310505_INSPECTIONS_20171231

NUHTH CAHULINA
Department of Environmental Qual

N
Type of Visit: O Coilance Inspection C.)Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: 2 r} Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative:
Certified Operator:
Back-up Operator:,
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: f ? S Z 13.a
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
C*urrent
Pnp.
Design C**urrent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
I
I
Dairy Calf
eeder to Finish
Y
Dairy Heifer
Farrow to Wean
Design
C►ID
Cow
Farrow to Feeder
Farrow to Finish
Dr, P■ouit ,
ILavers
Ca aei
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No C] NA ❑ NE
❑ 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 r_]
❑,NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes[] 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 21412015 Continued

1
Facili mber: jDate of Inspection:
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
12KO ❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environ entat threat, notify DWR
7. Do any of the structures need maintenance or improvement? es ❑ 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 ErNo ❑ 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 0 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
L21�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Lid4es
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[-�'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
to
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Io,
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
Io
❑ 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
C2<0
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ 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

Facility Number: °)/ -"`7! Date of Ins ection:
24 t7id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No - NA ❑ NE
25. Is the'facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No [] NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ❑ NoEJINA ❑ 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 ]U 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?
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 I/o
[] Yes QX6
❑ Yes C]-I o
❑NA ❑NE
❑NA []NE
❑ NA ❑ NE
Comments refer to question# Explain an _YES'answers',and/or;any. additional Neominendations or any other eoininents..
(. ) y
Use drawlna's.of facility to,better',explain'situations (use additional pakes,as:necessarY).
�+ t: .,ems t­t Kx 1
7, rt-,0V✓ 41f`IL j. tf
Y P (C� 5 ►�-�-� �- - w� c ¢ �'�ro f
` S - kok'j L �QKA dam' ea / 1
G
Ct
5C) t 4��5 s�r7�� lot rko CL(4--. 05
e -t cC7„>` t. c e c {' r< C,-t ;41. been ,„c�4 •'� eL
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: � 10 ! 16 7 �,,y
Date: Co r
IL 7
21412015

0
Type of Visit: (2rCompliance Inspection V Opera ' Review O Structure Evaluation Q Technical Assistance +
Reason for Visit: 0 Routine 0 Complaint oilow-up 0 Referral 0 Emergency 0 Other 0 Denied Access II
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design
.Current
Swine Capacity POp.
Wet Poultry
Capacity
Pop.
Cattle
Capacity
Pop.
Wean to Finish
IDairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
IDairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P.oult ,
Ca �ai
Pop.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
A
jBeef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZrNo ❑ 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
❑ No 0 NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
N ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
C JINo ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued `Z*

Facifl ° Number: - Date of Inspection:
WaetelCollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes to ❑ 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): '-Z S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [,Ado ❑ 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 FNo
5❑ 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 ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need D Yes ❑ No ❑ NA ONE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 0<E
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
[ZNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
E3<E
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
EPK'E'
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
<NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
FJINE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA �NF
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA &NE
❑
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑
Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[:]No
❑ NA [�]
23.
Ifselected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA NE
Page 2 of 3 21412015 Continued

Facility Number: 3 r - :�29 f Date of Inspection:
24.17i�i the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA VE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [—]No 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 concem?
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? (Le., 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 o ❑ NA ❑ NE
❑ Yes Z rNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA NE
[:]Yes [:]No ❑ NA ICJ "
❑ Yes No NA
[:]Yes fo NA
❑ Yes No ❑ NA
(�Vt% �I A
r
31�49e5�,
S�l H /,I s�IIt F
e- 0901101
Name:
iewer/Inspector Signatui
Kage 3 of 3
❑ NE
❑ NE
❑ NE
' Phone: 1 , O -q b 7`) 0
Date: 7
2/4/20l S

Type of Visit: 0 Co pliance Inspection U Operation Review U 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: l Arrival Time: FTt377 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 1jZ (�.i"� tom. r_H e o--- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: q11106 9
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
C«urrent Design Current
Pop. Wet Poultry Capacity Pop.
La er
Design Current
Cattle C*apacity p.
Dai Cow
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
d
Dr, Y�ouitr,
Design Current
Ca acit P.o ,
Dai Heifer
Dr Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
EirPullets
Beef Brood Cow
Other
Other
Turke s
TOkey Poults
Other
Discharges and _Stream _llmpacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZNo❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
VNo.,
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�Wo
❑ NA
❑ NE
of the State other than from a discharge'?
Page 1 of 3 21412015 Continued

. Facility Number: - Date of Inspection: UR4 it
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
YNo ❑ 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 environmen
,tl threat, notify DWR
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 �rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 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 land improvement?
❑ Yes
�
Q No
N
❑ NA
NA
❑ NE
NE
receiving crop and/or application site need
es
❑
❑
❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
L�J tV 0
❑ 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
VN
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
YXo
❑ 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
<
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
{ 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes fNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to property 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?
V�GL0S 0(-q4 z ye fz
��.
❑ Yes �No ❑ NA ❑ NE
❑ Yes [;j"No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes V7
❑ Yes Y o
❑ Yes VNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
L-TYVIE . G GT �t�vlm .D►�Cr �o SZ-
C'0(-. f)
Reviewer/Inspector Name: 1314R6 � G((� Phone:
Reviewer/Inspector Signature: Date: 5 026 b
Page 3 of 3 21412015

®1 o 1161E
(Type of Visit: Q3 Compliance inspection O Operation Review O Structu
revaluation O Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral Q Other O Denied Access
Date of Visit: l0 t `
Arrival Time:
Departure Time:
County: DJ91 mI>�
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: ' ECkk 14 81—SO Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Design
Current
Design C*urrent Design Current .. �
Swine
C►apacity
Pop.
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer Dairy Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current D Cow
Farrow to Feeder
ltr, Ca aci P.o Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
ers
BeefFeeder
Boars
�1[7Non-
JBeef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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
0 N E
❑ Yes
YNo
❑ NA
0 NE
❑ Yes
[�No.
❑ NA
[] NE
Page I of 3 21412015 Continued

Facili Number: I -S5 0S Date of inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? es ❑ 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: UAC 1J I L66" o`
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I
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 [ZNo ❑ 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? dyes ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Q No
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes 6/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
dNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
[:rNE
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
E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Surve
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
[2/NE
Page 2 of 3 21412015 Continued

Facility Number: 31 - Date of Inspection: jol
2�. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No ❑ NA Cj NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[:]Yes
❑ No ❑ NA XfNE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA. E
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
[3/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
E�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
dNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O�No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[Z Y s
❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
VYes
❑ No ❑ NA ❑ NE
Comments+(refer�totquestion #) $Explain anytYESsanswer's and/orlany additional recommendations;or any,othcr comments,. t
=. . .s Q,k a. ;i'sf5 4Rb4:11 rs.,3 I�.,., ;.� _ i; � i
Use drawm s,olifacili,}j� taybetter expfain�situations (use,addit!onal: agessas necessary): ; A �1 �, .4k y ti W _
C,oPTACtG!) ETC-G21 TOCo - of UgCxmku I.L-VEL . Od �b js�rs , MEr wzT�
K-rrG- WCSfiE�U-t r" HrLSO , AWD MAUL ICAVAyJRUCN. Ar -(alp N a;SS�M
lJAvmD I?owr=LLr i�kVX,lJ Kow I-ANS AN0 ,jo14,r �AM6t.l. ?(t,CSC.NT,
I.AC�iJ � wtaS AT Z�Ro NCH G- a� tr2cEB�1<a R� , 1�-rr�Lrv�S to -
} SCG PA GE U � vV0 u- . � " L-r US E.b To Co N1'1z-o L . r utv?_E,S fi(A i�£9�
sua-p ce w A TES- �R-Ar� . +no L� �� • W SATE rL W r�'i' JT,V� R�S�J(r W�i7��
O 14 06- 6)muom-4- OE.ElOS W0Rk,
8) UAC�
00 l R rz1�Cf� S Wes? ry � _SWQ�S UVT �V�L WAS
m6w 5x&HTJ-� 06
?u Mpluo AP D
Nw�LE D
Ta I.RCsMay LbGA 0EAQ 91.CU-ANJS, �F n� M EM?TY o( I� ,iS n, 6',30
bra r? l_� S WA 1�C W.I�NG- (AS W1 606 iwuicE,2.
3-3,) AND 3qa 61J 9C_TU2t\i VrS=T' pz5CuS5 .�ti1SPC Cr oN .
VwLATSot i ro FaI_L-O W wTT�4 TPtTC-PT -ro
1 � R F
�
GCCZVC, DA 90i� b �C N L t�L M
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
TdH-0 V1q(Z06LL-
Phone: C'1IV��V
Date: 1019 t S
015

Type of Visit: 0 Co pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: Departure Time:'-�L.�+� County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 12fc>�?fi Vr t�TC_j.{F�i
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 391069
Certification Number -
Longitude:
Design
Current
Design
Current
Design Curi
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle
Capacity' >pon.
Wean to Finish
I
11-ayer
I
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
a4aLi
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oul
Non-Dairy
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes E/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes 2� o DNA ONE
[] Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - () Date of Inspection: t (S-
e�.
Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
l2
❑ 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: [
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ff 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
2No
❑ 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
[�5/No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2f No
❑ NA
❑ NE
maintenance or improvement'?
Waste Application
WNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2No
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[21N' o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;KNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
�es
❑ No
❑ NA
❑ NE
the appropriate bo .
[;'�VUP ' ❑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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Vo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Vacilitj Number: - Date of inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes VNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [O'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 Ko ❑ 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 UIo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 o ❑ NA [3NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to -question #): Explain any��YiES answers and/or anyea'dditional�reedihmendations or anyrother comments.
Use drawings of facility.to better 6 fain sltuatiofls:(use;additional pages as necessary).
rs, Fs Los plea L-T-me, kC-Er cow off' t rw acia
sue, s-A m AL, pt c. L0s W&C- 0 MC-6 D COY T kA, ,
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phon 'l U 6 - , 13
Date: 011 1hr
21W20I5

Type of Visit: Q Compliance Inspection U Operation Review Q Structure Evaluation O 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: Departure Time: County: (>j.Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: t.I =. oA q4L Integrator:
Certified Operator: Certification Number: 1 7 CJ
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
Non -La er
IDai
Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oultr.
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
I
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othe
urkey 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
❑ o
[3 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
[3 Yes
Xo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
2 No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Ifacility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes jNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structurr -Ae j2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:11
11
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EeNo ❑ 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 environmentjtl threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 0 N
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes o
DNA
❑ 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 ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ es
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes ❑ N
❑ NA
D 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 � o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ 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? ❑ YesVo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - K Date of Inspection: 13
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Y
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Ton -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
[�No ❑ NA ❑ NE
❑No ❑NA ❑NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ 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?
Reviewer/Inspector Signature:
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
J1
914
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
JZ
No ❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Date: % 23
2 4/2011

U
type of visit. tJ t✓o nance inspection v uperanon tceview v structure r,vatuatnon U t ecnmcai Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L Arrival Time: Z 0 Departure Time: County: ,�IS� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: -jEtn ( Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
C►urrent
Design Current
Swine
Capacity Pop.
Wet Poultry
CapacityCattle
Capacity Fnp,
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
El
Dairy Calf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dt. P,oultr.
Ca aei
P.a
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
OUItS
—
­—Im
E=O�ther
OtherI
M
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [7�No 2 A ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
[:]Yes ❑ o ❑ NA ❑ NE
❑ Yes Zo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
Page 1 of 3 2/4/20II Continued

Facility Number: ( - O Date of Inspection: 4 11-1
11,
5.
Waste Collection & Treatment
j, 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: WaW I LAG=-� 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '�� ✓ 1
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
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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �N0 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes j(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [—]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes (2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
01<0
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�To
❑ NA
❑ NE
No
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ef
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
a<0
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
hfo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [] N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LJ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: " k - SM jDate of Inspection:
24. Di$ 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 [lo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 6N'o ❑ 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 E O ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes L3 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
follow-up by
❑ Yes No ❑ NA ❑ NE
Yes NA NE
34. Does the facility require a visit the same agency?
❑ L. o ❑ ❑
Comments (refer to.questionw#) Explain any YES answers and/or;'anyadditionalbrecommendations,or.another. comments..,
E
a.
Use drarvin¢sof taeilikV. to:tietter.,explain situations.'(d"se ed'dit�onal,'pakes as,necessary): &.
=' °
.. ,
S , ) �SC c_ +�� C� l �zV►�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:(_1,?16 ) 7n —?,3 °a
Date:
I

L a -
a € =:Division of Water Quality ,
;i rQ Drvt�s►on of Soil and;Wtater;Conservation: �y7t <4 4� �{ `� M s
xx, �i
;A t�1' Wti ��,$! t :ki
Type of Visit 7Routineoliance 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: Arrival Time: ® Departure Time: �lj� County: Dy„ , Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Pbysical Address:
Facility Contact: Title: Phone No:
Onsite Representative: u- L Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: e = , 0 « Longitude: = ° = 6
URI
FacilityNumber
- y € j
Design Current:, Desigi Current A iNCjpaci
`s fldesl+n{,rhCurrCnt ',
Swities� `tPopulattan Wet?.PouItry .Capacity Population - Cattle `Capacity Po ulufton st3
❑ Layer ❑ DairyCow
❑ Non -Layer ❑ DairyCalf
El Dairy Heifer
.-i� i�� �tyT i ❑D Cow
_ l` DryPoultrsyag4+fix=
❑ Non-Dai
r< ❑ Beef Stocker
1 ❑ Beef Feeder
❑ Beef Brood Cow
rx its °-"
;�;Othel f i.d l� r1 ❑Other $:`�'zi�•k# {a €
Number'of Structures
7,
❑
- y € j
Design Current:, Desigi Current A iNCjpaci
`s fldesl+n{,rhCurrCnt ',
Swities� `tPopulattan Wet?.PouItry .Capacity Population - Cattle `Capacity Po ulufton st3
❑ Layer ❑ DairyCow
❑ Non -Layer ❑ DairyCalf
El Dairy Heifer
.-i� i�� �tyT i ❑D Cow
_ l` DryPoultrsyag4+fix=
❑ Non-Dai
r< ❑ Beef Stocker
1 ❑ Beef Feeder
❑ Beef Brood Cow
rx its °-"
;�;Othel f i.d l� r1 ❑Other $:`�'zi�•k# {a €
Number'of Structures
7,
❑
Wean to Finish
❑.Wean
to Feeder
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
❑ La Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Dlscharge5 &C Stream Impacts
I. 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
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Flo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Numher: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure II Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 L(
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6
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 thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? [3 Yes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 7No
I ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 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 Drib ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) /
14. Do the receiving crops differ from those designated in the CAWMP?
t5. 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
OINP ❑ NA ❑ NE
7No
❑ NA ElNE
❑ NA ❑ NE
LJZo
❑NA ❑NE
❑ NA ❑ NE
Camments.(refer to question #): Explain any YES answers and/or any;recommcndations or any other comments. "
.Use drawings offacilit to:better .explain situations. use_AcIditional a es., necessar a
Al
o t bJ C6 P
+✓��
Reviewer/inspector Name
yN #t i o --73
��, 6 �4 s�i•r .,"0.� Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 1212844 ' Continued

Facility Number: — 6 Date of Inspection 'I
71
Required Records & Documents
19
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
❑ Yes d No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
2 L
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
DINo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
0Z
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[;No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
WNo
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
Vyy
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
o
❑ NA
❑ NE
Other issues ,�, /
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El yes Zo
❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? El;N/o❑ NA [INE
33. Does facility require a follow-up visit by same agency? ❑ Yes o ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit 9Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: .0NPO±A Region:
Farm Name: I Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: B z-T It H614• integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = = I{ Longitude: = o =' =
III Ij
Design
Swine Capacity
_urre t
Population
Design Current
Wet Poultry Capacity Population
HOW
Des€gn Current
Cattle Capacity Population
airy Cow
airy Calf
❑ Wean to Finish
❑ Wean to Feeder
ceder to Finish
Dry Poultry
❑ La ers
❑ No ets ers
❑Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
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?
El Yes
[a No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
r o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

'Facility Number: Date of Inspection
v'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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 environmenta7thrct, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes[
❑NA ❑ NE
{Q
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) No
9. Does any part of the waste management system other than the waste structures require ElYes 2 ❑ 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?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
//
LYNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% 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
0,4o/
❑ NA ElNE
15.
Does the receiving crop and/or land application site need improvement?
2 Yes
❑ No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
I d No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑
El NA El NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
,,,'%
I �No
❑ NA ❑ NE
Comments (refer to`,questtan #) Explain' any YES answers and/orany recommendattans or any, other comments
kt
Use drawings of facility to better explain situations. (use additlonal,pages,as,necessary):
Z160 Po1V;re Y_ , RE RaD �S
IF
t 1 f
Reviewer/Inspector Name:,, , E ,: , ,: �,'= Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 ' Continued

Facility Number.: — Q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Co [I NA [INE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
/No
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
12
❑ 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
t3No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P10
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,E.
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
,EK,00
Li'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�To
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ N
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
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
L: 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 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
//
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
BNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;2No
❑ NA
❑ NE
Additional Comments aridlor'Drarvidgs
Page 3 of 3 12128104

Type of Visit g7Routine
pllance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: / oZ lU I Departure Time: County: d� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
�w Ir'�p— BN
Onsite Representative:
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [--] o =] ' ❑ Longitude: = o ❑ 6 =
11
Design Current
Design C►urrent
Design C*urrent
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capay Population
❑ an to Finish
airy Cow
❑ an to Feeder
❑Non -La er
❑Dairy Calf
® Feeder to Finish
airy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑Pullets
❑Beef Brood Cow
Li Turke s
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures: a
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
dNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ o
[3 NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
❑ 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: Date of Inspection
'' aste 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 l Structure 2 Structure 3 Structure 4
Identifier: t Ae5-y z M (AA -L--
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 12-1 33
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 ENo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 23 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 [f No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Cr/No ❑ NA ❑ NE
maintenance/improvement'? �
It. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes D No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) -
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q40
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
2/Yes
El NA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
E❑l�No
Yj
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
ICJ Zo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CJ o
❑ NA
❑ NE
*ornriients refer:io uesiion°# .-Ez"lain.ao �YF.S:`ans°wens and/or4an recomlmendations or an olther`:c m�inentstp`
g�
U-eter,expmtaios:(s.edZonalpagesasse drawings°oftacihtyto�baul "
SR l �� F.� �t-b SN _qAO SHOK
6VT NOT 01V- ADn>ZE,Jl.
Reviewer/Inspector Name �� cJd
Phone:
Reviewer/Inspector Signature:
Date: a
i if
Page 2 of 3 12128104 Continued

Facility Number: 3 — p Date of Inspection 3
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CI No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑4o ❑ 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
TNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
fallo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L'J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ZNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
eNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CrNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
BIN' o
❑ NA
❑ NE
and report the mortality rates that were higher than normal'?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E?�o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
C J No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
L]-�o
❑ NA
❑ NE
33.
Does lacility require a follow-up visit by same agency?
❑ Yes
9�`No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

G
Type of Visit ,C pllance Inspection Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit ,SIJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: f`►3dS.2o " 1
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o ❑ & ❑61 Longitude: = o = ` ❑ "
Design
C•urent I
q Design Current Design Current
Swine Capacity
Population
`Vet oultry C*apacciity Population Cattle Capacity Population
❑ La er ❑ Dai Cow
❑Non -La er ❑ Dairy Calf
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Dairy Heifer
Dr..y Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
ID Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
10 OtherI Number of Structures:
❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
6N0
❑ 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
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
9/0
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Gi
Facility Number: — Date of Inspection 1� 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ZNo ❑ 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: LAL.A Cam"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes &No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 6 No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
,
El Yes L1 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 LI 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. El Yes LJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
EYes❑
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
2*NNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
Yes
�G(No ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
15') LAAc rx£ -_ L-ps • AIL- C-P D EEP Ca00- . SM,0 L L_ F scj,�krq o f .6 13 E.
C 4,14 101,6q �y I?_(- 10.0rAk , P_ewrdv� d LP /3k cf
Reviewer/Inspector Name 6 _[b Phone:
Reviewer/Inspector Signature: Date:
1 12128104 Continued

.y I/ /
Facility Number: Date of Inspection 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ff'No ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes L"J No ❑ NA ❑ NE
the appropiate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 0 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 - N
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes FNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 2<o
❑ 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 �VU ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ia 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?
EltT 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
ONo ❑ 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
iJ Nc ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
w
H
12128104

31 M. Soy"
Type of Visit 0 C mpliance 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: Arrival Time: /a O a Departure Time: County: _�Pt.Lt� _ Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 13R_.L'* MxTt idE.i-L-
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = Longitude: 0 ° =
Design
Swine C►apacity
Current
Population Wet Poultry
Design Current
Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
El Dairy Cow
❑ Wean to Feeder
-Layer
❑ DairyCalf
® Feeder to Finish a a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Dry Poultry
❑ La ers
❑Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Gilts
El Boars
Other
El Beef Feeder
❑ Beef Brood Cow
Number i f Structures:
❑ 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?
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 E No [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 E SpS Date of Inspection 67
Waste Collection & Treatment
4. 1s'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LACyn+•1 1 LA<rno+J 2-
Spillway?:
_
Designed Freeboard (in):
Observed Freeboard (in): 4Z 23
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 YNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes El No
❑ Yes ENo
❑ NA ❑ NE
El NA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Q,,,(�No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes C No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
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
No ❑ NA ❑ NE
ro ❑ NA ❑NE
No ❑ NA ❑ NE
�No ❑ NA ❑ NE
VNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES,answers and/or any recommendations or anyothercomments.
Use drawings of facility to better explain situations. (use additional.pages.as:necessary.):.
a3,) We rc t+Jof wIrr► Nc-'-' Aoo JP04T6 VP�Ls AM13
XE.
�
ai �Porsst`. S-rouc (r St,h,D C'e=45 lb t)wa 1ZM
laA§ Q()CZG ASi V 161 �
oo U L_Ts6X47ra10 ws�1,1�rJ L.+5 >A
35 po sw+D vE S�ru�by
W10n coN-fLoL_ Nt~L66p .9 .tt,LW-
_MXLLkT
Reviewer/inspector Name 62tJ1
Phone: q 7g� P
Reviewer/inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: —SOS Date of inspection 3 67
Reduired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 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. 13 WUP ❑ Checklists ❑ Design
g ❑Maps El Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis E J Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspectionss
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ff No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
E Y
❑ No
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
es�es
[? es
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2io
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
2NA
❑ 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
FI 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
��
l_J 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
El Yes
�
EJ No
[I 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
'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2'No ❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

E Ao: ivisionjof Water Quality t :'
Facility Number O Division of Soil and Water Conservation
O Other Agency 1/
Type of Visit 'Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit routine 0 Complaint Q Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region: 6JIA!S-
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone N
Onsite Representative: Integrator:
Certified Operator: Operator Certification umber:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 Longitude: 0 ° = ` = "
Design..,: Curren °'"' :'': Design Current
nwrne capacity. N,oppiation
❑ Wean to Finish
❑ Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean it
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Other'
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ on -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
C
❑ Other
C
Design: , Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures,.ED
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
12128104 Continued

Facility Number: 31 -JbJT 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
Struc ure 1 Struc e 2 Structure 3 Structure 4
Identifier;
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I Phone: 1i
01
Reviewer/Inspector Signature: Date: 3
Page 2 of 3 12a8104 ` Continued

— Date of Inspection
Facility Number:
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El maps El 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 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
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (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
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
a-� rl'c2� h oc�rJ �0 00vf���-�--
/`r�
AWtK� � l �
,�Gec� rQi�1/ /�Co`ro�s 7 Q ri
Page 3 of 3 12128104

50 S
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1 241/0 J 1 Arrival Time: Departure'rime: i 16o County: OuPt/7a% Region:
Farm Name: G I.1N ri'� tea" 1 4- 2 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: l Title:
Onsite Representative: GE00 Kef.�ijtb _1
Certified Operator: t ' WMC r`:EI�A
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Phone:
Phone No:
Integrator: D'./ P Um lJ
Operator Certification Number:
Back-up Certification Number:
Latitude: = o E 3 = Longitude: = ° 0' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
1 ❑ Layer
❑ Non -La ec
Other
-❑ Other - - - -
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ 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 Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes C No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
12128104 Continued

Facility Number: —
Date of Inspection �5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier:
1,7S t
Spillway?:
Designed Freeboard (in):
a-3
Observed Freeboard (in):
23
Structure 2 Structure 3 Structure 4
J-S 'L
u6
❑ Yes 11J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 5No ❑ NA ❑ NE
(iel 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 treat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �1] No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C!(,� o ❑ NA ElNE
(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 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 > 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) fvL,t.t_C-T O E (L- ,L1.1Dq C U) S GO
13. Soil type(s) W 000:n J G-r'y % U L-<.
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? ElYes YNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes d�No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes d ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes �Zo ❑ NA ❑ NE
tq ] O C;( b FI✓ mTr ROD t-RTzFZCACE Of CW(_ R-I,&t+ k .LT►} XF-w-vS,
Zv+� iJV P tJ�c.+�s is t3E bNSStL. LA G-oan1 DCS.t6 +' - p, ,Ts Z $TAov'I PUMP srwres
m ue vp� - LA G O` ot- M(;6_0 5 PJC W nnA9-KCZ x,
21 } jr.�Jr/ALt- k" f,01PCt T NE(-_0 To CC D614 E frLbm. OC-T' 04 . TA-APSK6L LA&C-0
t�C.VG -fo oto �.� .15.
-)--ZZt.►g-tCALL_ 2-AZE;0 GpWC ,
Reviewer/Inspector Nam, H i l: Phone:
e
Reviewer/Inspector Signature: jXWl:-V Date: `ZI rt 1 d S
12128104 Continued

Facility Number: 31 Date of Inspection a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Zes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check LJ Yes ❑ No ❑ NA ❑ NE
the appropirate box. 2WUP ❑ Checklists E(Desi n g El Maps El 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
ElAnnual
Certification
ZRainfall [IStocking ElCrop Yield El120 Minute Inspections 12"Monthly and l" Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
U Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
01yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
[� A
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑
[ NNA
El 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
VNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
YN 0
❑ NA
❑ NE
29.
Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes
go
❑ 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?
ElYes
VNo
❑ 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
V14
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�J No
❑ NA
❑ NE.
Additional Comments and/or Drawings:
12128104

Facility Number 7/ Date of Visit: I V Time: S
Not Operational 0 Belo Threshold
JZ Permitted ®.Certified 13 Conditionally Certified D Registered Date Last Operated or Above Threshold:
Farm Name: �/ �llt R R .i ��i'f County: _ �i`/ d, "Pl%.1
Owner Name:
Mailing Address:
Phone No:
Facility Contact: yy Title: Phone No:
Onsite Representative: �Ct?0- �C�rtwt _ __ __-__ _ ____ Integrator:.�L__
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 06 44 Longitude 0 4 «
Design Current Design Current =Design Current
Swine capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 La er 1 1[1 Dairy
Feeder to Finish Z ILI Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total:Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of°Laganns ❑ Subsurface Drains Present ❑ La oon Area ❑ S ra Field Area ?
. .......... - . _�....
HoldtngxPondsklSohd Traps a ❑ No Liquid Waste Management System
Discharges & Stream lmnacts
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 Structure 5
Identifier: 1 7-
Freeboard (inches): 7-6 tom)
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste A.anlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type ."
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? .. ❑ Yes - ❑ No
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Re
fired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[:]No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps. etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ 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 reviewhnspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visir by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence'aboui this
dvisit.
� ... �_ � '��]. � •-..bS.�;.Ye•;kif.':bT.i { �F isY=.wwY�'�iMkf�i`�Y<4os',ie+'-4i i,ri"u,�i'Cs.31f .f�
Comiments,(refei to goespoa s`' x-'P" airi.any£ YES aig;iii tand/orany,Ymmmendations:or any dW&,commenta ,.
-fi y',�.jL
Use drawings of facility to better explain situations (use addrttonaI pages as necessary) , �, N h, +';
[] Field Copy ❑Final Notes w
j
i(�ii,
#7.
eN�'I�• 'fir v 1 t 7 ���i.<''N&B s .�£ A � ��S.R,�'���%dr£� ,�,$
Reviewer/Inspector Name,.
t�:
£�
Reviewer/Inspector Signature: O Date: r
05103101 Continued

Facility Number: 2Z — Date of Inspection r
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
05103101

Type of Visit Ocompliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine Q Complaint O Follow up Emergency Notification O Other ❑ Denied Access
Date of Visit: Time:
Facility Number D
O NotOperational erational O Below Threshold
Permitted 0 Certirsed E3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ..... � .TA.... ...4,1,.. �. ................ County: ..�)Akk1:.1J.......-...................... .....................
Owner Name:....Q I �?. ..... . Phone No:
MailingAddress: .........................................................................................................................................................•--.--...........................................
FacilityContact: ......................................... Title:......................................................... Phone No:...................................................
Onsite Representative —� D N aJ f� Lr � TF� ......9. kh6mIntegrator:..I . l U P 'a .......................................................
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm-
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude " & 66 Longitude ' 6 C�K
❑ Wean to Feeder
❑ Layer
eeder to Finish
❑Non-1
Farrow to Wean
' ❑
ElFarrow to Feeder
.Other
❑ Farrow to Finish
❑ Gilts
❑ Boars
I I::....................
Subsurface Drains Present } ❑ Lagoon Area ID Spray Field Area
.......... _......... ........ .
No Liquid Waste Management Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any, adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard pins storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure,11 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .......6! .q'.7................................................... .......
Freeboard(inches): _........... 01................... ............................... ...................................... .......

� y�'� �,fwa�YM °,�y�"4[�wt .a,,.� i,:n' - � , .. � - — . r. a •�; ' "c . ra, � '.. .. _ - r cn _ - �rt rl,:
-- c Failh*_�Number. � [ -�Q �_ Date of Inspection f `
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6..Axe tbere structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of Questions 4-b!a-as answered yes, and the situation poses an
❑ Yes
❑ No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintcnance/improvement?
XYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/impmvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
[:]No
11. is there evidence of over application? ❑ Excessive Pouding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12, Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
1.4. 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 impmvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required Records & Documents
.17. Fail to have Certificate of -Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
'18. Does the facility fail .to have all components of the Certified Animal Waste Management Plan readily. available?
(ie/ WUP, checklists, design, maps; etc.) .❑ Yes []No
19. Does record keeping need improvement:? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes -❑ No
20. Is facility not in compliance with any applcable.setback.criteria in effect at the time of design? ❑ Yes .❑ No
.21. Did the facility fail to-havea actively certified operator in charge? r ❑ Yes ❑ No
.22. Fail to notify regional DWQ of emergency:situations as required by General Permit?
(ie/ discharge, freeboard problems, ovcr.application) ❑"Yes XNo
23. Did Reviewer/bTector fail to; discuss reviewfmspection with on -site representative? ❑ Yes #RfNo
24. Does fscilitysequire.afollow-up visit by same agency? _❑ YesNo
25, Were anyadditional problems noted which cause -noncompliance of the Certified AWMP? . ❑ Yes .❑ No
E3 Noviolations �or.deficiencies-�wemnoted,during.thbvisit. Youwillreceivenofiurther.correspondence:aboutthb—visit.
❑ Field Copy : ❑ Final Notes
107
1%seT (.OiiJvNCr�O �EC'r91� DFJ/7s'c�/��C �pr2��G'f}7� iJ ��n
744W 5 PD2 T 4*16,r �6eO Cr,O
iC�ii'e'^: }Y:iNJ�y.+�..?:1�..-FI}J.GfifidK?khYF.%5i`iry.)J�•.4G'Sl;';Y:±:A:/E:}:.xuspsf�:�x«q^rr,.::rya.,r�;'<Smr...+.;;^•:=:cfXv,:+.a..'+D.c„"w.:^.w,;p:a;
iF:i'.. :'f'.: :. �tii:: vn� ::yii .:.-
R e Cjii. i ` x..2i::»'} .4.x-. eviewer/Ina ect rNam ••.i: s ;s:Gz:,. .:.<..i�::::..i.,,.i<..:::i::},>:,,.i:,:.�•.:..::;�.::.,..,f:.,..�.::::::..,.:.:
/� 03 ReviewerAnspectorSignature: Date:

0510310I Continued
,.
Facility Number: Date of Inspection a O
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 0 Yes 0 No
liquid level of lagoon or storage pond with no agitation?
27. Are there an dead animals not disposed of properly within 24 hours?
y p p p y j] Yes Q No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes Q No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No

Type of Visit & Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit (5 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Z OZ Time: ; �M
�
O Not Operational Q Below Threshold
® Permitted ® Certiifled [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .._._._ _.....
Farm Name: ......Y..Qer
►?11...�.. Z.......................................... County:.....•s=`=l�.--•--•--•-----•--•--•--.....................
Owner Name:...�0!?�` .--------------- .etc%-``----------------------------- Phone No: -------------------------------------- -----
MailingAddress: .......................................................................................... ; .......................... ...................................................................................... ...........................
FacilityContact:...........................................................Title:............................................... Phone No: ......................................
OnsiteRepresentative:-_-Sn�Q--!_LC+!_C`-------------............... Integrator:----rn�it'ri--------------------------•
Certified Operator: .................................................. .............................................................. Operator Certification Number...........................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle
[]Horse Latitude �• �'
�" Longitude �• �� ��
1­7IDesign
`Current
Design
Current =: Design Current
'Poulty Pt
Caaci
'Po"uaoCaait'Swine ulation
❑ Wean to Feeder
❑ Layer
❑ Dairy
® Feeder to Finish Z
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
Other
[] Farrow to Feeder
❑ Farrow to Finish
Total Destgn Capaeity ,
❑ Gilts
❑ Boars
„ LW
Total SS
�'I
-
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? (1f 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 H No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: ...... .................... ..... &J'.A......... .......................... -•--1...................... ........................ _............................
Freeboard (inches): Z 37
A!Wp/Af .._...,...._a

UJ/UNUI
Facility Number: 3 — 3a j Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures tack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
Uurtrrnueu
❑ Yes 1�4 No
❑ Yes ® No
❑ Yes No
® Yes ❑ No
❑ Yes ❑ No
10. Are there any buffers that need maintenance/improvement? K Yes ❑ No
11. Is there evidence of over application?? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type �ra7K� � Y 1 ��L[_Crvtin 41&-5ed _.lteatm. W -I _ R otr+t1S
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 0 No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receiving crop need improvement? ❑ Yes M No
16. is there a lack of adequate waste application equipment?
❑ Yes
IV No
Rectuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
igNo
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
R No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
MNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
K No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
M No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
54 No
24. Does facility require a follow-up visit by same agency?
❑ Yes
R No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
10 No
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-Cammen" it fe o�uesflon �Ez `1aa'n a i'E nswers andlo11
r'ast recommendations or a `anther comments."
( q,y y13Ms
'ng's f�facdif""'to explain sivati' ri (use ddttion 1`pag, as i'Y : °
;Usedra betted , necesS
❑Field Copy ❑Final Notes
,de �a� d,�C,� o.� Cafoa•�,
5 etoe-A.1- /As lem, r'P1Ano A^ */`�/
OAP I e Anz,,I nee S Tv III e ^0 Y 6,1 A'P'X 1w B/1 e, 0-f — jL)G 4 f ooA ,
n, 4err4 IVA6 $40f4 In I/Wx%s. Arr,W 0,ctgKln�
if,
Narne- �G" �" `" . aW'
Reviewer/InspectorVO
Reviewer/Inspector Signature: Date: Q Z

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 M No
❑ Yes zj No
❑ Yes No
❑ Yes M No
❑ Yes ® No
❑ Yes 51 No
❑ Yes bg No
Additional Comments and/or Drawings:.
05103101
05103101

itine O Complaint O Follow-up of DWQ inspection
Facility Number
#Permitted 13 Certified © Conditionally Certified 0 Registered
FarmName: ..............................................................................
OwnerName: ................................................... ...........................
w-up of DSWC review O Other
Date of Inspection
Time of Inspection 24 hr. (hh:mm)
113 Not O erational. Date Last Operated:
County:
Phone No:
Facility Contact: .. Title: Phone No:
Mailing Address: ...........................................
..
....... ......................... ..........................
Onsite Representative:0 �.. ........ Integrator:...................................................
Certified Operator: ................................................... ....................................................... Operator Certification Number:..........................................
Location of Farm:
A
......:... .. ................. ................................ .. ..
Latitude 0 A 64 Longitude 0 ' "
' Design ;
Design Current" ;' L, Design Current
.:Current
Swine Ca actt 'Po"ulation Poultry.
Ca act ,,_ Poulataon:? ,Cattle ......'_! l ..Ga act �Po 'elation
❑ Wean to Feeder ;- ❑ Layer
❑Dairy y
ceder to Finish ❑ Non -Layer
❑Non -Dairy
❑ Farrow to Wean
i; ❑ Other
❑ Farrow to Feeder
-tj� ,
❑ Farrow to Finish
y,.,
TtifaI,De§ign Capacity;: ,
❑ Gilts
" ❑ Boars
i
;,. TotaIESSLWt
's
,. , ,., ...,. . ,.
Number of Lagoons ! ' ` ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Areas
•
Holding Ponds / Solid, Traps : ❑ No Liquid Waste Management System , i,
i
�.
I - 3, i.. E< ,..
.. f 3�.:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ycs, 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 D�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes I�M
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ................ .......................... .................................... ....................................
5. Are there any immediate'threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ANo
seepage, etc.)
3/23/99 Continued on back

1FAility Number: • -• QS 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
ANo
(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?
O(Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
krNo
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
ONo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
VNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
t�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
XNo
16. Is there'a lack of adequate waste application equipment?
❑ Yes
;<No
Required Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
WNo
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
XNo
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
bqNo
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 review/inspection with on -site representative?
❑ Yes
bNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
P(No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
XYes
❑ No
�'�iQ yiQlaiip>js;op dirfceticjes -"re pote� d1x it}g �h�s;visit! Yop wi��eeeiye po #'u>E'tper
cor'resbofideike: abbuf this visit: ....:..:..::::.::.............::::: .
Copiments (refer to question #) Expla'n any YES answers and/or any recommendation or' any outer cnm is J!,
� ...� •
rc ,. �_..............t a...:i.... •...r:;.sa..........r...� ..:.....a......., �.........aa:a:,.«, i'�........�� ..i-.,.............:.i., .. N'.: . '1 .? la:.�...� r� i:.. <....."t�: d:.,.r...r., r.r� ' .r�
Reviewer/Inspector Name , 3 1 ' i IMI
� It
Reviewer/Inspector Signature: �� Date. r%• -Q�

r
" cility Number: — Date of Inspection
Odor lssues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Q<Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
C
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
�No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
�No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
o
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
o
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
AINO
Additi6nal Comxiients and/orraw1R�S:I,; , (� "'y3 S �.I"f ' tj s 57i 3 t :3:' I }i
1 1 A,
p �c
15 7� A� \ G e
3/23/99

q; Division of Sail a'rid Water"Conse'rvahon _Operation Revtew
i„ tti s [J Division of Soil and Water Conservation ,CoinpLance Inspectyon ,� r a T r�
I 3.
1h j t�� I in� ' �� - , 1 � -:: e rk t, s E '
! I �, ■{!{.=�WDiYision of Water alit Com ]ranee has eckion
'Tl' 1 �_ p
e leW`
D Other Agency Operation R v i }
.7,.- . �"
Routine Q Complaint. Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
1`ime of Inspection 24 hr. (hh:mm)
Permitted 0 Certified [,] Conditionally Certified 0 Registered JE3 Not Operational Date Last Operated:
FarmName:. County' f .............................................. 7............................................................................................... �l +.,�.
OwnerName........................................................................ Phone No:......................................................................................:
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address : ................................... .........................
.........
..............
...................
..........
....
.................................
Onsite Representative l"«-.eY,.G... .. � :. .... Inte};rator:............�..... .............................................
`... a... �........ ..............
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
..................................... .................................................
.............
Latitude E__1 • 0° Longitude • �' ���
Design Current Design Currerit Design Current
Swine t r �, �- �.., ,,Ca acit Po elation. ,Poultry,,. ,� ;, ,Ca acit Po utahon , Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
gL
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts I
t
❑ Boars
1 ElLayer ElDairy
[N on -Layer JE1 Non Dairy
❑ Other a
Total Design Capacity d,
7�L
,�,Number'of-Lagoons:: �, 9 h ❑ Subsurface Drains Present ❑Lagoon Area Spray Field Area
Holdrn Ponds/SohdTra s ®•,
g p ,; ' ❑ No LiRuid 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 DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d, Docs 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 IN No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [klo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes O(No
Structure I Structure 2 Structure 3 Structure 4 StriwLurc 5 Structure b
Identifier:
Freeboard(inches): ................................... .......................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [XNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: `3 — Date of lnspection
6. Arc 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 implication
10. Are there any.buffers that need maintenance/improvement?
11. Is there evidence of o er application? ❑ Excessive Ponding ❑ PAN
12. Crop type -5 ti" 19 . �Z
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24, Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0:Rio yiola�igtis ;or deficiencies mere pQte�1 cl�ring •this;visit; • Y:ojr :wii1•teeeiye Rio: furth'
;corres oricieirce: about this visit.
�) -0- we e..' eL \—
q
Reviewer/Inspector Name
Reviewer/Inspector Signature:
❑ Yes 9No
❑ Yes D<No
My
❑ Yes (LANo
❑ Yes "V'fNo
[]Yes CR No
❑ Yes O No
❑ Yes f rNo
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes K No
❑ Yes MNo
❑ Yes KNo
❑ Yes XNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 11;y No
❑ Yes No
❑ Yes ZNo
❑ Yes J�5 No
Jc-Yat...2v:
1A Z(441._ _�XC-4--Q
Date: Y -4
3/23/99

Facility Number: - d Oute of Inspection J 'X
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
[]Yes
liquid level of lagoon or storage pond with no agitation?
JkNo
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
O'No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, ctc.)
❑ Yes
o
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
TNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
KNo
3/23/99

,❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality'
h,
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Facility Number :5D Inspection
Time of Inspection i3:00 24 hr. (hh:mm)
Registered fN Certified U Applied for Permit 13 Permitted 113 Not Opera Date Last Operated:
Y
Farm Name ,o�nnv...... Sill' ik6..'........41.... °..I'.�:.................................. County: ..... Lu.h,........................... ............. .......................
Owner Name: .......... I�Am- �.................... ....'�!?1I.6.................................................. Phone No:...�`�,I��l...�q.�G'.-..�� �o.........................................
Facility Contact:.............................................................................. Title:.......
Mailing Address .....2o L...., bM.�,
ff............................................
.....
Onsite Representative: .... �p1=r c
Certified Operator. .................................................
Location of Farm:
PhoneNo: .............................
..... ..... &Wif.V.A.tk.... r Al ..................................... ..Ztiaw........
..... Integrator: ........kt.d�61.............................................................
Operator Certification Number,...J,!l. Ol ...............
rr-..�...an....na......... �r..Q.....S�i�....i7ali...�:...�....i1,rS��..........�P,...L�zA...................................................................................................
..etx ................ .......... ... .
Latitude 9 6 44 Longitude =• =1 =11
:.
Design „x;,.Current
,; �: Design Current Design Current .
Swine F` x
Capacity Population
Poultry Capacity Population;: €'Cattle Capacity Popalation
;. "
❑ Wean to Feeder
❑ Layer
I0 Dairy
Feeder to Finish
Z�
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Other
❑ Farrow to Feeder
y
❑ Farrow to Finish
Total Design Capacity
R
❑ Gilts
��;. ,
0Boars
��, Total
SSLW
�.
„
NM11umber of Lagoons I Holden Ponds
❑ Spray Field Area
❑ Subsurface Drains Present
❑ Lagoon Area
T
❑ No Liquid Waste Management System.
. .
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes �3 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 1�3 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes .p No
c. If discharge is observed, what is the estimated flow in gallmin? N jAc
4
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 56 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes V No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures fLaLoons,lfold ina Ponds, Flush Pits,_etcl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Structure 2
Identifier: 4 1
...........................
#�
.................................
Freeboard (ft):...........t,..,G...........................11..................
10. is seepage observed from any
of the structures'?
Structure 3 Structure 4
11. Is erosion, or any oilier threats to the integrity of any of the structures observed'?
❑ Yes N No
❑ Yes JE No
Structure 5 Structure 6
.......................................................
❑ Yes JO No
❑ Yes RNo
12. ,
Do any of the structures need maintenance/improvenent'?
$ Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
1
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
MNO
Waste Application
14.
Is there physical evidence of over application'?
[]Yes
UONo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) _
15.
Crop type 1S.SL.tI.!'r............. .... ruhVl................ ........ SUJxO..... A YUA .................W..�.Y...D[
Y4xiu.�..........
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMIT
❑ Yes
[9No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
5Q No
18.
Does the receiving crop need improvement?
❑ Yes
® No
19.
Is there a lack of available waste application equipment?
❑ Yes
K No
26.
Does facility require a follow-up visit by same agency?
'Yes
)(No
21,
Did Reviewer/inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
9 No
r
22. Does record keeping need improvement? ;i Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes [0 No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes S No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes 5M No
0 No.violations or de'ridencie's.were' note'd-during' this:visit.Aou.will receive no further
correspondence a4out this.visit:-
k. &,,-- axt&_ car\ to jmr S60IJ �4. Me,eJC�• E�ros.or` GvT �D.= V� L. eft PVOp 1,6jj tue 1JJU `
0 YtSt�t}4t1�tY d:V,. Well e4 t0.�oat� 1rrZ ��u�� p^t7k%�.
'Z7- s� r[co�s s6A be V-tt+ by rm f rt5er in.v"er � �t tJ3 rtvrt lamer 1 U V: j �aLVU1e-
0Z M6- r\\ kor 4„_. ri� v` bAvue.s CPACvE a4 tMs ,
7/25/97
Reviewer/inspector Name ' L;
4 ,
i 4
Reviewer/lnspector Signature: AW � 10 — Date: if rl4V

❑ DSWC Animal Feedlot Operation Review
;j[ZDWQ Animal Feedlot Operation Site Inspection y
•"
i<} 4 ` S ",. -1 fit` 3 t4
11MRoutine 0 Complaint 0 Follow-up (if DWQ inspection
0 Follow-up of DSIVC review 0 Other
Date of Inspection L
Facility Number
Time crf' [tlspertion 24 hr. (hh:mm)
Total Time fin fraction (if hours
Farm Status: [] Registered ❑ Applied for Permit
(ex:)?5 for l hr 15 min)) Spent on Review 0
Certified ❑ Permitted
or Inspection (includes travel and processing)
© Not C) �erati-onaf
Date Last ...................................................................................
.. ......................................
lOperated:
Farm Name: .....��'IM1`k�1� CMAX *..�..... `.�.:..�t. Z............................................
Count':.... �.�Isz....................................... .......................
OwnerName:....., .QY1h�k1�.....�kt*,........................................................................ Phone No:..,.t��i .,2.r �.? is 12.............................................
Facility Contact: ... jf.hytu�l�...... SM.i ir.................................. Title: .....
4W.new......................................... Phone No: 4..1V)Aq&-.&2_ ..............
1�lillhi] l�Cldl'8a5:...t ip!LX....Ul.....LA....... Fj.,r............... I ..............................................
��.ti.�Ql lk.>P....1.3.1/5�.......................... .......
Onsite Representative:.........A�Y1Y.. ......<s-th .at' - ......................................................
A ` j�
Integrator :.......��!111i.1a�............................... ........:..................
Certified Operator: ....... s�Qhxni.e1�.. ........... ....... ..�Mi..'�'�n.......................................
Operator Certification jNumber:....112-kQ....................
Location of Farm:
...L+ttS....... ram....... flit ..., � ......,..ail,.,.. �
................................................................................................................................... ,.
Latitude a I ©" Longitude ©0 C 7y?64
Type of Operation Design :.Current Design ,'Current { :°' . Design. Currrent?s°
Swine Capacity Population Poultry Capacity. Population Cattle:-, "Capacity, Population,
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
Numbet ,l'onds Z ❑ Subsurface Drains Present ❑ Lagoon Area [ISpray Field Area
of Lagoons / Holding
*:
General
I. 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. lf'discharge is observed, was the conveyance man-made?
b. if discharge is observed, (lid 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
m a i n to n anceli m provemen t?
4/30/97
❑ Yes ® No
❑ Yes M No
❑ Yes $4 No
❑ Yes iK. No
❑ Yes [i}No
❑ Yes JUNo
❑ Yes ' K No
❑ Yes ,® No
Continued on back

Facility Number:31 1 505r
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes MNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes $iL.No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lagoons and/or Holding fonds
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
Z $ 1.'1
.......................................................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes R1 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12. Do any of the structures need maintenance/improvement? R Yes ❑ No
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes P No
Waste Application
14. Is there physical evidence of over application? ❑ Yes CENo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............. -� e� SLvsr.....................................................................................U..0;4IJ........6lfi.&............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes gNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
%Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
K No
For Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
KI No
23,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
&No
24.
Does record keeping need improvement?
® Yes
❑ No
r1x1
4L. iSa arccs aw I oo,, # 1 s±041 6-e nsefj¢ . Etirosio,n �V' on (a3Go=,-� Z ley wyce
1 i � S6vu be �i 1 wL c.� °�Y rcCec�eci, j )IAW In✓ai 1 iOik
1+1 k (a 0" s 5k0d a 1� �e-
w�owCd. y y �,
(a, Ve5c ve. Gib -5�+ot��ra - 4 h'LpY VeJ
1A. 5�i" vccorjs s�n 4 bet 14 * �I +ri5erl+rur.
Reviewer/inspector Name
I I ).yam,,.,."
Reviewer/Inspector Signature:
Date:
ec: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention: # JQ
Facility No. 1- o
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _7" .X d 1995
Time: 1 C) 4 S
Farm•Name/Owner: ,D� Vln Sn'`s N /L_A�vl T C L T1
Mailing Address: 2-0 (a n `= S 1
County: - D V (;7 ` '^
Integrator: ir Y1 Phone:
, ' 1 � e
On Site Representative: �^ 1 o" se". T4� Phone: S�I �ct �? gall C,
Physical Address/Location: N_C S K _n a �_ O .4 w., ; Puri._ : y s.�J;� w
ocsR nao_
Type of Operation: Swine.- ✓ Poultry Cattle
Design Capacity: 1 a 4 Number of Animals on Site: a- DL _
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: _°" Longitude: ?I° �'_" 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) es or No Actual Freeboard: Ft. Inches
iWas any seepage observed from the lagoon(s)? Yes or�Was any erosion observed? Yes o No
Is adequate land available for spray? es r No Is the cover crop adequate? Ye or No
Crop(s) being utilized: % ,'I .y +_
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 0 or No
100 Feet from Wells?crropor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes oryVo�
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 olo
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 To
Additional Comments: ` ' cD 1 R Q
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

OPERATIONS BRANCH - WQ Fax:[phone] Jul 18 '95 12,08
P. /23 10 �
.. : is .'f.'• lr..,', .L', •..l .•• •Y'. _ ,
3j
_ __.Fac' Tumber. I
SITE VISITATION LORD: '
f_- DATE: 7 I'995
'Owner �]a' J lra .. Fatni,-Naine:
County:
Agent Visiting Site, • Phmw D
Opeiator: Phone:
On Site Representative: Phone:
Physical Address:: „ n: S Il o G W 17,1 _
Mailing Address:
Type of Operation: Swine ^ Poultry Cattle -_
Design Capacity: Number of Anixnals on Site:
Latitude: ° ' _ _" Longitude:
Type of Inspection: Ground Aerial
Circle "Y'es or No
r
a ,r oexythe Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
_> = ipproximawly I Foot + 7 inches) Yes o s F Actual Freeboard: f Feet _ Inches
w Q' for facUides with more than. one .lagoon, please address the other lagoons' freeboard tmdcr the
d omtY9euts section.
W, any seepage observed from the lagoon(s)? Yes o& Was there erosion of the darn.?: Yes crweQ-1
Is Wdequate land available for l.and application? Yes or No Is the cover crop adequate? Yes or No
7
Additional Comments: q •Y► .� # 0, AW__ .4/tc __A$tr0'_.1'1
. Fax to [phone] signature of ant