310587_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quaff

Type of Visit: erCompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 9-MO0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
,'Date -of -Visit: Arrival Time: Departure Time: ] County: Region:
Farm Name:. a/rit Owner Email:
Owner Name: _-,a-0e2d51 Phone: REGEIVEDMODENOWR
Mailing Address:
FEB 14 2018
Physical Address:
Wa lity Regional
Qua
Facility Contact: 72r�� �/y`%ff Title: �r{�/2. /` r�grs c ctioLl
Wilmington Reg!pnal Office
Onsite Representative: r ��� Integrator:
Certified Operator: j �u Certification Number: / 9` 'yf
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design arrent
Curren
Curren
ne Capacity
opo
Tin
;abaci Pop.
>attle Capaei op.
Wean to Finish
11
I 11-ayer
Dairy Cow
Wean to Feeder
lNon-Layer
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
1 ,
ign Curran
Dry Cow
Farrow to Feeder
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
he
Turkey Poults
Other
10ther
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes CE�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? . ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters -of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
KNo
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: /
Waste Collection & Treatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? JaYes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes B No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes ❑—No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[[ No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
®No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
®, No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
&LNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > m 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 E .No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0,No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes QNo ❑ NA 0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
❑ Yes [KNo ❑ NA ❑ NE
❑ Yes M_No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
allo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
f�qNo
❑ 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
allo
❑ 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
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5LNo
❑ NA
❑ NE
Page 2 of 3 21412014 Continuer!

[Facility Number: -M Date of lns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0—No ❑ NA ❑ NE
r
r 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f�3_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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ,�D No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 Reviewerhnspector fail to discuss reviewlinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [3 No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
Yes EjNo ❑ NA ❑ NE
❑ Yes �4 No ❑ NA ❑ NE
❑ Yes B No ❑ NA ❑ NE
[:]Yes ® No DNA ❑ NE
®—Yes �No ❑ NA ❑ NE
Comments (refer to question #) Exin rawings of facility to=betteany.�lES'"answerstand/ar any additional recommendations or a�resother conuneots
Use dr expla�o srfuatib�ls (use .aclditianal pages as necessary}.` ,'r,e
fe, rr�
drn1 �7o Su 'TO A7
w 1lrlo�-r up5� w ��leTT
7X
`3 ba c� ' \ ! j ' C
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: L0
Date:
21412015

Type of Visit: Q Com nce Inspection O Operation Review U Structure Evaluation V Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2•
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: 4 County: Region:
Facility Contact: Title:
Onsite Representative: �
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 17 Z � 5-
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C►urgent
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er I
Dairy Calf
Fe to Finish
arrow to Wean 9
frp
Design Current
I) ,ry P.oult Ga aci_ P,o
Dairy Heifer
Dry Cow
Farrow to Feeder
Non-Dai
Farrow to Finish
I Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
I LEI
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes E rNo,
❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection: 2. 1, i 6
Vaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes RM'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J S�
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 [D-No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [�_No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ErNo ❑ NA ❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 6 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes ff 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
LLJ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
[�j NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
E3�4E
18. Is there a lack of properly operating waste application equipment?
0 Yes
0 No
❑ NA
5/NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:]No
❑ NA
ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:]No
❑ NA
EJINE
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
CDNE
❑ 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
❑ No
❑ NA
E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes [:]No ❑ NA Q'NE
Page 2 of 3 21412015 Continued

Facility Number: - S Date of Inspection: 'Z
24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [—]No ❑ NA P-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 fait 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 concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes d No ❑ NA ❑ NE
0 Yes ENo ❑ NA 0 NE
❑ Yes ❑ No D NA I E
❑ Yes No
❑ Yes . E(No
Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to :question #): Eiplain any YES answers.and/or, any.additional recommendations or anyother, comments.-"
Use drawings of facili tytobetter ex lainsituations.(use additional, ©nalp pa
ges as necess'ary). -
CK
71
ey-rr- 110 1`. I C a'6-0 L`�
f bl� a- I-,(- le-4 / ^
Reviewer/Inspector Name: "/u" I �,i'4tii r(
Reviewer/Inspector Signature:
Page 3 of 3
L__� (0-. j�c4'�
Phone:
Date: 12 3-(2
21412015

(Type of Visit: (3Ciance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: p Title: Phone:
Onsite Representative: �.r- l7�/ f`^'��rYrl Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design CurrenI
Swine Capacity Pop.
Wean to Finish
I Design C*urrent
ity Pop.
Wet Poultry Capacity Pop. Cattle CapacWfa
La er er DairyCow
Dairy Calf
Wean to Feeder
FANon-La
Feeder to Finish
Dairy Heifer
Design Current Dry Cow
D $ou{t , C•_a acity P,o P. Non -Dairy
F
Layers Beef Stocker
arrow to Wean
f
Farrow to Feeder
Farrow to Finish
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?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
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 [3'No ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
0 Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ Now ❑ NA ❑ NE
❑ Yes ❑'N�No
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: - 3*' Date of Inspection: L
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [.�Ye's ❑ No 0 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): I I
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes © No Ll 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 environment -threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes j No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ YesFff-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 rNo❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E 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
Ej�qo
❑ 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
No
❑ 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 []� ❑ 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 EZrNo ❑ 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 �rNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facill plumber: - Date of Inspection: A 16
24tDid 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 0 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No Fj'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 4No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes o ❑ NA
❑ Yes
❑ Yes
❑ Yes
[� No ❑ NA ❑ NE
X�No ❑NA ❑NE
1:3 o ❑ NA ❑ NE
iw .... ., vu .....rvvw. ...�...... Q « .w.w. p • "r, , r
Reviewer/Inspector Signature: ` Date: /Z 3r �b
Page 3 of 3 21412015

N'vi'sion ofWater Resources
Fa tty Number `� 1 - Division of Sail and Water Conservation
� Other Agency
type of Visit: C�ompliance Inspection Operation Review 0 Structure Evaluation (:)Technical Assistance
�
teason for Visit: ('Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: O Departure Time: 1 O r County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Onsite Representative: P- ` 4 (IN °Te-e // Integrator:
Certified Operator:
Certification Number: j 9 Z,>
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry C*apacity Pop.
Wean to Finish La er
Design G�urrent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Fe er to Finish
arrow to Wean d Design Current
Farrow to Feeder D , P,oultr. Ca a_ ei t P,a ,
Farrow to Finish La ers
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Trke s
1TuTkelyPoults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0-79o­
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
aWas the conveyance man-made?
[a 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
F:(No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: IDate of ins ection: 25
71., 5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[—]Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L) t
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0"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
[3/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
E3<o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
IS 1N'o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E?-I"o- ❑ 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 E2'Na ❑ 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
0-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
Fj No
❑ 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
rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
'N
- ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
g/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
dNo
❑ 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
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E/No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: jDate of Inspection: Q 3
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 1=J o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes NNo ❑ NA ❑ NE
the appropriate box(es) below.
Cl 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
❑ Yes
Ej No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
'
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
10 ❑ 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
ff No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
EfNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F:] No ❑ NA ❑ NE
Comments (refer to question #/): Explain any YES answers.and/or any additional recommendations or any other comments.
Use=drawinss ot-faeility to bett& explain situations (use 'additional vases as necessarv).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 7 T G 7 34�
Date:
214,12015

Type of Visit: PCompliance Inspection 0 Operation Review C) Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: [ j / Arrival Time: ® Departure Time: ® County: Region:
Farm Name: W LL F—F} �- Owner Email: TT
Owner Name: I�N��t l i i , ! r f DCLL Phone:
Mailing Address: L Y' 1 K. Ht L_L f a lli� 1 N K. 141 LL %V e 9 ? 5`1d'95V"dr'--
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
M 0' y
9a�s
Certified Operator: � r � 1 O�i ��L� Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine C►opacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Design Current
Dr P,oultr. Ca aci P,o ,
Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Q
Gifts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
ill LI
Turke s
Turkey Pouets
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)
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Fac>iIi umber: - S'4 1 1 Date of Inspection: 1l
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 77J❑��� No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 9g0cw
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [] Yes "o No ❑ NA ❑ NE
waste management or closure plan? vvvv����
If any of questions 4-5 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �` �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): C -/jj
13. Soil Type(s): FQ /"1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes W No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes IA No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes bq No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WUP ❑ Checklists 0 Design 0 Maps ❑ Lease Agreements
❑ Yes XNo
❑ Yes X No
❑ Yes No
LIFY
❑ Yes )gkNo
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No
0 Waste Application Q Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers
Q Rainfall ❑ Stocking 0 Crop Yield Q 120 Minute Inspections 0 Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
0 Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facil' 1N6mber: '31 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes XNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes tA No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWIVIP? ❑ Yes No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
[DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES. answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
� A Lim iale� f 3
SL�Ap6 C
S,-A�uE
MON
5
C.IA�oor� R �-
SC, S J+aLk�D ZG /N Sooty
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C)Q —�fl[9-)-mz
Date: I q
21412014

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: `Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
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:I�L I) L'\
(
Certified Operator: HJVD L\ l y LpQ�L LC�
Phone:
Integrator:
a Certification Number: )9935
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultn3' C►apacity Pop.
Layer
Design Current
Cattle C►apacity Pop.
Dajg Cow
Dairy Calf
Wean to Feeder I
INon-Layer
I
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D . P,oul Ga aci P,o .
Layers
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Dischaarr es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes � No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes No
❑ Yes INO
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facia tyNumber: `z, - Date of Inspection: j
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 ' ❑ o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L44aocN
Spillway?:
Designed Freeboard (in): 17, J
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
[:]Yes *No [DNA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [3Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes , No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WUP QChecklists r❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
❑ Yes
❑ Yes
❑ Yes ArNo
[:]Yes ONO
❑ Yes No
❑ Yes No
❑ Other:
2l. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )A No
0 Waste Application Q Weekly Freeboard Q Waste Analysis Soil Analysis ❑ Waste Transfers
0 Rainfall Q Stocking 0 Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
o ❑NA ❑NE
Page 2 of 3 21412011 Continued

Faciljty Number: r - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
1 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 4 No NA ❑ NE
❑ Yes ❑ No RNA ❑ NE
❑ Yes XNo
❑ Yes IP-No
❑ Yes �No
❑ Yes ixNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any othericomments.. I
Use drawings of facility to better explain situations (use additional pages as necessary).
h ��z 4 - �l a a-F_� a
/v0 Spl�' �G= AS 5ooN A-5 el(' fl�Qc `��
m��� C
j9-�li4LL S � D4�s 8E�F
�„n,�,�uc, r�U� 1 s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q/6� Iq�j�
Date: 4
91
i GL
21412011

Type of Visit: . Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: // Arrival Time: Departure Time: CountyRegion:
Farm Name: �[tj aff e t— L F iz rm Owner Email:
Owner Name: Aa D LN M . Phone:
Mailing Address: Lp �/Nip I -A, LL 1Va Vr �J K i A i u . Nc
Physical Address:
Facility Contact:
Title:
Onsite Representative: 1q /V o �=A f ' ! U {t Q.- F- t— {-
Certified Operator: /qx c)Ll\ 1 > > • Q 2 (t C. C__
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
gal,
Certification Number:
Certification Number:
Longitude:
199`35
Swine acity
MG51
Wean to Finish
Pop.
Wet Poulmr.y(i►apacity P,op. Cattle Capacity Pop.
I 11-ayer I Dairy Cow
11
Wean to Feeder
iNon-Layer
I
EEJ
Dairy Calf
Feeder to Finish
Farrow to Wean Q
O
Dairy Heifer
Design Current D Cow
Drr P�oult , C_a aci_ P,o Non -Dairy
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
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?
❑ Yes
ExNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
tNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

i
Facility Number: jDate of Inspection: 919t!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
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): �«MLkQ lq
A 13. Soil Type(s): ro
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes M No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
0 WUP EDChecklists [] Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis Q Soil Analysis
❑ M&ste Transfers
❑ Weather Code
Rainfall ❑ Stocking 0 Crop Yield 0120 Minute Inspections 0 Monthly and 1" Rainfall Inspections
0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
9No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[DNA
❑ NE
Page 2 of 3
21412011 Continued

i
[Facility Number: ] - Date of Inspection: 9119-� III
24rDid 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 No D. NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes [—]No _0 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
0
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
7�
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:
7�
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.-.,',,',' }
Use drawings of facility to better explain situations (use additional pages as necessary). ..
/vu/ tU 0)(C_6_0) AN ACfLE INCP
�btA E �l I
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
G .qi
Phone:
Date: r(�
21412011

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: (�( O Arrival Time: ® Departure Time: County: Lt Al Region:
Farm Name: 1 ' '�Q-� E LC , �A a m _ Owner Email:
Owner Name:��t L Phone:
Mailing Address: [ 9 `t i Nl< <-At t-L Q_d ` 11V K OiLL./V(z D O s V_ � s1_4
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: AAo MO LC_ Integrator:
Certified Operator: '� Q�l`LL Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = c 0 g ❑ Longitude: 0 ° = { [� "
Design Current Design Current
Design Current
Swine Capacity Population Wet Poultry Capacity Population
Cattle CwV—ac i AF0,111ition
❑ Wean to Finish ❑ Layer
❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer I I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Dry Poultry
El Layers
❑Non -La Non -Layers
❑ Pullets
❑ Turkeys
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Other
inOther
❑ urkey Poults
ther
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
X'No
❑ NA
❑ NE
12128104 Continued

Facility Number: — S�
Date of Inspection 9jI G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: L4 6COA/
El NA El NE
El NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 50
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [3NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) A
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? 0
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 oNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;q J 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 kNo ❑ 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) Ce4457A L Fake MkD A 5 C
13. Soil type(s) FQ A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JVNo
❑ 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
ANo
❑ NA
❑ NE
Comments {refer"tq question""#}: Explain any YES answers and/or any.recomniendatians or"any otiheT comments
Use drawings of facility to better explain sit4ti6r s.'(use°additional"pages as,necessarv):
Reviewer/InspectorName m{aNpA ;�7 S g":=_" Phone:
ReviewerlInspector Signature: Date:
Page 2 of 3 12128104 Continued

i+acility,Number: j — Date of Inspection 1
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
X 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 0 Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ I/aste Transfers ❑ lynual Certification
Rainfall 0 Stocking ❑ Crop Yield El 120 Minute Inspections El Monthly and 1"
Rain Inspections 0
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
kNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
t(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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
FR
LA-). A. a
now
-qjn [1 > 1.1
aJi62l/6 o .oa
Page 3 of 3 12128104

Facility. NumberFacility.
J
Dtvisipn of.
vOtherAger
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up o Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: (y� Arrival Time: ® Departure Time: County:
Farm Name: &a-m Owner Email:
N1 /Yips) n ► i
Owner Name:
Mailing Addre
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator: (ME LL
Back-up Operator:
Location of Farm:
Region:
Phone No:
Integrator• nn
Operator Certification Number: d 3 5
Back-up Certification Number:
Latitude: o = = Longitude: 0 0 = 6 "
Design :,Current* Des
Swine Capacity;:Population Wet Poultry.Capa
❑ Wean to Finish 10 Layer
ElWean to Feeder 10 Non -La er
" ❑ Feeder to Finish
Farrow to Wean Dr Poul
❑ Farrow to Feeder Y. ry '�
❑ Farrow to Finish
[--]Gilts
❑ Boars
Other,
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
I
I Ej�
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood f
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
❑ NE
ElYes
tNo
❑ NA
❑ NE
12128104 Continued

IY cili#yllumber: 1 — 58 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ ``No ❑ NA ❑ NE
I Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 A4660,i
Spillway?:
Designed Freeboard (in): S
Observed Freeboard (in): 141)
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 XNo ❑ 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? )5
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below
❑ Yes / No
❑ Yes 4NO
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑NA ❑NE
❑ NA ❑ NE
❑ 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 types)[
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 (refert o questions#} Explatn�lany VES"answc and/or any recommendations or any other comments.
< ,
'Userawtngs�of�factlitYJOMeuepr�.explaTsin, use add itional.pagesjas�+necessary)• q .
- . 'i :�j •Y^ .t_s^JY ..� 1�S' �.A�. :i`ire..r"i!cf'?:37C-�.iOr:F.�'i'._
y'j a� a.oy ►. 51
140V
Reviewer/Inspector Name �' �} /�/ , Phone: /
Reviewer/] nspecto r Signature: Date: 9AQ
Page 2 of 3 12128104 Gonhnued

Facility Number: J — Date of Inspection
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 �No ❑ NA ❑ NE
the appropirate box. 0 WUP 0 Checklists 0 Design 0 Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes A No
El NA
El NE
El Waste Application El Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ 1)(aste Transfers'' ❑/nual Certification
Q Rainfall ❑ Stocking 0lop Yield 0 120 Minute Inspections El Monthly and V
Rain Inspections ❑ Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes 10 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Wo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes AN
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 1XNo
❑ 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
�XNA
❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes KNo ❑ 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 4No ❑ 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 fi�No ❑ NA ❑ NE
Page 3 of 3 12128104

0 Division of Water Quality
Facility Number rjg- O Division of Soil and Water Conservation
---- O Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: C] County: Ld N Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: i'7 ]U��i L' t 4 �� �LL Integrator:
Certified Operator: �lva2 �t �'.l ' + �� '��~� Operator Certification Number: j ` als
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = & = Longitude: = ° = i = ff
Design Current: Design Current. Design'= . Cu renC,`
Swine. Capacity. Population Wet Poultry `Capacity Population Cattle '" Capacity Population
❑ Wean to Finish
ElWean to Feeder
❑ Feeder to Finish
® Farrow to Wean
50
C00 '
ElFarrow to Feeder
ElFarrow to Finish
El Gifts
� ❑ Boars_.... ars
K: ❑ Layer
❑ Non -Layer
Dry Poultry. .
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharses & Stream Impacts
1. is any discharge observed from any part of the operation?
f Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Numberof Structures �gC
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 NNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
P(No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

p
f `
Facility Number:'j'j — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P(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: M
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 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
VNo
❑ 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 WNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ElNA 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 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I�No El NA [I NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.) 11
❑ 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
XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Q�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
� No
El NA
El 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.'.K
Use drawings of facility to better explain situations. (use additional pages as necessary):
�A2M L�t�S G Oo� .
Reviewer/Inspector Name r L, PING— S - � Phone: ���'� 3ot�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 j — Date of Inspection 1 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IN No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Cl Yes bo No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
10 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
hn
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
1No
N NA
ElNE
Other Issues
19
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
I� No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
1l
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
D No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
DrNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
F
Page 3 of 3 12128104

i
r
�r
[Facility Number 3+ $7
p'Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
F
f Visit 9"Routine
piiance Inspection O Operation Review O Structure Evaluation 0 Technical Assistancen for Visit 0 Complaint Q Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: o tS Arrival Time: I 15 Departure Time: County: 1)LVQTx) Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: A U112�W N1aItl�E t� _ Integrator:
Certified Operator:
Sack -up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: a o = I =" Longitude: = o= 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -La ers
El Pullets
El Turke
s
El Turke 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 Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ N ❑ NA
El NE
❑ Yes
El Yes
o ❑NA
ElNE
ElYes
WNo ❑ NA
❑ NE
12128104 Continued

Facility Number: 3 ( =j$'] Date of Inspection Oi
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L^LjgL.J i (5 fim ata
Spillway?:
Designed Freeboard (in): I ri _S
Observed Freeboard (in): S_l
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EJ 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 environmentalth
ElYes2No
o eat, notify DWQ
7. Do any of the structures need maintenance or improvement? [I NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes El 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 ElYes [ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E3/No ❑ NA ❑ NE
maintenance/improvement? ,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,1J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
❑ No ❑ NA ❑ NE
QINo ❑ NA ❑ NE
[�lo
❑ NA
[I NE
6Z❑NA
go
El NA
[_1NE
0 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 p Phone: %3
Reviewer/Inspector Signature: Date: I oIt ,IC o 1

r Facility Number: 31 —Sg7 Date of Inspection to
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes EJ 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 appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E4 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑,Ko
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑INo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[3 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?
El Yes
,�,�
L' No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
eNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El[2 Yes
,,��,,``
" 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
El Yes
,�,`
ldNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ea No.
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LI No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number 31
(Division of Water Quality I
0 Division of Soil and Water Conservation-
Q Other Agency
Type of Visit
pliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
7Routine0 Complaint
Q Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: p{e Arrival Time: �; �(S Departure Time: C] County: CTj Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: Aw7aRE_W A46(-u'_"� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 1 = u Longitude: = o = L = «
•Design Current.
. Design Current' `
Design A urrenta-
Swine
.Capacity Population - . Wet Poultry
p ty - p try
Capacity- Populatitin A Cattle :.-
Capacity Population•
❑Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
4
❑Non -Layer I
❑Dai Calf
❑ Feeder to Finish
_-
❑ Dairy Heifer
Farrow to Wean
1 O
Dry Poultry
El D Cow
❑ Farrow to Feeder
❑ Non -Dairy
i~'
ElFarrow to Finish
❑ Layers
ElBeef Stocker
W'
`:
❑Gilts
❑Non -Layers
1':
-
❑ Beef Feeder
fi
❑ Boars
❑ Pullets
❑ Beef Brood Co
_. _
—
❑ Turkeys
Other.
❑
I
❑ Turkey Poults
I
Structures
;
El
i
Other
Other ._-- ._- _ .._ ..�....�
Number of
-- -
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 WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�Nc
❑ NA
[-INE
❑ Yes
N0
❑ NA
❑ NE
12128104 Continued

s
:Facility Number: 3 —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
identifier: l A[ozori 6LO u44MVa
Spillway?:
Designed Freeboard (in): r .
Observed Freeboard (in): So '40+
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes C No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes L/( No ❑ NA ❑ NE
❑ Yes rJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LI 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 Ed/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/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) LGI) S "
13. Soil type(s) Y a4
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[allo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Dofes❑
No ❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
j��, NNo El NA'
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
VNo ❑ NA
❑ NE
Comments (refer to question # ): Explain any YES ,answers and/or any recommendations or., any other..comments.
Use drawings of to better explain situations. use additional a es as necessa
g facility P ( P g rY):
l5,} WEED CQi�1Z,oL E1=�olz.TS �.vi.0E►�i� , ��TS�.sUk �
LA) VASTE A0$W,gSXS LAPSf t'1W OOC to SAMFLk SKor TLn taa,r3 A062ESS.
Reviewer/InspectorName 36gtJ rAaXX tA_- Phone:
Reviewer/Inspector Signature: Date: 3

Facility Number: 3 — 5$ Date of inspection 3 d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑Other
❑ Yes [�/No ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard 13/waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
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
[i]No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[2/No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ 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
ONo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ldNo
❑ 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]"'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
E No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E N
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

IType of Visit oCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other Elnie Ded Access
Date of Visit: /O 5 Arrival Time: F[-(C-s-7crQA A Departure Time: nty:
Farm Name: Owner Email:
Owner Name: /-��,%oQ,�l.,l� _ E%Q/!� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _
Certified Operator: — /1A J Z217 X-L Z7
Back-up Operator:
Location of Farm:
ne No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
6
Latitude: = o = i = Longitude: = 0 0 ` = „
MaciSwin ' Design Current Design Current Design Current
e CaptyPupulation �^ �?�?etP.oultrY.�Capacirty Populon Cattle Capacity Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
❑ Wean to Feeder
❑Non -La er
El Dairy Calf
❑ Dairy Heifer
❑ Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Layers
❑ Farrow to Finish
❑ Gilts
❑ Beef Stocker
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
I
Other
m ❑ Turkeys
❑ Turkey Poults
R
Number of Structures:TI
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
❑ 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
Z No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
0 No
❑ NA
❑ NE
other than from a discharge?
1
12128104
Continued

Facility Number: Date of Inspection // O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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?: O
Designed Freeboard (in): i�. S -�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes /ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ 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 ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;eNo ❑ 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 ZyN o ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yeo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) l
❑ PAN ❑ PAN> 10% or t0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Winddoow� �❑ Evidence
eeloff Wi d Drift ElApplication Outside of Area
12. Crop type(s)
t�.l.�Ddt2s�n�
13. Soil type(s) )< deq -
14. Do the receiving crops differ from those designated in the CAWMP? ❑ YesNo ❑ 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 5rNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes UrNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes OrNo ❑ NA ❑ NE
JComm ents (refer to question #) Expfatn any YES„answers£and/or. any,�recomrnendations ar any„other!cotnnuents
Use drawrn s of fiat;/; to better ez lam situations use add�ttonal a es as n essa
JI:la ty P ( P, la
�� crG�"r �'F�C'PPczc�7ta.✓ .4tV 4J Je� < 3 p F.:sc�f,
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
121281#4 - Continued

r 4.
■
Facility Number: — Date of inspection / D
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes 9No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes )ZNo
❑ NA
❑ NE
the appropirate 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 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes /No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes �No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes VNo
❑ 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 7fNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes Ef No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection dial 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 p No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes i No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes /� No
❑ NA
❑ NE
IAd'ditionai:CommentsTand/or Drawin>rs. a'� ." . , w . s . �.._•.. ,y. h s'.)
-00
471
12128104

Type of Visit M70utine
iance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
acility Number Date of Visit: Time:
Q Not erational O Below Threshold
Ef'Permitted13/Certified © Conditionally Certified 0 Registered Date Last Operated or Above resbolth _ ....
Farm Name: - 1.:.. 0 rECAL A nJ11�� _ .. _ _ _ ._ County:. r. r. _ ... ........... .
Owner Name:
Phone No: .. .. _ ..
Mailing Address:
Facility Contact: __W_ _ _ _ Title:._ . _. Phone No:
Onsite Representative: M a 1�-9-LV _---_-_-_ integrator.
Certified Operator:
Location of Farm:
Operator Certification Number.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • " Longitude • 4
Dischumes & Stream Impacts
l _ 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 ❑
2_ Is there evidence of past discharge from any part of the operation? ❑ Yes 2Ro
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [ ' is
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4. Structure S Structure 6
Identifier:
Freeboard (inches): 3 O
12112103 Continued

Facility Number: 3— 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 maintenancerimprovement?
9. Do any stuctures lack adequate, gauged markers with requited maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
z.
12. Crop type L ,n^,)LL i �) Ff s co (? J) S�
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structwre, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes zo
❑ Yes
❑ Yes Not
❑ Yes ���X�00
N
❑ Yes
❑ Yes MIN911!
❑ Yes QNo
❑ Yes
l�
❑ Yes
[
❑Z's
rNo
❑ Yes
dyes
❑ Nod
Yes
No
❑
❑ Yes
No
❑ Yes
;C
❑ Yes
No
❑ Yes
No
❑ Field Copy ❑ Final Notes
��,
-TOe- �� x-s��
-�, C,
���A Q � ;
UVDA`T�G-
wof ro
swr:' �OCL
T,J —4-\I(- LA
Ue �-
GAO � � � rl _ - ����Cq
M u N�To��-tOG,
Am (z
SRr^Pcc roAX
Reviewer/Iaspector Name =-
Reviewer/inspector Signature:
Date: 7
MUM Ununum

Facility Number: - —5H Date of Inspection
i
ReQuired Records & Document-
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspe= fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
LAMES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes /No,
❑ Yes Z,No
o
❑ Yes
❑ Yes 0
fN'
❑ Yeso/
❑ YesfN
❑ Yes
El YesElYes
Yes ❑
❑ Yes
ElYes Now
❑ Yes �<7INjo:/
❑ Yes
❑ Yes L'J No
12112103

Ff
IType of Visit (2Mompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit 0 Routine 6Complaint 0 Fallow up 0 Emergency Notification 0 Other ❑ Denied Access
I S Date of Visit: 3 3 Q3 Time:
Facility Number 0 0
Not O erational 0 Below Threshold
Permitted 0 Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
r T
Farm Name: Kyy�� os 4 � 6 r� Crg' S Fa -,— County: �6 >04 /t V\e r �-
Owner Name: _ Ot 0 h� �_ra► rp' r� f "� Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Xt ' Li 6rl-E
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' " Longitude a 4 �K
Design
Current Design Current Design Current
Swine Capacity
Population Poultry Cavacitv Po ulation Cattle Capacity Population
❑ Wean to Feeder
1 10 Layer I I , ❑ Dai
❑ Feeder to Finish
1. JQ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
-
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gibs
I
❑ Boars
Total SSLW I
` Number of Lagoons
. ❑ Subsurface Drams Present ❑ Lagoon Area
❑ Spray Field Area
'Holding Ponds / Solid-Tra s
g P
E:. [] No Liquid Waste Management S stem
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? 0 Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier:
Freeboard (inches): 3%
05103101 Continued

Facility Number: 31
— Sg7 Date of Inspection 3 31
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
'Ps'aste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA\VMP)? ❑ 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?
Reg'uired Records S_Documents
17. Fail to have Certificate of Coverage &: General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ %k UP, 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 notifi regional DWQ of emergency situations as required by General Permit?
(ie! discharge. freeboard problems. over application)
23. Did Re%dewerninspector 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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes,.ETNo
❑ Yes ❑ No
❑ Yes ❑ No
113 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
Conmeeats'(refertonesmn - EiP_ -_ Yan_s pEry rec�mmendatons. or any othccommenaay�wr:
. .
Lse drawings of faefflrty to better explain situai ttops. (nse addrttonal pages as necessary) _
ar° m d ❑Field Com Final Notes „1
m., _
r cSpo�a[�t� a q 17. 1 r. �ra� �� GiC ��✓c Yf 4 f'�c yr,S T��T
vve-s'l c rundA.0y 4CZ_of✓cal. S;"f/cr and fr'cL) -eS
Reviewer/lns ectorName_•�;—�--.5..
Reviewer/Inspector Signature: Date: 3I 03
05103101 Continued

i
Facilih• ,Number: 3 j -$ 7 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 permanentitemporary cover? .
Additional Comments and/or Drawings:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
El Yes El No
❑ Yes ❑ No
❑Yes El No
El Yes El No
O5103101

Facility Number 3 S Elate of Visit: q l Z- Time:
10 Not Operational 5 Below Threshold
© Permitted O Certified M Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: IKo'i De 6 r"A Feel'-'"'` County: D VP�►"1
— ff V
Owner Name: `' �° C rlo CroO. Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: ^y�PS S Q L`/ G� i c� Integrator: -pr¢ 3 j eul e
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 0 `° Longitude
Destgn Current _ n
Design Current ;: Destgn = Current
Swore: _.
Ca acih Po ulstton -`Potsttrr
Ca acrtr aesti ' Po ulatton'
-Pa ulation Cattle__. mCa
A ❑ Wean to Feeder
❑ Layer
❑ Dairy
[] Feeder to Finish
i
❑ Non -Layer
❑Non -Doi
❑ Farrow to Wean.;
a ,
(] Farrow to Feeder
❑ Other
❑ Farrow to Finish
_ w
Total Design Capacity =
❑ Gilts
❑ Boars
:_ Tota1Is
Number of l,a otitas _
goons
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdtag Ponds/ Sold Traps'
�-`'-•-���
l� F W ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes '�'No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c_ If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 17 4;y e 1;mcG ►'✓<
Freeboard (inches): 3 [p S
05103101 Continued

Facility Number: R1 — ,5
Date of Inspection O-
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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADolication
[:]Yes ONO
'4Yes ❑ No
❑ Yes ONO
❑ Yes ONO
Yes ❑ No
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ONo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
12.
Crap type Ae f ^+ +/dG Pn S 4 e 5-A-tq 1 60.1 d n . r e 5 ew e po! 54 V
JUNo
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?
Eyes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
I5.
Does the receiving crop need improvement?
ZYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Re uired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
j�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.)
Oyes
❑ 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
ZNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
`Yes
❑ No
23_
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Cotnmeots _
.. (refer to questtoit #) E>rplairt any YE5 answers and/or aay recommendations or anv:ather oommentsr-
Use drawings of fartliry to better explain situations '(use addttronal;'pages as neary) ❑ Field Copv TT ❑ Final Notes
tj� The i�ac};.rc lo�cfaaf., kns aboui F;ve 1rc1-,0S OF �'reeboa,�d .You heed
1, --o ec :X4 11 ' -'et o f e het Ii -TC ttef, OP {� ee be" -d 01 4i c
1
1�taC,�-i•/e IaL:9eC�. Y,Lt ►jeer -4O lower 4tje %agda1'% �t'G%t/,'C� �eve�
6 y q�o l y ; �l� 014 6X9 rvno► ; C rqq es 1�� � Ott �'� e- A r , d n 44
n'L41+'l�'1 �a
res�o,.� s , b I e -� �,el y ¢ l' Also 41, y c�h ��� d s 4e0 6c .
cc.A�nfed �'�►, r'-n e wct4a
-
Reviewer/Inspector Namee��ba�at����'
Reviewer/Inspector Signature: Date: 4Z-
05103101 Continued

' Facility lumber:
— Sg% Date of lnspeetion
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
❑ Yes ] No
❑ Yes 'a-140
❑ Yes ❑ No
❑ Yes ❑ No
'Additional Comments ,att or'Drawings: �- . ,. _ - �_ .. _ � � �. �. -
-�� CKOV%
1 ? • C e ✓4 �',< ► c 44 e o C Go v e --gat g e A., '%'SGleC�,'.1�
��e C.j-1a � jrl v��'r'a�,'oY,-���e lu;r beams ;s��ed , b&4 -01e
6� • � � ,/
l8 • _ -li a Gt/ct 54 e f let Y, d •, S �'4e. t S ,r r � Z' f �a .r-,�w 4p
The w,,jfe rt�th �'�f 44e /r%5D 5c vew,&Lv 4¢ t.�lear� o na4;e-L
i7Qeeys 4, 6� ovi -r '-�e . Ake, lagoo" des' &i �+'!�'of+"tA�r'o� `+s ►'Ieed<zAon-roc
1q- A W&tic otereS 'o -% #7e✓%dS 4o 6e dele -fat- 44e
�f 67 a I ve? �ti°il� 4e-rti ✓1�L�t� Ve-C,'a%,W . -7�,Q Loe46E/C
4,eee(j •fe be- s i y n e/jt A''?�-f SYIi m •' _
-T-he 1,Ve#ab1e olcfeS Pleads --14i v+C-RC-e'-J -Ae opel-6,410z,5- a4 llile
Fc r'-, roc in a 1 4I e vse af' ,ee t I ) P e 05 - A ke, -/A e (/V,-,s~le
PI,Ptl t n Cf -�o wt ;-%den q ccd.tc(,'n9 �o Mlle we�ia�l gores
Ufvek-t
Cq 16041 �� ��,j , MZ)19, q rtot �3��,; � flaLn vleeolS �40 va 1e76le
40 &e d6ne Gc C&or4e,wM4 46e bve04!S1e acm-c, I'VaS4 fk'-1)
b pe /i r "-4 (,, "e n41 y , ��e 41,c- apcc )c , Xac o l-d 4e,-
-� he ��Y e r K,�dcr t4418 (ot St'tat.,. s 11, t q cte s � b ✓-I -fie wti S� P �la+-�
ta,34s 4 kvc —, Aa - ot 1-lo4a 1 er 6 . /Ot c
tq. liem To 6e sure- 7d vSe et Uv,,s-1Q )et►,afy;s de ,-4 w,+inn hodq ys
P / 0. � 1 ° Cq } �G' + eVe✓1 � s -{o ced c O4 4 � 44 c n1'q r\O C" qf��P
a" -ltt e
;-�
�'�y h q qrl aP�1;Caa;o�eve*-rat. J sLro�tld rlsP JSc�
.4 z poi 4 e beg ;-r✓1 > -j a e Pi -Ae<Gee
ct s P�4 ✓ ► ded �� ��e lv 4-51e lcz�Cts�"' f�le�e
capY o�^ct t w�s-le a �-ta1 ys/�;1 po JJ' ;stead o.F -{� �'►-,� -,+ie pc�e i'? 4gAo.
S cAvino-� Ve'r ►��J deh 4."e"t, .5,TAwle lP pa5e ;S -le,eL - Gort�. n ✓Qd�
r

Py5 e /
Facility Dumber: � — 9-7 Date of Inspcetion R ! 01
Odor- Issues
26. Does discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/ elow ❑Yes ❑ No
liquid leve aeoon or storage pond with no agitation?
27. Are there any dea als not disposed of properly within 24 hours? ❑ Yes El No
28. Is there any evidence of win during land application? (i.e_ residue on neighborin getation, asphalt_ ❑ Yes ❑ No
roads, building structure, and/or pu " roperty)
29. Is the land application spray system intake ocated near the liquid ace of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ven - tion fa 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 a priate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged ipe or a permanentitemporary cov ? ❑ Yes ❑ No
Additional Comments:a ©ra*cin s:,`, _ -
4, 4A,- abo14-2 O✓t ILle
Wgs�� gr�4�lr sus J a lov'n p-tr , kq4 does ho� show da-k t0-- Woke
Ana f,s , -foll v<lve off' 1.0 1b.5
tool
440 ,-C vy'--ty�4� mid OG�abe-�Yap�l►"cq-};d.� as welt Gus
��'�(� 'w; �, �c�, 20o z a�P 1'c��1 ans: -�T�P ..�.✓- 'he a n.� l�s it Cav1�c�
21. Rn., C,"a" :s >� S�C4 aS 1�e apefq,',-7 enti^-q e .
ALLY �, Se . 4 r+$ Gja4R✓—kkCj✓✓� f2-ev1 C Ag.i
is oie4 -Ae neees54av y dv4i<5; or qn ole.'a4✓ in
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a •-e 54 :11 O'r -4 � F s ✓+mot 1 �2r �e �w1 vGi��i -�; I! -�12�
heaoC 40 vta-/e Ae beam vdc,
-r;ela( ,apJegr-F 40 tiove s,o'v?e eaY" e4 -4oa 1' Jpleo to 1 ,/e
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A J dad r OVC ,--e�t• a te,01.-44 4n Ac--Se r1�eO-r. 71 W
9 A -v n >^kc��- I1 S 1 nee- f4eot � h "r��t o i ►,\el Cry' o Ot ��o
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zz JT e 6,ici.n,�.-� �orl geJ, o^CJ) 4{r"C_s needs 1�Q be n4'-F;124
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05103101

)Zbivision of Water Quality
vision of Soil and Water Conservation
Q Other Agency „
ERea8son
of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit- line: Printed on: 7/21/2000
Facility Number
0 Not Operational O Below Threshold
APermitted © Certified © Conditionally Certified [3 Registered Date Last Operated Above Threshold: ..........
Farm Name: ......... C.P,&...I.-....... ^r.-.�.................... County:....... .C. yl 11
.....................
- ....................
Owner Name: „4? •5.f�' ........��Y .... .................................... Phone No.. .................
FacilityContact: .............................................................................. le:.................................. Phone No:
Mailing. Address: ............................................ ............. ........ ......................... ..............._..................... I ............ I. ..........................
Onsite Representative: . ...........
... ....... Integrator: ..
{/
................................................
-
Certified Operator: ................................................................................................. ... Operator Certification Number:................ .
Location of Farm:
16 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° Longitude �• �� �
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
arrow to Feeder
2--
El Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer 1 JE3 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lag—n Area ID Spray Field Area
Holding Ponds / Solid Traps JED No Liquid Waste Management System
Discharges & Stream Impact~
I. Is any discharge observed from any part of the operation? ❑ Yes WNo
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. II'discharge is observed. what is the estimated flow in gal/min? 1y y¢
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 Rio
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
l c,
Identifier: ......._.•L((J..................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Number: — Date of Inspection 125 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Elo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? 0—Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge'?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
::I NO-yioiatidfis:or- defeieucies were ngted during �bis:visit;- Yott will•reeeiye ino further:
.. ....
corresp' oridence: abo' ut. this visit.::::::: :
P
❑ Yes 'E(No
❑ Yes JCR�4o
❑ Yes )RI_No
❑ Yes KNo
❑ Yes 0314o
❑ Yes 'L�fNo
❑ Yes -E3�No
❑ Yes No
❑ Yes o
❑ Yes &�No
❑ Yes J;a-No
❑ Yes �No
❑ Yes 51No
1fYes ❑ No
❑ Yes �fNo
❑ Yes �No
❑ Yes -No
❑ Yes J;Z No
❑ Yes N,No
❑ Yes EYN- o
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):
1),q
S � � f2 (�
.,� + S
�o
Reviewer/Inspector Name i [, �e YV' [,-V {
Reviewer/Inspector Signature: Date: / 0 UU 5/00

Fafility. Ni mber: - Date of Inspection EMZOUJO
-31
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes �No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes RNo
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 JNo
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 TIO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes F�No
d tion ' bentnents-*an or rawmgs: �r
[ems--��-�- ----
sr5 . J r , CV, o �.J�� t ic_ c- 40
Cry�
OL, r t Ow, LZVJ-1
ttm�
�Yv-g
ram ,
V-) V-P ,ram t '� —' ""0 .
-�) r I -t- , "- ,
i4y T�
G`
tFW P%IL�
3/23/99

. Drvisioii of Water Ouahty
0 Conservation
vision of Soil and -Water C
w�
I Other Agency
.,
Type of Visit',6Compliance inspection O Operation Review Q Lagoon Evaluation
Reason for Visit XRoutine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Date of visit: 5 Z3 Time: F1330-I Printed an: 7/21/2000
E: Facility Number
Q Not Operational Q Below Threshold
13 Permitted © Certified Q Conditionally
/Certified ❑ Registered Date Last Operated or Above Threshold: .........................
Farm Name: ............P, O rt � I 1 �. r �i C�� A 1 �t r"1 County:..-.................................................................................. ..� O n...... ............rr ............/... ..
OwnerName- e F7 r�1,I'Ot Phone No :........... .. .................................. ..... t.......................................................................
FacilityContact: ........................................ Title:................................................................ Phone No:...................................................
MailingAddress: ...............................................................................--..--..................................................--........--........--..................................... ..................
Onsite Representative: ,,d�'1 C�..(�.e.S.'�e.....r'.�].--....-.. Integrator:f eS4ItC t
..........I....-. ...1 J ..... .............. ................
Certified Operator „ „ Operator Certification Number: ..............................
Location 'of Farm:
,pj Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 66 Longitude • 4 ��«
Design Current
Capacity Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
jig Gilts
Boars
Design Current Design Current
Poultry Capacity Po ulation Cattle ',"'Po lion
❑ Layer ❑ Dairy
❑ Non -Layer I I 10_Non-Dairyl
❑ Other
Total Design Capacity
Total SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. 1f 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 ; Structure 4
IClCntlfiCr:..I�.r,,i-� y e `� ve
// ...............� �:............................................................................
Freeboard (inches): 2-4J Lq
5100
❑ Yes ,ffNo
❑ Yes 2"No
❑ YesIz"
r] Pi
❑ Yes
No
❑ Yes o
❑ Yess�No
xffryes ❑ No
Structure 5 Structure 6
Continued on back

Facility Number: . — 87 Date of Inspection Q/ Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes J�:rNo
(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 tnaintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
` .-Iste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding PAN ❑ Hydraulic Overload
10
12. Crop type 15e rM t,af a r-io/2n sJy re 1 Fe__ SGu e FkS4 v ✓an/
❑ Yes'ZNo
❑ Yes,dNo
❑ Yes.1dN0
❑ Ye�No
Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Ye 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? ❑ Yes10<o
16. Is there a lack of adequate waste application equipment? ❑ Yes�No
Required Records &_Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Ye�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
o
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 (Vo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes
zeeNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes P<o
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes TO
24. Does facility require afollow-up visit by same agency? ❑ Ye/s�L (
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes a
1a••volati6 ser &r1ciehc{es-were hated- &ig Ns'visJC- Yoi� 'Will fW futthr • :
cories Bence ahaut this visit
Commentser,to q stton #) Explain any YFS answers and/or any recommendations or any outer comments Y x.?
Use cEt ar of facility to',better eatpla in situations (vse addtt,oaal pages as necessary) � �
i 1f-
-. 00 n
1 _P) e-v"e IA/c, S Sor-tc_ a t> 2 rasp GR� e-� ►� i -� �a�t o ►, 4e z000 - zoo f
Smq tl qr4, h, crof . Y ] 1 ]
_G ke s-a i� .Sciw.p��S ?rnt a�l �'; e ids. �SQ a� inlGS 1e q nary J ��1 L°�I �11r'tzt:71
4 kejj r."'a-jfe �s� l of &vex 6Xs �a knot,,, fi
1 S be-t ^g sff-o' E9 r dr T4 Sera 4� (�vl
Reviewer/Inspector Name j g
Reviewer/Inspector Signature: Date: J� Z.3 % 51M

Facility Number: Date of Inspection S/7 3J printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes IRWo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ YeSXNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ YesZNo
A 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,,ffNo
31- Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )dNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
lAdditional"C-ornments and/or ravings:
be -ru re, 4e Use c, sefe .- 4 e -L R9 - 2 L L, c roPD; k - A, I .J
iS- ca�,�S�Ve eieX, 1�f JQ i��Q vG q�e h�Lk �,,UGig riG��•
fTr pravcr-�eqs ti-/-ve bee►-' ol"tete -�o bec�c bey- v�� el� and
I ej oon S;r�C2 M�''r 5-� 1/r % s, 6000 wor
5100

h
i­
0 Division of Soil and Water Conservation (3 Other Agency'
Division of Water Quality fx�
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Date of Inspection a--( �$
Facility Number
Time of Inspection EGU 24 hr. (hh:mm)
0 Registered Alcertified [3 Applied for Permit © Permitted 10 Not Operational I Date Last Operated:
Farm Name: ... ...✓.G....1..4 ..�� Count `
y ....Cr .�..�i-,...............................................
Owner Name:....... d ... ............................................................... Phone No: L 1v 1��� L............�.................
...............qr...+............
FacilityContact: .............................................................................. Title:............---........j.---....................................... Phone No:.....1.1
\N MailingAddress:.. g �L � 1,1. ' `�� ................ .................. ..--.-- ................�-- Into rator:..
Onsite RepresentaEive:.'.^:2........1..:.�..�;& ....... g �............_...�...�'_.........................---�
Certified Operator:............................................................................................................... Operator Certification Number;.........................................
ocat' n of Fa
nt �Q nL ...........
Latitude • 0' " Longitude 0` ' o «
€EQ Design Current'Design.',.,CurrentDesign
Current
"Population
�Capacity'Po p'ulation
; Poultry Capacity. Population Cattle Capacity
a Wean to Feeder❑
Layer ❑Dairy
FE01Fe eder to Finish
N ❑ Non -Layer ElNon-Dairy
Farrow to Wean
-
k Farrow to Feeder S"
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑Gilts
Boars
Total SSLW
LL
Nember of Laganiis f Haldng I`flnds
ILI Spray Field Area
❑ Subsurface Drains Present
......
❑Lagoon Area
......
y _
`
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
P,No
2. Is any discharge observed from any part of the operation?
❑ Yes
UNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
W No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gaUmin?
`\ k
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
❑ Yes
CR�No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
1(No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
E�No
7/25/97

�'' Facility Numher: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures Lagoons.HoldingPonds, Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: A —
Freeboard(ft):..........241................................................ ........... ..................... ....... ............. I.........
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(if any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes ONo
❑ Yes
C�No
Structure 5 Structure 6
❑ Yes
1XNo
❑ Yes
[ffNo
N(Yes
❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
I4. Is there physical evidence of over application?
(If in excess olf_WMP, or`runo a tering waters of the State, notify DWQ)
15. Crap type ��J...........`.............................................................................................................................
�!
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20_ Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22, Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0' No.vidlatioits-or deficiencies. were -noted -during this;visit.- Y.oa:vKiii eeceive' nil&ftiri er
:.:: c0frtspondeikie 6bodt
❑ Yes 0 No
❑ Yes [2(No
❑ Yes allo
❑ Yes MNo
wxYes ❑ No
❑ Yes allo
❑ Yes M No
❑ Yes O No
Yes ❑ No
❑ Yes VfNo
❑ Yes 12l No
Cl Yes U(No
Ilk
f 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: to 3

x DSWC Animal Feedlot Operation Review
j; MDWQ Animal Feedlot Operation Site InspectionM.
s. 'F
® Routi6e O Complaint laint O Follow-up of DIVQ inspection O Follow-up of DSWC review O Other
Date of Inspection 111 IT V
Facility Number 3
2f �—=� I Time of Inspection � 24 hr. (hh:mm)
13 Registered ® Certified E3 Applied for Permit © Permitted 1E3 Not Operational 1 Date Last Operated:
Farm Name: ..11................................o... "C.--.-- a.x.. ... . .....4!'! County:..
Owner Name: ............. ES.C,�. ..............
...T.c).. !�..P.:S�................. ,.. .................... Phone tio:..�.�!..�.v.�... �q.�(..-�$. �.�.......... I..................
Facility Contact: . Title: . Phone No:
MailingAddress:..... . . ...... ...... Hn..0.... [LEI .......................................... ....e..ti.,n.`' ..... .j..N.�...................... .Zg.,9-1Z.
OnsiteRepresentative:.......................................................... Integrator :..... ?.Y7t5-f....................................................
Certified Operator,...Fj.ta.b.-Ja.� - ._..........s%a.n..I..................................... Operator Certif;cation�Nitmber,.....1-i..h?$..�i..............
Location of Farm:
.t..lqn....,Q.�.j.L......�.1.p1.L..... `.. ....... .. .. ...i..(�..�......CS.. ..p...Y7a` -. L.SC7�S.�... .. .....�..:..•d. .....KY.S.L..rr..b....... ........ p i
�.rs,e.t......Y'.'. . ..... ........1........................................._........................-- .--................................................................_................. .
Latitude I illje I LI i` 1 7-1 1=` Longitude 1 i j I• I Li Zc'j1 1 3 j;J°4
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design„ Current,.
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
Jl ❑ Non -Layer I Nan -Dairy
Ell
❑ Other
Total Design Capacity 6 2-
Total SSLW 3 2 S Z Z $'
.. .... ... .... ... ... ....
Number of Lagoons./ Holding Ponds 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Sprav Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ' [9No
2. Is any discharge observed from any part of the operation? ❑ Yes F4 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes CgNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify- DWQ) ❑ Yes & No
c. If discharge is observed, what is the estimated flow in gaUnlin?
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 DUNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes MNo
5. Does any part of the waste management system (other than lagoonslholding ponds) require ❑ Yes 2fNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of deli-n? ❑ 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: — 5S
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes § No
Structures (La oons.Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (Freeboard plus storm storage) less than adequate? ❑ Yes lig-No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
............................................................... ....................... .................... ................. I................. ................ I.................. .......---.....---.................
Freeboard(fty .....2.. z-1.5................................ ................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes allo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes PS No
12. Do any of the structures need maintenance/improvement? ❑ Yes C3 No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Application
14. Is there physical evidence of over application? ❑ Yes XNo
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type..%a-t.Mrt^.v:�.�................. !L4.,I.,��................�,az.. �---...-�---.G-¢.✓..h........-.....-.............. ...........................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes RNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ® No
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations or. deFcienCies.we' noted during this, visit.-.You'wiil receive -no further
cofre*)hdence about this'. visit'.,
J Yes ❑ No
❑ Yes El No
❑ Yes ® No
❑ Yes AR No
R[ Yes ❑ No
❑ Yes 10 No
❑ Yes Ej No
❑ Yes 04 No
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Q (� „ ,�;�,�,�� Date: i 17

Facility Number .3( Date of Inspection f f
Time of Inspection 24 hr., (hh:mm)
® Permitted © Certified © Conditionally Certified E3 Registered JE3 Not O erational Date Last Operated:
Farm Name: ................... ®. hG 5.....P0, r !G +' q / +'h(ounty:.............-......-...................................... .......................
Owner Name :................�O LL6 �1 Ul— Y)t- S
............. v........................................---.......---............I..................--- Phone No:..............
Facility Contact: ........................
................. Title:
Mailing Address: ...................................................�.............
Onsite Representative 13Q .. Vo►'1CS
.. J...:..............5
Certified Operator: ................................................... ............
Location of Farm:
....... Phone No:........
...............................................................................
Integrator:
........... �. ...............
._. Operator Certification Number
..........................
r.............. ...... ............... .................................................................................................�............................................................ ............ .......
.........- �.
Latitude • �° Longitude • �° ��°
- Design Current
` Design* -Current - ; _, Design Cuireiat -41­
Swine. Ca acity Population
-_Capacity, Population Cattle Capacity Population-:'.
` ❑ Wean to Feeder
❑ Layer ❑ Dairy
❑ Feeder to Finish
- ❑Non -Layer ❑Nan -Dairy
❑ Farrow to Wean
Farrow to Feeder 24
❑ Other _
❑ Farrow to Finish
_ - Ttitai Design -Capacity
❑ Gilts.
=.
❑ Boars._
, = _ ..- . Total'-SSLW
Number of Lagoons-- ©
❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray Field Area
Holdrng;Ponds / Solid Traps
rt = ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes J.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? n q
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes XNo-
2. Is there evidence of past discharge From any part of the operation? 1 29 Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P9 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes iK No
Structure i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches). .......... N. ................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IN No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31 - 87 Date of Inspection
vw
6. Are t(tre structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there -evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type ^XV4k Co4_1-roj 6r�a?e , Ge/­MVcjC, 4a-Vj Fesc.Je
- r
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?
Rectuired 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: Io violatiotis:or• deficiencies mere hated diWi ig this'visit' • Yoh will ree6y6 fio futther
.. correspondence. about: this visit. ...
1K Yes ❑ No
❑ Yes §4 No
kYes ❑ No
❑ Yes JZ No
❑ Yes JO No
[:]Yes ® No
❑ Yes OgNo
❑ Yes ® No
❑ Yes No
❑ Yes It No
19 Yes ❑ No
❑ Yes IR No
❑ Yes R No
❑ Yes :9 No
❑ Yes VNo
❑ Yes IN No
❑ Yes X No
❑ Yes X No
❑ Yes I@ No
❑ Yes 16 No
❑ Yes JO No
Comments (refer to'. ueshon # E � W lain an -YES answers `antl/oi- an recommendations oran other comments` _ q } Y Y Y
Use drawin of facih to Better ex lain --."situations. ,(use additional' p g 1•Y)'a es as necessa . � a
2. Tit a re a p G o r5 - o be so ✓►n a t..,tot 54 e i rl 411 e s4oe m trva-� er d rq, I V1 9e #
di,FcLl he,-- 411c Ji,,) hottseT, WO sc,"tPfes bv;[( be,4et "
�. There i-r Owl 0161 letocon Oh 014-u . P-ei.-oier' 54 5 wQ<4e' ko_ S
"64 b e-e`' l r ldtGeo( , n +11 9 lagoon ;h e&0(4-% 5"1)c Gq r4r,.
-HI-q qle, pile re �hqM year a 14sk�ui� be reMoycd
or tl''ilr ed. 54,,4;onar sj°c'tklev' P7 _<kelc d be
W o v k 4 b rdrne ve 4l a eet f at nd 044er 9 ea s se s
Oefmada qc -%,Ad swtali Se,^ri► vdc4 c,,4ee1Jcd 6ve.zC �►'�Id .
ReviewerAmpector Name -M rQ:
Reviewer/Inspector Signature: Date: s
3/23/99

Facility Number: 3 - S87 Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes A No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes M 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
A 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 ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �M No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 9 Yes ❑ No
Additional.Comments and/or Draw n
a c,'M ud e, C,0,1 ,,0 ll aol C-fq 2-e -r, dd ned s
- HgVe wQ.s-'�e �lan vrat a / /eC weft ed elcres ,
3123/99

Site Requires Immediate Attention: , Va
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: b 1995
Time:
Farm Name/Owner:
Mailing Address: / fv//,�_ 1
County: 1 d'PZ_! -
Integrator: Phone:
On Site Representative: = t Phone:
Physical-Address/Location:
l � ll.� �• � l Lam- � � �.
Type of Operation: Swine Poultry Cattle `
Design Capacity: y To LcJ Number of Animals on Site:
DEM Certification Number: �ACE DEM Certification Number: ACNEW
Latitude:° -' 0 77 Longitude:31" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches)(9r No Actual Freeboard 3� Ft..6Inches
Was any seepage observed from the lagoon(s)? Yes r N Was any erosion observed? - Yes r No
Is adequate land available for sp y? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:'�l��i
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e' r No
100 Feet from Wells es r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters oLthe state by man-made ditch, flushing system, or other
similar man-made devices? Yes r N If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:�c��C t;lt'l
Inspector Name Si
cc: Facility Assessment Unit Use Attachments if Needed_
If