310612_INSPECTIONS_20171231

'Facitity Number ( -
UDivision of Water.Resources
4 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: C=outine
ce Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Q Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: r f Arrival Time: j0 [3a Departure Time: J p County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
71 arrow to Wean z 90 p!7
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude:
Phone:
Integrator: q
Certification Number: —7— 7/
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Laver
Design Current
Non-L
Pullets
furke s
Other 11"urkey Poults
Other 10ther
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)
?. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes V rNo ❑ NA ❑ NE
[] Yes
[] No
❑ NA
❑ NE
❑Yes
❑No
DNA
ONE
❑Yes
❑No
❑NA
❑NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - (o / Date of Inspection: 1 ;
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E] 1Vo 0 NA ❑ NE
a_ If yes, is waste level into the structural freeboard? ❑ Yes 0 No ❑ NA ❑ N E
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 0 3'L
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes L3<o ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0❑ NA ❑ N E
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 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):
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
CoF❑
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
tj""' ❑ NA
❑ NE
18. is there a lack of properly operating w-dste application equipment?
❑ Yes
No ❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ -o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ©No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [zqo NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NA ❑ NE
Page 2 of 3 21412015 Continued

Facili • Number: - Z jDate of Inspection: z/
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes Ej-go�7 ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tle 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 E3-9-o ❑ NA ❑ NE
❑ Yes ❑ No E3 q_A ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑�4o NA 0NE
❑ Yes No NA ❑ NE
❑ Yes No ® NA ❑ NE
Reviewer/Inspector Signature:% �� Date: 1 A'
Page 3 of 3 1 j 21412015

L. VDivision of Water Resources f
Facility Number - O Division of Soil and Water Conservation
0 Other Agency �/ I
Type of Visit: 0 Coi iance Inspection 0 Operation Review © Structure Evaluation O Technical Assistance
Reason for Visit: a outine 0 Complaint 0 Follow-up ® Referral 0 Emergency O Other Q Denied Access
Date of Visit: p Arrival Time: Departure Time: County: J%PLjjj Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:_Jd Apaj K'as'y—
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Title:
Phone:
Integrator:
Certification Number: ,�' f 9I b
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Design Current
Dr r Poultry Capa Pop.
Layers
Non -La ers
Pullets
Turkeys
Turkey Puuets
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E' No ❑ NA ❑ NF
❑ Yes ❑ No F1 XA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify p)ArR)
❑ Yes
❑ No ❑ N A
❑ 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
® NA
ErVNo
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
❑ NA
❑ NE
of the State other than from a discharge'?
Page 1 of 3 21412015 Continued

Facility Number: - Date of Ins ection:
,{
Waste Collection & Treatment
4.`Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EzNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 5 O L>
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1KNo ❑ 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 rNo ❑ 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? 0/yes VNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 24
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes �o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ 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 EZ�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes o
0 NA
❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
M 20. Does the facility fail to have all components of the CAWP readily available? If yes, check
[:]Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? © Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Ins ection:
�4. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes
25. is the facility out of compliance with permit conditions related to sludge? if yes, check ❑Yes rN,
the appropriate box(es) below.
❑NA ©NE
❑ NA ❑ NE
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 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 DNA ❑ NE
[—]Yes 2/No ❑NA ❑NE
N
❑ Yes
E3
❑ NA
❑ N E
❑ Yes
Ez� o
® NA
❑ N 1
❑ Yes
[�fNo
❑ NA
© NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
'[No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pales as necessary).
�', C,,n CoW �) J iM lA t L'AM19a 51a 6-6 - �(
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page d of 3
Phone:
Date: It/
i U
21412015

0 Division of Water Resources
Facility Number 0 Division of Soil and Water Conservation
r O Other Agency
Type of Visit: 0 9MRoutine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance �-
Reason for Visit: 0 Complaint O Follow-up © Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: L Departure Time: County: QR_Zlj Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: juNq7ice _[-((. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Certification Number: Pq 1119
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -Layer
Layers
Non-L
Pullets
Other
Puults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Da'y Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
r] o
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
Page I of 3 21412014 Continued

Facili Number: } - Date of Ins action:
Waste Collection & Treatment
. 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: f A9 &oZ _Xj 1 ( (�'�P 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): G d{
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 (ZI/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 D«'R
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 [3/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?
No
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes EZ�
❑ 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Y�lo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2�
to
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L.C1
© NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[J Yes ❑',No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes dNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo ❑ 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 DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes FZ/No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes [/ ❑ NA ❑ NE
2,5. 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No © NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concert?
[]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
U 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:
No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E�o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�'No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.,
-
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
0/ M -
Reviewer/Inspector Signature:
Page 3 of 3
Date: 1611,S
21412015

d Division of Water Resources
Facility Number _ '� d Division of Soil and Water Conservation
# 0 Other Agency
Type of Visit: C pliance Inspection Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: C Routine Q Complaint a Follow-up © Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: b Arrival Time: Departure Time: ® County: p((� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
OnsiteRepresentative: - J0�JA, j-HA 414 L '0, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number: q11 I I F
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer I F=
Design Current
Pullets
Other
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c_ What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3, Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
® Yes ❑ NA ❑ NE
Yes No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - ( Date of Inspection: 10 3a j
Waste Collection & Treatment
4i 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 Structure 3 Structure 4 Structure 5 Structure 6
72
Identifier: p0 1
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 ElYes O 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 environmenta threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA
❑ NE
PN""O
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [] NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
ED 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 craps differ from thaw designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesVNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
F!f
❑ 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 6 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [ 1V
❑ NA
❑ NE
23.1E selected, did the facility fail to install and maintain rainhreakers on irrigation equipment?
[:]Yes No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Fnciti Number: - Date of Inspection: to 170 q
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 �10 ❑ 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 1 ❑ NA ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EK'),
❑ NA ❑ NE
Other Yssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ef/No
❑ NA
❑ NT
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
D No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
J:
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
t No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWiVIP?
0 Yes
�o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
y
❑ NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
I__I 1''o
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any otber`comments.
Vise drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
t< Phone(Jid� ?
Date: o3c-
21412014

M 0 Division of Water Quality I
Facility Number - O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 CCopliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up 0 Referral ® Emergency O Other O Denied Access
Date of Visit: l ZL Arrival Time: © Departure Time: County: VWLSPJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ l� b:�ry i l i�{} 1 ' l61 _ Lt
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Pullets
Other
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) D Yes D No ❑ NA [] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3_ Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ o
Yes YNN❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: p 15
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[—]No
0 NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Stricture 6
Identifier: Lgoiv 1 I- LA GoA3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed throuh 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 envir nmental threat,
notifv 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
0 NA
d NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
VINI,
❑ 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
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
FfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[;K<o
D NA
0 NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ed/No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ulfro
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
""
❑ 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 [J'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 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 ETNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,.❑ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

jfaiftty Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pernnit:1 ❑ fires ❑ 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
61�o ❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[-]Yes No
❑ NA
[] NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ©'-Tq'o'_
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
© NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
�/©
❑ Yes J �No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings'of facility to better explain situations (use additional pages as'necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: M
-� � 3D Q
Date: � )
21412 11

0 Division of Water Quality 11
Facility Number - �� O Division of Soil and Water Conservation
O Other Agency
(Type of Visit: (2) Co pliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O IDenied Access
Date of Visit: (l Arrival Time: Departure Time: LJ County: 1 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �411ATUAt,) Gf UA_f,jL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean J 1,&r,
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Layer
Non -La er
Pullets
Other
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Daig Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes LJ 1`'o
❑ NA ❑ NE
❑ Yes
❑ No
0 NA
❑ NE
❑Yes
❑No
DNA
ONE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes YNq ❑NA ❑NE
❑ Yes �io ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 11
I it
Vr` to Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [] NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:&i-1 L Ai
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 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 o ❑ NA ❑ NE
waste management or closure plan? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ElYes 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 Fonding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[�Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
63 o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q'No
❑ NA
❑ NE
18. Is there a Iack of properly operating waste application equipment?
❑ Yes
[-Wo
❑ NA
❑ NE
Reasuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes q' - ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes_ . ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes EKo ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ SoiI 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 Ali o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �j(No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faepity Number: J Date of Inspection: 11
24. Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
o NA [i NE
25.'Is the facility out of compliance with permit conditions related to sludge? If yes, check
Q Yes
TNo 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
Q NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
El Yes
fNo NA I] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours andlor document
© Yes
No NA NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
Yes
No NA NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
No NA Q 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
CNo ® NA NE
❑ Application Field ® Lagoon/Storage Pond [] Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
❑ NA Q NE
34. Does the facility require a follow-up visit by the same agency?
Yes
fNo ❑ 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).
I)je-S N-t 46!?FM( J46 PLAMT(V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0 r/ -%
Phone: C ]l i' i b ` %3 %ov
Date: t /
21412011

AD Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: C pliance Inspection 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: li I Arrival Time: 3 U Departure Time: ® County: iO(�z Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title:
Onsite Representative: _J o u gjUqjj
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
y(
Farrow to Wean
(I vo
g00
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
[hher
Latitude:
Phone:
Integrator:
Certification Number: C,(0 S
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Laver
Nets
Pau lts
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
1 Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity ' Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
—.Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Yes [0/No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Ej Yes ❑ o ❑ NA ❑ NE
❑ Yes V [] NA ❑ NE
0 Yes VNo ❑ NA [] NE
Page 1 of 3 21412011 Continued

Facili Number: -I Date of inspection 11 lta
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: LA(,�yorr5 (('Jc
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 60
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 CNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DR'Q
7. Do any of the structures need maintenance or improvement? ❑ Yes J ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNoo ❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes CNo ❑ 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):
l4. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes F2/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?
[:]Yes [� a ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes Q
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes E3 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 CTNo
❑ NA
❑ NE
❑'Waste Application ❑ Weekly Freeboard [:]Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Pacili Number: jDate of Ins ecrion: l t o ti
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [, rN ❑ NA ❑ NE
25. Is t13e facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes IJ 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes �Z_❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 0 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 0 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
,%
❑ Yes [�' o ❑ NA ❑ NE
❑ Application field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes fo ❑ NA ❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Qq
Phone:( iv f 6" 3 0 v
Date: 1 i
21412Oil

i
Facility Number
Q Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: I I Arrival Time: S Departure Tine: County: PLYL- AJ _ _ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: _ Title: Phone No:
Onsite Representative: J�+�� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
n Boars
Other
❑ Other
Design Current
Capacity Population
Operator Certification Number -
Back -up Certification Number:
Latitude: = = = Longitude: = ° 0 6 ="
Design Current Design Current
Wet Poultry Capacity Population Cattle Capacity Population
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ N
❑Yes
[]No
❑NA
❑NE
[]Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
[]Yes
[]No
❑ Yes
VNo
❑ NA
El NE
El Yes
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: , Date of Inspection /t
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Struc e I Structu e 2 Structure 3 Structure 4
(r6o�
Structure 5 Structure 6
Identifier: 1 1-ACs�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): &0 3 F
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes D 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 L2 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered ves, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �9,/No El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? D Yes Q`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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,_,/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes lY No ❑ NA ❑ N E
maintenance/improvement?
11. Is there evidence of incorrect 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 101bs ❑ 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 2o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [[2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes Er No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ErNo ❑ NA '❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [:]/No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
a
�J s
Reviewer/Inspector Name {,q�t�/iu Phone: r,�U
Reviewer/Inspector Signature: Date: 1%
inn® % of 3 1 12128104 Continued

Facility Number: — Date of Inspection
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. ❑ -Urr Tp ❑ Checklists
❑ Desi n ❑ Ma s ❑Other
❑ Yes
Ld No
❑ N A
❑ NE
❑ Yes
❑l�o
❑ NA
❑ NE
g P
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C No
❑ NA
❑ NE
❑ Waste Application 0 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
C2" ko
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O 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
[:fNo
[I NA
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E5 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
21N0
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;�kNo
❑ 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
LJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,,,__,, //
E1<0
❑ 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
LJJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
P1 ""
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
[Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Coo pliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit �9 Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: / 6 (3 Arrival Time: ® Departure Time: County: li��(. lAl Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �a `A�1 _L_,r ft-y
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 [ Longitude: = ° a =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Laver
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ 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 Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: a
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
[-INE
❑ Yes
❑,No
Yes
El�
L� No
❑ NA
❑ NE
❑ Yes
Ck<o
❑ NA
❑ NE
12128104 Continued

Facility Number: — jp Date of Inspection
Waste Collection & Treatment r
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 13 Structure 4 Structure 5 Structure 6
Identifier: Uq(�r.1 1 _ �1ACZctv7 3 LA&13 r/ `f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 113�t 40 g
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes CJ 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 ,K No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes iCJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ 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 LJZo ❑NA ElNE
1S. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 0No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 7No
N[I NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes❑ NA ❑ NE
Comments (refer to question #I): Explain any YES answers andlor any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name �_ Phone Ov
Reviewer/Inspector Signature: ILIDate: tv 4 0
1 L/1S1U4 c. ontntueu

Facility Number: 3 f —(p Date of Inspection I I o
r
Reouired Records & Documents
I9. 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 ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ll hio ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 7N9
El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
El NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes L� ❑ NA ❑ NE
25_ Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes rN�o
❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El 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
ElNA
ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ffNo
❑ 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
❑ YesdNo
❑ 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 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
_O No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

I Division of Water Quality %
11 .Facility Number {of Z 0 Division of Soil and Water Conservation /
0 Other Agency 11
Type of Visit
Ccoompliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
41(Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time. Departure Time: County: QIEL-11 J _ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
1-1
Onsite Representative: c ) 6 NATI440 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = Q = = Longitude: = ° =1 = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La yer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
p
QGG
❑ Farrow to Feeder
❑ Farrow to Finish
-
❑ Gilts
Boars
El Boars
Other
❑ Other
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Puliets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ DaLq Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 121 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes [2'No ❑ NA ❑ NE
❑ Yes �N/o ❑ NA ❑ NE
12128104 Continued

Facility Number: j — 6 f L Date of inspection b s.
r
Waste Collection & Treatment
/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes lTTNo ❑ 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: LA Csr6 L4 Go76nJ 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
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 IdNo ❑ 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 Bj No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA j] NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes LI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L' I No ❑ NA ❑ NE
maintenance/improvement?
it. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C No ❑ NA ❑ NE
C❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
l2. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VN
❑ NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes l� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question ##): Exptain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
G
�
T
Reviewer/inspector Name .4t✓ r4raivEL-i Phone: q0 4 -73 $
Reviewer/Inspector Signature: Date: top
Page 2 of 3 1 12128104 Continued

i
Fdeility Number: 51 —`jy Date of inspection a
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 E�No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists ❑Design ❑Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Plo
❑ 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
E No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�o
❑ NA
El 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
1� o
❑ NA
[INE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
LJ N
ElNA
ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L`J No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than nornnal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes LKNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
Dyes [(No ❑NA ❑NE
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes EJ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
,r
Page 3 of 3 12128104

�� r� ( DiNision of Water Quality
Facility Number l 1 I-1 V 1 (/ 0 DiNision of Soil and Water Conservation
0 Other Agency
Type of Visit CrC,00 pliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit CJ Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: rJ� Arrival Time: C� Departure Time: County: Q I Region:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: /Title:'/y�
Onsite Representative: JIIyA�N/ / ' `l U, /C
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ° ` Longitude:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Weanto Finish
❑
Wean to Feeder
❑
Feeder to Finish
Farrow to Wean
7.,!1'
IC%
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
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)
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dain Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stoekei
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
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)
iI
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 D No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ ATE
❑ Yes
❑ No
❑ NA
❑ NE
0
ElNA
❑ NE
❑ Yes
❑ No
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
[; No
❑ NA
❑ NE
12128104 Continued

Facility Number: — 6 Date of Inspection
rite Collection & Treatment J�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
/ Struc e l Structur 2 Structure Structure 4 Structure 5 Structure 6
Identifier: c-+'l yd A``3
Spillway?:
Designed Freeboard (in): c
Observed Freeboard (in): qj
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes IJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,�,/
6. Are there structures on -site which are not properly addressed and/or managed El Yes [? No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th t, notify DW+Q
7. Do any of the structures need maintenance or improvement? ❑ Yes �No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes LJ 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 El L.d 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 Z�40 ❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > lo% or to 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
[j No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
ayes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
E o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
YNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ft 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):
11-J' Coa/i.l✓v WW C0r11l26Li,
fir,) 1/4,00 C"P —"ret O S7v(/&04, Poiq fsfl- s�✓aGC, c 6412 O141 oP1?Ar1G,,l
IF,) aTA:r / a (4 C t_ F xr rar- GAG.&'0j
Reviewer/Inspector Name Phone: l�el 79 J P�
Reviewer/Inspector Signature: Date: 'To
1212RI04 C'antinued

Facility Number: Date of Inspection o
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 appropirate box. ❑ W UP ❑ Checklists ❑ Design El Maps El Other
CJ Yes ❑ No ❑ NA ❑ NE
❑ Yes [I/No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
es
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
[]Rainfall Stocking D Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
El NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
NQo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L3 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
0, o
❑ NA
[,•:3 NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT") certification?
❑ Yes
❑ No
ET NA
244E
Other Issues
�/
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElE Yes
N-o
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
U 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
C21']Vo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[:I<o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Elma
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

U Division of Water Quality
01 Facility Number Q Division of Soil and Water Conservation
n Other Agency
Type of Visit Q Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: — f .^l 4J ffgZdf �! 3 Owner Email:
Owner N ame:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
]Integrator: 14',
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = Longitude: = ° = 1 = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
2G�
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ _Dairy Cow
O-Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: O
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[I No
❑NA
El NE
12128104 Continued

Facility Number:f—i! Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Struck e 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
S. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
[--]Yes [--]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
0 yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O 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 h`Pe(s)-e Yksl C
-
13. Soil type(s) — -
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NTE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Al
Reviewer/Inspector Name v, Q Phone:
Reviewer/Inspector Signature: Date: `
Page 2 of .t 12128104 Continued

*Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
� P
Y/7/0'� Ve _C)((JS fje,�7
/L
Page 3 of 3 12128104

J
Division of Water Quality
Facility Nunther ti, { © Division of Soil and Water Conservation
© Other Agency
Type of Visit Q'Compliance Inspection 0 Operation Review d Structure Evaluation O Technical Assistance
Reason for Visit &Routine O Complaint © Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: 2 OS Arrival Time: Departure Time: iC3L10 County: OOPL-12J
Farm Name: gF IZ f ig.M 5 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facilitv Contact:
Onsite Representative: G<'Z�GE1](15
Certified Operator: _ &� V ,,*)
Back-up Operator:
Location of Farm:
Swine
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = e = S Longitude: = ° = ' E
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ on -Layer I I El
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
12.Q
d
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
El Pullets
ElTurke s
El Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef 5tockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes L(J No ❑ NA ❑ NE
12128104 Continued

Faceiity Number: 31 -1Date of Inspection
r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LA&00,%J i LAG-ao0 L CA(ozO 3
Spillway?:
Designed Freeboard (in): 1q k �j o�Co
Observed Freeboard (in): '5'0
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
E Info
❑ 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 that, notify
DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
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
[2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
M 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) (9EfLn1")0A 070 SGo
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
`' ❑ NA
ILJN El NA
t!J No ElNA
rX0
ElNA
El NA
Comments (refer to question ft 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):
' A (L+-, -1- (Zk r_'0 JIUD 5 T,O-j Crater? S"k A9 E .
❑ NE
❑ NE
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Name Jc� -APJ RWC-LA-, Phone:(91q % 355-- 3 9" A 7 o 3
Reviewer/Inspector Signature: Date:
iL/L6/V9 C ontinuea

Facility Number: 31 2 Date of Inspection ti5
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ZNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If es, check the appropriate box below.
P g p Y
❑ Yes
[I 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?
El Yes
o
❑NA
❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
7No
❑ NA
❑ N£
d
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
A
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z10
WNA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ A
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
LJ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L'I No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
El NE
and report the mortality rates that were higher than normal?
7No
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ 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
l,Q 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
Ir'11v
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ l'es
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency 11
Type of Visit J& Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit .Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Time: f : • "
/Z
Not Operational 0 Below Threshold
Permitted IM Certified Q Conynditionally Certified O Registered Date Last Operated or A ove/Threshold:
Farm Name: �f 1�t Zgr� County:
Owner Name:
Mailing Address:
Facility Contact: / 1 Title: f
OnsiteRepresentative: Z�%%d Al- / I�G r'lie I' e/
Certified Operator:
Location of Farm:
Phone No:
Phone No: r
Integrator / h t
Operator Certification Number:.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 - Longitude �' r-�•
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder 1 10 Layer I i
E
Da in
❑ Feeder to Finish ❑ Non -Layer Non-Dairy
59 Farrow to Wean zC
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons _� 1U Subsurface Drains Present IfU Lagoon Area
Holding Ponds / Solid Traps 0 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Iy
Freeboard (inches): v' Ti 7 .3
05103101
J spray rieia_Area l
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Structure 6
Continued

Facilit} '.`umber.—E/721
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 andlor 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?
N aste Appileation
10. Are there any buffers that need maintenancerimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hvdraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
U Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes El No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA'AFMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ElYes ❑ No
b) Does the faciliry need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
19. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design. maps. etc_) ❑ Yes ❑ No
19. Does record keeping need improvement? (ier irrigation. freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notifi'regional DN'i'Q of emergency situations as required by General Permit?
(ic discharge. freeboard problems. over application) ❑ Yes ❑ No
23. Did Reviewer.'Inspector fail to discuss review/inspection with on -site representative ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this Ash- �
Comments (refei to question :' Explain any YES aasw=ers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): El Field Copv El Final Notes
l�tItPl 0kfr-lo, rv.�ry reed f6 � 17240,y •n��i!. �4� �w<<
Reviewer/lnspector Name - V; -
a '
Reviewer/Inspector Signature: Date: �
05103101 / '
Continued

Facility Number: 3/ -41,17 1 Date of Inspection z/ L}
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 permanenthemporary cover?
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No

40 Division of Water Quality -
Division of Soil and Water Conservation
Qihtlier.Agency - --
Type of Visit Compliance inspection O Operation Review © Lagoon Evaluation
Reason for Visit Q Routine Q Complaint 0 Follow tip © Emergency Notification O Other ❑ Denied Access
Datu (If Visit: Time:
Facility Number �/ —"� ���J
Not Operational OBelowThreshoid
Permitted ® Certified ® Conditionaliv Certified © Registered Date Last Operated or Above Threshold;
Farm Name 's 'p '' �+��"r5 County: a'az! i
Owner Name: Piton" No:
Mailing Address:
Facility Contact: Titie:
Onsite Representative:�n�
Certified Operator:
Location of Farm:
Phone No:
Integrator: LE'1`/d1�
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude I Longitude
Design Current
Swine if'51n51rity pnnuintinn
❑ Wean to Feeder
❑ Feeder to Finish
CO Farrow to Wean
'2 3
❑ Farrow to Feeder
ED Farrow to Finish
Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Laver I ❑ Dairy
❑ Non -Laver ❑Non -Doi
❑ Other
Total Design Capacity
Total SSLW
- °Number of Lagoons
Holding Ponds I Solid Traps
10 Subsurface Drains Present 110 Lagoon Area
❑ No Liquid Waste Management System
❑ S rat• Field Area
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
Q No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. if discharge is observed, did it reach Water ofthe State? (If ycs, notify DWQ)
[J Yes
❑ No
c. if discharge is observed, what is the estimated flow in ealimin?
d- Does discharge bypass a lagoon system! fif ves, notify DWQi
❑ 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
P9 No
Waste Collection 15` Treatment
4- is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
[5�No
Srructure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: % 3r
Freeboard (inches):�!y
05103101
Continued

Facility Number: S1 —�, Date of Inspection s �
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 maintenanceiimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid Ievel
elevation markings?
Waste Aup(ication
❑ Yes El No
El Yes '❑No
❑ Yes 21 No
❑ Yes E No
❑ Yes RNo
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponndingg El PAN ❑ Hydraulic Overload El Yes ® No
12. Crop type P/m "We (G%/ �_ �.s�El�lTr� %t ��!'.•�OP�
13- Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes E No
c) This facility is pended for a wettable acre determination? ❑ Yes ® No
15. Does the receivin, crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes ® No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes N No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP. checklists, design, maps, etc-) ❑ Yes ® No
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ® Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes MNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes PH
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes NNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes M No
24. Does facility require a follow-up visit by same agency? ❑ Yes RNo
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? El Yes 2 No
❑ No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
met�xir�a�es[;irm�#}'Ea�7sna'#ans�wersr�ny�esoramensla6or€s:b_r�any�_tl3ter4vi�um "'� � "a �-� "-�` ;
r7rapti�*s.u�faia'tlrty #o betier�baa�ons�use hdt�t#io�a��age�.necessar�'� � - _ �'_
_ �; _ _ �' ©Field Copv _ ❑ Final Notes ���•`'
/
/f /%`ee/ lo, 7,/Ze �ww/Af,�
�/
Reviewer/Inspector Name
Reviewer/Inspector Signature. Date:
05103101 ell Continued

Facility Number: ZrYZ Date of Inspection
dor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes IV 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 n No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt. ❑ Yes Xf 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? El Yes allo
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 N] No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes CK No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes SZNo
AdditioDW Comments and/orDrawinu:
05103101

13 Division of Soil and Water Conservation - Operation Review
Division of Soil and. Water Conservation - Compliance Inspection
Division of Water Quality - leompliAnce inspection
{Q
0 Other Agency - Operation Review.
10 Routine O Complaint Q Follow-up of DWQ inspectit
Facility Number
of DSWC review 49 Other
Date of Inspection
Time of Inspection 1(liP 24 hr. (hh:mm)
® Permitted 0 Certified 13 Conditionally Certified 0 Registered [ Not Operational Date Last Operated;
Farm Name. ............... �r—.%. ' �r-..- ` ..J' f......... County: .T!�........... ...................................................
..-... .......--... ..."t
Owner Name: el ✓t L } Yl i ✓'
........................................................... Phone No:........................_................--- ......................... _..
FacilityContact:....................................•.....-----...............................Title:..............--........---............_........._.............. Phone No:........................................
MailingAddress:............................................................................................................................................... .........................
Onsite Representative: _...............A.._..........L..•....._..................................... ...................... Integrator:.............a...................................._....,...................
Certified Operator: ................................................... ............ . ............................................... Operator Certification Number:..........................................
Location of Farm:
Latitude a ` *' Lon-itude 0 4 &-
Design Current
Swine Canacitv 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
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Slruc€urc 1 Structure 2 Structurc 3 Structure 4 Structure 5
Identifier: 1 2
t [� tJ rl
Freeboard(inches): .................�� ................. ........4.w ..................... ....... .,................. I ..... .....
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ❑ No
Yes ❑ No
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
❑ Yes ❑ No
Continued on hack

Facility Number: 3 ( — 6 1 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
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?
0: N,6-*iolations.o • deficiencies were noted• dtWirig this:v sit: • Yoit will -receive fio further -: .
comes oncience: � ' *f this :visit: ::: :: :::::::: ::: • : :::::: :: : :
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to question #)t 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):
A" A ► A hA S be_c-n 4-c —r-r !•'et rr' t r�f rcrA ; rc,4 . E7rrS i Oij G j,,Lckvvw f �
Are r05erl � iYl eke -CA of trG . G i ; an _<4t,0d t o ,ke f ih
Check ntiM rCra: rep{ /is n 4c D�P.d • Teo 6rer'C'L\e�
— r/M 'la�z;i Tj o4),er JAs,Qor
x'O,V - hb3 1"h 44 A401 VI &
wts4e- or
Reviewer/Inspector Name -�p c �� % q j l7 Ji J 5� • S d O Z.O' 2 0 3
Reviewer/Inspector Signature: �� 4 Date: 2 V
3/23/99

Lagoon'Dike Inspection Report,
Name of Farm/Facility 14 �y q�P/t 3 / b 1 Z ► �' 2�"'�`
Location of Farm/Facility hall
Owner's Name, Address
�� e _ ( 9/6 - agy - zc 73 }
and Telephone Number
I
1 gD
Date of Inspection
�� `�- 9y Names of Inspectors Cl
Structural Height, Feet
/ Freeboard, Feet 1 leg,r
Lagoon Surface Area, Acres
2 Top Width, Feet
Upstream S1ope,xH:IV
Z % Downstream Slope, xH:1V ZA2 y /
Embankment Sliding?
X� Yes No
(Check One, Describe if Yes)
Seepage?
Yes No
(Check One, Describe if Yes)
-
Erosion?
Yes No
(Check One, Describe if Yes)
Condition of
YGf3 QC� C,4.(
Vegetative Cover
ass ees)
Did Dike Overtop?
Yes No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? _/ Yes No
Engineering Study Needed?
_Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes L No
Other Comments
J)i ki e 9 e jjq 1 9 14 W
4 Cat '� AO- k rr1 ole-,A:� )kq hut
� ron f �' / �' Y' a
r
/ I

' 13 Division of Soil and Water Conservation -Operation Reiiew
13 Division of Soil and Water Conservation Compliance Its}rection
fflUvision of Water Quality- Compliance Inspection
C[ Other Agency - Operation Review
nine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Facility Number Date of Inspection
m� Time of Inspection 124 hr. (hh.mm)
�(Eermitted 13 Certified [] Conditionally Certified Q Registered 113 Not Operational Date Last Operated:
Farm Name: --... .Gi!!'l. , .... fa��- County:. ! p --... �......
...............
Owner Name:......9-�L1,4,Vt
rt.ALL ............................... Phone No: _-..f. d
.......�...,.-
Facility Contact: ......... , Ae ................ Title:......L�!! � ?�._........ ....... Phone No: ................................................
Mailing Address: ..............
............................................... ................ ............ ..........................
Onsite Representative: C..... ..... �3..tegratar:....,.....,...... 1Y.............................................
Certified Operator: ............................ ........... Operator Certification Number:
Location of Farm:
r-------------------------------------------------------------------------- -------- ------ ---------------................................ .............. .......................... ,....... ....... ...,.....,................... ..,.,...,................... ...................
Latitude F-7 • 6 •° Longitude 0 4 «
Design Current
Swine Canacitv Population
❑ Wean to Feeder
❑ feeder to Finish
arrow to Wean
10017
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts ;
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
�1' 0Mber of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds / Solid Traps 1 10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Dues 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
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
_Np —
❑ Yes ❑ No
❑ Yes �Vo
❑ Ye so
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L 4 � C " z,� s N,,,w L,,Soa -� 0
� L z T�
iti h /!
Freeboard(inches): ..... .................. ...... P�...............,.,....,.., .C...:.. ...... --4 ................................-.....---..41...................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, yes ElNo
seepage, etc.)
3/23/99 Continued on back

Fztcilit;dVumber: " — ( Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8_ Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? / [I Excessive Ponding ❑ PAN
12. Crop type A a . X P, 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?
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 Revi ewerA nspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
E.
No Aolaii6hs•or• ilefc eunde$ wser� potec� d(Wirtg •this visit: • ;Y;o4 :will•i-eeeive iio further:
' - . - corresp_ _ nee. abou this visit. :: : ::::::::::::::::.:::::::::::::: :
I.
❑ Yes "do
❑ Yes JNo
❑ Yes �(No
❑ Yes kNo
o
Yes
❑ Yes WO
El Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes J<No
❑ Yes [XVo
❑ Yes JNo
El Yes �No
Yes / No
❑ Yes gNo
❑ Yes Mi o
❑ Yes No
❑ Yes ZNo
/
`�es /❑�No
❑ Yes krNo
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):
A,
rl � �i1 /': S�[.c� s�in�l r . 'LT►�� � %t.EJ�.t � Ct�.•.r�-�- c�-
4v ((c 10.j,4 —vA) cvt--qOL—
C f r P ^
r
` 00 c �.
//%// /�.t h�� 7a c a�S !'i't_a�n) Gi /.-bra • f .! ►w.f -kvze s (kkvz
Reviewer/Inspector Name r?�
Reviewer/Inspector Signature:
Date:

WacilitW Number: 1 1 Date of Inspection D�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ YesNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? Q Yes K_No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, Q Yes �r'? iN0
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 X-1V0
30. Were any major maintenance problems with the ventilation fans) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes DNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Wo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? jYes ❑ No
Additional Comments and/orDrawings:
MJ'O F'vr
R23/9

- . 0 Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency,
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit +Routine O Complaint O Fonow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: fTJtr— (T 1 Time: ( C
Facility Number
Q Not Operational Q Below Threshold
*Permitted [3Certified Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..............
FarmName: .... .!%.. ? . °........................................ County:...• �.!,........................ .......... .......................
OwnerName:............... ........... ......................... ........................................................................ Phone No:.....................................................................„,...........
FacilityContact:.............................................................................. Title:....,....................................,...................... Phone No:...................................................
Mailing Address:................................................................................................................................ ......... _...,..............
.... ....
_....
.,..,.........
...
Onsite Representative: ... "1" �� Integrator. �,�+-�... ,y... ...................
Certified Operator:
Location of Farm:
........................................I................... Operator Certification Number:........... ._ _w........
❑ Swine [] Poultry ❑ Cattle ❑ Horse Latitude " O4 64 Longitude • 4 66
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder 10 Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean O —71
Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons J J J❑ Subsurface Drains Present JU Lagoon Area J❑ Spray Field Area J
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes 06No
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 RfNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes X No
Stru/c ure I Structure 2 S cture Structure 4 Structure 5 Structure b
Identifier: .�..E .. CYQi,�
...........................................................................................................
Freeboard (inches): 1.)
5100 Continued on back

acility-lumber: --� I — A, (} Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? l'Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes kNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes gNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes O(No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN []Hydraulic Overload ❑ Yes W No
12. Crop type v►`-r,��-�r , �!72vi��i� �i 5 CA Ct�2t�1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? [:]Yes ffNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
D 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
�fNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
KNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
allo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
,4No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
W No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EjNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JRfNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes tRNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes �oo
10 yiolalritgtis:© de........ were noted dirrif .. t....s..... H.. reeeiye a ufib,er ,
correspondence: shoot this visit_
Comments (refer to question #):. Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to jbetter explain situations. (use additional pages as necessary):A.
I
`1s ►�e�e� tic LOR8 y t�G+�Q�(
ku "ve
WLL
Cc.t^�►� L_- Q15 A_ t_- QIA ��� �clti w. Gc.ti�i �,-.�.��` �et�
7
Reviewerllnspector Name
Reviewer/Inspector Signature: Date: % (C1 --Cl Sloo

Facility Number:31 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 *o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 9No
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 ONO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes � No
Additional. Commentsravings:
jland/or
(_
Gu ♦' 'ACC 1�++� i~-c`-�CI1�j0 J i
#
-k•
CQ C
L
5100

❑ Division of Soil and Water Conservation (] Other Agency
Division of Water Quality
10 Routine O Complaint O Follow-up of DWQ imspection O Follow-up of DSWC review O Other
Date of Inspection ra q
Facility Number 2
Time of Inspection 3Q 24 hr. (hh:mm)
0 Registered O'Certified 13 Applied for Permit P Permitted 113 Not Operational Date Last Operated:
Farm Name: t 9,mz......... ... ... County:......but."^.............................................................
Owner Name: ............ J....... J a ..... taiY............................................... Phone No:..... � 4 '..2
Q.3........................................
Facility Contact: ........................................................ ......... Title: ............... .............. Phone No:
Mailing Address:....».. 9 Q.....� �. .... WA ........................................................ ......... �... � ti.l...%................................... ..��-IASI.......
OnsiteRepresentative.......... Y _%...... L�......................................... --....... Integrator: .......... 4.ris.1'.Yo.1.1......... _........ _..................................
Certified Operator•...._......................................................... ............. ........ Operator Certification Number :....................... . .
Location of Farm:
Qxx-- !� ........... Q...2.... txj»%i.RW.t?1..... . .
........................... ........... ...................................................................................
................................................. - ........ �►
Latitude • ° 46 Longitude • 4 ��144
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes [N No
2. Is any discharge observed from any part of the operation? ❑ Yes [2 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is obsen�ed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes (] No
c. If discharge is observed, what is the estimated flow in gal/min? N IN
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any parr of the operation? ❑ Yes ( No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [� No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

sacillt5,Number: 31 — (, f ,& 1
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (Lagoons.Holding Ponds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3
Identifier:
Freeboard(ft):............z:.t............... ... ......... ..................... ............ I.r.................
10. Is seepage observed from any of the structures?
Structure 4 Structure 5
❑ Yes V] No
❑ Yes 0 No
Structure 6
❑ Yes UNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
P No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
N No
Waste .Application
14,
Is there physical evidence of over application?
❑ Yes
[PNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ )
15.
Crop type...........'i!�U�a..............................+1(!A,....... ,ira............... .......................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
PNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
j No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�R No
22.
Does record keeping need improvement?
{VYes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
q, Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
0 Yes
® No
0 No violations or deficiencies. were noted during this. visit. You.will receive no further
correspondence about this visit;
iz. -Trtcs St,,aV'j �.e rc►no�1e� � O X w-- edit Joq0- la�ar` *f. 1+\►u Irl�' }� Vr�nll`sf
0[ �UyaA,, _2--'++3, `� ei4'1� �' _ V►•0L:1L� 1�'c A PU"K ' t�K.' Qr� �A GC'ri Z S�iC'L�f1 �/� 1'�liti
`ctSJeae3lc,c� bSA:dt 0{4 _
2L7_ Wi"A-"Cr- ONt% �Or 6rMvjo. SYIG¢'t� k� tl ZZ1 {tl� VC,1 r
Af7s ,M,%Aa- c,4ekropp)ita�)or, c 't1.t�v'bsz�
�1 J 7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �� ! Date: 10141

© Division of Soil and Water Conservation ❑ Other Agency
[3 Division of Water Quality
Routine Q Complaint O Follow-up of DWQ inspection © Follow-up of DSWC review O Other
Date of Inspection ?
Facility Number
Time of Inspection Z 24 hr. (hh:mm)
© Registered 01 Certified 0 Applied for Permit 0 Permitted 113 Not o eratic►ttal Date Last Operated:
Farm Name: County:........ .�1i.n..........................................................
Owner Name:..........,,...:.. ff!] .k> ..................1:!"�........................................... Phone No: -LA10.2 ` ..?.7.3.....,.............,.........................
Facility Contact: .......1 ........... a4 1C............................ Title:...., QWk,.&r ......................................... Phone No:. �i��j.,7 .:.�- 3...........
MailingAddress:..:....................................................... ..... 1 .... Cf x i�..1-••--N..................................... ..ags4.......
Onsite Representative:....,r tY.,,, ,
aiGi,k� ....d.k'►4........................................... —,.. --. - Intel;rator:......C�:!!Y3.A............................................................
p i .- Operator Certification Nuimberz....�,`�A(t!! . Certified Operator ---.���.._..�......Sc-¢t[1.�4:f�............................................... ... ...............
Location of Farm:
...TAL.... .t.k .,. vw..�sx�. t; ..,.l1 al :...icxM.....L.... c*�,...
M....�a...... Q i .iM.-61.... Dn... in.P. JS......In. l................ .
Latitude �• ��"
Design : Current
Swine Capacity. Population
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
(Z C
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Longitude • 4 ®46
Design Current Design Current
Poultry Capacity Population Cattle Capacity "Population
❑ Layer ❑ Daiy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity 7 Q
Totat SSLW
Number of Lagoons f Holding Ponds 10 Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement? ❑ Yes 19 No
2. Is any discharge observed from any part of the operation? ❑ Yes allo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes 1R No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes NO No
c. If discharge is observed, what is the estimated flow in gal/min? N f
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 9 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes Q No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes EQ No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes PQNo
7125/97 Continued on back

0
Fkility Number: :S
8. Are there lagoons or storage ponds on site which need to be property closed? El Yes (9 No
Structures (Lagoons Holding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? El Yes Q No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......... 4_1 .................. ......... ItZ ............. ... __At-3 ...... ....... ........................
..........................
Freeboard(ft): ...... .......... ............ .............. I . ..... I ............................. .................................... ....................................
.........................
..........
10. Is seepage observed from any of the structure,;?
0 Yes
10 No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
NYes
El No
12. Do any of the structures need maintenance/improvement?
04 Yes
El No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
I--] Yes
EgNo
Waste Application
14. Is there physical evidence of over application?
El Yes
M No
(If in excess of WV[P, or runoff entering waters of the State, notify DWQ)
15. Crop type .......... .............................................................................. 5."...V ... . .................................... ................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
12 No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
E4 No
18. Does the receiving crop need improvement?
El Yes
O-No
19. Is there a lack of available waste application equipment?
C1 Yes
10 No
20. Does facility require a follow-up visit by same agency?
-0 Yes
0 No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22, Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
E-1 Yes
JO No
25. Were any additional problems noted which cause noncompliance of the Permit?
0 Yes
[A No
No violations or deficiencies were noted during this.visiL You.wifl receive no further
correspondence about this visit.
Comments Irefer to question- -Ekohdn any.YES answers and/orany recoimiendationsorarty ,other comments
Use drawingsof facility tobetterexplain situations. (use additional pages as- neemary).
"11C. &fv--cv, ovto.,s o,, OL,v walls o� jajovAs -0-_3 -�6vjj w r44r, (.I&y pM
V-fc�cedcJ. Gos %�o n. af v oL5 on �,vxiw )om .01 41 swd be- q1W W1 41- A4 vrscec4d.
Ife'eS OV' SIA0116 6C rt'w to ticd , `Vat� b- -eX4*�ej'
zz.5�1(01 Ttclorh S6e- 14 A 661 1A 94 4kv%�r k+� arm
S&KaL'.5vuJO 6 V?a"W-
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature. Date:

01
r
A
4°
Site Requires Immediate Attention: `
Facility No.a-
DIVISION OF ENVIRONMENTAL MANAGEMENT
AMMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
DATE: 1995
Time:
6 k y'I,-� Lin, C/C_
Mailing Address: `I U i f e '0
County: bs., j C ^-
�I tegrator r-o l C( Phone: —70
On Site Representative: 1) -- Phone: _ y� 00 ? 3
Physical Address/Location: /k/(S k i ti-au /+4 k� `f �(�d t o F-)e N r r UU
0 V1*
Type of Operation: Swine Poultry Cattle
k fa& 1 '� 0 0 FJk t i
Design Capacity: �, �a, /v Number of .Animals on Site:
DEM Certification Number: ACE - DEM Certification Number: ACNEW
Latitude: �� S� I `'� " Longitude: 7 )( 4 ' I l " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: Ft. Inches -
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? es r No
Is adequate land available for spray? Os
No Is the cover crop adequate Ye or No
Crop(s) being utilized LAI 6a ( a4
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No �. t/ -` v M1
Additional Comments: Gorzw 6'ei-4-)'e `"`' �"-.11c
F ! ,�itt
Inspector Name �J� Signature
cc: Facility Assessment Unit Use Attachments if Needed.