310653_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: QrCo ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 46 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: /2p County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: f Title:
Onsite Representative:
Certified Operator -
Back -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
C•usrent
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
WqAn to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
'{ l 0
Dr. l;oultr.
Layers
Design
Ca aci_
Current
P,o
Dairy Heifer
Dry Cow
Non -Dairy
I JBeef Stocker
Gifts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
©ther
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes No ❑ NA ❑ NE
[:]Yes ❑ No
[:]Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
❑Yes rNoo
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

'4
Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ETNo ❑ 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 la< ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment eat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Cj 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
❑ 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
o ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dy— ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
r��No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
El Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

1
Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes 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 Q "" ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes ❑.l o�_M 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 ❑ N¢. ❑ 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 NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes C�J-W ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes C3.No- ❑ NA ❑ NE
Coninjeots (refer to question ft.,Explain.any YES'answers and/or any additional recommendations:or any other comments .°
Use drawings of facility to bettei,egplain situations (use additions! pages'asnecessary).
Reviewer/Inspector Name: ! * Phone: 0 7 -1 Gno
Reviewer/Inspector Signature: CZ! Date: /111,706
Page 3 of 3 2/412015

Type of Visit: 0 7Routine
Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: owum Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: _ 3�X>-b N`.LTC14C7U�' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 11 M.
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity. Pop. Wet Poultry Capacit3° Pop. Cattle
Layer DairyCow
11 INon-Layer I Dairy Calf
Design Current
C►apacity Pop.
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design Current
DrF Poultry C•_a acit P,o ,
Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Caw
Other
Other
Turke s
Turkey Poults
Other
DischariZes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ N
❑ Yes
❑ Yeso
❑NA ❑NE
❑ NA [] NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

F cili Number: - Date of Ins ection:
Waste Collection & Treatment
4Js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E10 ❑ 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: (A (5VU-1i C * L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L L16
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 UdNo ❑ 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 I YNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZfNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E/>o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN ❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes VNo
N ❑ 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 E24o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONO, ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFspility Number: -7 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes hJ N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes V ❑ 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 gNo ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes Z KNo ❑ 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 Zf 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 facility9 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 2 No ❑ NA ❑ NE
33. Did the Reviewerllnspector fail to discuss review/inspection with an on -site representative?
❑ Yes ff ;N ' ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 8"No ❑ NA ❑ NE
Comments (refer to question ft Explain any; YES answers and/or any additional recommendations or any other comments. .
Use drawings of facility to better, explain,situations use additional pages as necessary).
Reviewerllnspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone ppd
Date: V
2 4/20 1 5

Type of Visit: UCgfnpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: C Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: l'1 1 _ Arrival Time: lQ J.?J Departure Time: County: DOP14-r-tj Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: -6 fte,h� rAzrr" N [—.[,_ _. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I un (p 9
Certification Number:
Longitude:
Swine
Design Current
C►►opacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
tea::,... Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wcan to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Il , P,oultr,
Layers
Design
Ca aci
Current
P,o ,
airyHeifer
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turke s
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ N ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - Date of Inspection:... (0 1-1
15
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2/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: UA&uw I LA`45q6N`Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): j o SO
5. Are there any immediate threats to the integrity of any of the structures observed?
E Ye S_1ZNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ZNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmZo
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 2/NjYNo
" ❑ 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 ❑ 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?
WNo
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o 2fj
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNo
❑ 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 VNo
❑ NA
❑ NE
Required Records & Documents
ZN
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
❑ NA
D NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes VNo
❑ 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 l" 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: JDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ]No ❑ NA ❑ NE
25. l 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 VNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes EKO ❑ 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 to ❑ 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
l!J 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
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Zq�❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VN ❑ 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 exnlain situations fuse additional na2es as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phon jy� r r 1 3
Date:
2/4/ of S

(Type of Visit: la Copliance Inspection U Operation Review r) Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: ice( , Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Owner Email:
Phone:
Phone:
Integrator: rr Q
Certification Number: b -1
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design C*urrent
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pap.
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Dr, P.oult , to acity Pao
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
REr
Turke s
:ke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes /No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes ❑ ❑ NA ❑ NE
❑ Yes rNo
NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Faci!!q Number: - Date of Inspection:
�Z4. Did the facility fail to cbrate waste application equipment as required by the permit? ❑YesVNo
❑ NA ❑ NE
a i
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 F!rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
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
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
N ❑ NA ❑ NE
No ❑ NA ❑ NE
N ❑NA ❑NE
❑ NA ❑ NE
No ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES, answers and/or, any additional recommendationsorany other comments.. I
Use drawinSs of facility to better explain situations (use additional pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phoned
Date: aZ�
2/4/201

Facili Number: - Date of inspection: !
f, 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 [] NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A k1saj I LA 60111,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en ironmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes V ❑ 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 I XNo ❑ NA ❑ NE
maintenance or improvement? 777"""
_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
[/ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
N
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
TNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

(Type of Visit: 0 Co�pipliance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access II
Date of Visit: Arrival Time: Departure Time: ® County: bUPLZ:sJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: � o p lj AT44AO MZ(,( _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: t-7 Ga 9
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Wet Poultry
Layer
Design
Capacity
I
Current
Pop.
Cattle
IDairyCow
Design Current
Capacity Pap.
Wean to Feeder
I
INon-Layer
I
EEI
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I . , P,oul
La ers
Design
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[a No
❑ NA
❑ NE
❑ Yes V;"4,0
❑ NA ❑ NE
[—]Yes
❑ NA ❑ NE
[:3Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: '2_,- (c Date of Inspection: tb
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: �-►� Lw&moZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZR 3 r7
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 [i No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [% No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [% /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ 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 ��O
❑ 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 ]/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E2No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes 12No
❑ NA
ONE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes U 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 o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes WNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili umber: Date of Ins ection:C154 Il
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 I ,lNo ❑ NA ❑ NE
the appropriate box(es) below. TTT
❑ 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 ❑'h 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 Oo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
E:fNo
❑ 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
ErNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
D<o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
ETI�o
❑ 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 exalain situations (use additional naQes as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
N 0 f A(z.rJEu_
Phone: (Q,ia
Date: (�
21412011

Type of Visit: 0 Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ( Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: d County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: VUAIATKA.J PAXLL QL Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: o
Certification Number:
Longitude:
Design
Swine Capacity
Current
Pap.
Design C►urren AEF--son_L@urrent
Wet Poultry Capacity Pop. Cattle Capacity Pap.
Wean to Finish
Layer
I
ai Cow
Wean to Feeder
I
INon-Layer I
I
airy Calf
Feeder to Finish
Farrow to Wean
L40
30n
Design Current
D , P,oult . Ca aci P,o ,
Layers
airy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Gilts
Non -Dairy
Beef Stocker
Beef Feeder
Non -Layers
Boars
Pullets
I
113eef Brood Co —
©ther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E31No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No [:]NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
[:]Yes o ❑ NA ❑ NE
❑ Yes [rNo ❑ NA ❑ NE
Page 1 of 3 214,12011 Continued

Facili , Number: - Date of Ins ection: p
Waste'Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA&COJ Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 34 3ti
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E017No
❑ 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
ff/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes NO
N ❑ 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 [3/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
EZ/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
ONO
❑ 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
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
fNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[No
[] NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspecti��No
❑ 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 QX0 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - 3 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes /1�0❑ NA ❑ NE
4
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesVNo ❑ 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
�-r►'� 0 ❑ 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 o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ✓�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes W,. No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments = � ,
Use drawings of facility to better explain situations (use additional pages as necessary)..:.:;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
W-1
Phone:
Date: b
21412011

Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: lb Arrival Time: Departure Time: County: OL* tZa_ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: J6PNIxTHP'4 MrtLT-r-k Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 17 661
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle C*apacity Pop.
DairyCow
Da' Calf
DairyHeifer
Wean to Feeder
Non -La er
Feeder to Finish a1"
Farrow to Wean
Farrow to Feeder
Design C**urrent
D > P,oul_ , C_a aci P,o
D Cow
Non -Dal
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
[] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 2/4/2011 Continued

lFacility Nuffiber: - S3 Date of Inspection: 6 s
Waste. Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 s, z
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 environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes N ❑ 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 2 Np ❑ 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
W_�,
❑ Yes❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes o
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 11
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Nudsber: 2j - Date of Inspection: D 11
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 &N/o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
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
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
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Wo
❑ NA
❑ NE
En
❑ NA
❑ NE
CNo
❑ NA
❑ NE
21/y❑
V
NA
❑ NE
❑ NA
❑ NE
No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments r
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date: /d1s
21412011

Eaciltty"Number. 3 ! 6S3
ya
V Division of Water
O.Division of Soil and. Water;Conservat�on •'
O
Other Agency
t »:
NL �
Type of Visit erc7ooliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: / Arrival Time: Departure Time: County: LW006 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 6W4tAWA1 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = [= Longitude: = ° = = «
Design Current s Des
Swtne Capacity Population `Wet Poultry Cape
r
'10 Wean to Finish "❑ Layer
Wean to Feeder 10 Non -Layer
Feeder to Finish (
❑ Farrow to Wean 1) Point_,
rye ryx
❑Farrow to Feeder
❑ Farrow to Finish
❑Gilts
Z ❑ Boars
-
❑ -Other --- 1
Current'
'opnlat�,on t:art[e
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
El -Turkey Points
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L'J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑]No
[:]Yes
E No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —
Date of Inspection I6
W48e Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA(eWW I L.A6V-4U `L'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ;'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ 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? E Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
(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
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes Rio ❑ NA ❑ NE
❑ Yes dNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L` I No
❑ 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 Soi
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of property operating waste application equipment? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
Zo El NA ❑NE
7❑NA ❑NE
LJ No ❑ NA ❑ NE
�o�'No
El NA [I NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendationsor any other, comments
Use drawings,of facility to'better explain situations (use:additional pages as necessary) µ
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of 3
n Phone:
ly Date:
l 6 -?
r6 Z.
12128104 Continued

Facility,Number: — 653 Date of Inspection a a
ReAuired Records & Documents ,_.,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes E; No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [3 No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
R N
❑ NA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
FNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[T No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B<o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
O 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
Q 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
/
B 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
E3 No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2<o'
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

A
Type of Visit
'pliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7Routine0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Arrival Time: Departure Time: County: N Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: J6 N *Tw A t M ILG- - Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = = I = « Longitude: = ° = d
Design Current
Design
Design Curen#Swine
Capacit
Population
Wet Poultry Capacityin
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dai Cow❑
Wean to Feeder
❑ Non -La erairy
Calf
Feeder to Finish
7j
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turkeys
Other.
❑ TurkeyPoults
❑ Other
Number of Structures:
I10-0ther
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
[j o
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
Zo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
ZNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection b
lWaste 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%Vv 1 '� Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): [ice55
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
jNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
ENo
❑ 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? E(yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
dNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes
L1 No
El"
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
E(No
❑ NA ❑ NE
maintenance/improvement?
'
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
,_ /
E3 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
l4. 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
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
��No
El NA
El NE
17. Does the facility lack adequate acreage for land application?
El Yes
,L_.,,d,"//No
NN
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
No
❑ NA
❑ NE
Sw us E
PuT7
c.L*A N A 94 W-0 Ate. LA &vZ VT . L A 2f- W-6
13L/r 1Mos1 /1C 17UAtED AS sf Ik i' r91-Ei wrrL- c c4sA&
Reviewer/Inspector Name - �/ 1?�rtr1 t-G�. I Phone: id 3YY
Reviewer/Inspector Signature: Date:
i uge uJ j�...�.,... ».»

;y -
Facility Number: ' —[ Date of Inspection o�
f
` Required Records & Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Id No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E3 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
CJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El"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
qNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑'ffo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
eNNo
❑ 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
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
0 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
I o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12178104

Type of Visit Coouliance Inspection - O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit tine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit. Arrival Time: Departure Time: County: 44 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I yr� �Ti',tle:
Onsite Representative: �'Y&ogj 4t� ' ' _c�n--
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 6 = is Longitude: = ° 0 6 0
As
Design Current
Design
Current
Design
C►►urrent
Swine Capacity Population
Wet Poultry
Capacity
Population
Cattle
C►apacity
Population
❑ an to Finish
❑ La er
❑ DaiEy Cow
❑ can to Feeder
❑Non -La er
❑ Dairy Calf
Feeder to Finish 7 G
❑ Dairy Heifer
❑ Farrow to Wean
Dry poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
Non -Layers
El Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
❑ NE
❑ Yes
El Yes
9ZZ NA
El NE
El Yes
❑ NA
❑ NE
12128104 Continued
14 A

Facility Number: 31= Date of Inspection a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l /� [sts�ItJ� CA CgcDU '-`
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thFcat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P40 ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes [3 o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes `T"' ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
,El NA
7Np,
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑Yes
LI 1v ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
No ❑ NA
❑ NE
Cvmmientsl( fe tv finest n #); Egplatn any YES answer�or�any recommendations�or any other comments.
�Useddrawmgs�of1fac�ty tonbet�ter explain situation§. (use additiat pages as necessary):
Reviewer/Inspector Name Phone: g( y L
Reviewer/Inspector Signature: Date: z6
Paae 2 of 3 I2128104 Continued

Facility Number: — Date of Inspection �]
Rewired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes n No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
;'Vo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p 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
Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspection�No,
22.
Did the facility fail to install and maintain a rain gauge?
El Yes❑
NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L�J N
ElNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E"
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

r
Facility Number (,
.dDivision of Water Quality
O Division of Soil and Water Conservation /
Q Other Agency ✓
Type of Visit (2(Con2pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine ()Complaint O Follow up O Referral ()Emergency 0 Other ❑ Denied Access
Date of Visit: /b j) Arrival Time: Departure Time: I � County: D11A Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: .� Title:
Onsite Representative:, JGNl4T 01,TL
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: 1--] 0
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ 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?
Longitude: 0 ° = ` = "
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑N ❑NA
El NE
❑Yes
❑ YesFo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: 3L_ _ Date of Inspection 6
Waste Collection & Treatment
4. Is storage capacity (structural plus stone 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
Struc1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: tur lA &0NZ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�io ❑ 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 t;h at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes y9o
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes L/J No El NA ❑ NE
maintenance or improvement?
Waste Annlication
10,
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
IVNo
[]NA ❑ NE
maintenance/improvement?
11,
Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes❑
NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
EX
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
[I NA El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,'�""o
ICJ No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
Q<o
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
Q,l<o
❑ 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):
1)A41D 001 L" yf 6 C ve A?,¢.Jy`t1r
zy) 61 LZP_TZ6
6 ? �p ��t✓ j� � C-
Y
Reviewer/Inspector Name L Phone: W 4c- % 3ho
Reviewer/Inspector Signature: Date: /d i/
12128104 tontinued

r •
Facility Number: — Date of Inspection FIVIr Lo
Repaired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑l No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropirate box. ❑ V,1Up ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IdNo ❑ 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
1 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
s
�
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
ry'es
I(rgNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Ye
l4 No
El NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
Yes
❑ N
❑ NA
[I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CJ Zo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
1 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
CZ(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
�o
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
CJ No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

f
n
Fr
acility Number
r
f Visit Gomn for Visit 1P11C
Date of Visit:
Farm Name:
Owner Name-
Mailing Address:
Physical Address:
vision of Water Quality
0 0 Division of Soil and Water Conservation
0 Other Agency
iance Inspection Q Operation Review O Structure Evaluation 0 Technical Assistance
tine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Arrival Time: Departure Time: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
�u
Latitude:
Owner Email:
Phone:
Phone No:
Integrator: 14 %)
Operator Certification Number:
Back-up Certification Number:
Region: 6
u Longitude: =0=g
Design Current Design- Current Design. Current
Swine Capacity Population Wet Poultry,.;,.Capacity Population Cattle ,: < Capacity Populatton
❑ Wean to Finish ❑ Layer
10 Wean to Feeder 1 ❑ Non -Layer
10 Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
El Layers
L) Gilts
❑ Boars
Other
❑ Other
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Ether
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 Cowl
Dumber of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2, Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stn,rtnre t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
:Comments (refer to question 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):
AL
Reviewer/Inspector Name 1 Phone: - 2
Reviewer/Inspector Signature: _ Date: l
Page 2 of 3 1 Z12 810 4 Continued

Facility Number: 3 Date of Inspection Era
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ W`Up ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need im=teklyFreeboard
ent? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
EjWas pplicati ❑ ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rai all ❑ Stoc ing El Crop Yield 120 Minute Inspections [:1 Monthly and I" Rain Inspections Bather Code
id 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. id the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
aZ Ve 5 u (,,p ko Gore GE s ck e sw v"�-�r a.Qo 6
a 1) 1 N q s) vt�, 2- e- I2-1 4,1,. ✓i o+ r e Cor[Qi- ce c4.
0( Ida M1r\xt lnse�eG —Lr,n5 3 /y- APcc
�4 e !�e sate7-A-1,5
Page 3 of 3 12129104

Type of Visit ecompliance
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
Routine O Complaint
O Follow up 0 Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: j O Departure Time: j L Count
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: GEC
Certified Operator: —AkoawLy D 1;ti3Sb r
Back-up Operator:
Location of Farm:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: � O= g 0 i" Longitude: 0° Q"=
it
SOW
Swine
❑ Wean to Finish
❑ Wean to Feeder
Desgn Cre'r o.Deg� Curr nt ,>
CapactPopulation & Wet Pouitr}y CapacityPlopulatton
_+-.Vl•.:i'ES'S..•..t..i. '.
"❑ Layer "
❑ Non La ei
1) N �Desna ` Current
Cattle% "CapacityPopulatian
h: ..-•1.�'u.1"^,'_ �'.I
❑ Dairy Cow
❑ Dairy Calf
® Feeder to Finish
0
�00
4 a
`a
Drv�P,00ltr�
"?� `
El Layers
❑Dai Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
ElD Cow
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑Beef Feeder
❑Gilts
❑ Boars
� ❑ Non -La ers
El Pullets
❑ Beef Brood Cowl
Nutnber of Structures:
Others x* s _^El
❑ Other
❑ Turkeys
Turkey Poultsi€
T ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
El Yes
El No
❑ Yes [] No ❑ NA ❑ NE
❑ Yes E2No ❑ NA ❑ NE
12128104 Continued

Facility Number: '3 — 3 Date of Inspection a 5
WAte 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 Structurey 2 I Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 12M I ad 0m'LI+►��1
Spillway?: t
Designed Freeboard (in): Cl
Observed Freeboard (in): 3V 415
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P(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�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? El Yes D No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes YNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesCl/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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) 3i ca'M 0phi CO S 6,0
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 [3/No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes VNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [3/No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 2 No ❑ NA ❑ NE
�`aecx:s.3_ - vA%. 5:,iraflLE:42.L
(<.W3 COPY Of C-CZ ir sr'.rCAi6 CaAlt &F_ Awb PERM Zr w,Lrk 12E�6ans,
gyp.) CEP GOP'' 6�F WUR AND t.AGaotJ DESZ.C-,DVS VjtT I QCcan.DS,
To 1.lEW t-o(C-N1 J. NtVS� I-�t-1 TNSPE�f .Lbl�i,
Reviewer/Inspector Name Phone: 3400 a,- 103
Reviewer/Inspector Signature: Date: OJ
12128104 Continued

FacilitytNumber: — Date of Inspection j� S
Regsaired 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 a components of the CAWMP readily available? If yes, check WY es ❑ No El NA NE
the appropirate box. V�p ❑ Checklists lam/ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
leYes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil alysis El Waste Transfers
El Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield El120 Minute Inspections Monthly and 1"
Weather Code
Rain Inspections.
%❑
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
E No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WN o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ffNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
dNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�No
❑ N
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
LJ NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
ElE
' No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
ElYes
E4
❑ 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
LI No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
UNo
❑ NA
❑ NE
Additional -Comments and/or Drawings:
12128104

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 150koutine O Complaint O Fallow up O Emergency Notification Jeother ❑ Denied Access
F_ Facility Number Date of Visit:
Permitted [] Certri�fiedy Qr Conditionally Certified [3 Registered
Farm Name: `� !�/Cl� � f� ` r'n y T /'% G�
'�Ar,i11
Owner Name: 1� j� C k r ►t i�� C� r'r �ri�: Ce
Mailing Address:
Facility Contact: Title:
Onsite Representative: J a !fie Prl'ce 6a-6
Certified Operator:
Location of Farm:
Time %&
Date Last Opor Above Threshold:
County:eradve l r n
Phone No:
Phone No:
Integrator: GOId; bol-d
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 K Longitude 0 6 �u
Desi nn"
ne' Ca acity
Current Design Gur" r` nt 1 il` Design Current
Po ulation P�nuitry Ga acity P,o ulat'on Catle Ca aci E© ulation
Wean to Feeder
❑ La er ❑ DairyFeeder
❑Non -La er ❑ Non -Dairy IFarrow
Other
Total Desin CaaciGiltsBoars Total SSI.W
to Finish
to WeanFarrow to Feeder
Farrow to Finish
[01
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon AreTIE3
Holding Ponds i Solid Traps L� ❑ No Li uid Waste Management System
S
�FieldAren
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [--]No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: Date of Inspection 5 Q
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion. El Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a xettabie 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
Reouired Records b Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WTJP. checklists, design. maps. etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ❑ No
22. Fail to notify regional DkN-Q of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑Yes [I 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 visit
y to better erplatn situations. (use additional",pages as necessary)
... . <.. - .. , ❑ Field Copy ❑ Final Notes ,
tvo3 done 4e yev:ew ��non -4Z Glesure �Oroc jS
�•^ SGvsS Glosure e-{ ,,gr+•yci;.b,,.� lgG,aO,,r �4 4 �. �-F ap�oears
reasanab�Q e�`Fords 4A e beer, ,wide ,•�,�at e sludi
[9s9 oon W z, 717e kva3 jro^i1a!� �o S dons 4_
Gem sa y S-ll,e•� is q j a v e .,�)e e r e rw re, 04 6q%Xj v,4 il l a9aQ� Z
&t-Ak,- an +et-4sen am''' p ' j -440, 1^0061-1 #4 wr jo done]
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
05/0"1
Continued

a
Facility Dumber: 31 — s Date of Inspection 5 03
Odor Issues _
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation. asphalt.
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. \Vere any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shuners. etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ )-es ❑ No
❑ Yes ❑ No
'ken'- /mod y 4 cv'-� ;-fy C 1 o.t v le o-� I o or2 4z , 7n►w
4 C'r ,S To.' GaCCO h W 2 ez --e
�4,1
J �
cQ _<,g,'rlWeLy �S 4,1e 1,V c upl eP7�)� e )c '-f cis a Fresl•�.w4��'
pond, olp,-td �}�ass %� do`s-�vrbe�q�itts.
—rkc
o � Gloss l a j oa• f 't� � . T)�e
b ; a j aq i Ga 1 ,O� vL i a" l elDQr) T. ,
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G1JEeh 4 der 4kte. bCrt r'oC
I, qv� onto spf�,I',e)4s a�' -ire -1!ar�
s S �- �a a ;I
al e a r rn•, � a l� req,,r1 a bl e effo�
here a y 5
� S �� �o� � e v+e� UQ
-¢ lie s t V Q "tot 'A ona
sy.JeY%I%.
O5103101

Type of Visit ?acompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ISRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of visit: OZ Time:
Not Operational 0 Below Threshold
Permitted MCertified 3� Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: / %✓k/d,t7 County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
11
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0. 9 C� " Longitude 0• '
Swine
Design Current Design Current c' Design Current
Ca aci P,o ulation P,o_ultry Ca aci I'o ulatian Cattle Ca acity P.o ulation
❑ Wean to Feeder
IQ Dairy
Feeder to Finish
❑Non -La er
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
Total Designs Capacity
Total SSLW
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Trapem s ❑ No Liquid Waste Management 5 st
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: ! 7—
Freeboard (inches):�
05103101
❑ Yes OKNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 'B�lo
❑ Yes KNo
❑ Yes RNo
Structure 6
Continued

4V
Facility Number: * — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes Q!�No
❑ Yes (INo
❑ Yes No
4 Yes ❑ No
❑ Yes 5Yo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes MNo
It. Is there evidence of over application? ❑ Excessive PPondiinng ❑ PAN ❑ Hydraulic Overload ❑ Yes MNo
12. Crop type &211414 l /1 /1�ti ���✓
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes C,&No
14. a) Does the facility lack adequate acreage for land application? El Yes L§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
[5J No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
19 No
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
KNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
KNo
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
;RNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�KNo
2 t.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
;,No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ]p No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes J,No
24. Does facility require a follow-up visit by same agency? ❑ Yes ,K No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes IgNo
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Conimentsi(refer to question'#) Explam any YES`answerslndlo>r�ny recommendahans or any other camments.l�� �;
Use.drawings of facility to better, egplatn sttdahons ;(use�addthonal;pages�as necessary)
.. ��,WAFF ❑ Field Copy ❑ Final Notes
Reviewer/Inspector Name
„ '� _
Reviewer/Inspector Signature:
Date:
05103101 6 V v Continued

V - +
F'aciiity Number: 3/ —(p Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments and/or Drawmtts.`
V �NM -W Z A- l.GfWd lei t%� e
[�,, 4 S lL d-4 - * &.- /-wAo 1 -
OSIO310l
❑ Yes PNo
❑ Yes O.No
❑ Yes .9 No
❑ Yes Wo
}
❑ Yes gNo
❑ Yes '9 No
❑ Yes XNO

1>
i•. � _ Divisiowof Water Quality -
Q M iviston of Soil and Water ,Conservation .
O Other Agency
IType of Visit j04;ornpliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 0outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility NumberE2TIDate of Visit: / Q Tine: jQ-dli Printed (in: �10/26120{)0
p� Not O erational Q Below Threshold
ermitted !3Certified .0 Conditionally Certified 13 Registered Date Last Operat or Above Threshold: 1
Farm Name: LMel4it--'r
County:.....,
OwnerName: ............................................ Phone No:..................................................................................
Facility Contact: ........................................................................Title:................................................................ Phone No: ................................ I...... �..........
......
MailingAddress : ...................... ...................................................... ...........
Onsite Re resentative: ��rJ ��/ �i� ator:
p ............ .......... P....... 7. v1.....................�,,%
Certified Operator................................................................................................................. Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �' �°° Longitude �• �' "
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JE1 Subsurface Drains Present JjE1 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharge & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. 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
Aructure I Sn u re 2Structure 3 Structure 4 Structure 5
Identifier: ....L..............................Q.............._...._................................................................
Freeboard (inches): 0 710
5100
❑ Yes ❑ No
A/14,
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes XNo
Structure 6
Continued on back

Facility Number: — '% Date of .Inspection t Printed on: 1/4/2001
30. fs there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes '1(No
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNO
32. 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 90
V0
33. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes VNo
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNO
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
§?M'J �� Aps &ev- � . p �aA') uluP /ems brew
L/7I-/d Gbs7' /tle,.) /a COY1 obsJ � yt--�
Y44%-e-' �4'
U e
40
U
are bin
J /
��-�yl �l.�fi �OD�S !�D/,� '-�/✓+����5 4.4'e-
t/
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
01/01/01

Fac`i'lity Number: — Date of Inspection / Printed on: 1/9/2001
• 5: AYe there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does thefacility 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?
PIN, Q yiol;aigris'o� defic�enc�es wire pQted duringhis;visjt; You w�i� lreceiye na fuhr
cori•esnorideh ' abanit this visit:::::...::::...::::.... .
mein b (refer to question 4#): Eolau m any YFS�answers and/or any rebi
irawinp..of facility to -better earplam sit uatioiis_(use additidual pages a
�-
ndatiii or'an -atlki co-11AU �e'
y-- . d .
❑ Yes KNO
❑ Yes JKNo
❑ Yes No
❑ Yes No
❑ Yes yNo
❑ Yes iio
o
❑ Yes
❑ Yes MN
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes 1No
❑ Yes ANo
❑ Yes trio
❑ Yes ANo
❑ Yes 01no
❑ Yes jNo
o
❑ Yes
❑ Yeso
❑ Yes oo
I&
Reviewer/Inspector Name
Reviewer/Inspector Signature:
vffrff
Date:
5AW

3 Division of Soil a:
,3?, .r © Division of Sots a:
A Division of Watei
Othei:Agency . C
Routine Q Com Taint Q Follow-up of DWQ inspection O Follow-up of DSWC review 10 Other
Facility Number 3 f 53 Date of inspection 3/zZ BQ
Time of Inspection 24 hr. (hh:mm)
0 Permitted [3 Certified © Conditionally Certified 0 Registered 113 Not O erational Date Last Operated: .
Farm Name: D.`.. County _ ._...r..A.........................................................
................... U 1
Owner Name: � Pr i CG Phone NO: .................
....... ............................ ............... .... I ... ................
FacilityContact:..............................................................................Title:................................................................ Phone No:
Mailing Address:
Onsite Representative v� OE ►� ►'1 a o� Integrator:.........................................................................
Certified Operator: .................... I ........ . .................... ....................... ....... I ....... ..................... Operator Certification Number: ................. _.......................
Location of Farm:
__ _ ............... _ _
....•...._.•._.•_•._......._.•._........................................................ •I.......•................._.___ .. ............•....•.._...._...._ .._....-_.._......_..................._. _....._ ....... T
.
Latitude • �' �•• Longitude u • �' �"
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts.
❑ Boars
E Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
- Total Design Capacity
- TotaI SSLW
Number of Lagoons -- >_' ❑Subsurface Drains Present ❑ Lagoon Area 10SPray Field Area
-.
- Holding ponds I Solid Traps w ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If dischargc is observed, did it reach Water of the State'' (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2- Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...................................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed'? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3123/99 Continued on buck

Facility Number: 3 — 6S3 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 maintenancelimprovement?
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
3ZZ Ob
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 & soiI 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 AW'LYIP?
0: Rio yiolatioris:or deficiencies --wig re hated ditriitg ibis-vssit;- Yoil will•reeeive rid further
eorresporidei ' e:ab' ' th" :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 #): Explain any YES answers and/or any recommendations or any other comments. - -
Use drawings of facility to better explain situations: (use additional pales as necessary}:
Tv1sreC41 o✓% 4o rev icw Iagoo-\ :1 dos urr- Anal r rL,! t -3 aon z--4e �
Q h s i+e. ree. j sv t l -qee( 14 -�00 " C bs Ure r-e jOo r 4
Farm TO !Ayoovt dur;�5 insloec4-o".
I s� �� 1qg oon ,mod rg r
qr M"'k.-I
Asked. Clio rdund �a s��e� ves4e-
a(
`
�.! Q b e ad %� r cA p Y/ o Y U G�Y1 ST/ V c-4 O t� Od r /T ✓l r /!_/ay .
J ✓)
Reviewer/Inspector Name S-AO),1C ,) Cry ; r
RevieNver/Inspector Signature: Date:
' 3/23199

Facility Number 31 53 Date of Inspection d CY}
Time of Inspection S_ 3p 24 hr. (hh:mm)
© Permitted 0 Certified El Conditionally Certified © Registered 113 Not Opera Date Last Operated
Farm Name: ....:...1hC k' n �e ..................c .......r ............
�r ' c r f..-, County:. v�...'."`...........................................................
n
......................................
Owner Name... �.;. m...'.......; ±Q. .........v.�rr. ... pri.ce................................... Phone No:...............:.......................................................................
Facility Contact:
Mailing Address:
................................... Title:
Onsite Representative: Gera remS .. Integrator:
Phone No:
Certified Operator: ................................................... ............................... ................. Operator Certification Number:..........................................
Location of Farm:
............. .........- ... ..................I...... .I.......................... .............. ...............................................................
Latitude �� �' ��' Longitude 0
Swine
Design', _Current°
Canacitv;= Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Desi)h Current
1�
Poultry Capacity Po ulation Cattle , ty ataon
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ :..
Other
Total Design.' Capacity
Total �SgLw-,
Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Dischmes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the Statc? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated glow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes El No
2. Is there evidence of past discharge. from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than.from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ' ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ...............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility A-mber: 3 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
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
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?
yiolatioris or• defciencie5 were noted• during this:visit: • Y:oi} will-keeeiye Rio; further -; ;
correspondence. ab6ui 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
Comments (refer to'quesaon #): Explain any -YES answers and/or any recomiaiendations or any: other c'o`'mments._
Use drawings of facility to: better explain situations (use add%honal,pages as necessary) _� T
C, ,4vr4,z-A 46 l�tctca-ti e_rOsvres 1t 14 McLt
Con fa5oen �
,,!CoS �rvG�ia q ,
1 ,cY'04 e ' �c+, o .5 ti y S Yi e: tv r<(n�( oat , 1 $ r' e q1! � 4., b e
No C togoa'', 1 �qs be,, -r, jjed ,h Ar1d sa,"e 5)()d04 is 4o ke v,hPej�
°'I+ or rare of leioah. Are,, 4� q4 114J l eel �illec� l�ced3
46 'have I/eger��,�>�n es�a61;�h,4 ilnrr►meolr'a�Ely 4e p,-ev'e►04 ��✓-�I�tr
e yr s S i oln
'Jig t
q vv��
Reviewer/Inspector Name r 3 x� S 3! d f i- Z CJ'" 't
�. S ,
Reviewer/Inspector Signature: "56bc;� Date:

Division of Water Quality
0 Division of Soil and Water. Conservation
0 Other Agency -
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
IDateurvisit: q-Zr'�d Time: !•3 r It� Printed on: 7/21/2000
,3
Q Not Operational 0 Below Threshold
O Permitted © Certified 0 Conditionally Certified ❑ Registered Date Last Operate or Above Threshold:
Farm Name: _...:(..!.L.�i..N:! Jt .....�.`...! r!. ....r4,rPl-\—County:... ........G!/..........
OwnerName: .......................................... ........ ........................................................................ Phone No:.......................................................................................
Facility Contact: .............................................................................. Title:
.. Phone No:... .................
MailingAddress: ............................................. .. ......... •-- ...... ................................ .............................
..........................
y
Onsite Representative: ��i Inte rator• ---- t
p f .. - ...... r�cc...................... .----. ..-....... g �.......�f.�..
T
Certified Operator:... .............�'�G�/ -� ........... �-r........... Operator Certification Number............--..........
Location of Farm: "
k Swine []Poultry ❑ Cattle 1—]Horse Latitude • 1 Longitude • 6 4C
Design Current
Swine Canacitv Population
❑ Wean to Feeder
Feeder to Finish
Y
3p00
❑ Farrow to Wean
❑ Farrow to Feeder
: f
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I F
Dairy
Non -Layer Non-DairyI I
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag -on Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b. If discharge is observed. 'lid it reach Water of the State'? (If yes, notify DWQ)
c. if discharge is observed. what is:the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than' adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............�1% ..'/....--.............................. ..... ................................................
Freeboard (inches):
5100
❑ Yes ❑ No
-:wlf
❑ Yes ❑ No
❑ Yes �No
❑ Yes �o
❑ Yes �No
Structure 6
Continued on back

Facility Number: — ! Date of Inspectionpet-VCF?
Printed on.• 7/21/2000
S�Are there any immediate threats to the integrity of any of the structures oie/trees, severe erosion, ❑YesNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 66No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
`Waste Application
10. Are there any buffers that need maintenance/improvement`?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type / Y7 6, �
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?
vio�aris:or &flcien6es *e're ngt;ed- d&iftig this:vislL • Yoft ;Will -receive Rio; fufth& :.:.
correspondence. about this visit.
❑ Yes tNo
❑ Yes t(No
❑ Yes 0 No
❑ Yes KNo
❑ Yes tLNo
❑ Yes 'o No
❑ Yes [S?rNo
❑ Yes E�[No
❑ Yes qNo
❑ Yes k No
❑ Yes �zNo
❑ Yes 4No
❑ Yes �No
❑ Yes ETNo
❑ Yes [gNo
❑ Yes 4j No
❑ Yes No
❑ Yes .\"0
❑ Yes 9No
❑ Yes 1)(No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings off facility to better explain situations. (use additional pages as necessary):
AY. 10
a-c-
Reviewer/Inspector Name /���/ �( / &4� rsn
Reviewer/Inspector Signature: Date: a7/ 5100

I Facility Number: 1 _Z31 Date of inspection L( p Printed on: 7/21/2000
(�Icir Issues
T
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge it/or helow ❑ Yes JP No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes M'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes k] No
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes VNo
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 ej No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes M No
Additional Comments and/orDrawings:
5100
5100

f
[>>DiAsion'of Soil and Water Conservation - Operation Review
1 ];Division cif Soil and Water Conservation - Compliance Inspection
Division of Water Quality --Compliance Inspection
w = Other Agency - Operation Review
Routine 0 Complaint 0 FollOW-rm of WO inspection 0 Follow-up of DS«'C review 0 Other
Facility Number I Date of Inspection
Time of Inspection 0 3b _ 24 hr. (hh_mm)
© Permitted l] Certified 0 Conditionally Certified Registered JE3 Not Operational Date Last Operated:
Farm Name:.... t�;e:...�5. ............ County: ................ 1�
Owner Name: ................ Phone No:
Facility Contact: ..............
Mailing Address:
.............................................................
Onsite Representative: ................. ... fy.�.........
Certified Operator:.........
Location of Farm:
Title: ......................................................... Phone No:............. .
................................................................................................................ ..........................
Integrator:
...�-{ Q... .. ......................................
..- ............................. Operator Certification Number:..........................................
Latitude �' �' �" Longitude
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish}
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JE1 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 (If yes, notify DWQ)?
❑ Yes [ 4No
Discharge originated at: El Lagoon ❑spray Field ❑ Other
a. If discharge is observed, was the conveyance man-rnade?
❑ Yes
Ef No
b. If discharge is observed. did it reach: ❑ Surface Waters []Waters of the State
❑ Yes
❑ No
c. if discharge is observed. what is the estimated flow in gal/min'?
d. Docs discharge bypass a lago6n system?
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
gYes
El No
3. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
MNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Yes
❑ No
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Slruyu-e
i �
Identifier: +dpx�
r�u e-.t
Freeboard (inches)...."'....0............I............. � '. `............. .......... a` .,., /. 1.....................
N I
.............Io
116/99 Continued on back

.,.,Facility Number: 1 — j Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? 4
(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?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application'? ❑ Ponding ❑ Nitrogen
12. Crop type ................................................................................................................................................
0
%Yes ❑ No
13. -Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application? (footprint)
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 certified operator in responsible charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ❑ No
V Yes ❑ No
❑ Yes ❑ No
%Yes ❑ No
❑ Yes ❑ No
❑ Yes $9 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ 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
No AWaitiorns.or. deficiencies .were noted driring .Hiis:visii:. Yoti rivilfre� eive nar Nrtheir .: .
eorrespoiidei iee: about; this visit.; :: : ; ; :: : :
Comments (referto question_#): Explain any YES answers and/or any_irecommendationsor any other comments .`� t
Usedrawings of facility to better explain situations. (use additional pages as necessary)• m r
aL �`t- 6y A=
Reviewer/Inspector Name
Reviewer/Inspector Signature: I �__u N,_ Date: ��. [� 11/6/99

Y- 13 Division of Soil and"W%ter_Conservation -Operation Review ==
C] vision of Soil and Water'Conservahon .Compliance Tnspechcin
[3 Division of Water Quality =Co*oliance,Inspection
D Other Agency - Operation Review N
_ 3
10 Routine Q Complaint Q Follow -tip of DWQ inspection Q Follow -tip of DSWC review 0 Other
Facility Number 3 3 Date of Inspection
_,. .., Time of Inspection D 24 hr. (hh:mm)
© Permitted 0 Certified 13 Conditionally Certified 13 Registered I0 Not Opera Date Last Operated:
,,vf / p ..........................
Farm Name: �•''7GKi����j tf�'� �/'t'ce {•q�r� County: p� /IYl
........................... ( ........................-....-......
-.........P....................................... .......................
�. ►'t?b� l "/� 4 J_`r tor' j tG
OwnerName :....................................................' . Phone No: ---....................
Facility Contact: ...................... ..............................
Mailing Address : .................... ...
............ ........ .....................
..
' , 1
Onsite Representative: „ ...L.... -- }.......... r.) G
CertifiedOperator: ................................................... .......
Location of Farm:
Title: ................................................................ Phone No:.............................
Integrator:.....' ................................... .......
..... Operator Certification Number:...._..
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------a
Latitude �' �� �•� Longitude
Design Current = Design Current ', Design Curient
Swine _ Capacity Population Poultry - `Capacity, Population ' Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of -Lagoons 10Subsurface Drains Present ❑Lagoon Area IDSpray Field Area
HoldingPonds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field [:]Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ 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 s ~tern? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ! Z 3 q 5 C
3to.rr... � Freeboard (inches): ........................... ...........`................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Date of Inspection
6"xre 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
IT Fail to have Certificate of Coverage & General Permit readily available?
18" Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
2L Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio yiol.. . o. deficiencies ►sere noted iiuring this:visit; Yoir will reeeiye Rio further
correspondence. abmit. 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 toxquest ou,#} „Explatn ariy YES answers and/or any recommendations or any otliier comments.- G
z
p (' :_
UseAdrawin s of facility w etter ex lainusiti�ations use_addihonal pages as^necessary)
g • - _ _....... ._._
Assess.r,t!Pof � Iaon dolt
I&
Name Reviewer/Inspector
p
Reviewer/Inspector Signature: 1 y�,�, � Date:
3/23/99

(y e
Lagoon Dike Inspection Report
Name of Farm/Facility�a4e_ F/
Location of Farm/Facility
Owner's Name, Address j S//y /t ti 9ifp
and Telephone Number
S i 04, .fle- 111 s Scmaef
Date of Inspection -2 7 -y' Names of Inspectors I -a
r
Structural Height, Feet % 3 Freeboard, Feet Z
Lagoon Surface Area, Acres Z 4 c___ Top Width, Feet _ r
Upstream Slope,xH: IV 2 Downstream Slope, xH: l V Z= i
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes _ No
(Check One, Describe if Yes)
Erosion? Yes _ X No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
�rees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Yes _ No If Yes, Depth of Overtopping, Feet
Yes No
_Yes _ No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes No
a

Division of Soil and Water Conservation Operation Review
13
Di' ion Co of Soil and Water Conservation .mpliance inspection
Division of Water Quality .,Compliance Inspection
Other Agency._ Operation Review
0 Routine 0 Complaint 0 Follow-up of DWQ ins ection 0 Follow-up of DSWC review Other
Facility Number Date of Inspection - qq
.. Tithe of Inspection ©24 hr. (hh:mm)
Permitted 0 Certified [3 Conditionally Certified © Registered JE3 Not Operational Date Last Operated:
FarmName: -......... `... C..-....---�.......................... County:....--... --......-- .........................
..........................
Y-.......Y� v......................................
Owner Name:.---...-.-.. Phone No:
FacilityContact: ....................................... ...................................... Title: ................................................................ Phone No:..............-...--.---...........................
MailingAddress:..........................................C.... .........P�....................'....................................-....-...........
Onsite Representative: Q .......,. ..+ ^'�( Ante rotor.
.......... ............ K 4T..............'I
Certified Operator:.........................................................................................I....................... Operator Certification Number:.........................................:
Location of Farm:
i
......................................................................................................................................................................................................................................................................... 1
Latitude Longitude
_ Design Current Design.,, Current : Design - Current;" T_
Swine =Poultry ,-
Ca acity Po ulationnCa lahin Cattle.Ca -Capacity hy Po ulatioachPou
El Wean to Feeder ❑ Layer ❑Dairy
- ❑ Feeder to Finish -`' ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
-,; ❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish - Total Des* C�PaCity
❑ Giltsr --
❑ Boars - TotaI-SSLW
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes gNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -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? El Yes � No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? XYes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: )� nnnn
Freeboard (inches): "I S off` 33 a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 9Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

Facility Number: — Date ref 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 �'r,viri�Pc�s ir.. V4-� SG� L n 1n1
❑ No
❑ Yes
❑ Yes
❑ No
KYes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
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?
.... violaticjr... deficiencies mere noted ... . g his:visit: You l - I reeeiye rio #'..... •
corresp6iideitce: about: this visit. . .
❑ Yes ❑ No
❑ Yes ❑ No
XYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
jf yes ❑ No
KYes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comments (refer to.questiou #): Explain any YF.S aaswers andior any recommendations or.. -any other comments:''
Use_drawings of facility to better explaiii situations (use additional pagiisas necessa -``
A 6-
' f ��pY� 5 h0�r �� �. „ ( � I � t,,� tt S
II _O,_r
s mow-, . � �1� tiw 2�►-�_ ��Scc� ` a "�- �w L
4� �V&@e��7�� 111CL �3}LCr
Reviewer/Inspector Name ` : ` - —
R:
Reviewer/Inspector Signature: Date:
3/23/99

Facility Number: 3 ( — 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 ,(No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
A:ddifionalCommentsan or rawrngs r; a
S`fi1�� ►�� a wee. ��w--.e�e�- s�.
41- -A
r
D`LJC� l "�k,L--
3/23/99

Lagoon Dike Inspection Report
31-
Name ofFarm/Facility eG F/ b53
Location of Farm/Facility
Owner's Name, Address ?/1 tL f1 f 45T_ �7z 6
and Telephone Number _
5 jOle if%
Date of Inspection _ 9�7 % 'f�9 Names of Inspectors
r
Structural Height, Feet �J Freeboard, Feet Z
Lagoon Surface Area, Acres 2 s e__ Top Width, Feet �r _
Upstream Slope,xH:l V Z= Downstream Slope, xH: l V Z= f
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? Yes _K No
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
as�rees)
Yes _ C� No
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 X No
Other Comments

f r
❑ Division of Soil and Water Conservation ❑ Other Agency �F y
Division of Water Quality
NO Routine O Complaint O Follow-up of DWO itasnection O Follow-up of DSWC review O Other
Date of Inspection 1L G
Facility Number
Time of Inspection S 24 hr. (hh:mm)
Registered [3 Certified 13 Applied for Permit [3 Permitted [3 Not Operational I Date Last Operated:
Farm Name:..... \e- I V--t 42 ............................................ County:.... '' 1�.`..1............................... ............ I..........
Owner Name:.. ..:..!'�G{ !.^......:..1-�e''YY VACR.................................. Phone
FacilitContact: y ......... Title: �^Q„ ft
................. Phone No: Iri
Mailing Address:... ab[..... i. `.1............. Cs�eh t >" 1 �C............� ................
LOnsite Representative:- &&d ..e .... i. .�. U.... .................................... Integrator: ... ... ............... ..........
(Certified Operator.......4...WC!................................................ Operator Certification Numher:.--_1....1..
Lqcation of F rm: ,
...... ............. ............ ` .... ':....}::..!... t...... . ........F..... .......... n%AR...5►�-�. G ....
c�. ....5 ..15 a. . ............................................. ................... .
Latitude ' 6 « Longitude 0' ' r_� 46
Subsurface Drains Present 11❑ Lagoon Area
No Liauid Waste
Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
Yes
❑ No
2. Is any discharge observed from any part of the operation?
❑ Yes
VNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gal/min?
1 } t
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ)
❑ Yes
NNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
14No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
XNo
5_ Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
XNo
maintenancelimprovement?
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
Po
7/25/97

.►
Facility Number:3 � - 443
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La¢oons,Holdine Fonds, Flush Pits, etc.
❑ Yes gNo
9. Is storage capacity (freeboard plus storm storage) less than adequate? XYes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft): ...............1. �.. . S `a. r.Q.............. —! .
......................................I....---.--............. ............. ....
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... ­­ f............* . 5.............................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Qnly
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0• No.vialatio'ns•ar. deficiencies:were-nflted-duii_ng this;visit:- You;will i-&eive,mi�furiner,
::•c6rrespQr�dettce:aliouffhis:visit:•" ;-.•_-; .::.•:�.�::�:•.•:•;•:•:�:�:�.:•:•:.........
.•
❑ Yes, O No
Ryes ❑ No
0 Yes ❑ No
XYes ❑ No
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KNo
t4 Yes ❑ No
❑ Yes 1ANo
XYes ❑ No
NYes ❑ No
❑ Yes 19 No
❑ Yes (;4No
c� -A A-C k1jL ":O"L
13) Q GCl�Sr .
�4 , ►\ C�v �'rtQ>J . �d C2 �►-�l`f� �7Lczt 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: ' C- Date: 1A f �G 19 2

��f i facl l�yNumber 1 �� Dof inspecttonT:i: me'.J,�flQ_ Inp42t4iate ,GY
FhimeUse_
Farm Status: _ C�'�... Routine ❑ Complaint ❑Follow-u
Farm Name: Qi ��� �05�... _.�_... _ County:..,/..
Owner Name: . e G" _ Phone No:
Mailing Address:(? .�P /yG�i/ Syu $ r.n 5AO9'
Onsite representative: - — 4Grd44-tAQ_ _ Integrator: : wg� "r y
Certified Operator Name:
Location of Farm:
i�G id Z 3 srs. �r-r A_-1oA rW 55 /Z1 S�!
a
Latitude ' a� '®" Longitude
❑ Not OperationalOperationall Date Last Operated:
Type of Operation and Design Capacity
Syv�rte�Nurii6era rP.Utrr R.7 Num`eE
bMW WOattle umber=_
13 Wean to Feeder Laver Dairy
Fe Feeder to Finish Non -La er Beef w
- $»;
rl Farrow to Fpedpr
Farrow to Finish 0 Other Type of Livestock '
imw^�w�a�x sr sew
NtirnberofgaonslHoldrngPonds� fio OSubsurface Drarns Present e
.��<4 0 ^,•�� .�3r � � � ,��� � � Lagoon Area ❑Spray Field Area
Genera! `
1. Are there any buffers that need maintenance/improvement?
❑ Yes
ERNo
2. Is any discharge observed from any part of the operation?, - _
❑ Yes
1S No
a. If discharge is observed, was the conveyance man-made?
❑ Yes
9,No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
(2 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
3. Is there evidence of past discharge from any part of the operation?
19 Yes
❑ No
4. Was 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 lagoonsiholding ponds) require
Yes
❑ No
maintenance/improvement?
Continued
on back

6. Is facility not in compliance with any applicable setback criteria? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)? [:]Yes ® No
8. Are there lagoons or storage ponds on site which need to be properly closed? PAYes ❑ No
Structures (Lagoons and/or Holdina Ponds
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoop 1 Lagoon 2 Lagoon 3
10. Is seepage observed from any of the structures?
❑ Yes ❑ No
Lagoon 14 5 10
O
❑( Yes ❑ No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ,Yes ❑ No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWO)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels? 9Yes ❑ No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ®,No
(If in excess of WMP, or runoff entering waters of the State, notify DWO)
15. Crop type F 5 5C L4 C�
16. Do the active crops differ with those designated in the Animal Waste Management Plan? _ ❑ Yes ® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the cover crop need improvement? -fvl-k"
Yes
❑ No
19.
Is there a lack of available irrigation equipment?
❑ Yes
No
For
Certified Facilities Only
20.
Does the facility fail to have a copy of the Animal Waste �agement Plan readily available?
[� Yes
[ %
21.
Does the facility fail to comply with the Animal Was a Management Plan in any way?
❑ Yes
® No
22.
Does record keeping need improvement?
[Yes
❑ No
23.
Does facility require a follow-up visit by same agency?
HYes
❑ No
24.
Did Reviewer/inspector fail to discuss reviewfinspection with owner or operator in charge?
❑ Yes
❑ No
49
Re.vrewerllnspector Narne.�.:�- :-�, � � w��.�»..::g,, � • s� � x. �; � � ��t -� � �� x�r�����"�"�"a
Reviwecllnspector ;;�5ignature � �� _ w date �. '�' � ,v
cc- Division of Water Ouality, Water Quality Section, Facility Assessment Unit 11/14/96

Site Requires Immediate Attention:
' Facility No. 3 1- 6 S 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
c DATE:
Time: 3oD
Farm Name/Owner: c. V i
Mailing Address: G60 �- N C- - It ScABy
County: _
Integrator.
On Site Representative: _
Physical Address/Locatic
CS-2 c1st
ISoI
Phone: G
C1 `ass �t�
Phone:L
r i ✓�4,. S_. 7
Type of Operation: Swine L/ Poultry Cattle +Design Capacity: Capacity: 5 ot-b sue' S ' Number of Animals on Site: 155-D
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: !>S ° 0'6 ' 41 Longitude: 11 5 4 ' } 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) 6>r No Actual Freeboard:_Ft. Inches
Was any seepage observed'from the lagoon(s)? Yes or&)Was any erosion observed? Yes or To
Is adequate land available for spray? Yes or No Is the cover crop adequa e. Yes or No
Crop(s) being utilized: K!�_j rC `G
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 YDor 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 -trade devices? Yes or� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage, with cover crop)? Yes or No
Additional Comments: ( 1 ov�rs `j k e,`=es
N.. v4irw.. nt1' 0c cP,.— \ f!r,&—A, ,_, r_4, _. '1'"
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.
. \I

e /
{' Site Requires Immediate Attention
--r
Facility Number:
31 �3
SITE VISITATION RECORD
DATE: , 1995
•
Owner: �..-40r I=_c_�" Farm Name:
County: .041 t A
Agent Visiting Site: } Phone: 91,0 -- q 4 '� I1 0
Operator: Phone:
On Site Representative: Phone:
Physical Address: On SR 15Q 2 u 0 o-1' /So
Mailing Address:
Type of Operation:
Design Capacity:
Latitude: o
Type of Inspection;
Swine ►�
Poultry Cattle
Number of Animals on Site:
r _" Longitude: 0
Ground Aerial
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: Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed fxom the lagoon(s)? Yes or No Was there. ero'sion-of the dam?: 'Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
Fax to [phone]
Alo i h_�4r.M_.d4 �1�1✓1 - - • -
Sinnature