310688_INSPECTIONS_20171231

NUH I H UAHULINA
Deparbnent of Environmental Qual

Type of Visit: C) Co Hance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: CYRoutine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: �/g�1 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: G-PoiVC ST(-C— 19 - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 9_�So
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
ILayer
I
Dairy Cow
Wean to Feeder
Feeder to Finish
I jNon-Layer
I
EEJ
Dairy Calf
Dairy Heifer
�(
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
REN PjU-I .
Ca aCi
P,o .
Non -Dairy
Farrow to Finish
I Layers
lBeef Stocker
Gilts
Boars
Non -Layers
Pullets
Turkeys
I Beef Feeder
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [] o
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412015 Continued

FaciliNumber: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier: i ACIO-WIJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —
❑ NA ❑ NE
❑ NA ONE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 1�9"No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envtronme al threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes 1 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA. ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes X-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes [I 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 Inspectio;/Vo
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Vacility Number: - Date of Inspection: a.
, 24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
r 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 ❑HNo
No [] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZNo ❑ 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 EA ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ YesrNo
❑ 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:"answerstandlor,any additional recon mendations or;any'vth r comments�w.:
Use drawingsofa6li ty� to bittereg �lai�n,situabtiolis useadditional pages as,.neces.sarJ)
1
Wjco a -or
J
Reviewer/Inspector Name: Phonel q��g
Reviewer/Inspector Signature: Date:
Page 3 of 3 14120l

7r .
Type of Visit: a Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time:1 � � County: t,lT Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: "ImE .�-t p Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Ponitry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
E]
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Desiur1re
D , P,oul Ca aci Pao ,
ILayers
'Dairy
Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other.
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes I o ❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
Page 1 of 3
21412014 Continued

acili Number: JDate of Inspection: to
Waste Collection & Treatment
4:,1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
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 property addressed and/or managed through a ❑ Yes Q/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen t threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 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 E(N o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes / o
0 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
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
WNo
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
r❑ Ot er:
21. Does record keeping need improvement? If yes, check the appropriate box below.
9] 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
22. Did facility fail install Yes �
Sludge Survey
NA NE
the to and maintain a rain gauge?
❑
❑
❑
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment?
❑ Yes
rNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

I.FacilityNumber: - Date of Inspection: C{
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dl,40 ❑ NA ❑ NE
25".' Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑Yes [T, No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey O 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 El"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E N ❑ NA ❑ NE
❑ Yes [jrNNo ❑ NA ❑ NE
❑ Yes M No
❑ Yes C3 NNo
❑ Yes
❑ Yes
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
[� ❑NA ❑NE
❑NA ❑NE
No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. J
Use drawings of facility to better explain situations (use additional pages as necessary). I
'2�j 561VO COPL� 01C kU06,6 5Wd A DW9 cmn'u'
�G1
060 kE(P Lori OF O'R- w"fl 1�Eco��,
Reviewer/Inspector Name: JJ 014fo
Reviewer/Inspector Signature:
Page 3 of 3
Phone a -�
Date:
2141120 5

Type of Visit: QCo ance Inspection Q 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: I 5 / 5: / Arrival Time: r_j7FFG____j Departure Time: OO County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: �iK r% r `'t54 (- C d Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design
Swine C►apaclty
Wean to Finish
Current
Pop.
ILayer
V4'et Poultry
I
Non -La er I
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
an to Feeder
Dairy Calf
Feeder to Finish
32
D . P,oul
Layers
Design
C•_a acity
Current
P,o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Non-DaEl
Dry Cow
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
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?
❑ Yes
10
❑ 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
E:rNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

+ Facility Number: 5 7- Date of Ins ection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ICJ "o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 r
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes-11
No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
[] No
[DNA
❑ 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
Ej No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
0 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 E:fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ff No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes M 'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ENo
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[3 Yes ❑ N ❑ NA ❑ NE
El Yes No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
P'ste Application ❑Weekly Freeboard []Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�ffilo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

' FacifiVy Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Blyes ❑ No ❑ NA D NE
the propriate 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: i
26. Did the facility fail provide documentation of an actively certified operator in charge? [Yes ❑ No N ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No L 1VH ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes dNo ❑ NA ❑ NE
[—]Yes 0"No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ]dNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Signature: �i.�-o%r��..�C/� Date:
Page 3 of 3 21412015

• l rn
"I)iv'i'sion of Water Quality
Facility Number `—J - ©Division of Soil and Water Conservation
✓`►—� OO Other Agency
Type of Visit: Co liance Inspection Q Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: outine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: s Arrival Time: Departure Time:a�l County:bj)PC,;tZtJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: &BOL�----Integrator: r/
Certified Operator�50 %yldV rc_ �d3rtificatiou Number: oG�p Jb
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet PoultWp—acit-VINPop.
Wean to Finish I iLayer I
Design C►urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I Ell
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►►urrent
Dr, loult , Ca aci P,o .
Layers
Dry Cow
Non -Dairy
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?
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 En No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑N ❑NA ❑NE
[-]Yes ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Insection:
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 I Structure 2 Structure 3 Structure 4
Identifier:�1�
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ 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
2/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, 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 VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes C21No
❑ 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 E
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes (No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes V
❑ 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
Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio;/N�
22. Did the facility fail to install and maintain a rain gauge?
ElYes
❑ 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: 3 - Ds ection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
VNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? 0 Yes
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
M/No ❑ NA ❑ NE
�No ❑ NA ❑ NE
7No
❑NA ❑NE
❑ NA ❑ NE
V VNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
(Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
Z/4 011

(Type of Visit: (D pliance Inspection U Operation Review () Structure Evaluation U Technical Assistance
sit: Cor +Reason for Vioutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i r Arrival Time: Departure Time: 30 County: �_ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Gl Ag mr" 51 EE D
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 2 5
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
fLj
Design C►urrent
Swine Fapacity Pop.
Wean to Finish
Wet Poultry
Layer
Design Current Design Current
Capacity Pop. Cattle Capacity Pop.
Da Cow
Wean to Feeder
Non -La er
Da Calf
Feeder to Finish
Farrow to Wean
Z,00My b
Dairy Heifer
Design Current Dry Cow
Farrow to Feeder
Farrow to Finish
Dt, P■oulti,
ILayers
Ca aci P■o , Non -Dairy
Beef Stocker
Gilts
Non -Lave
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 d No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of -Inspection: a 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: CA GX$6J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zb
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Z f No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes dNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �`Zo
❑ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes [No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes EJNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[:)Yes dNo ❑ NA ❑ NE
[:]Yes F�(No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 2N0 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes [rNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes
o
dWNo
❑ 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

FaciliNumber: jDateof Inspection:
2.4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [Z"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [2f No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [::]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ElYes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [3"*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:
❑ Yes 0No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ,"No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[;,No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
El"No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
[]No
❑ NA
❑ NE
Comments (refer to question 9): 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
off.) F6WQ_,1
06a,.4L�,JV
Phone: 910036 --1118
Date: 1 / 1113
21412011

Type of Visit: Q C
o Hance Inspection O Operation Review (� Structure Evaluation () Technical Assistance
isit:
Reason for VO Complaint O Follow-up_0 Referral O Emergency O Other Q Denied Access
Date of Visit: *7 IL Arrival Time: Departure Time: County: k Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: &1 Integrator:
Certified Operator:
Back. -up Operator:
Location of Farm:
Wean to Finish
La er
Wean to Feeder
Non-L,
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry, Pj
Layers
Gilts
Non-L
Boars
Pullets
Other I I IMI IOther
Latitude:
Poults
Certification Number: pij�j`�
Certification Number:
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?
Longitude:
Dairy Cow _
Dairy Calf
Dam Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [1] No ❑ NA ❑ NE
[:]Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 9] o NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility -lumber: -2t - Date of Inspection: U1a'1�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EZt No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:��
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _�a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
[—]Yes
O/No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public bealth or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�To
[] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes o
❑ 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 E2
❑ 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 dN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes U No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑Yes .o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility, Number: 31 - OR Date of Inspection:
2¢: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes EfNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jrNo ❑ 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
EJ "'o
❑ 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
12 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 To ❑ 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 No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other, comments.
Use drawings of facility to better explain situations (use additional pages as'necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhoneAto 7T6
Date: '(r oZ�i
21412011

FacllltyaNumber
er CanserFahon
Type of Visit Co pliance 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: l u n Arrival Time: 4 �U Departure Time: County: � �AJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Cx Aulc_.rE S-t C E9 integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number: _
Latitude: = c = d Longitude:
Im
i "'.".ems 3X.,`�Aw, .'" ,ate � � e. 4 5+�..�„ e,� 4 ��-„ h�� •, m�
- Design Current`* Design 'Cu r
Ha: `k"""..
er CanserFahon
Type of Visit Co pliance 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: l u n Arrival Time: 4 �U Departure Time: County: � �AJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Cx Aulc_.rE S-t C E9 integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number: _
Latitude: = c = d Longitude:
Im
i "'.".ems 3X.,`�Aw, .'" ,ate � � e. 4 5+�..�„ e,� 4 ��-„ h�� •, m�
- Design Current`* Design 'Cu r
Ha: `k"""..
4q,. - -�.F_ yyr. •_
enC
_
Design
. •.
Current
wt 'w..*,.,,�, •,v,,r, met„.,y^.w-. -k.... �.. ;'^` _-,. ,- , . _- s...^w..,»
�ygSwr�ie� ~* �Ca ace jPo ulatio_ n "M'et Poult .Ca aci Po ulatton Cattle wCa
aci
Po ulatton
❑ Wean to Finish
❑ Layer
❑ Da' Cow
❑ Wean to Feeder
❑ Non -Layer
' ❑ DairyCalf
® Feeder to Finish 3
�`tOC> �' ❑ DairyHeifer
❑Farrow to Wean�Poult
❑ D Cow
❑ Farrow to Feeder
�`` ��
❑ Non -Dairy
❑ Farrow to Finish
"°
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Cowl
Other '
ems.
+�
❑ Other
Number of Struetures:
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
' ❑ NE
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
WNo ❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

facility Number: 7j —(p$$ Date of Inspection 1 z
.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA&vto,,J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 311
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes EdNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E�No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
t 0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ld Islo ❑ NA ❑ NE
maintenance/improvement? //
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E� No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Y,No ❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
Yes
Ell
-Id "No ❑ NA
❑ NE
Comments (refe r 'to question#): Explain any YES -answers and/or any reeoinmendations or any otf�er comments w
Use drawings.of facilityto better explain situations (use additional page, s as necessary)
�j1,�Y1 G C Sut-VE iS 1>6 0E 6%JT PAPERW .lc OCR- w cAre� Lo C
+
Reviewer/Inspector Name � �j oN;0 - 'CA", � Phone: *6��1 �a — Fj
Reviewer/Inspector Signature: Date: 1 z.1 It
Page 2 of 3 1 12128104 Continued

•Facility Number: — Date of Inspection t 2,
Required Records &_Documents
l9. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [3No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropriate box. ❑ W`Up ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
1 I No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E(No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[ZNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E�No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ErNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
D No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
D No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
LJ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
�(
E No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ElrNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E!�No
❑ NA
❑ NE
Adi IW6fiAfC6inmie&ts an"d/or Drawings
Page 3 of 3 12128104

31 H
Type of Visit (X7Routine
Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I bL a-IfD I Arrival Time: ® Departure Time: County: I C L �-N Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: �6A& k S`Tcr�a „!
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 e = I = 1
1 Longitude: = o =1 [� «
fine
T
pulation
Wet Poultry Capacity Population
C►attle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
JEI Non -Layer I
❑ Dai Calf
® Feeder to Finish ? 70b 160-6
❑ Dairy Heifer
❑ Farrow to Wean
Dry Ponitry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
ElBeef Stocker
El Gilts
❑Non -Lay ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cow
❑ Turkeys
Other
❑ Other
❑ Turkey Pou Its
❑ Other
Number pf Structures: a
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�o
ElNA
ElNE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
WNo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

iI -A
Facility Number: 7j —
Date of Inspection L�O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes iNo ❑ 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: LAGatwl)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [;No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 9A0
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No
❑ 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
El NA [I NE
El NA El NE
0 No ❑ NA ❑ NE
❑ N ❑ NA ❑ NE
ld No ❑ NA ❑ NE
[2N ❑ NA ElNE
5' Zo ❑ NA ❑ NE
t
TP ¢s'-0+.. .,ry�ViM.M f4. 3LI:✓6.ai+kf.4YM{.Zy.i4.y4,Y`4'.
Comments{r`e(er to question #} Explain au} YES answers and/orYany recommendattiins or,any"other_comments
Ilse drawings of facility to better explain srttu'ii s Y(use a_dditional pages as necessary)
l^h..a - ` - �'� .+�4rha, nM..f {.q�,4. nL,.. it scc�'. •.R .�.��IL:J e'":. _A`,` .i' .
ReviewerlInspector Name A �" Phone: 9g8
a�: �.,-
Reviewer/Inspector Signature: Date: at I Z I o
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑'NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L�`No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E(No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L 9 0 El NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
El Yes
Eo
❑ NA
❑ NE
El Yes
Vo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
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 [?� o
❑ Yes I,4 No
❑ Yes O No
❑ Yes [I No
❑ Yes � o
y
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
12128104

3t H
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit Routine Q Complaint O Follow up 0 Referral o Emergency 0 Other ❑ Denied Access
Date of Visit: $ � Arrival Time: 4J Departure Time: County: bUA�' Region:
Farm Name: Owner Email:
Owner Name: _,,,
Mailing Address:
Physical Address:
Facility Contact:
Title:
Prone:
Onsite Representative: FRj-oj1Ct.=t.J Srz-en Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = a = 6 = u Longitude: = o = , 0 ss
056Purrent
Design Current
Design Currenne
ulation
Wet Poultry Capacity Population
❑ Layer
10 Non -Layer I
Dry Poultry
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
Non -Layers
El Beef Stocker
❑ Gilts
El Beef Feeder
❑ Boars
❑ Pullets
❑ Turkeys
❑ Beef Brood Co
Other
❑Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
RNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes
R(yo
El NA
[I NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — �%R Date of Inspection O
x
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L3 o ❑ 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. CAGoor41
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes VNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes U<O ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes <o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L4I 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 acre determination?[:] Yes
�io
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
Cl Yes
EK
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[;Xo
❑ NA
❑ NE
'of facility to tietter.egplain situations.:;
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12128104
4. 73 V
Page 2 of 3
Continued

'Faciility
Number: 3 —
Date of Inspection S
Required
Records & Documents -
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
21/No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q4o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
;/No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
(
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Zo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2�No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[9No
❑ 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
M/No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
No
El No
El"
❑ 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
Ko
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
WNo
❑ NA
NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit RCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit §D Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: �� u Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: �s Title: Phone No:
Onsite Representative: NK LI A/ J7 E E D Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = i = Longitude: = ° = d = 4i
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish o� 00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Pouets
❑ 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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?
El Yes [NNo ❑NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
[I No
❑ NA
❑ NE
12128104 Continued

�FlacjVityN umb 3 — (g�� Date of Inspection 1 i9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L A GCKZ 1Af
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [K 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 Rn No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [& No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [--]Yes N 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 VRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5Q No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [3,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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
® No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[K No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name AIp f} C-1. QUYES aNN Fp ELL Phone:
Reviewer/Inspector Signature: Date: I I i
12128104 Continued

it
Facility Number: 'j Date of Inspection 1 1(v 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UlNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes M No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,3 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
91 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[N No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
IN No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[K 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
[0 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
R No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ERNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
fa No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

p Division of Water Quality
Lacility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 7Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 13 U Departure Time: County: Ut/ptZJ) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: t� Title: Phone No:
Onsite Representative: ��t q J� O E �D Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= o[= A 0dg Longitude: = o 0, 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 1 '316b 12.�lov
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et I — — T_�
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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 -
Capacity Population.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[ZNo
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
IJ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
2No ❑ 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
ILI No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
�No ❑ NA El 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
YNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
LJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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?
❑ YesZo
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes L No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes � o
ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WNO
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�4,) F600 COPY 6r
uta n-A rsat,-;, ro o w c?
Reviewer/Inspector Name Phonegt0) -176 - ]39r
Reviewer/Inspector Signature: Date: T
12128104 Continued

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

a
V
•
31
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: al% c Departure Time: County: �LLV Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: F4A j e w>) SWu Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 o Q i Longitude: 0 0=.= fl
Design Current
Design
Current
Design
Current
Swine Capacity Population Wet Poultry
Capacity
Population
Cattle Capacity
Population
❑ Wean to Finish ❑ Layer
❑ Dairy Cow.
❑ Wean to Feeder 10 Non -Layer I
1
❑ Dairy Calf
EgFeeder to Finish 1 3 L40
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts ❑ Non -Layers
❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
El NA
El NE
❑ Yes
,❑]�No
L�J NNo
❑ NA
❑ NE
❑ Yes
UAo
❑ NA
❑ NE
12128104 Continued

s
r Facility Number: — g Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA b zd/d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 L
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
Mo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[3No
❑ 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
dNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
LJ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
dNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
���
L7 wo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
M No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) �F � S (ro
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ef No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
,a
o
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
VNo
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawing
sdf facility.to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I <-�A/ &U- I Phone !0 79 — lN.,l
Reviewer/Inspector Signature: Date: oZ
. w6.... J a.. ..... I -

Facility Number: — ` Date of Inspection sl.
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists ❑Design El Maps El Other
❑ Yes 5f4o ❑ NA ❑ NE
❑ Yes C No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
If/� No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C44o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[; o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Bo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E:P&o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
U No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Cl/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
PO
❑ 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
[TNo
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
1j1vo
❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

k
♦1
Type of Visit P Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 2 •' Departure Time: County:
Farm Name: T,E,♦_ - �f� Owner Email:
r
Owner Name: _—.��ffnslP1Y? Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 66&�'
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone lNo:
Integrator: �(�/`:'
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = I = Longitude: 0 0 = s = `1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La ei
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 Stocker
l
❑ Beef Feeder
❑ Beef Brood Co
I
Number of Structures: F
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 IVNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Rf No
❑ NA
❑ NE
❑ Yes
)ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection !/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
El NA El NE
SPycture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:/
Spillway?: O
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes 0 No
❑ Yes ❑ No
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
to
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA ElNE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ;Z No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes A 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 Outs�aw_"Ov
rea
12. Crope `QI�I�iJ R'i V {r, /O(l L� ��
tm�i /T (�
�
P
s l�
() �I�
13. Soil type(s) Au U
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
7 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� No
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[] yes
PrNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
@omments (refer totquesbont#�"Explaln anyl'ES answers and/or any recommendations or any other comments.
Use drawings ofgfacility to better egplaln sl@aNE
ho.s. (useaa aiaotia� pages as necessary):
IS rlFi� 5 �O /D,((]] . �F P�n1 c Q
S4,0
a_000 .5 rw"Vo
I- �� PL4;1'c N 4OCKLO k P��� Z91_54es5
45 !NP rfo
f 1. wry
Reviewer/Inspector Name 2 -�Q=fir Phone:
B 345 39M,Y 724
Reviewer/Inspector Signature:
Date:
//
12128104 Continued

f �}
Facility Number: ?21 — Date of Inspection
Required Records & fDocuments
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes I4 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o/ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ;�TNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
00'NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes O-No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes eNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ZNo
❑ 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 21'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0<o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes rNo
❑ NA
❑ NE
Additional`Connments and/or Drawings:
/1)d rl;-7 •r
12128104

(Type of Visit g5 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for VisitRoutine O Complaint O Follow up O Emergency Notification O Other p Denied Access
Facility Number % Date of Visit:
;Permitted Certifiedtt[a Conditionally Certified ©Registered
FarmName: ...kvx iE 3...............................................................................
r~ u .......... �...... ...
Owner Name:..R�`� 1.n,�,C{!1'i` ...:_._._...�EAT�.�w10 E
4 O Time:
0 Not Operational C Below Threshold
Date Last Operated or Above Threshold: -........_._._....
County: ».o uPlZ.1.1..» �....... _ .._ . .....___....
Phone No:
MailingAddress . .................. _.......................... .............. ......... ........... ..................... ... ...... .......... --.... ..........................................................
Facility Contact: Title:...... __................. .. _� ... ... Phone No:
Onsite Re resentative. O
P �._...._H a Mrj ....... OR%__,........._ ..............................._.. Integrator:..........!��al.�%t1i.... �_............................_..,.�_......
Certified Operator:---................._..................................,,...._....,,..................._......._... Operator Certification Number:
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude • 9 64 Longitude • ' O&s
Discha •ees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes eK
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 7No
o
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 940
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................. •-......... .......................................................................................................................................... .......................
Freeboard (inches): 25
12112103 Continued

Facility Number: 31 — Date of Inspection '� O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
INO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
Z/No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
o
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
�lo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/unprovement?
❑ Yes
No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
7/No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type %qr..CAZP 6VC"§,M
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
E6
b) Does the facility need a wettable acre determination?
El es
ld O
c) This facility is pended for a wettable acre determination?
❑ Yes
[o
15. Does the receiving crop need improvement?
❑ Yes
ZIS
16. Is there a lack of adequate waste application equipment?
❑ Yes
7No
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes eNo
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 No
Air Quality representative immediately.
s,Comrnents (refer to question #) +��Iana any YE5 answers amd/ar„any recommendations or any ottiert;c�w aments.:� � �
Use disawjngsaiisa�ly to better eaGplau� s�buata�on�s-(tsseYaddrtwa� pages as necessary) n�
--� � ❑Field COPY �q F na� Note.W..s�,..�
•= � � ^=, � � -��. �,� ��- - ��,: ��-�����- :- T :,.� � �.� : � �;s �.,
�4�,CiRAT�:arJ Dam
`
CST. To g� 4►.A9 ior�n�
ANN-
SUd-dE� fa 4E 0 °NE QY -AP R.
YXL- t,rj
CA -of
SE U-SI�6j
Coo SSEy
E iZ
(�E�a1to5 4 rim mA A-ms �xp,
Reviewer/Inspector Name
ReviewerAnspector Signature: Date:
12112103 1 Continued

Facility Number: 3 — $ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall [:]Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes No
❑ Yes LINO
❑ Yes dNo
❑ Yes �7No
❑ Yes
❑ Yes EdNo
❑ Yes (eNo
❑ Yes
❑ Yes �No
�es❑
❑ Yes 1N
ElYes ?O'
❑Yes VNo
El Yes
❑ Yes ❑ No
12112103

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of visit: Z- Time: ' 44
10 Not Operational 0 Below Threshold
O Permitted ©Certified ©Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
Farm Name: �' * Fa,-rxS 'TnG C �44, 3) County D ye
_ V
Owner Name: Be 1l,`� a ij k Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: �� 11 ea'' P Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �u Longitude 00 •
m Design Current ��<- Design Current � Design Ctirrent
_
n8wcne Ea achy
�
Po ul8teon =,: Poaltr. -._._. _Ca achy Pia u[atian Cattle xC
s
achy Po ulation :T
El wean to Feeder
:. ❑ Layer Da'
z.
ElFeeder to Finish
t ❑Non -Laver ; ❑ Non -Dairy
❑ Farrow to Wean
:.
? ❑ Other
ElFarrow to Feeder
❑ Farrow to Finish
Total Dent Ga act
❑Gilts
f=
Total°SSLW
❑ Boars
Num r of Lagoons
� � ❑ Subsurface Drains Present ❑ Lagoon Area
❑ S ray Feld Area
_
Hotdtng Ponds / Solid !
No Liquid Waste Management System
O�4
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [--]Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes kNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �Q
Freeboard (inches): 3 !
05103101 Continued

`i
i Facitity Number: J -rj$�j Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?-(ie/ trees, severe erosion,
❑ Yes
ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
2TNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
PINo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
/
ZNo
elevation markings?
❑ Yes
Wastes Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
JZ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12. Crop type '�Er rti v 6f'i P 4 �+M q ] Gf^r► +.� C7 1, vs cc d
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
ONO
b) Does the facility need a wettable acre determination?
❑ Yes
0 No
c) This facility is pended for a wettable acre determination?
❑ Yes
P(No
15. Does the receiving crop need improvement?
❑ Yes
A No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records Documents
_&
17. Fail to have Certificate of Coverage & GeneraI Permit or other Permit readily available?
❑ Yes
;?rNo
18. Does the facility fail to have all components,of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
VNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
_Z
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONO
24. Does facility require a follow-up visit by same agency?
❑ Yes
Jallo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments -(refer to question #) ex Uii any YES answers and/Qc any recomirtendations:argnyother comment& � rt
Use drawitags of faclhty to i>etter explain sitttxttons: (use addinotial pages as necessary) y
i - ❑Field CotSv ❑ Final Notes�
h;-s �r r i 5 �C/'.1C� wlGrr''"��eii'+-►�'4� I h A� e)CCB�� hf GenG�+�a'o:-� -
-r. e K-ecor'ds o,ve j1Ver � well kefl . Tti e 6er'r­% v dot G.-ep �'s
exc�tle�t� . Tie l�9ao►', clued sw��le Ljor�se �fecc q''e well kprl_
Reviewer/Inspector Name p r1 Q 444• S
Reviewer/Inspector Signature: Date: 2/a L�-
05103101 Continued

Facility Dumber: --?'% - /py Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours:'
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. were any major maintenance problems with the ventilation fan(s) noted? (i.e_ broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes XIN0
❑ Yes �Na
❑ Yes �-lo
❑ Yes ZNo
❑ Yes JZNo
❑ Yes ❑ No
Additional Comments andfor Drawings:
05103101

(Division of K'atei Quality
/v
0 Division of Soil and:Water COtaservation
therAgency _
a.0 O
Type of Visit ,Z Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit -Otoutine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number +
B8 Date of Visit. 3 0 Time: f �' c5 S Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
© Permitted ❑ Certified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: .-
Farm Name: C� '' In G y: V ... r►
.......�`....._. �f y..............y................................................ Count �...............
�J f �j ¢ itrt I jDD �L�
OwnerName: !� ° �... { 1.��."l...................................................................... Phone No:-......................................................................................
Facility Contact:
.................. -11....... Title:
MailingAddress: ................--._..��..........................._....--....----
Onsite Representative: ..... • V_� � h G+^C
I ........ .....`......................
Certified Operator:
Location 'of Farm:
Phone No:
..................................................................................... ................. I .......
.
Integrator: • ye tn1ll a Cc{'"a �t h .
Certification Number:
dSwlne ❑ Poultry ❑ Cattle ❑ Horse Latitude ` & �•�44 Longitude • 6 «
Design Current Design Current Design Current
on Poultry CattleCa Po elatiCapidtyTiiiidlation
Wean to Feeder JE1 Layer ❑ Dairy
Feeder to Finish "o 10 Non -Layer I 1 10 Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
Boars Total SSLW
Nnimber of Lagoons ❑ Subsurface Drains Present Lag.-m Area ❑ Spray Field Area
]
Hogg Ponds /Solid Traps ❑ No Liquid Waste Management System h i
Dischar>res & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ YesEJINo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made? ❑ Yes/o
b, If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) El (If
c. If discharge is observed, what is the estimated flow in gallmin? 1't
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes"I VrNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes /ffNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes',�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 4No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................
.................... .................................... .............. I .......... - ....... ..........................
Freeboard (inches): 2-8
5/00 Continued on back

Facility Number: 3 / -% B Date of Inspection O l Printed on: 7/21/2000
Are there any immediate threats to the integrity of any of the structures trees, severe erosion, ❑ Yes P'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 A!fNo
(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 .d No
$. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes j� No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes�'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ) No
12. Crop type Be e —L U d A Aq -Y , �,^AA1 ! Gnao "%
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ff No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,�No
b) Does the facility need a wettable acre determination? ElYe �No
c) This facility is pended for a wettable acre determination? ❑ Yes /❑TTo
15. Does the receiving crop need improvement? ❑ Yes ❑'No
16. Is there a lack of adequate waste application equipment? ❑ Yes101No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ YesIdNo
19. Does the facility fait to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ,EfNo
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes J'No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes _ONo,
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ffNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes J2rNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes VfNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes _V No
:: ?9+*iolh06Fis:oe deficiencies -were noted- dtWing this;visit. • Y:ob will febd*4e iio l.uirther - : .
corresporidence: about this visit: ::: . .
Eestton fm . Expis ut any= Y-" answers anglor ant
GrOFT Ay1al-7eCPrd-� q�-e t„/e11 ke f;T 6einj dole
r,
Reviewer/Inspector Name
Reviewer/Inspector Signature: ,(�,/ //i/ .lij^, Date. D/ SI/U/ 5100

Facifity Number: I)ate of Inspection Printed on: 7/21/2000
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atfor 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 VNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ YesXNo
roads, building structure, and/or public property)
29. Is the land application spray systern intake not located near the liquid surface of the lagoon? ❑ YeSA 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/I No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes /❑INO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

t e111"ivision of Water Quality
Q Division of Soil and Water Conservation
O Other Agency
Type of Visit 0 Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit >4 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: Time: � Printed on: 7/21/2000
1
0 Not Operational O Below Threshold
Permitted 0 Certified Q Conditionally Certified 17 Registered Date Last Operated or Above Threshold: .............
Farm Name: Ci C County:. C..t..h......................................................
le
Owner Name a r ..........................
..../.............. h,. � ................................................. Phone No:
Facility Contact: ...................................................
Title: ................................................................ Phone No: ..
Mailing Address:......................................................
Onsite Representative: _7 -kn VVIA'af.e.......................
Certified Operator:... ...........................................
Location of Farm:
Integrator: ..^..ot� �t �ge �I ,
Operator Certification Number: .............. ...... .................
A.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 wi Longitude • 4 «
Design Current
Swine CaDacity Ponulation
❑ Wean to Feeder
Feeder to Finish
3 1)Q
3Z QQ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I JE1 Dairy
❑ Non -Layer I E77d 10 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present I ❑ Lag-nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance plan -made'?
b. If discharge is observed. slid it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed_ what is the estimated flow in gal/min''
d_ Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure , Structure 4
Identifier: ................. ..........................._.................._._............................._....................._......_...... .
Freeboard (inches):
5100
❑ Yes XNo
❑ Yes JffNo
❑ Yes 12fNo
� IA
❑ Yes ;9 No
❑ Yes FNo
❑ Yes $ No
❑ Yes %No
Structure 5 Structure 6
Continued on back

}, Facility Number: Date of hispectioll Printed on: 7/21/2000
f� 5'. Are there any immediate threats to the integrity of any of the structures observed? (iie/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 9No
(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?
l Excessive Ponding ❑+ PAN ❑ Hydraulic Overload
t2. Crop type 3e ✓-m v(i n. 44 Y.1.J "4 It v r'1f i -1
13. Do the receiving crops differ with those designdted in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement'?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available'?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: TVo.. i6ihti6ris:or def ciertcies •►sere noted• dirririg ihis.visit'.• Y:oi * 'Wiil •receive ii6 itirther -
.: �coiri * oridence:ah''fthisvisit. .:::..-:-:-:-.-.•.-.-.-.....•..............................
❑ Yes XNo
❑ Yes ONo
❑ Yes Z No
❑ Yes tZ No
❑ Yes KQ No
❑ Yes 16 No
❑ Yes ,g No
❑ Yes No
❑ Yes j No
).Yes ❑ No
❑ Yes e No
❑ Yes Rr No
Oyes ❑ No
❑ Yes 25 No
❑ Yes TgNo
❑ Yes JgNo
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):
❑ Yes )6 No
❑ Yes )gNo
❑ Yes IffNo
❑ Yes A No
7. i>cn4roI vej4,Y4',ve t� tOw4l eh +oher 1 VI, tva)j.
15. Ve--rZvG�g :Cefds Yfotvc bGeYt �t�� n _rli�re,, w t,;+ vn4;1
�Ie� IN+�'idbl�t) %S 4Gf-� ��of-e Eav►^�'tr�t�. I �%y �;�e uc�prdi��o "
.S I -�es� qS .SODIn S OSS ate • l
1g.,�I! or�� ;�1Sec-� dda✓�.b►�or- 1ff7 �� rod cke641;4s. Alve �va.saepin�
J; rrcelJdct-�cd Bt�nzr_r e,c i,u:, s ee;gt%,5�.
ac rest Jcel av1 -:MP —2- S y"t`t7 6yi 1/'f'�r�sL�; a►^t �, E�r,�/'!
w
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
5100

FELcility Number: l/ Date of Inspection 9 AD Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ONO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ]P�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ANo
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 ;KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ONo
J
5100

Division of Soil and Water Conservatzon -Operation Review
_ >:; e,
E Division of Soil and. Water Conservation .Compliance Tnspecttor
yDivision of Water, Qual►ty _Compliance Inspection - 475
,
[j Other Agency Operation Review.
Routine O Complaint O follow-uo of DWO inspection O FOIIOw-un of DSWC review O Other
I Facility Number 1 S$ I
Date of Inspection
Time of Inspection
24 hr. (hh:mm)
0 Permitted © Certified ❑ Conditionally Certified 0 Registered J{] Not Operationaj Date Last Operated:
Farm Name: /V�....%......� FP..f? lS.-.r �.�c aunty:........ .if?tr.�.................................................
.............. G� �1
OwnerName: ............................................................................................ . .....----..... Phone No........................
FacilityContact: .............................................................................. Title:.........................--..---................---............. Phone No: ........
MailingAddress: .......................................................................................................................................................................................................... ..........................
Ar-
Onsite Representative: .......�s?..&[.tT......... .... Integrator: ,.. .,; -.....oF.... ..l,
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........
Latitude 0 6 •4 Longitude ' 4 "
- Design Current = _
__ Design Cu=rent Design Current
Swine - Capacity Population `
Poultry '''Capacity Po ulakion -Cattle -Capacity Population----..
❑ Wean to Feeder -
❑ Layer ❑ Dairy
Feeder to Finish �v�
❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
= ElFarrow to Feeder
❑Other _
❑ Farrow to Finish
= Total Design Capacity
- . ❑ Gilts
❑Boars
_ -.Total SSLW
Number of Lagoons•.. I�
1
❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding -Ponds /Solid Traps
❑ No Liquid Waste Management System
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Dischar ,c 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. If discharge is observed, what is the estimated flow in gal/min'?
d. Dues discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ............. 3��............. ..................... ............. .................................... ................................... ....................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ko
❑ Yes z No
❑ Yes dNo
❑ Yes 91 /'1N
No
ElYes o
ElYes (No
❑ Yes �No
Structure 6
❑ Yes No
Continued on back
3/23/99

l
Facility Number: 3 — �$� Date of Inspection ? t
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or V
closure plan? ❑Yes No
{If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 9No
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
ZNo
Waste Application
No
10. Are there any buffers that need maintenance/improvement?
❑ Yes
0
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
Co
12. Crop type G V-41M v !�'tA, ;.d
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
fidNo
b) Does the facility need a wettable acre determination?
❑ Yes
o
tNo
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
O/Yes
❑ No
Yes
2No
16. Is there a lack of adequate waste application equipment?
❑
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
rl 1 o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes )dNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) 19Yes o
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? ❑ Yes 10 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes 9No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONo
24. Does facility require a follow-up visit by same agency? ❑ Yes ZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )?�No
0: N,6•yWattoris:or• &flcienctes were noted• du-rtrig �bisyisit: • You will•reeeive Rio furthers -:.
... ............
corresQoride"e. about this visit.....: ........... . • • • -
Comments {refer to question #) :Explain anyYES answers and/or any recominendaEians or_any'other comments:
-
Use drawings of-facrtrty to better explain situations (use addrtional:pages as necessary)
iy %T-fi� F--ac)O Tires A� -Q 4; T ,v+A:nl sAf.J vJc�KLy aaAzo 4EA,
aOa R_/ I�aCr
t.J S` GT c.�nf i 2a L /�r�i +) �R A lr� �► Cf`� �c� C.i S '1^
.s Haag `3� (n( C,"IAVEO
IS) fSAvy to CS D 1,11�7&s TA 7 s'ad,
ce'47-ic-1 l., rti-j a wD t4 4.1& C-00
62au tea&c"s0g.0.
I df'p-a (910 H
Fz __ -� — -
Reviewer/Inspector Name l r r', S 7_
Reviewer/Inspector Signature: Date: 't t
3/23/99

Y.
Facility Number: 3r — 64 hate of Inspection 1®
f I
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes O 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 P(No
28. Is there any evidence of wind drift during land application? (Le. residue on neighboring vegetation, asphalt, ❑ Yes '0 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 INO
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 N
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
3/23/99

Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
Routine
Facility Number
Date of Inspection
Time of Inspection i J'-l'Ls" i 24 hr. (hh:mm)
Registered V Certified 13 Applied for Permit 13 Permitted C
//-D��__$__� _
Fann Name:....... --t` L?-. .... �f -- I' /.�+r.......c8a... Grp. .....................
Owner Name: ........ _........S.4.1.... L4(.' i......./. 40..61....... lk'�C✓.................................
Facility Contact: ................ .!'.:...... 1'`.1 . ........................... Title:..........................
Date Last Operated:
County: ...... h.tltll4:t.......................................
PhoneNo: ...... (Ila ....................................................................
Phone No:._�910)
Mailing Address:.........0 3.......?71.....SuxidS.
........ .a :.......................................
2?�3
OnsiteRepresentative: .............
:.. Q61.......
gwe:..........................................
............. Integrator: .......�fn!rx..S............................................................
Certified Operator................................................................................................................ Operator Certification Number .........................................
Location of Farm:
Latitude =•=' =11 Longitude =• =' =11
�sR Destgtt= :Currenf r. DesiCurrent Design Current
Capacdy Population _ Poultry :Capacit Population r Cattle Ca aci Po Mahon':
v - y _P, _ p t3 P
❑ Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish 2po ILINon-Layer I I ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder r` ❑ Other '
❑ Farrow to Finish Total Design Capacity
°4� ❑ Gilts
❑ Boars Total SSLW '"
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Feld Area
❑ No Liquid Waste Management System,
General
t 1. Are there any buffers that need maintenance/improvement? ❑ Yes 13 No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes Q No
c. If discharge is observed, what is the estimated Flow in ;aUmin?
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
[ANo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
[A No
7/25/97

Facility Number: -- (p
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
(1No
Structures (LagoonsXolding Ponds, Flush Pits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft): ...............Z_
10.
Is seepage observed from any of the structures?
❑ Yes
EjNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
j No
12.
Do any of the structures need maintenance/improvement?
Gj Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type .............................. 4 o►`�C L.................+....... YL\a1(.\........... ...............................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes]
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
[N Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
W No
0- No.vitilations- v deiiciencies:we're-noted-during this.visit.� :You:e' -n' 6will receivriper : -
::�correspondei>rce about this:visit:-:�:.::.-..
it- Cer iYltse � iIS i�+�liw Y��i�mUd0. ivy yyww
� Z. iJ t�o t� SOi t 4-wa_sl �I II �c1 i } t (Q •
7/25197
Reviewer/Inspector Name
Reviewer/Inspector Signature: Atl.� �_L _ 14/ _ Date:

�M.❑ DSWC Animal Feedlot Operation Review a< c
�.EJDWQ Animal Feedlot Operation Site Inspection
0 Routine 0 Complaint 0 Follow-up of DNV2 ins ection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Numbe
Time of Inspection
r 24 hr. (hh:mm)
U Registered ® Certified 0 Applied for Permit [l Permitted [3 Not Operational I Date Last Operated:
Farm flame; iv+_ County: �. 1 R
Owner Name: .......... �..A..Y..t 4..�.�................. T.t].inuN.S4.rn................................... Phone No: ... .g.l.�?. ....2�...�...`..�.. .. ...f...............
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Nlailing Address:.....Y........ 9-jo ..-.......5.&... ..................................................... ... 4.ru�:o-^�:.5.�.t............�.$.� ....
Onsite Representative:...`f......... .€.►.....-..... Integrator:---.�.r-tr.x€Is---- .........................................
.................
Certified Operator; ......................... ............................................................. Operator Certification Number.........................
Location of Farm.
A,'....... 5�.�.t 1►�€-ism........�...�..e....-0.......,5... ..1. (.D.......I..... a.....�- o.�c. €..r+s .. . .....�..:.. m.A:.. ...... ...
'^-�..—... .r,. ... :-. ...�.a....._.. !-- .......S.i ..i.. .... ....................................................................................
....: .
Latitude & 1 44 Longitude • 4 ;'
Swine
Capacity,Population Poultry
❑ Layer
0-Non-Layer
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
/
❑ Boars
f=lhei:
Design . Current Design < Current.
Capacity Population Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds JE1 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
❑quid Waste 14fanagement System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes a No
2. Is any discharge observed from any part of the operation? ❑ Yes 4N No
Di., -char- e originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes EQ No
b. If dischan, is observed, did it r: ach Surface VI'ater'' (Ef yes, notify DW(z) ❑Yes g No
c. If discharge is observed, what is the estimated flow in gal/niin? &4/4
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes CRNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ($ No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
mai ntenanceli mprovement?
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?
7125I97
❑ Yes M No
❑ Yes 19 No
❑ Yes No
❑ Yes No
Continued on back

' F1r acility Number: i
S. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes KNo
Structures (Lagoons.11olding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes RNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... 2.,........................................................................................................................ I..................... ........... I..... ..........
........
Freeboard (ft):
10. Is seepage observed from any of the structures? ❑ Yes 13No
1 I . Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes Eff No
12. Do any of the structures need maintenance/improvement?
IR Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
($ No
Waste application
14. Is there physical evidence of over application?
❑ Yes
KNo
(If in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type ,�� .�.c t.......................................... ._..............._....................... ...........................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
PO No
17. Does the facility have a,lack of adequate acreage for land application?
❑ Yes
RNo
18. Does the receiving crop need improvement?
[R Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
94 No
20. Does facility require a follow-up visit by same agency?
❑ Yes
9KNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
XNo
22. Does record keeping need improvement'?
❑ Yes
99 No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes 19,1\10
No.violations or deficiencies were noted during this.v_ isit. You:will receive no ftirther'
Orre46nden6e: about this: visit
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: ���dQ y �s -j, p Date:

•
•
•
Site Requires Immediate Attention:
Facility No. 3 1-- 4 8
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANE AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _ - 2__ , 1995
Time:
Farm Name/Owner: C 5. e2r►)'1
Mailing Address: _ FO &av- 5'3 3 i:�2A -;n 5Vs /-e_ Al G 2
County: L QpL m
Inteuator. F5,MW115 Phone: Z73- 5)(600
On Site Representative: Phone: - 2C(6
Physical Address/Location: From ! ' j 03 I) if- C1 j 5iz jpc 4"
Q r );,l 5, ro% ro74 5 r 0,1
Type of Operation: Swine Poultry Cattle r <
Design Capacity: I -DO Number of Animals on Site: ?]y a
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 35 ' O s ' L • 74-1' Longitude: 7� ' s4F ' Z&- V Elevation: Fee t
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) Ye r No Actual Freeboard. —(27 Ft. _Q Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed- Yes r No
Is adequate land available for spray?2�1�
No / Is e cover crop adequate? Yes or o 1u JA
Crops) being utilized: U he- (fogqkal
Does the facility meet SCS minimum setback criteria? 200 Feet from
No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within. 100 Feet of USGS Blue Line Stream? Yes No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o ONO
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man -trade devices? Yes o No 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 r No r
Additional Comments: r I111 e, nil P, L �erlbl_ 5 ! C oe
L I ew
Inspector Name
cc: Facility Assessment Unit
Signature
Us: Attachments if Needed.