gyp', Current Design Current
Swipe Ca aci Po uiation, Poultry Ca act Po ulation . Cattle Ca cio 'uhitioo
,�, ❑ Wean to Feeder ❑Layer " ❑Dairy €?
eeder to Finish `] ❑Non -Layer ❑Non -Dairy
h' ❑ Farrow to Wean
' ❑Other
❑ Farrow to Feeder
❑ Farrow to Finish Total Msign Capaclty
it,� ❑ Gilts
❑ Boars Total Ssm
i Nu'mb'er;of Lagoons, ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Helrflrig Ponda% Solid;Traps, ❑ No Liquid Waste Management System s 3 `z ,
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [I Yes ]NrNo
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 Z No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes gNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes Q�No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier........................................................................................................................................................................................................................
Freeboard (inches): Z!3 35
5/00 Continued on back

14cility°Number: — Date'of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
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 gNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes Q(No
12. Crop type bp, Sy , el uI say
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes X No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
lkNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
(N No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Ohlo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
;<No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
19 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
X No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
PNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
51"No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
gNo
1 Yi a �Is:o ' def siejt���es v re iofed• 00iog Ns:visit; • You will tooiye do fuither .
conies• orideike'. ahauf this visit.
Comments (refer to question #): i Expla�ri any YES,answers'and/or any recom11 mendatioaas oT aay other continents. ;': ,1, ,', $ h ° "qa
Use`drawings of faei ' to better ex lain situations use additional a es as necessa , ! , e b
(.., „r ,,. , P „} t'y), . ,t,}lrr.:,.
��� ��-5•�"� 1� +r r ter' >z4. �a � 1 ate. c�-24.
s - - t F;
Reviewer/Inspector Name�3,.
t
Reviewer/Inspector Signature: Date: _Cj rG t 5j

Facility Number: — Q Date of Inspection CJ G
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 'Wes ❑ 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 [t-L.No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or /�
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
J�Addffional Comments an or° rawjngs:
� S} � ��� � � c ���_ K �- r �� fie,-►��,� ��� .�,�
OAI� 6 L-i
5100

10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 1 SO Z Date of Inspection
FTime of Inspection 3 /D 24 hr. (hh:mm)
® Permitted 0 Certified 0 Conditionally Certified 0 Registered 3 Not O erationna"ll Date Last Operated: ..........................
(vJ1;"/nevjYgr.n.�q�n¢tl�..J�[n/(..... "Count: /io�
Farm Name : ......
..... ................j........ ..... ...... ......................................... ........... .................... Y................L.n........................................................
nrS4�./¢n.r1Qd`......................................... Phone No:....................... Owner Name: ............................................................................... ................................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: '1 e t..Ka . ,,Integrator:
..............................�..............................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
...........................................................................................................................................................................................................................................
...........................................................................................................................................................................................................................................
Latitude =•=' =" Longitude =• =' ="
Design "[Current' ' D,esign Current Destgn Current,
3 ° POUR 1.is .. Ps '�attie'i q for �1 ,ad
wme, Ca achy Po elation iY Ca' aci , o trlahon w t ,Ca aei Po U atlon ., -
❑ Wean to Feeder ❑ Layer ,q ❑ Dairy 2 i
` ® Feeder to Finish 2 t{ 2 Q ❑ Non -Layer ,�"u ❑Non -Dairy t
+t % ❑ Farrow to Wean '` " - 't, '
t ,
i� ! + ❑Other 0Un ,d , i{ s � Vk , i�fi,n �. { e ` if'9 - ,rlt
[]Farrow to Feeder „ . ,. .
,' ; 0 Farrow to Finish
Total,Design Capacity
❑Gilts
i� f. Boars s
SI k'��r/ .1
F
g t j ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area `9
t3oldin Ponds Sohn id Traps •d0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier: 2 3 0 1 2 3 ,0 'L
Freeboard(inches): ............. .,`.........................3_T................................................. .............................
[]Yes M No
❑ Yes ® No
[I Yes FfNo
r R
❑ Yes ® No
❑ Yes ,® No
❑ Yes [RNo
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/9
❑ Yes Ej No
Continued on back

Facilay Number: :31 SSQ"L Date of Inspection
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 JD No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0 No
Waste Aaulication
10. Are there any buffers that need maintenance/improvement? []Yes 9 No
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ® No
12. Crop type 64 r 0�1 jd ";i T-140'-e , B e r ,-n VL yR y -S�a (�ra i'ht Go "Yl , 0r 07. > So y ben k s
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required
Records & Documents
IT.
Fail to have Certificate of Coverage & GeneraI Permit readily available?
❑ Yes
ONO
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
J@ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20:
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
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
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
�'VQ yii;�l�t iQgs'© d�fc�ejncies ry re pQte� d t�°ing 4.hps'vlsat;• Xpo Will•teeeiye t)o fu>rtl7�r: .
wires• orideirce: abauk this visit.: -
'1 '.M^ C '.`. ai. - 1 - ii �. E tl !' Y k t'" :i ." 1 N I 1 5YY-'1-::' f s �1'..
Comments' (refer to question #) r Explain any, YiE:tS answers and/or any recommendations orany other comments
�- ,-.. . � .-., .,_.�: � .. ,. �,4. ... 1 .'�.. 1 H ;n�,x . !. s._.... .!1' �. ._ml• ;��: f F,F',.r_4E ��(:: .. 56.:..'�.�:�!t.i. .: If xI .... T: .. � ... ... m .�6�' cE� LI, f. i I..I, n, t; �[§rw iIk ii. 44.i�'.?.k`� EI , b4i 3i 3�.
I5- Wo,-k �o ,,er,,eve w,-CofS -Fro, doj le, 6o-r7e, e-� lo-9e t&-✓­ ,4ot 4•4,
Work 4e—el,ave 405 _ehvte( l^ro,�+n 6��.►1VWa f4f�V,,4e,
1 g, ��s FY ee b oti rd rce_'O-d s Ann( be e.�i -rl �e w� �.Ja1�, l<'e oe
Ngn.D
Ve F;e(d 2 .5o rf4-c:54c -of mJQ
otw C OOS, PGreq� ' h 112Ky��Z�S
^dd tl� 4o yrQ ghz,Vj _4�,e cteeeolSes .s1,o/tiIh i,1 L✓o,S }e p1 �,Yi• "14+�1e
yy�sd,�iGG-%iDY,S •S1�G� 7"ltc-�' L✓r,S••�B �?]/lyt'�''�'� a,`-r�.{ !r�'�c��l��ohL4�sy�%"1
a ejIrce ee board /'ecor6tr -ca.- new eer w"A r't- cad c�
. Y � T; ':d"•'F' u Wr a t''RT x 'v^a 'tl" m.e' �I wiC :' y^"-"Y+`YII ,E,
Reviewer/Inspector Name >? I;-jtT,w�j r f G,f'I i +, t , I i ! -J•
h �.� u �.< `� ,= r
Reviewer/Inspector Signature: Date: r% 11

Facility Number: fate of inspection 117.11IF1961
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ® Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes .® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 91 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 0 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ® No
Ndditionalommentssan
or; raw�ngs:
o./^ 117
GjOSvrec®
lmd
J

�� Divisof Soil Water Conservation Operahon,Review.
Division
tE, .a
ion of Soil and Water,Conservation Cornphance Inspection p
. ..
s Division of Water Quality m Copliance Inspection
�I ,Other Agency ,Operation ReVlew':;
Routine Q Complaint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review O Other
III
Facility Number Q Date of Inspection -
�- Time of Inspection 24 hr. (hh:mm)
*Permitted Certified O Conditionally Certified © Registered E3 Not Operational Date Last Operated:
i' � � % ..'jam ---- .....
Farm Name: Il��l."�K. ...f"!G.t.rrq..................................................................... county :...........DU�611.-ft . ..................... . ...........
Owner Name:..4Eq.y. .. 7 ................2... 4E."--r Phone No: ....110.... e21(,).=15_3*7......................
Facility Contact: ..G-C.... ........ 1`.Y�L-d ......Title:................................................................ Phone No:.�..........�........�.�D
Mailing Address: .........f.. ....�L1ra.L.......... ...... .............. ...
,-.. Xe.:............ -.
Onsite Representative: .... !-?,l..t�'l [).............. .ftfl ............................... . Integrator:...........,�,J
f " FF....................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:....,.,...,..... ..........................
Location of Farm:
r... ................ .. .... ...................................................................................................................... •E
11
Latitude • ° 11 Longitude Lam• 6 44
Design Current "''Design Cti'r'rent' Design Current
Capacity Population'., : Poultry, ; _ , Ca achy, ., Po utatio'ri " 'Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑Dairy
FderFinish 2 Z ❑ Non -Layer , ❑ Non -Dairy
E..
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish -� `
t
Total Design Capacity
❑ Gilm
❑ Boars „ E Tata1:SSLW
Lago
HoldinPoiids /Solid ns ❑ Subsurface Drains Present ❑Lagoon Area Spray Field Area
, 4l�ug ber of Traps ©� �< � . ❑ No Liquid Waste Management System ,..4
E¢
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; El Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made.'?
h. If discharge is observed, did it reach Water of the State? (Ifyes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Docs discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 73
Freeboard (inches): ..... ....................................................................................................................... ....................... .<...
.
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes Wo
❑ Yes OLNO
❑ Yes $No
❑ Yel Wo
❑ Yes Wo
❑ Yes [ INo
❑ Yes *o
Structure h
...............................
❑ Yes $No
Continued on back

Facility Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
QNo
(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
O No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement?
❑ Yes
WNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
4N0
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
eNo
12. Crop type zz!. r-3-7
13. Do the receiving crops d' er with th e designs ed in the Certified Animal Waste Management Plan {CAWMP}?
El
�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[KNo
b) Does the facility need a wettable acre determination?
❑ Yes
o
No
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yes
PNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
5No
Rettuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
1N0
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
Rlo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
gNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
PTo
(ic/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EKNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
Mho
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IqNo
yiplaii6ds'ee- deficiencies mere piofpd- during this'visit! :Y:ou Wii1 ree iye 6 fufte• '
correspotrideirce' ab' f this .visit. : :
Comments (refer to,4juesd6n #) Explain any YES answers andlor'any-rii6mtnendt
ilse drawings of fad ity,to� etter explain Situatibns (use adcltttonal pages as necessa
--,)S, Ar6 ��Iee
Reviewer/Inspector Name
Reviewer/Inspector Signature:
1
ents..
)_/a,44 0", / / le fq A,kf /OurKi-e_2r_{/
lob, Sj / L /w lVeeli
,:,�^fir
Date: //— ,Z1-
3/23/99

Facility Number: 31 — 5? wtc of Inspection
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to. discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes [VNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes d(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 IXNo
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 RN
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/ternporary cover? ❑ Yes No
1
.j
,j 3/23/99
7q
4 r. .. .. _ _ "�?',TS'.'1 ;�',',?_R" _`�r.er,.�.S'^S';?7t"-.r.-r.. r.r..-�•S.+r — _ __ _ — _ — - _
_

❑ Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
[� Routine O Complaint O Follo�%r-up rrf 1)11(� inspection O Follow-up of DSWC review O Other
Date of Inspection 7 17
Facility Number L Time of Inspection � 24 hr. (hh:mm)
D Registered 1A Certified
D Applied for Permit 0 Permitted JE3 Not O erational Date Last Operated:
Farm Nance: �Y..:'. ...... � .nt,.................................... County: ..... but?LN........................................ ........... ............
Owner Name: ...................... jF4V.Mf....R:.......Xvhur...................I................ ... Phone No:..� �Q.. �i.g,.. !7......................................
FacilityContact:....................................................1........................... Title:................................................................ Phone No:...................................................
Mailing Address: U..L.....4,.i d.. 14 ......... .. . pza 11'1k,........ ... ��......
OnsiteRepresentative: .......... LNG....1 :p............................................I.............. InteKrator:...... 11C:.................................................
II
Certified Operator:............................................................................................................... Operator Certification Number:.-----.--.........
Location of Farm:
............DC6 ... V%ft-I: ........5.k £......J�.......-5L.123.. ...... :Q,.5:....ta, L.4.....................................................................................
B
Latitude ' =L " Longitude ' =' =«
'AASw_tne��,.{
y.', 4 Desrgrt
Current; r Desxgn �Cnrrent :' Design �Currenthg
CapaeityxFopuiatrbn
CapacityP,apulatlon
Poultry- :Cattle�CapacttyPopula_ hon x
❑ Wean to Feeder
ri' ❑ Layer r ❑ Dairy
' _
❑Non -Layer r ❑Non Daury
Feeder to Finish
7,L�
'
Farrow to Wean
❑Other
❑ Farrow to Feeder
�� k
: z a n ,a u Totai�Des�gn CapaClty
❑ Farrow to Finish
❑ Gilts
❑ Boarst;
f
.: a� otal SSLW
� Subsurfacepray Field Area
Numberoa nsIHo�s �©
nfLsPo
se�aroArea
REM �❑ Liquid Waste VanaemeSystem
}Ni
eneral
1. Are there any buffers that need maintenance/improvement?
❑ Yes
5 No
2. Is any discharge observed from any part of the operation?
❑ Yes
(9 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min?
A Does discharge bypass a lagoon system'? (If yes. notify DWQ)
❑Yes
[ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
;E No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4
[, Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[ No
T Did the facility fail to have a certified operator in responsible charge?
❑ Yes
JW No
7/25/97
Continued on back

Facility Number: 3, 1 —
8. Are there lagoons or storage ponds on site which need to be properly closed? Yes No
Structures (Lagoons.11oldino Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): ..............`.................. ................ Z:6.......... ............ �.................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes )0 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 14 No
12. Do any of the structures need maintenance/improvement? �] Yes El 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 tA No
_Waste Application
14, Is there physical evidence of over application? ❑ Yes ;@ No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ................ bay.r1[rtt:L......... !�M.!� ..... Tait ................. Car, ....... 060........... b.&LA,.r
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes IN No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
0 No
18.
Does the receiving crop need improvement?
im Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
ZNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
JO No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
INo
22.
Does record keeping need improvement?
,Yes
❑ No
For Certified or Permitted Facilities Qn1j
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
t"No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
0 No.vlolkioits'or deficiencies were•itoted-during this;visit. You:wiil receive ii6 ftirther"
' correspondelke Ei 4oiit this'visit:: ;
cy� P �cs c;>fas n jr'\;"kJe �i� sb►avlc� Graftttec� �o prL►�c,�" �� c.
(I. 10%A r 6AX tacit rvwwej. o
`�, CADQ� -13v,. -sfu oP be Ls �, 61�+ toy
'> uA 6, 1 '''� Ybwr) VeIVA�-W cy-c.s e.5
•1z. (rcti� oas.., d�eS� � i. �cA- yuc,? � a5aow�. °�}' �c�se � e�re� 5 �mw� C� � L,1 ' �- i"t�'I►-�-
1r�C� .
W U? no� I Ctjcoi--
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: %Sij,�:.—� % [late:

i
!� ❑ DSWCt Animal Feedlot Oper'atlo i§A,ivlew'. x
® Itoutine O Complaint O Follow-up of DW9 inspection O Follow-up of DSWC review O Other
Date of Inspection `1-10
Facility Number 3 5
Time of Inspection '. 3�0 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: 91 Registered ❑ Applied for Permit (ex:.1.25 for I hr 15 min)) Spent on Review
❑ Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not .raI
Operational Date Last Operated:................................................................................................................... ...................n.....n.....
Farm Name:...- 4..+�5� .. 14./tYaYl�,rr.(a�..r...m....................................... County:.D.ki f1i.rj...................I....................
Land Owner Name:..i�i.A:Y..J1:��.:� ....... ........ K//..4.V. )1.f............
I......................
Phone Na:.. .. ........ 5. y.1...................................
FacilityConctact:............ ........... .......... ................................ ............. Title:................................................ Phone No:..............:.........,..................................
MailingAddress:...i.A.....;;��... C.i....v r r { :k.....R 3?..u-c�............................................. x.,n..iL... ............. N..S...r ..._............ .. Z.... �.:
Onsite Representative: ,�k[dt y.]..__............ ....................... ....... Integrator:..�&!.r:.`1.....
...............................
..........
....
Certified Operator:. CIxe5........ R.R.......... ..Gi.!~tuler..1�..}r................................ Operator Certification Number: ..... t..71 4........._...
Location of Farm:
11x►....n..a.x...!a....sa.d�.....Q. ...SK,�. r.....r`.....r�.7 1..hn.ra.1.:.......x�r:..l�S......►�..�...
�......
.....sr.!+... E.[ .L
.kj1±A.......lT...lr.�l... ........A.a.��1. .....Jri..k......:�q..Y..1`+.....4..di........ .. ...Arex.......�..�..:........................................................................
Latitude • 6 64 Longitude ' 6 64
Type of Operation and Design Capacity
5 �vs<� D SiIl t�itrrent'' �� n e'
g �€�Design Current �Desi n Current
faultM.MqSwine x : Zip;aci Pop �ulatian� �,, s. v �'; Ca act °Po utation s' 4 Cattle � ,mCa aci �Po ulatioq
❑ Wean to Feeder r Layer ❑ Da'
Feeder to Finish EIRE Non -Layer on- airy
Farrow to Wean x,
Farrow to Feeder�Total Design Capacityt
SLw P k.
Farrow to Finish
❑ Others , x
' '.'R'^t "h ' i %''. k €s '?% ..tea r? es�. �r.'.'L 3 .: "` >_ o .»-.Jna 5
14
Number of°Lagoons f Holding Ponds : ❑Subsurface Drams Present
E
�MRLagoon Area ❑Spray Field Area
.�
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes B No
❑ Yes [ffNo
❑ Yes
®,No
❑ Yes
RNo
?J �
❑ Yes
BNo
❑ Yes
® No
❑ Yes
E3.No
❑ Yes
Z No
Continued
on back

Facility Number:..:...... —..37.
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 9 No
8. Are there lagoons or storage ponds on site which need to be properly closed? aYes ❑ No
titructure,jlauoons,and/or Holding Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes $-No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
.........4.............. .......... I ......... ..... ............................ _........ ...... ...........................
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)
13. Do any of the structures lack adequate minimum or maximum liquid'level markers?
Waale Apillicatigg
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... 6.er,.^!J.-f..,=.......... .... s.k..,arx................. .......... .ln0srALIA........................ .5.4.�.�r.4�v-��
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes B No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
9 Yes ❑ No
ER Yes ❑ No
❑ Yes U No
❑ Yes O[No
❑ Yes allo
❑ Yes 93 No
❑ Yes ® No
ELYes ❑ No
t�,omments trererto :question; i;) t xpiain any Y to answersanwor. any recommenaations or any other comments:.'. ,
Use drawings of facility to better explain situations (use ad'd, itioridl pagesas necessary)
s a
$.VOta l o-ow t�dd 6n �e (SW
ccc►C G[oL&.o out. Atso r�c-o -S "��S( 6V_ �
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Y L 14 b V v.4 R J�Rn.� � �1'� sw, ? G� Q.v�� vti) � G`�`'v'-�s'-q -e - r
Reviewer/Inspector Name
Reviewer/Inspector Signature: (7),, 1 A , . -I J-j Date: y / r C
cc: Division of Water Quality, Water Quality Section, Facility Assessnrent Unit 4/30/97

Facility Number: 34 ..... Date of Inspection.. 17
Additional Comments and/or Drawings:
2-1 w-" f-e i
4 1 1 S o" D
AC v,---dL r 0-1-1� 0 v v-4-t-CL Tr a t 71 Z 0
r L
vv*-�
L ) C04tom" L;�-+ -
4/30/97

J Site Requires Immediate Attention:
Facility No. 3'1
• DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS srm VISITATION RECORD
DATE: , 1995
Time:
n
Farm Name/Owner:.
Mailing Address: ?
County: ,
Integrator: ` (—, A, Phone:
On Site Representative: 6 C '1- Phone: 3-3 `l
Physical Address/Location: W- 4104 to o /�.0 V) 3 �
Type of Operation: Swine —1, . Poultry Cattle
Design .Capacity: ,u Number of Animals on Site: /� T
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: - Y-° 0 u ' P4__" Longitude: �° _' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) e r No Actual Freeboard: Ft. 0 Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Ye>r No Is the cover crop adequate? Yes o
Crop(s) being utilized: Ae
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es or No
100 Feet from Wells? es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS 'Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes RNow If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with. cover crop)? Yes or No
Inspector Name
Sign e
cc: Facility Assessment Unit
Use Attachments if Needed.

to Routine O Com laint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number 31 QZ
Time of Inspection 1I 0 0 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:.1.25 for 1 hr 15 min)) Spent on Review
CO Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:................................................................................................................ .................. ...................
Farm Name: llu..! ....C..1Y1... .................... ........ .._.... ....... .......... .......... »»...... County:1)./t.1ir-,...... ........ ..... »........... .... .I. ...
Land Owner Name: »G?? mt's .......... ....Kh.h.k...................................... Phone No:.»»�1.��.......�i.��C�.r1.��1•....... ............... »............
FacilityConctact:......1.................................r..-...............r.......................... Title:................................................ Phone No: .............................. ............................
Mailing Address: ..»� J �t..... !�5r ..... R(............................................................,.�LY11�...•k'�1.��....... ........ N....L:.................. ....4.:ip ..
Onsite Representative:r.1....».t7�........»....».......»»..................... Integrator: h..jl...
................................................
Certified Operator:....' w:G2 t......�............. ..... 12111:1 .................»............ Operator Certification Nu/mber:..17r a4.................... ...
Location of Farm:
..... .si v ..... A.. ....... & .1. 1Z.-.. .. ..... rk-," R .0......t.s .......... .► To
.....i.kk.....Hw: .2y..1.......Tex,&...�h :......�.�c.�,....t ......�..
.r+ �....."...:.........................................
Latitude �• O 4� Longitude ©• ©6 ®"
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 PS No
b. If discharge is observed, did it reach Surface Watcr? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min? N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes N No
4/30/97 maintenance/improvement? Continued on back

Facility Number:-:11......
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
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes &No
ti uct 1 a Holding
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes &No
Freeboard (ft): Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
. ............. ............................ ............................ ............................ ............................ ......... ......... ....... _
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)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes 12 No
❑ Yes M No
KYes ❑ No
❑ Yes (g No
'astf, Applicatioll
14. Is there physical evidence of over application?
❑ Yes
B No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
[ _
15. Crop type ...:........... .... LAX.-. A...........................1"hA.oA..............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
0 No
17. Does the facility have a lack of adequate acreage for land application?
Yes
❑ No
18. Does the receiving crop need improvement?
® Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
9 No
20. Does facility require a follow-up visit by same agency?
❑ Yes
91 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
ONo
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
24. Does record keeping need improvement?
Ejj Yes
❑ No
Comments ,(refer to question #) Explain any YES "answers` and/or any recommendations or any other comments
<,'..
Use drawings;_of facilityto better explain situations. (use additional pages as necessary)
12-. r--1 Vcq CO, i0" a-'L 4.agao +.�a II t+ 0444 16n, hemege{ 4
Ic o••w2 a -re uL ft
i -1 • W , a t �'� • f1.Q77 0. ��l 0-J `G f -d r ✓Lt-ei..3 i.
T .-.-• c o �1. c�z-r l a a� to Le a b o- J t, y e u i S� a
! Gorr-e c
[ a. n J r ``"L�p { � , � .r-e.�-f Q L t '�-t1. e�'� I-
L
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18 . C'O r +- a crt w e e-<-. .--0 b l Q. .,y.. S � ,, b - ,.-
1 Cst'tr w wr-e.�.�• 101 '_'L '') O k Ora �y , i s t a� krr-.P�►-, . i h a-drel- I
•� e,k a1. A S C S w,. aP t"�-m_ "t• S �.o W S T v a [. % ! 2!] 3 i r e L� 3i- +, `rin,i i i Q-1 r1- i 1 K ri
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
cc: Division of Water Quality, Wafer Quality Section, Facility Assessment -Unit 4/30/97

Site Requires Immediate Attention:
Facility No.
• DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: V , 1995
Time:
Farm Name/Owner:
Mailing Address: _
County: _ � � 12 - -
Integrator:' M�1� L14 Phone:
On Site Representative: Phone: 0 916' S 3 y 7
Physical Address/Location: Ale
Type of Operation: Swine L/ Poultry Cattle
Design Capacity: 2± _�� `f Number of Animals on Site: /-- D Lam'
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: '�) ' O b ' O�L" Longitude 27 • 5- ✓tea-" 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) (:
Y:4br No Actual Freeboard: 3 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or49 Was any erosion observed? Yes o No
Is adequate land available for spray? e io
Is the cover crop adequate?C-,_jD_1No
Crop(s) being utilized: (�Gl� ��1/ti -
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? �sjor No
100 Feet from Wells? � r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch, flushing system, or other
similar man-rnade devices? Yes o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specificfacreage with. cover crop)? Yes or0
Additional Comments: aj�C
Inspector ame
1
Sign e
cc: Facility Assessment Unit Use Attachments if Needed.