310681_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

1 W
Type of Visit: Q'Co=outine
Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:% Arrival Time: p D Departure Time: a o County: Region:
Farm Name: 2� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title: Phone:
Onsite Representative: '0 ^(/fr���,r.I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: f 7 ��7—
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
L.
eder to Finish
Design Curren
D , P,ouIt , Ga aci I;o
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turkey Poults
Other
Beef Brood Cow
Other
Other
Discharees and Stream ImD31CtS
1. Is any discharge observed from any part of the operation?
❑ Yes
[J'N—o ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑-No DNA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Ins ection:
*ante Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes C o DNA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA. ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): DJ
S. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[3 Ko ❑ 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
❑,N6 U NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[� NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[3-% ❑ 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
[a-�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
❑' 1�❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[]-Iqo--❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
io 0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'Nqo NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�❑
❑'No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0-Ne—❑ 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
o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Ej+t E] NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[j4fo❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: jDate of Inspection: G
24, Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes To ^❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes 0110--l-❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes .�❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No [_❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes o ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes P_ND---M 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 [D-N-57-❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑`N-o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Reviewer/Inspector Signatw

Type of Visit: (a Co pliance 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: ® County: t Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: c.)dN P'E AA (y1:S-LAEj7, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I C1 Ct ( -!-
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
I JNon-Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
Dairy Calf
Feeder to Finish
(y
Dairy Heifer
Farrow to Wean
Farrow to Feeder
l) . Poultry
Design
C•_a acity
Current
P,o ,
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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)
0 Yes
o
❑ 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 1 of 3 21412015 Continued

Facili Number: jDate of Inspection:
1 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: �r�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes WNo ❑ 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 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) VN(o
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 Zt,40 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
El 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
CoKO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records &_Docu_ments
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
d1No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
FZf/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. ❑ YesPA o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VN0o
❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

aciliNumber: jDate of Inspection:
i ' 24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
-the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
WNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
D NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes FNo
4 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or�any other"comments:
Use drawings of facility to better explain situations,(use,additional pages as necessary).
Reviewer/]nspector Name:
Phone. lo
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 21417015

Type of Visit: Q�Cophpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: I FM= Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ' Tittle: Phone:
Onsite Representative: `T jv,�r/ Ir f,L1�Z Integrator:
Certified Operator: Certification Number: I c�
Baca -up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design
Pop. Wet Poultry Capacity
Layer
Current
Pop.
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I
JNon­Layer
I
Dairy Calf
Feeder to Finish D
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
Layers
C►urrent
Dry Cow
Non -Da'
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turke Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes [—]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 dN ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

FaciliNumber: jDate of Inspection:
Waste Collection & Treatment
4. i 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 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
C�/No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes zNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes to ❑ 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 PTINo ❑ 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 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E(rN
❑ 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
❑ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[!�No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
�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
fail
❑ Sludge Survey
NA
22. Did the facility to install and maintain a rain gauge?
[:]Yes
❑ ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

Favffity Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [] NA ❑ NE
25. It the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes eo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 2 No D 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?
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:
[] Yes n No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes n No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑NA ❑NE
❑NA ONE
❑NA ONE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
J �� N Retjak Phone:gr )T(`� g,
re: Date: 1 .
2/4 01 S

Type of Visit: O Co ance Inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: J y Departure Time: EZ= County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Jd��-AIy MIL" 1-- _ Integrator:
Certified Operator:
Phone:
Certification Number: 1 1 I Fr
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet PIII Oil ltn5 Capacity Pop.
La er I
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I INon-Layer
I
Dairy Calf
'Feeder to Finish
Design Current
D , P,oulAPTO Pao -
Dairy Heifer
Dry Cow
Non -Da'
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
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? [—]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 ❑
❑ Yes
❑ Yes 1N` o
❑ NA ❑ NE
[DNA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: rt - 1 Date of Inspection:whij/14
*Vaste 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: (, (�bOIN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesVNo
❑ 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 LZ'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [] Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ 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 rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes IVo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 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 qO
❑ 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 ENO
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes r�(o
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Ins ection:
2� Did the facility fail to ca ibrate waste application equipment as required by the permit.
❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes No El 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes�Zo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 6 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 C�/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 C1 N [:3 NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No- ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes P - ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any:additional recommendations or any.other comments:
Use drawines of facility to better eanlain situations fuse additional nacres as necessarvl. f'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
v
Phone: C" I �- D O
Date: i
/4/20I4

�`1'ype of Visit: Q Co�ipliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: DUIP1,T Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: J100 r A1J
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
iNon-Layer
I
EE]
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
a aci no .
La ers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
I
I
INon-Layers
Beef Feeder
Boars
I
I
Pullets
Beef Brood Cow
Other
Other_j
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes KNo ❑ NA ❑ NE
❑ Yes i O ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of inspection: q
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): 31
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 environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ 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 hfa ❑ 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 CXINo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 6/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes Io ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �Zo
❑ 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 ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
<" ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: C4117J 1 3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ 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 to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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/]nspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNIo
❑ NA
❑ NE
❑ Yes
[�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
�' ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments -(refer to question #): Explain any YES answers and/or any additional recommendations or any, other comments:.
Use drawinji of facility to better explain situations (use additional pages as necessary).
{
Reviewer/Inspector Name: Phone: C ID
Reviewer/Inspector Signature: Date: qJ (Z
Page 3 of 3 2 /201

Type of Visit: Qf pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
sit: CoVRR Reason far Vioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: $ Arrival Time: ❑ Departure Time: [ County: i Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �_TG Lj w M_ _UJ /Z
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator: 1 CC
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er I
p
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
Feeder to Finish
Dairy Calf
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
E My P07ult . C_a acit Po
Layers
Dry Cow
Non -Dairy
Farrow to Finish
I I
113eef Stocker
Gilts
Non -Layers
I
113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
,Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ o ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Faciti Number: - Date of Inspection: a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �J/No Ej 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&ao
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No ❑ NP
❑ NI?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
o ❑ NA
❑ NE
S. Da any of the structures lack adequate markers as required by the permit?
❑Yes
o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ICJ No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2f No . ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes No
❑ NA
❑ NE
acres determination?
W�i�No
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
❑ NA
❑ NE
Required Records & Documents
INO
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 0
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes o
❑ 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
Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectio;/N/o/
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 o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: JDate of Inspection: Ii
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNNo ❑ NA ❑ NE
25. Is fthe 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 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yesr:�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signature:
Page 3 of 3
[—]Yes
fo ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
JO/No ❑ NA
❑ NE
❑ Yes N
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Date: jV
2/4 OII

Type of Visit: CyCo liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: $ g Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: (Jp%�%� �j /,It` Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:_
Certification Number:
Longitude:
Design C►urrent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer I
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder Non -La er
I
Ell
Dairy Calf
Feeder to Finish �%W dDairy
Farrow to Wean Design C**urrent
Farrow to Feeder Dr. P,ouiti, C_a .aci_ P,o ,
Farrow to Finish La ers
Heifer
Dry Cow
Non-Da'iry
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars Pullets.
Beef Brood Cow
MI
Turke s
Oey Poults
Other JELOther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes [-]No
❑NA ❑NE
❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes R�N ❑NA ❑NE
[:]Yes ❑ NA ❑ NE
Page 1 of 3 21417011 Continued

Facility,Diumber: - f Date of Inspection: R ll
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: L46OZIA)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [DNA ❑ 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 environments. threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [:]Yes VNo
❑ 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 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 6 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes d
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes rNo
❑ 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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes E]Zo
❑- 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 dN
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili umber: jDate of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
U o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA ❑ NE
27. Did the facility fait to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Cj No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
U O ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
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
0 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
rN,0
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
0 Yes
❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
.140)
Phone:fill
U1 712
Date:
214 011

Division of Water Quality
�«
clltty'Numbe' 7j f
F
Dwis�on ofSoil andWaterConservat�on
m�
0 Other=Agency,.
Type of Visitpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit gRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other . ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: OUPL=�J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: J rJ AT:HAiJ Ma_V R-- Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 6 = Longitude: ❑ o = i =
R
Design eCurrentN N- 'Design Current
` ,'Design Current.
Swine w Capacity ,Population Wet Poultry Capaclty Populat,on " C the = "Capacity Po ulatrou
p¢-
❑ Wean to
r
Finish
® Feeder to Finish -o S�vla
❑ Farrow to Wean
,
❑ Gilts
Farrow to Finish
❑ Boars
El Layers
El Non -La ers
El Pullets
❑ Turkeys
Turkey Points ❑
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 WNo ❑ NA ❑ NE
❑ Yes
El Layers
El Non -La ers
El Pullets
❑ Turkeys
Turkey Points ❑
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 WNo ❑ NA ❑ NE
❑ Yes
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 WNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yeses,/No El NA El NE
El Yes )�'No ❑ NA ❑ NE
Page 1 of 3 12/28/04 Continued

s�
Facility Number: 31
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2<01 ❑ 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: Lig
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lit?
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th;eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes El"No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require [] Yes [;,No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [-IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
io
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
Ex"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ztm o
❑NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Comments refer to - uest�on.# Ez lain an YES answers and/or an recommendations or an other comments
Use drawings facility to better�explain situations. (use addittonal pages as necessary); T
d...
UfJD6P�- IJU10 IfALf FS6LD rj 1'`AA/EbD 16 ►-EEe
Ore— cAap
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: t)
Page 2 of 3 1
12128104 ' Continued

0
Facility Number: $r Date of Inspection 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Zo
El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑Checklists ❑ Design El Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. �J Yes/No ❑ NA ❑ NE
❑ Waste Application ❑ 2Crop
ly Freeboard ❑ Waste Analysis ElSoil Analysis ❑ Waste Transfers ElAnnual Certification
❑Rainfall ❑ Stocking Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes N/o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes EX(l) ❑ NA ❑ NE
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes El NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ YesVNo
El El 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 to ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
L�No
rr�
El NA
❑ NE
El Yes
No
❑ NA
❑ NE
❑ Yes
,4
❑ NA
❑ NE
❑ Yes
E rNo
❑ NA
❑ NE
❑ Yes
�
❑ NA
El NE
❑ Yes
2
❑ NA
❑ NE
Additional Comments and/or Drawings: -°
Page 3 of 3 12128104

M
Type of Visit 0�C,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
(2
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Q (�, Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: ),Iu)4Tht6,6Z _ M--rt 1_trt. Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ' [=] Longitude: = ° = ' =
�esign
Crent
Wet Poultry C►►opacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Wean to Feeder
❑ Layer
I
I
❑ Dairy Cow
❑ Non -Layer
I
I
❑ Dairy Calf
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
60 "Lfb
Dry Poultry
❑ La ers
El Non-Lay!letsers
El Pullets
Li Turke s -
❑ Turkey Poults
11, JEI Other I
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
Stocker
[I El
ElBeef Feeder
❑Beef Brood Cow T
!Number of Structures:
Other
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify D WQ)
❑ 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
❑rNo
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
�
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — g Date of Inspection o
i� Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L"J No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
J 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
eat, notify DWQ
environmentaZvo
7. Do any of the structures need maintenance or improvement?
❑ Yes
ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
MZNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2fNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
EJ/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ld No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
dN o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
d
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L''J No
❑ NA
❑ NE
Comments (refer to question' #) Egplatnaany YES answers and/or any recommendations,or any other comments.
Use drawings of facility'to better explain situations (use.additional pages as necessary)
Reviewer/Inspector Name I �b „ a� Phone: (�
Reviewer/Inspector Signature: Date: 0
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents �,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes Ld No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C" No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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
ErNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0"No
ElNA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
�(No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
E'No
Ld o
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
LJ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N/o
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El
,V,
(rJ/No
ElNA
El 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
EZ"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
dNo
❑ 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
9'<)
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional"Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Co Hance 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:&WL1 N Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
� l �
Onsite Representative: J��41�-1-�� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 6 = Longitude: = o = ,
Design
Swine Capacity
Current
Population
Design
Wet Poultry Capacity
Current
Population
Cattle
Design
C55aci 1P
Current
]ation
❑ Wean to Finish
ID Layer I
❑ Dairy Cow
❑ Wean to Feeder
ID Non -Layer I
I
❑ Dairy Calf
Feeder to Finish !a a
7-q7—
❑ Dairy Heifer
❑ Farrow to Wean
El Farrow to Feeder
Dry Poultry
I
❑ D Cow
ElNon-Dairy
El Farrow to Finish
❑ Layers
Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other I
❑ Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
Other
❑ Beef Brood Co
umber of Structures:
❑ Other
Discharges & Stream Impacts
/No
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ 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
❑1No
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
ElE Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
O No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — g Date of Inspection
Waste Collection & Treatment
1 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EZ 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
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes NJ 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 UKN❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LI No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ❑
4. Does any part of the waste management system other than the waste structures require C1 Yes 2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O/No
❑ NA El 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 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
L"J No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ryes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
�
❑ NA
El NE
17. Does the facility lack adequate acreage for land application?
El
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
VN
❑ NA
❑ NE
1r), GJ (amE LE FT CLeU) f 0, E-r(,-l./ Cj" SSES ��D !✓�Eo Ll� T�2a L
291,) xft" r uRvC Gqc. e44 rt,,,, o, L�Pi
% Ll±k.o bu � °1r�rcc
Reviewer/Inspector Name E 1 Phone: MV
Reviewer/Inspector Signature: Date: g

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

i,
Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency ✓
Type of Visit (-Gam ance Inspection 0 Operation Review Structure Evaluation 0 Technical Assistance
Reason for Visit Routine o Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: pU?0i-ZU Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: VON
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ Longitude: ❑ o = ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
1114 0
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current`'
Cattle Capacity Population
E]Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
El Yes
El No
❑ Yes
L No
❑ NA
❑ NE
❑ Yes io ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection fd i o
y Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: L fzxg5- 1
Spillway?:
Designed Freeboard (in): I
Observed Freeboard (in): W
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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 LEI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [?/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Zo
o ❑ 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 C2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Lf No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 14% or 10 lbs [--]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
R�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
1,j j _Tge Z Lj s 1-6 03 E r*t)( Eb 10,1M PIN & M/ S6Prr- AXE111 f 66 .4fft 40 Ad
Sdd /A+V d9wo VVEkjT(__ -ta t3E )PCA�6J.
A/FE 19 SnG,XN (r ,00-1l6 ,
-2 L,) A!ff 0 CYP j ;rs c
L
erlInspectorName V Phone: 9/0 71berllnspector Signature: Date: v p

Facility Number: Date of Inspection Fl_eTigh,71
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WiJp ❑ Checklists ❑ Design El Mans ❑Other
❑ Yes 2/No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
21. Does r cord keeping need improvement? If yes, check the appropriate box below. Yes
❑ No ❑ NA ❑ NE
Waste Applic on El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste
Transfers
❑ Annual
Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
L/J No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
[,'%Io
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Y
�No
El 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
ICJ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ 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
C2N<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�/Nq,
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[I NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes❑
NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

L"C_i'lIty Number 3 t 6 81
W Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit CZr7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: (! 00 Departure Time: County: Dtl�l Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 661-6 d (-.Dq
Certified Operator: _ CH 9--05 _cyi.1 Ir4trJ
Back-up Operator:
Location of Farm:
Swine
Title:
Owner Email:
Phone:
Phone No:
Integrator: rrh ir_fw�
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 1 Longitude: = ° =
Design Current ' Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
"I
11"
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ko ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes El No El NA ❑NE
El Yes El No El NA El NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
12128104 Continued

Facility Nimber: 31 —LVI Date of Inspection
Waiie Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑Yes ENo ❑ 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: tkeyy
Spillway?: Na
Designed Freeboard (in): 13
Observed Freeboard (in): 14
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
d No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
dNo
❑ 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
ElNA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
,fNo
IlNc,
❑ 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
LJ 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 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Croptype(s) 134:s_A,�04(it 4, S�
13. Soil type(s) J4OTO-L L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IJ 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,
El Yes
E�No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LI No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[XNo
❑ NA ❑ NE
5cxt—M � :5 s err Fa0 cf1_sS a F TA_YZ 4 G- '�o GGT FuLr uaTC tij
r ET NEkI LAUC-L CrAIjC" Pt1r �1� • NEEDS L-ZM46 Vo CFZ,
Reviewer/Inspector Name Phone: 3 ..3� 1A3
Reviewer/Inspector Signature: Date: °jLos.
12128.104 Continued

Facility lumber: 31 — (oil I Date of Inspection d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
0A ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[FNo
❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
ElEl Yes
El"No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes
El No
E NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No CKNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No [?NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
!2 NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[2"'No
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
VN
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�,%
L� No
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
El 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
E2096
❑ 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 Reviewerhnspector fail to discuss review/inspection with an on -site representative?
El Yes
E ffNo ❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional -Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit _/Routine O Complaint O Follow up O Emergency Notification O Omer ❑ Denied Access
Date of Fig U l 0 3 o Tune: 2 S
cility Number 3 t 1
Fa O 7ot—Operational. O Below Threshold
© Permitted (3 Certified 13Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: &W=r—A S l `!- Z - County: Z)UPLMO
Owner Name:. _ . .» .. ..... _ ... 'Phone No:
?I+Iudling Address:
Faciliity Contact: .._ ... _ .. W-----Title: __ __._ ... -------_ ... __. Phone No: w
OnsiteRepresentative:Integrator. �il'-R-R-a�-l-$--------
Certified Operator:
Location of Farm:
Operator Certification Number:
a
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • " Longitude a ' Du
Discharses S StreamImpa
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 ratan -made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 13/No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [?1(40
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes C4
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: .. _. _ �. _ -
Freeboard (inches): 31
12/12M3 Continued

Facility Number: 31 Date of Inspection 1 t) o
5. _�},re there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
0 Yes
2(No
'' seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑yes
No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public heaIth or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
L3No
15 No
8. Does any part of the waste management system other than waste structures require maintenan�mprovement?
❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
dX0
elevation markings?
Waste Application
10. Are there any buffers that need maintenancoimprovement?
❑ Yes
:NN
I I- Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
!� �o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop Mx P C-0 .rnuv (,) SGO
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
��o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
QNo
b) Does the facility need a wettable acre determination?
ZYYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
01�0
Yes
16. Is there a lack of adequate waste application equipment?
❑
ETNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ yes
[Ko
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
[311 q
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
To
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
Uto
Air Quality representative immediately.
� Camm�s {re€er #� qne'-�) �� 'YES^a�sv�ts aadlor slay reoammeadati� or aity¢oticr Commeais.- � �`-
W;1- drawynllrs offs mbe r a srma�aa�. {use acidil�onal paw as; r3!? C Notes
NP❑ ❑F
a
I FAQ-X:-TY IJC-ADS W6-rrAw—(; ACAA- �ETEtw�nIAT�GcN Ar/n -NC.w WUP (?JaSe�
22) o1l 06w AC-'W6-*— , L-NTPc;' DwQ uNGOJ Cain V(,e-T6TP,
rAc.uTTy &J07 GCrt,T?-�- rcp, t�(�-6�SS of GET NG U-0-1 t, 1* STARTFo AND wa tj
ol4 060 1-O61 "r%-T AHID ?4�a4v►2T c #,JTAcx bwQ LJ"j COMPLETEb,
23+� GARCFUL or.) APPt,-r-tagTYor1 wwOaW ;ori WASTE A14AiAa$S, AjJW--?s.Ls SS
(?aah F,,,_ Ga 8A l-s Pa-=olt_. AN-n tif`r2 5AN►PLE, 0ATI , APQ rrt, 2-00+
P
DZ0 N� t 4 Av 6 - wA^Iei 3-rr vjYks T'E 1► is A L 9 SSs , 5 a Ct, S ArAJ G, N ECD S
O o rJ 6t.tAut�.N,nn
G Lrrn 3 .
T
- -- Z _ v_ _ . ... __
Reviewer/Inspector Name _
Reviewer/Inspector Signature: Date: 16113104
12112103 T Cont bumd

Facility Number: 3 — (o Date of Inspection D D
Reduired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
RYes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
Yes
❑ No
23. Does record keeping need improvement? If yes, check the appro ate boz below.
JYes
❑ No
❑ Waste Application ❑ Freeboard (Waste Analysis Cd Soil Sampling
No
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
TNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
Qrfo
27. Did Reviewer/Inspector fail to discuss reviewrmspection with on -site representative?
❑ Yes
Q No
28. Does facility require a follow-up visit by same agency?
❑ Yes
Ef'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ffKo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
�No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDFS required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit F Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit/ Q Routine O Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of visit:
Q Permitted M Certified © Conditionally Certified 0 Registered
Farm Name:
Owner Name:
Mailing Address:
rAIrrR
Date Last Operated or Above Threshold: _
County �PG� 1 _
Phone No:
Facility Contact: Title:Phone No:
Onsite Representative: _ 4rly- &&V f_) Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0.0i u Longitude 0' 1 0«
Wean to Feeder aUL,
Feeder to Finish ❑ N
Farrow to Wean
Other
Farrow to Finish
Gilts
N
I Number of Lagoons JLJ Subsurface Drains Present _ JLU Lagoon Area JU Spray Field Area I
Holding Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharees & 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 gat/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: 1
Freeboard (inches):
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes XNo
❑ Yes No
Structure 6
05103101 Continued

5�
Facility Number: Date of Inspection /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El 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
Z o
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
.;No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
Waste Application
lg�No
10. Are there any buffers that need maintenance/improvement?
❑ Yes
1. Is there evidence of over application? ❑ Excessive Ponding . El PAN ❑ Hydraulic Overload
Yes
�.fNo
J/J No
12. Crop type jPG r%!/�
/
13. Do the receiving crops differ Witt those designated in the Certified iinal Waste Management Plan (CAWMP)?
ETYes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yes
E❑/No
[jN
�o
16. Is there a lack of adequate waste application equipment?
El Yes
✓
;�JINO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
XNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
f
(ie/ WUP, checklists, design, maps, etc.)
El Yes
U No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
!`!!!❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
o
21. Did the facility fail to have a actively certified operator in charge?
ElYes
ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
o
24. Does facility require a follow-up visit by same agency?
❑ Yes
No
X1,o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El Yes
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cdhfn is (refer to quekidh #) , Explain any YES ans ers and/or any ammendahon5�©r�anyxother comutents
_ .
Use drawrngs of facilrty to be a egplam sstua ons {use addittidnatppges as n essary) � ., Field Copy El Final Notes
.. �.y
I usE Z Le g,kz!1 Jr_
Reviewer/Inspector Name Q
Reviewer/Inspector Signature: Date:
05103101 1 Continued

Facility Number: —01 Date of Inspection
O or 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 Drawings:
Z4/t�'O 70
❑ Yes No
❑ Yes l/ No
El Yes No
❑ Yes No
❑ Yes No
❑ Yes Vo
El Yes ❑ No
1?),V
4we , 45�m�- Ae6'1.'
�. er e- Sibs.
y
-,Y-r 11*49 70
56
6000 ('911J40Z-725501J�
05103101

M[Division of Water Quality
s¢' Q Division of Soil and: Water Conservation
O Other Agency
Type of Visit )K Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date �{ Visit,OD 'lime: ss Printed on: 7/21/2000
Facility Number 3
Not O erational Q Below Threshold
E3 Permitted Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: ......ra.cl,�k!'\-Fale'r%`....°.Z...................................................... County: A,(./i...:)...........................................................
OwnerName: ............L�.L'...'..3....................�A.'......................................... Phone No:.......................................................................................
FacilityContact: ........................................... Title:................................................................ Phone No:...................................................
:Mailing Address:.............. ............................................................................................................................................................................................ ..........................
Onsite Representative:..... � ?..Y..i. f �" t. ................ g rre � S
............. ............... _ Integrator: al.............. �...... ...... ..................... ........................
Certified Operator Operator Certification Number:,
............................
Location of Farm:
a
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �° = Longitude C�• �� �«
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
I"1 n
! 80
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed. did it reach Water of the State'' (If yes, notify DWQ)
c. II' 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: .............................................................................._................................,_..................................I._......................
Freeboard (inches):
5100
❑ Yes �5 No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
EfNo
❑ Yes
0No
❑ Yes V No
Structure 6
Continued on back

Facility Number: Date of Inspection Printed on: 7/21/2000
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 allo
(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 3 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes jo No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 0y No
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Excessive Ponding 10 PAN ❑ Hydraulic Overload Yes ❑ No
12. Crop type 6Vr" VdG �a�7, 8e�'`1.1,�� Pure �" et.-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
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?
(ic/ 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?
•violaiioris or• deficiencies -Were h6fed• during this:visit: Yoii will •reeeiye Rio further • : • : •
' corresp&idence: about this visit ... ..... :
fiRl Yes ❑ No
❑ Yes ❑ No
❑ Yes jZ No
❑ Yes FfNo
❑ Yes �9 No
❑ Yes No
Yes ❑ No
❑ Yes No
❑ Yes fi� No
❑ Yes X9 No
❑ Yes (0 No
❑ Yes 10 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 pages as necessary):
t�. p„e�R��l;e�( o►� ! 9� 9 lgc�'��A4 �,,s�-�� e r �sey 3 by ya �6s �N�4cre.
13. Cows siloufa( hof �e al10ttle,0( 4e�jeld Aes�►�ep( es_s �q Gray
de4e► r1,7ihR-�iar) alld iv r-,S4& pran �o ,vta-its,!
H. UA-4e mcJ yf.s ne_e4 4o be Svck -�o COvo, a��l� eq-]�anr oGLUrri
tv;44j,-t �0 d a h �
a-f A4C oRA1', Si S �tTo 7`L,ere
rire ho p��P;�9 r^eao�oEs or
1197- 2600 Srv0111 _J.'ctih Cre . Grawv, rlPeds 4o-�oi(oW oc�7r�cCAi ia� LJ'hQa+vs ik�I�n
►)4e: �i4d,-,v45- F41 s}to41 d 6� en ,re 1%4 slorA yi " in ) A V-tie1d. w
Reviewer/Inspector Name S/o 4 uVt 0 1y) 4 A ;1
Reviewer/Inspector Signature: � �,,,���( Date: $ fl 06 .5100

Facility Number: 3 hate of Inspection
r dor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes M 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 91 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes AA 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 E] No
ditional. omments and/or- Dr#iings;, . a
a
3/23/99

j] Division of Soil and Water Conservation - Operation Review
❑ Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality - Compliance Inspection
Other Agency - Operation Review
L1ERoutine-�Q Complaint O Follfo-v-up of DWQ inspection Q Follow-up of DSN C review 0 Other
Facilitv Number Date of Inspection i
Time of Inspection T100 24 hr. (hh:mm)
❑ Permitted 16 Certified ❑ Conditional1v Certified ❑ Registered ❑ Not Operational Date Last Operated:
Farm Name: ��y��.... ll - �a lk . tY #Z ......... County: ....... DLf 1i.............................................................
............ / � _t �............. Ym.......................................
yxj
Owner Name:4..X!vY.±.S.............?'KPhone No:.-Cil...:.8.............................................
Facility Contact:
....................... Title: ....................................................... I........ Phone No: ........
\tailing Address: ..... ..... ^Lrv�T�tlC�... �(.?.k�.....t�tl.:..................................... ......... :�Jf\ I1.FAi t..1\fIL.......................... ..2X-5-- .1.
Onsite Representative:................4� V.�r3�..... FOt!^�011f�.................... .. integrator:.......I. Jr1CC�1 5................ .........................
....................... .............
Certified Operator:
...�5... (c.:....................... .................4lnlL TkAl7........................ Operator Certification Number: ...... �19.,�..................
Location of Farm:
...:.....�r2.............5 .f.... s .-.. .....+..... :......NS.t�,GS......t'FLS......Q.......- ......................................................................... �
-
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ T
Latitude �' ®Z E347- Longitude —["l ' ' ©`=
Design Current
Swine Canacitv Population
❑ Wean to Feeder
10 Feeder to Finish
U0
❑ 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 l & o
Total SSLW Z3`7 Goa
Number of Lagoons : _ ❑ Subsurface Drains Present ❑ Lagoon Area El Spray Field Area .-
Holding Ponds / 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 9P No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes P No
c. if discharge is observed, what is the estimated flow in gal/min? _
d. Dees 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 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 09 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) Iess than adequate? ❑ Spillway ❑ Yes M No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard(inches): .......... ........................................................................................................................................................:.....
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
❑ Yes M No
Continued on back
3/23/99

4
r Fatty I�Iumber: 3� — (D 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 1A PAN
12. Crop type
13. Do the receiving crops differ with tho a 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?
Reeguired 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?
�: o yUhtiori:s:or• ..&flcie ....were jpotea- ding 4his:visit: - "Y;oir Witl-k&6*e rid further
- Corres�onc ence. about this visit.' . . . . - .
Comments (refer to questson. #t) 'Explatn any YFS_r
Use.dra«ings of faciltty_to better explain situaho (u
7• I�ot, ��
dCIc
wo.lt o�
16fa, Shcaa
b, 0'.0 rrseed(j.
nLkJQ. O y. fQa O,, GV,_ j MoAtr.
❑ Yes .® No
Q Yes ❑ No
❑ Yes ® No
53 Yes ❑ No
❑ Yes @ No
ix Yes Ifi No
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
5d Yes ❑ No
❑ Yes 10 No
❑ Yes 0 No
LPj Yes No
[Yes ❑ No
❑ Yes No
❑ Yes 10 No
❑ Yes 19 No
❑ Yes No
❑ Yes ($} No
❑ Yes 0 No
Lj_ -c,.d� ' s Ovte.,� � � cclivr or rCSeY 3 0^ 1D,.rY ude, c3 l 40 hx/ ,tc. R `� Ga i
1+ I� g
tS Sr+�e.lt gY-ntr- t.. From �o�r� oc Yt2�f� a}taVj� �ae-- fm{�r-ovt�. Mr� �`ocy�i� �rl�s �lfovt� i'b
x eS� i� Ce1A5P'l (��`{l0ci ray ZCL-V 3 1
!g. j�7'ck4 rr-f-erd 5 Co1r `� a' 19 5 WA{i 9 Mis kOJId 6,a— Sl k - A cool 4 *, sQ fti (-a s
Reviewer/Inspector Name
AL
Reviewer/Inspector Signature:
Date: 1-7 / IC—M I
3/23/99
r

Fa, ijity Number: (— (o I 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? Cl Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
A tional . ommentssaan or: grarvrngs
1 1
�
s
3/23/99

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
Routine O Cont laint O Follow-up of DWQ inspection O Follow-n of DSWC review O Other
Date of Inspection �
Facility Number Time of Inspection =0U 24 hr. (hh:mm)
(3 Registered V Certified © Applied for Permit © Permitted 113 Not Operational I Date Last Operated:
Farm Namc:..... .......`..oUr- air.. .........i.'�.L ............................... County: �if-lift.............•----. .......................
OwnerName•.ltr.�...............................>~5.................N.....------............................. Phone No: ....�����..3z�.��$�°.........................................
Facility Contact: ..
Title:
PhoneNo:.. .............................................
Mailing Address:.......2..........I`our.-W'.Tawyy............Kd1........................... ..........� l�ct /vim.................... ?.......
Onsite Representative:.......... �lr�S.......Ml�^ 7hirt.............................................. Integrator: .............1...1r1!!1' Irs ..............................................
Certified Operator: .................. L Jm-ica.......-........6WA1^..................... ...... Operator Certification Number, ..... 1 l.5-.1.......
Location of Farm:
fir..-.....Sa....................................................................................
..... --................................................................................................................................................................................................................... F
Latitude 34 Longitude • �i L� ' ©"
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
O No
2. Is any discharge observed from any part of the operation?
❑ Yes
[M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
[A 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?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than Iagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
I
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
( No
7/25/97

acility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsJlolding Ponds, Bush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: '' ll
Freeboard(ft): ........"L A.................................................................. ..
10. Is seepage observed from any of the structures?
I I- Is erosion, or any other threats to the integrity of any of the structures observed?
Cl Yes [A No
❑ Yes RNo
Structure 5 - Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
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. l P type!r�y1 a ............................. `3.11R'`4k�.1..........0,mt�n...............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
P
0 No.violations-or' deficiencies:we're-noted duffing this:visit.- You.vi�ill i-ec_ give noltirth�er•
corrOpbadence dtiout this: visit. s .
❑ Yes
MNo
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
...........................................
10 No
❑ Yes P No
❑ Yes No
'Yes ❑ No
❑ Yes W No
❑ Yes iV No
❑ Yes [9 No
1AYes ❑ No
❑ Yes PR No
j1 Yes ❑ No
Yes ❑ No
it- i�'Ef jv'- '56uldf be, rir*��4aod rI• S. r,� i i
LZ. `itb liar �ahi f� 6mvd0. oW zt if vo�►1` 5 �� � e- �? %evwd.
of, }i0 r O i/�• 6..ymuO a. &'�{t,V- 5 hlpcl
kro�1n +r�;�1ror 1�Jrtil(�IrtEg• 1 �-{s�" '_ 06W 6 upd�
lw. awrl, gYw7,1v) 0.akk Q�.Lcge . 41 S1Vovjf e. GU{ 4 .ZSo�i.• c.Ccore)i
4 UJO- J
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: .�.Date:

MR
v
❑ Division of Soil and Water Conservation ❑ Other Agency v�y
Division of Water Quality
® Routine 0 Complaint 0 Follow-up of DSi ins eetion 0 Follow-up of DSWC review 0 Other
Date of inspection 6 7
Facility Number !
Time of Inspection D` 0 24 hr. (hh:mm)
© Registered It Certified 0 Applied for Permit Ci Permitted Q Not O erational Date Last Operated: .................
Farmlame 1-6u.Y4t,G` .................................................................. County: ... ...b ..........................................................
Owner Name: ............. CA%r5....... 9Q1,-6th............................................. ......... Phone No: ..� idi. ? .-..!f$fa............................................
Facility Contact:.......G iS , 61�Jlur..................................... Phone No: L�103; �-yi—A
.............................. ri ►..................... Title
Mailing Address:..... ?......�- t. n.... ,................... .. .. .. iu
nn r
Onsite Representative.......... Arl....... E.ki.. jam ..................................................... Integrator: lrQ.��s................... .... .......................................
- rr p /
Certified Operator:......... i.5.........1.'fJ. n4i..................D.L('r Operator Certification Number, .......... 1. ?..............
Location of Farm:
4-...1. .. _--Ou�k ...... uu ;n �..... ��,^ ..... n ..........4a......5..�'T.l .�...... a+c.nr....t.s...... a:5...........
.rn��t ...... .....o. ......SIB....��.L.7.ern.....5�V'.�:-.._.:�;.t�c,....�...r..A......�.A......................................................................................................
Latitude �• 0� �« Longitude
H Destgii' Current Design Currents Design Current
'5�vtne . Capacity Population
'' PoWfry „ ' , CapactEy Population Cattle _ Capacity I'opuEation
It
, .. s
❑ Layer ❑Dairy
01
❑ Non -Layer ❑ Non -Dairy
M E
❑ Other
Ir Total Design Capacity, 0
-: �T6 L t
Number of T,agoons 1 Haldtng Ponds--�--�-� ❑ Subsurface Drains Present © Lagoon Area ❑ Spray Field Area
F.
W- ........
No Liquid Waste Management System
El Wean to Feeder
(� Feeder to Finish
to 0
❑ Farrow to Wean
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
" Discharge originated at: y❑ Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DR'Q)
c. If discharge is observed, what is the estimated flog;• in gal/min?
cl. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. is there evidence of past discharge from any part of the operation?
4. -Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than larpoons/holding ponds) require
maintenance/improvement?
6. is facility not in compliance with any applicable setback, criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes
JEPNo
❑ Yes
Z No
❑ Yes
M No
❑ Yes
(0 No
❑ Yes
5g No
❑ Yes
t9 No
❑ Yes
($No
❑ Yes
®No
❑ Yes
� No
❑ Yes
� No
Continued
on back back

Facility Number: 31 — G$I
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures „(Lap oons,[fold itte Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
.............................................................................................................................................
Freeboard(ft): ...........3�.�.............................................. ...... ...............................
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?
❑ Yes id No
❑ Yes j. No
Structure 5 Structure 6
................................................................
....................................
❑ Yes 1Z No
❑ Yes 09 No
❑ Yes ®No
❑ Yes 10 No
Waste Application
14. Is there physical evidence of over application? ❑ Yes A No
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type ............. GY.r!4.G_...................................................... ..Sls�s�.�.�.....�M1tl... ....... .........................................................................................
.........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes IS No
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 reviewlinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations-o'. deficiencies' were noted -during this'visit.- Yod4ill i &e' iVe-iro-fdrthei~ : -
correspbndence about this.visit
Yes ❑ No
Yes ❑ No
❑ Yes (9,No
❑ Yes IQ No
❑ Yes 10 No
❑ Yes 91 No
❑Yes •®No
❑ Yes El No
❑ Yes tA No
cicrear!Se, 444ve.}1`(
wlII he a� SGrF v% of n;61en. Ikiiz, is _ �ntr51,
y►lahor�t'i � 0.[t�iti. Pjiku5er, S6v,O Vik Pe' owro A 40 j- 5DA,'cids-
lg. cinct &V16 6e lm�ro spnr� '91 .
Reviewer/inspector Name
7/25/97
Reviewer/Inspector Signature.
Date,.

•
1 0
Site Requires Immediate Attention: A�
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIlYIAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1e2119, 1995
Time: 3✓�O
Farm Name/Ownt
Mailing Address:
County: -- )L
Integrator.
On Site Representative: 1V
Physical Address/Location:
i
S4' / ii
Type of Operation: Swine -V_ Poultry Cattle
Phone:
Phone: J25/— _
. .6 AP. 6AS7_
Design Capacity: Q Number of Animals on Site: _Zbl/11.
DEM Certification Number: ACE DEEM Certification Number: ACNEW
Latitude:°' 30 Longitude: 7*7° ' �
�3 " 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) Gr No Actual Freeboard: 3 Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o DWas any erosion observed? Yes o No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:SC1J�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings Yes r No
100 Feet from Wells? _ es-' r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 00 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: _ 2 4104ISe� —' 600i4;� 70 S& dt:5df.PL41 k�j
11
(/CJ,1GL1,4 4
Inspector Name
cc: Facilitv Assessment Unit
Use Attachments if Needed.