310717_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual
II

Type of Visit: 0-Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Q Routine O Complaint 0 Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: jArrival Time: + Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: 9F '�-e a ^' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: -J3-7
Certification Number:
Longitude:
Design Current Design
Swiue Capacity Pop. Wet Poultry Capacity
Wean to Finish I Layer I
Current
Pop.
IDairvCow
Design Current
Cattle Capacity Pop.
Wean to Feeder
I
INon-Layer
I
Dairy Calf
ceder to Finish
2.4-6-9
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D . P.onl Ca aci
Layers
Current
P.a ,
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?
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
VNo
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[—]Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 - 21412015 Contin! ed

Facility plumber: `3 - 7 7 Date of Inspection: 1 S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZfNo ❑ 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): r i 2" 1
5. Are there any immediate threats to the integrity of any of the structures observed? El 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 ffNo ❑ 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 hreat, notify DWR
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VN
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
7. Do any of the structures need maintenance or improvement? ❑Yes VN
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
�No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? Ifyes, 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 El Evidence of Wind Drift ❑Application Outside of Approved
Area
12. Crop Type(s):
U. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? -
❑Yes
NA
rOo_—]
[] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
No ❑ NA
❑ NE
18. Is there a Pack of properly operating waste application equipment?
❑Yes
f
o ❑ 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? Ifyes, check
❑Yes
No ❑ NA
❑ NE
the appropriate box.
Page 2 of 3 21412015 Continued

Facili Number: \ - Date of Inspection: Z
M Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I__I N ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes dNo ❑ NE
L rJ
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
ZO
❑ NE
Comments (refeir,,to question #) Explain any YES,answers and/or anyradditionALreeommenilations or, any, other comments,
Use draWings''of facility to bet#er explacn'situatioosf 6e additional pages as, necessary). �,,,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 0 I
Date: -�(5,117
21412015

IJ
Type of visit: u t:ompnance inspection u uperanon xeview u ntructure Evatuanon u tecnmcat Assistance I
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: G Arrival Time: Departure Time: © County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L1C_'q^ /' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Certification Number: C
-71
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Cattle
Design Current
Capacity Pap.
Wean finish
La er
Dairy Cow
W n to Feeder
Non -La er
Dairy Calf
eeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dry P�oultr�y Ca acity P`o
La ers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
1
M
Discharr-es and Stream Impacts
1 _ Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ' ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued

Facility Number: 3 - / jDate of Inspection: Z /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EfNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: 1 2
Spillway?:
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in). J d ^ 2 7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the pen -nit? ❑ Yes RNo ❑ 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 Ef No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes El"No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift [:]Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesZ
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Xo ❑ 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
❑ 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 E3/No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 2/4/2015 Continued

Facility Number: JDate of Inspection: Z
.24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes21N0
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of First survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes [:]No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality 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 EJ N ❑ NA ❑ NE
[—]Yes No [] NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑Yes rN
❑NA
❑Yes ❑ NA
❑ Yes fNo ❑ NA
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 necessat-0.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:���_..---[/l ^
Page 3 of 3
❑ NE
❑ NE
❑ NE
Phone:I�`�� 73�1
j
Date:
21412014

1
'� � Division of Water Resources
Facility Number 3 1 - 7 Division of Soil and Water Conservation
� Other Agency
Type of Visit: QIt rRoutine
dance Inspection Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: 0 Complaint Q Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 4 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: 6C T h'l Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: %' (�- 7
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity- Pop..
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish Z�it? Z (�
Dai Heifer
o Wean
o Feeder
o Finish
EFarrow
Design Current
Dry l;ouItry Ca aci P,a
La ers
D Cow
-Dairy
Beef Stocker
Beef Feeder
Non -La ers
Pullets
Beef Brood Cow
Turke Puults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [JNo ❑ NA ❑ NE
❑ Yes rNo❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility dumber: - t Date of Inspection: Z
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r t + r
Observed Freeboard (in): 3 l ?
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
ffNo ❑ 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 environm��pat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes❑
NA
❑ NE
8.Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑'No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Ff No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No ❑ NA
[[] NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑ Check] ists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
[]Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections -❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [-]Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility dumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo, ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ 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
Q 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
E!I-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
ffNo ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
[ N ❑ NA
0 NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Reviewer/Inspector Signature: �" Date:
y -
Page 3 of 3 21412015

Type of Visit: p Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Q Routine O Complaint O Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: j f Arrival Time: Departure Time: ® County: S G1L1/V Region:
Farm Name: �j.Lt �jC�L &6LEVI Owner Email:
Owner Name: 41U L) }0-'TP lAe_ Phone:
Mailing Address: of l bp C+4 (LTE _ 'iwirgpew U fACu N-1 n L V0�NC- 0 S 3(0S
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: LCbN 9 . A(ul14g- L
Back-up Operator:
Location of Farm:
Title: Phone:
Latitude:
Integrator:
C1 t/
Certification Number:
Certification Number:
Longitude:
Design C*urgent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
C*attle
Design Current
Capacity Pop.
Dairy Cow
Wean to Feeder
[Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Design Current
Dr. PoouI . Ca achy pop.
Layers
Dairy Heifer
D Cow
Farrow to Feeder
Farrow to Finish
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)?
[:]Yes t*No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
[DNA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes � No
❑ Yes � No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: 1 - --I 17:�- 1 Date of Inspection: f 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:
Spillway?:
Designed Freeboard (in): 1— L , S • S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑ No ❑ NA ❑ NE
waste management or closure plan? /
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes V No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 9 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) 1iG
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 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 Approved Area
12. Crop Type(s): 6L.D G3dGZ0
13. Soil Type(s): S G
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �Q No ❑ NA ❑ NE
acres determination? ''TT
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WUP ❑ Checklists Q Design Q Maps ❑ Lease Agreements
[:]Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No
❑i Waste Application 0 Weekly Freeboard 0 Waste Analysis Q Soil Analysis ❑ Waste Transfers
0 Rainfall [:]Stocking 0 Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
[DNA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili - Number: t - '=7 ? Date of Ins ection: l
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes M No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes A No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[X No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Od 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).
w. A. ALA-Q-U
�1Au1JL/
4+
Lt 1 V /V
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: f 6j-4q!-lTrSS0
Date:
21412014

type or visit-. t7t_:ompnance inspection CJ uperateon tceview u btructure r:valuanon V Iecnmcal Assistance I
Reason for Visit: 9"Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: '� 5 0{ Departure Time: '.3� County:
Farm Name: �1V� �(� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Region: h
Onsite Representative:
Integrator:
Certified Operator:
�� �. �Yw('
Certification Number:
�]
I `� O `�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Net Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Q
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oulti.
La ers
Design
Ca aci
Current
Rio
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)?
[—]Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ;�JNo ❑ NA ❑ NE
❑ Yes �TNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued�

i 4.
Facility Number: -M 19 1jDate of Inspection:T�� j
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Strjucturr-e� 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L 4 `
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ice'' No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes KNo ❑ 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 VfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes gNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0No ❑ 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
VjNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
17f No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VfNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesZransifers
No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis. ❑ Waste
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes K No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eN
o
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1 . . I
Facili Number: - ri Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Vj No [DNA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes oNo
❑ NA
❑ NE
❑ Yes to No
❑ NA
❑ NE
❑ Yes VT No
❑ NA
❑ NE
❑ Yes V1 No ❑ NA ❑ NE
❑ Yes 44 No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Z No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 56 No ❑ NA ❑ NE
Reviewer/Inspector Name: 74 av�
Reviewer/Inspector Signature:
Page 3 of 3
Phone: a"' aL :�
Date: 2i-13L
21412011

Type of visit:
Compliance Inspection 0
Operation Review 0 Structure Evaluation
0 Technical Assistance
Beason for Vis :
Routine 0 Complaint
0 Follow-up 0 Referral 0 Emergency
0 Other 0 Denied Access
Date of Visit: 14MJ&� I Arrival Time: 1 a Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Phone:
Onsite Representative: LF—,:�W kTNU. Z— Integrator:
Certified Operator: L£- % AfLT'guf - Ad tc!tion Number: �~ S
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Curren#
D . ];Dolt . Ca aci_ P,o ,
Layers I
Dry Cow
Non-DaiEZ
Beef Stocker
Gilts
Non -Layers
I
lBeef Feeder
Boars
Pullets
NJ
jBeef Brood Cow
Qther
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes J)-kNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �4 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes fpo ❑ NA ❑ NE
of the State other than from a discharge? TT
Page 1 of 3 . 21412011 Continued

n
Facili "Number: 1 - } Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 7❑No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: O�
Spillway?:
Designed Freeboard (in):�i^7-rj
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
IX
I No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 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? 0
11. Is there evidence of incorrect land 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 Approved Area
12. Crop Type(s): SG Z-ee (0)
13. Soil Type(s): _ G OZQ5 604-C>
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ffffTTTTNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes RNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes )0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists ❑ Design © Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ YesKNo ❑ NA ❑ NE
Waste Application [] Weekly Freeboard Q Waste Analysis 0 Soil Analysis ❑ WasteTers Q Weather Code
❑ Rainfall ❑ Stocking Crop Yield 0120 Minute Inspections Q Monthly and 1" Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

l
Facili Number: - Date of Inspection: g
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes . No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 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 No
❑ Yes No
❑ Yes No
❑ Yes, ] No
DNA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes tNo
o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yeso ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers:andlor any additional recommendations or any•other comments:
Use drawings of facility to better explain situations (use additional pages. as necessary): '
IM
!�Au1gwvcw i�UC-_
Reviewer/Inspector Name:
Reviewertinspector Signature:
Page 3 of 3
6 PPhone:��}' [43ct�
Date: I d
2'412011

4 tI?ivi"sion of Water Quality
IK Facility Number I_ ? �J - j`� ® Division of Soil and Water Conservateon
Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: it Arrival Time: f Departure Time: County: LI li/ Region:
Farm Name: Vs�E'1 1 % -Y-- P Q.1& Owner Email:
Owner Name: L z—c))q � , O (L- N U �L Phone:
Mailing Address: lD C p(2 j � (L M q� ?Gy �za ffi0Ux J OC4 U(Z— , /VC D e 3 c
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative:
Certified Operator:
%
Lr e oN
Av_T#uPL.-
Integrator:
Cerh'fication Number:
(fpN
6 , rl�7NU
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
) _:H S "+
Design Current
Design
Current
sign
PCIDPL0N
Current
Swine
C►apacity Pop:
Wet Poultry
Capacity
Pop.
Cattle
Wean to Finish
Wean to Feeder
Layer
I INon-Layer
I
Dairy Cow
Dairy Calf
Feeder to Finish
t7
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr.. I;oult .
Ca aci
P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �Vo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA D NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - -- I Date of inspection: /
Wste 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: .I pL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
19.5 _11Q�S
_
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 �f No ❑ NA ❑ NE
❑ Yes �qNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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? X
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): 45 G3o
13. Soil Type(s): S G Q r__ (L P
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes VNo ❑ NA 0 NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes / \ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[:]Yes
ko
❑ NA
FINE
Required Records &Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
OWUP ❑Checklists QDesign 0 Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�4,
No
❑ NA ❑ NE
Waste Application Q Weekly Freeboard [3Waste Analysis Q Soil Analysis
❑ Waste Transers
[] Weather Code
O Rainfall Q Stocking 0 Crop Yield 0120 Minute Inspections Q Monthly and l" Rainfall Inspections
O Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA ❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - `}) Date of Inspection:
2,fDid'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 EI NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes '0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No NA [3 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes j No ❑ NA [] NE
h
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 WNo ❑ 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 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.: h e:
Use drawings of facility to better explain situations (use additional pages as necessary).
' oq
S 1 r l I I 1 ,---z' G S"
boNt l' Fo�-6cr /it 5o1 C_ SA,,TL-"-_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ��U���
Date: o /l
21412 0; 1

(Type of Visit RCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit aRoutine O Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access I[
Date of Visit: Arrival Time: _g ° -- Departure Time: County: L ( �� Region:
Farm Name: FA GZ NM Owner Email:
Owner Name: LEO T?-:� • ) N LA�Z Phone: 9111- 6 S9 -9 6 0 7
Mailing Address: D'4t9 CC AQ3CCU i H p __ I f b.A T ou k3 /VC OR NO5
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: LP—CAQ-7i4LA Inte actor:
Certified Operator: LEon� t• > - �-T��� Operattor ertifcation Number: � f s �
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = N = Longitude: = ° = 1
Design Current Design
Swine Capacity Population Wet Poultry C++specify
Current
Population
Cattle
Design
C++opacity
Current
Population
❑ Wean to Finish ❑ La er
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Dai
Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish El Layers
❑ Gilts ❑Non -La Non -Layers
❑ Boars El Pullets
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes *o ❑ NA ❑ NE
❑ Yes $No ❑ NA ❑ NE
12/28104 Continued

Fac.Qity Number: — 1�+ Date of Inspection
Waste Collection & Treatment X
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ElNA ElNE
a. If yes, is waste level into the structural freeboard? ❑ Yes El No ❑ NA ❑ NE
5 cture 1 Structrg2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L 1"1i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 14
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �Q No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.) `
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ElNA ❑ NE
through a waste management or closure plan? X
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 0 No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes to
o El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes ❑ NA ❑ NE
maintenance or improvement?
Waste ADDlieati6n
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ElNE
maintenance/improvement? 9
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes '94No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l 0 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) sC (P)
13. Soil type(s) �jpt_QS(aQV-6
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
// No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination. ?
❑ Yes
�& No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JVNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CNo
❑ NA
❑ NE
Comments'(refer to�question #),`;Explain any YES answers or any recommari& mm ' endations or any om ther coments y
Use drawings of facility tobetterexplain situati6ns (use additional pages as necessary) h f ®
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Phone:
Date:
Page 2 of 3 12128104 Continued

F'aciliy Number: 3-1j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists 0 Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J�No ❑ NA ❑ NE
0 Waste Application [3 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis El Waste Transfers' ❑ Aual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
FNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
kNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings: ; a
j4 f A
Lifi0o '99 AS
GAS-tiUA 7 ► dN 11,UVIIJ
Page 3 of 3 12128104

Type of Visit 3kcompliance Inspection O Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit ARoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: & (t Opt Arrival Time: G Departure Time: County: lil/ Region:
Farm Name: // ��t ti - G PP, Lm Owner Email: p
Owner Name: �J/� ' ). U �9-•Td U ft _ n 1 ,(y� _ Phone: gig - (053 - 9&,Qc
Mailing Address: � D �ZTE4- J m / t( 1 � d / +r lwwr- QC_/ UE NC oI-C3 — s
Physical Address:
Facility Contact: ,/} Title:
1-I
Onsite Representative: LCcyy a,7l4(1(?.—
Certified Operator: Ceou (j�Q-TNu
jL
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 5�
Back-up Certification Number:
Latitude: =1 o E--] Longitude: [� o [� g = u
uDesign =Current
Swine Capacity a'opulahoit " Wet Ponitry
A ❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
v ❑ Other
LJ Layer I
I
LJ Dairy Cow
❑ Non -Layer
L
❑ Dairy Calf
`Dry Poultry "k �,
- .. :� w �,�.�
❑ Dairy Heifer
❑ D Cow
❑ Non-Dai
❑ Layers
❑ Beef Stocker
❑ Non -Layers
El Beef Feeder
❑=
_ Pullets
❑ Beef Brood
Turkev Poults
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ljll No ❑ NA ❑ NE
❑Yes ❑No
[I NA
[I NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes 'kNo
❑ NA
❑ NE
❑ Yes _NfNo
❑ NA
❑ NE
12128104 Continued

acility Number: - j 1 —TR Date of InspectionMMKI
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: 1 0-
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
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes] No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �] No ❑ NA ❑ NE
S. 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 0 No ❑ NA ❑ NE
maintenance/improvement?
1. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or 10 1bs ❑ 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) &6Q M S<-
13. Soil type(s) (-ADS QoizC�
14. Do the receiving crops differ from those designated in the CAWMP? ElYes No ❑ NA El NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 10 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes &fNo ❑ NA ❑ NE
L
er/InspectorName �ry ��}/ S Phone:er/inspector Signature: OAI" Date:
Page 2 of 3 12128104 Continued

Facility Number: j j Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes %No ❑ NA ❑ NE
the appropirate box. 0 WUP El Checklists Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ j�aste Transfers ❑/Mual Certification
0 Rainfall El Stocking El Crop Yield El 120 Minute Inspections 0 Monthly and V Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
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
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
9 No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
)ifNo
❑ NA
❑ NE
❑ Yes
❑ No
ONA
❑ NE
❑ Yes]
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
❑ Yes
toNo
❑ NA
❑ NE
Add"ional.Comments andLor:I?rBWuigs. Xw . »_, a ' s ix _ j� ` � x'a s ri
Oflaq D 3 1.9
11prlol D- 6 .0- -
Page 3 of 3 12128104

Division of Water Quality
Facility Number j 0 Division of Soil and Water Conservation
--- —. — - — '0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit X Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 9a Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ��jjTitle:
�
Onsite Representative: CEO � 1?-_
Certified Operator: L&o/ .L Aazw_. i?_
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: S
Back-up Certification Number:
Latitude: [�J o = ' =] Longitude: [= ° = 6
b Design Current
Design Current a'
<���
=Design��Current
Swine + Capacity 'Population
Wet Poultry
Capacity. Population Cattle
Capacetyy Population-
❑ Wean to Finish
❑ Lale :r
❑ Daia Cow
❑ Wean to Feeder
❑ Non -La er
I
I
❑ Dairy Calf
i
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
- ❑ D Cow
❑F
❑N
arrow Loueeder
❑ Farrow to Finish
❑ Gilts j
❑ Boars I'
-:Other-
Other
❑ 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?
on- at
❑ Beef Stocker ;
❑ Beef Feeder
r,. ❑ 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?
Page I of 3
❑ Yes ;6No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
14No
❑ NA
❑ NE
❑ Yes
Wo
❑ NA
❑ NE
12128104 Continued

Facility_Number: 1 —
Date of Inspection !]J
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 S Lure 2 Structure 3 Structure 4
Identifier: I
Spillway?:
Designed Freeboard (in): �i , s �•'S
Observed Freeboard (in): y 31
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes A 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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes .0 No El 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
maintenance/improvement?
❑ Yes R No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 9%No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question # ): 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):
C 6 GL,46f v CjC's/q D T1 CSi�/
Reviewer/Inspector Name F Al jqyAl Phone: [phone]:24
Reviewer/Inspector Signature: Date: __T l QLd 15�
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes N�No Cl NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ; No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )] No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
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
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? (iel 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?
lAdditional Comments and/or Drawings:
❑ Yes ONo
❑ NA
❑ NE
❑ Yes
jqNo
❑ NA
❑ NE
❑ Yes
Ej No
❑ NA
❑ NE
❑ Yes
EoNo
❑ NA
❑ NE
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
Page 3 of 3 12128104

{(Division of Water Quality
) Q Division of Soil and Water Conservation /
•- Facility Number � 1 ✓
11 Q Other Agency11
Type of Visit ,Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Koutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 6 6 Arrival Time: Departure Time: County: +DyP�CL� Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: [� ,/�,/}�! ] y� Title:
Onsite Representative: l Z 6 I`tlti! H11/C
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =c 06 =" Longitude: 0° =' ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -Layer
Dry Poultry
Pullets
Turkevs
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: =.
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 C14 ❑ NA ❑ NE
❑Yes
El No
❑NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 7No
❑ NA El NE
El Yes❑ NA ❑ NE
12128104 Continued

t Facility Number: 31 — Date of Inspection r 0
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure` 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: CS�N 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): y�U
5. Are there any immediate threats to the integrity of any of the structures observed?
%
❑ Yes B 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 ❑Io ❑ 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 environmentallttheat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes E3/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes O No ❑ NA ❑ NE
maintenance/improvement?
] I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �xo ❑ 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
E�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yesZNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L? No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
1 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
►�'/ U(AT6 0 60
�- C 4 ©R1Q..IYLl_f
Re-viewer/inspector Name lsilkl kfA Phone: ! 7I `- 73
Reviewer/inspector Signature: Date: �6
12128104 Continued

'Facility Number: ' — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [a Yes ❑ No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑;fo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E(No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
..�� //❑
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
,L�'[Vo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
7No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L7N
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑.Ma ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EjxO ❑ 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
!J 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
ElE Yes
No ❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
LJ'No ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No ❑ NA
❑ NE
Comments and/or
12128104

I
Facility Number
((Division of Water Quality
O Division of Soil and Water Conservation
0 Other Agency
b�xr
Type of Visit O0Co liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Il i ` Arrival Time: Departure Time: County: 40I.-I&AA1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: ��/� Title: Phone No:
Onsite Representative: U Od AAMyh _ Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o ❑ d ❑ H Longitude: = ° u
Design Current: Design'..J.
Capacity Population Wet Poultry 'Capacity P.c
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
�!
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑Other
Dry Poultry
rrent..
l
nation
Cattle _ C
�•
0 Dairy Cow '
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑N D
ElLayers
ElNon-Layers
ElPullets
ElTurkeys
❑ Turkey Poults
❑ Other
Gurrei
on- airy
�. ❑ Beef Stocker;
❑ Beef Feeder
❑ Beef Brood Cowl
21,
iig: 4
IVumber'of Struct
ru
.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
ElNo
❑ Yes
ElNA
ElNE
❑Yes
o
❑NA
El NE
12128104 Continued

Fatuity Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes n No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA
❑ NE
Structure 1 Structure Structure 3 Structure 4
Structure 5 Structure 6
`2
Identifier: lA&'O-% 1 (AT�"v'�
Spillway?:
Designed Freeboard (in): MIS'
Observed Freeboard (in): (41 L/ y
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes L7 No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
_,/
El Yes O 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?
ElYes EhrNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RrNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] yes ErNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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 El Application Outside of Area
12. Crop type(s) (3 C,(r� u
13. Soil type(s) (7o us j0do
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 YJ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes 2rNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes : NNo ❑ NA ❑ NE
❑ Yes IJ No ❑ NA ❑ NE
Comments (refer. to question°#): Explain any YES answers and/or any, recommendations or `any ottier comments.
Use drawings of facility to better explain situations. 6se;additional pages.as necessary.): r
Reviewerllnspector Name I Phone:
Reviewer/Inspector Signature: Date:
X-Use L Vf J J L/L O/V'f LIV,... rg"e„

i.
Facility Number: — j Date of Inspection a L
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes Pf No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections �❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes l' No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes O No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
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?
❑ Yes
L1No ❑ NA
❑ NE
❑ Yes
fNo ❑ NA
❑ NE
[:1 Yes
El NA
❑ NE
El Yes
,E]'<
Lo F4 KA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
(Additional Comments and/or Drawings:
❑ Yes
r No
❑ NA
❑ NE
❑ Yes
124o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[ fo ❑ NA
❑ NE
❑ Yes
0 -14
❑ NA
❑ NE
❑ Yes
To
❑ NA
❑ NE
Page 3 of 3 12128104

IType of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up ' Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: D ZQ Arrival Time: LYJ Departure Tirne: ; County:
Farm Name: f T 6 Owner Email:
Owner Name: �C� &22VzC Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Gf�FJn/ /'7` c-rwLl/e Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region: Zip
Location of Farm: Latitude: = o = 1 =Is Longitude: = ° 0 i = «
ISM
lqlV_eS1M_ijMWC41urrent
Design Current
Design Current
Swine
Capacity Population
p--ity. Pop lahon, ...
C•attle Capacity Population
❑ Wean to Finish
❑ La er
El Dairy Cow
❑ Wean to Feeder
❑Non -La er
ElDai Calf
eeder to Finish
28
❑ Dai Heifer
Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood - Cowl
❑ Turkeys
Other j
❑ Other 7
"urkey Poults
Other
Number of Structures:
10
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes ONo ❑ 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
f (No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
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?
Structure 1 Structure 2 Structure 3
Identifier: J.' 1 14�z
Spillway?: _/UO A)a
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4
❑ Yes /EfNo
ElYes ❑ No
Structure 5
❑NA El NE
El NA El NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc_) ez
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes yNo ❑ 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
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ezNo
❑ Yes )eNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes le No ❑ NA . ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes XNo
15. Does the receiving crop and/or land application site need improvement? ❑ Yes XNo
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes gNO
17. Does the facility lack adequate acreage for land application? ❑ Yes ONO
18. Is there a lack of properly operating waste application equipment?
El NA El NE
❑ NA ❑ NE
El NA ❑NE
El NA El NE
❑ Yes F] No ❑ NA ❑ NE
� "�-4 ✓ s' omments � ;.. ssY
aC(refer twquestion #)E — lhiffhny YESjaners swand/or;:any� recommendahonstor auy other comments + s
17'se drays�ngs of facility to better explainsituations (use additionalvpages as necessary) .
� (/rl�.L{/9-LL/ �%�iQn1 �5 (/�/�LL. �i¢�Nri�z�+/Eo, /��'�D•e4s
Di4��2 D,iYf (_v.J f Sea IJ 60il.' C j7edf=f7-7z4A/ 0g5Ve""n s
l�f.rrsza�✓ s�2 vzc /�aur �lf,�,Pm s.
Reviewer/Inspector Name Phone: IY169(vTcZCo
Reviewer/inspector Signature: Date: /O
12128104 Continued

Facility Number: — Date of Inspection
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 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2(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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
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
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?
Additional. Comments
❑ Yes P�No
❑ NA
❑ NE
❑ Yes PfNo
❑ NA
❑ NE
❑ Yes PfNo
❑ NA
❑ NE
❑ Yes ZNo
❑ NA
❑ NE
❑ Yes ONo
❑ NA
❑ NE
❑ Yes 9No
❑ NA
❑ NE
❑ Yes A No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ioNo
❑ NA
❑ NE
❑ Yes ;dNo
❑ NA
❑ NE
❑ Yes X No
❑ NA
❑ NE
❑ YesZE No ❑ NA ❑ NE
12128104

Type of Visit 0 CoQ{liance Inspection O Operation Review O Lagoon Evaluation I
IReason for Visit CIF Routine O Complaint O Follow Q Emergency Notification O Other ❑ Denied Access
Date of Visit: $ 0 Time: . JZ JS
Facility Number 3
0 Not Operational Q Below Threshold
Permitted Cer!lii�fiied © Conditionally Certified © ».
Registered Date Last Operated or Above Threshold: ....._ .. .......
Farm Name: L (/ E'('J: G..•_` »...» County: »..».. »»......... .». .. ��w .».......
Owner Name: ». » ........._ .»...».» ...... »....... » _....» _ ..» ...... ».� - Phone No:
MailingAddress: ....... ............................................ .....»...... ».»..................
FacilityContact: ... ........ .......................... ....................... .rr....,..1F......... Title: ............................................. ...... --.. Phone No:
Onsite Representative:__....---1 . ....... .... Integrator:..._ ... i .i�b.ir_.....
Certified Operator: ................. . . . . . .......... . ....... .... ......_...._._.._.... Operator Certification Number:
Location or Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude ' 4 64
Discharges & Stream l_moacts
1. Is any discharge observed from any part of the operation? ❑ Yes C rNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [I Yes [ 70
Waste Collection & Treatment �,�
4. Is storage capacity (freeboard plus storm storage) less than adequate? [ILK
Spillway ❑ Yes No
Struc
ture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...».......L................. Z. .. »..»»..» .
Freeboard (inches): Z. 2
12112103 Continued

Date of Inspection `-
Facility Number: 31 1 '1
'J
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmentaI great, 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 maintenanceRmprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADDlication
❑ Yes 2�0
❑ Yes ®No
❑ Yes To
❑ Yes EWO
❑ Yes LyNo
10. Are there any buffers that need mainter ance/improvement? ❑ Yes To
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes e
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12_ Crop type Rum" ( H)._-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWNP)? ❑ Yes Q' ro
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes O-IdS'
c) This facility is pended for a wettable acre determination? ❑ Yes 9'01-
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes CMo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Leo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes M<o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes LJ i o
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 Q-Ko'
Air Quality representative immediately.
nts�(Fder.th' question ): E amry Y)L p�wets ami/ar arty rectanmeada#aons MY Dther
i e s to b latn`satiaa . { tianaI Pa$�► 93 ❑ Feld Copy ❑ Final Notes
_
Ut'' p i�TC C 2a e
LxLac.+-E coN 017 t'ad
FAR-vl�, _
Reviewer.(/�,_ m 4i
/inec sptor Name1N
Reviewer/Inspector Signature: Date: a
12112t03 1 Continued

Facility Number:It
3 j --
Date of Inspection
Reouired 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, traps, 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/mspection 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 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ONe
❑ Yes u Nc
❑ Yes �' o
0 Yes
❑ Yes To
❑ yes ;rto
❑ Yes coo'
❑ Yes�:/o
❑ Yes L.4o
al �zo
❑ Yes ❑ Yes Woo
❑ Yes
34. Did the facility fail to calibrate waste application equipment? ❑ Yes [2�l96
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes 9A
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute inspections ❑ Annual Certification Form
12112103

Type of Visit Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit _Qr Routine O Complaint 0 Follow up 0 Emergency Notification i7 Other ❑ Denied Access
Date of Visit: O d Fime:
Facility Number 3
Not O eratianal Below Threshold
©Permitted E3 Certified [3 Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: `� er; L ��� r►� - — County Z) y!p h
Owner Name: LC A eA v Phone No:
Malting Address:
Facility Contact:
OnsiteRepresentative: ,^LeevN Irir-�h�r
Certified Operator:
Location of Farm:
Title:
Phone No:
Integrator: Pro's agile
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a & " Longitude ' 6
Design Current
�wme Un acity ro ulatton
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Gilts
Boars
:Numberof,Lagoons
oldiiigiPondsv S6,111d.Tki0i 0
Design Current Design Current
Poultry Capacity Population Cattle Capacity
Population.—
❑ Layer I 1 ❑ Dairy
❑ Non -La er I Non -Dairy
❑ Other;
Total Design Capacity
Total SSLW
Subsurface Drains Present ❑ Lagoon Area JEI Spray Field Area
No Liquid Waste Management System
Discharees & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i �L `3� 4T
Freeboard (inches): N T (�
05103101
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes _,ONo
❑ Yes JT'No
❑ Yes �No
Structure 6
Continued

rFatility Number: 3 Date of Inspection 34 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ YesZTNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ID Yes _ZNo
(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 ETNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 12'Ro
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes -ErNo
11. Is there evidence of over application? ❑ Excessive Ponding) /❑ PAN [I Hydraulic Overload ❑ Yes 12No
12. Crop type 3", V-," 1'/ d4 �c, S 4 v.,¢ �y►.1 G} �! �i rti i r. Qy e r-sear_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes .TNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes _,ZNo
b) Does the facility need a wettable acre determination? ❑ Yes E;?No
c) This facility is pended for a wettable acre determination? ❑ Yes j'No
15. Does the receiving crop need improvement? ❑ Yes J214o
16. Is there a lack of adequate waste application equipment? ❑ Yes [,_�No
Required Records &: Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes -EfNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) 'Pryes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 120'No o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 'Femo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes _L:�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes -.ffNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes _-El No
24. Does facility require a follow-up visit by same agency? ❑ Yes -TNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes _No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments.(refer-to.gtiesiioii #j Eiplaia any YES answers and/or• any recommendations or any. comments.
-
_. _ _ -
iise drawiisgs of facdtty to better e-rplaur i tuatsons.:(use addtttonal;pages as aeeessary) ;❑ Field Copv ❑ Final Notee
-7- S Fc,C. �` �'-) i, i f (�Je �1 mq�'z-�otinc`�Dj. -%l.la �7e,V.ti, Vd�s G✓Up rS
exeeIlet, Td,e s
q)13�.-e qr14 Swi-ic- reG it Gamer) J�eio4-
u Lc S C Gt
d V.;Ydt i7> 4L e �eGOro{r ' lace LVe ll e .
j�e q j G�r�;r YC�or�,(sv� cc,arotot�lce
wi-Fl.-�-he P�1I.� 1�ade gcc.n���r�� -1¢ ��e we{�at�l� gtresd�-�e•�►�,:�t4-���
Mr. Plegst Ae lit oo�^�es>�►-t -Fo- 6 res _-q,q I.,y
Reviewer/Ins ector Name
Reviewer/Inspector Signature: 46 Date: 313 DZ
O5103101 Continued

Facility Number: SI —?/71 Date of Inspection D A
Odor Issues
2& Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
-;-OKes ❑ No
❑ Yes 2 No
❑ Yes-- =' o
❑ Yes -,21qo
❑ Yes j}�vo
❑ Yes JNo
❑ Yes ❑ No
Additional Comments and/or Drawings. mm _ --
05103101

`� l ter Quality {�
vision of Wa
Di
Y ion of Soil
and ate Conservation
.: ,.. Q;Other`Agency_ ,
Type of Visit _)2ri✓ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit.,ORoutine O Complaint O Follow up O Emergency Notification O Other p Denied Access
Facility Number / Date of Visit:
❑ Permitted 0 Certified © Conditionally Certified ❑ Registered
FarmName: ............6I t3-....4.. G..............._................................................................
Owner Name: Leo f'} r't
...............
Facility Contact: .............................................................................. Title:
Mailing Address:
Onsite Representative: .... L��,,, o h A r 4li L11 r
CertifiedOperator : ................................................... ..................................
Location 'of Farm:
urine ❑ Poultry ❑ Cattle ❑ Horse
Ded& - Curr
waae capacity Po uls
] Wean to Feeder
Feeder to Finish �$
] Farrow to Wean s
] Farrow to Feeder
7 Farrow to Finish
Boars
5719 T1 Time: �Printed on: 7/21/2000
tD Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .......................
County:.. V. l..i.t-,...............
Phone No:
Phone No:
..... ...................-..........-...............
Ir
Integrator:,�e
�2w �iC'
Operator Certification Number: ... -......
Latitude ' 4 46 Longitude �� �6 64
Design Current DeAp- - Curireat
Poultry Capacity Po ulation Cattle :: ;Ca ace - Po "tilatio
❑ Layer ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total §nW
�Iljpm nt I,pQps ❑ Subsurface Drains Present I ag+w�n Ares ❑Spray Field Area
Holldtg Poiickl,Solid Traps '< :::7n No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`?
b. If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............................................ .......... ....
Freeboard (inches): 4 :5 [_
5100
❑ Yes'12'No
❑ Yes No
ElYe/s/L} No
❑ Yes
/V1No
❑ Yes o
❑ YeNo
❑ YeS
Structure 6
Continued an back

Facility Number: 3 ( — r] Date of Inspection Printed on: 7/21/2000
• S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes o
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
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes�No
8. Does any pan 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-IdNo
Waste ADDlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes P*110
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑/Hydraulic Overload ❑ Yes gNo
+'
12. Crop type ker"'ydo GQ•�iv
olled lea -zz �.-vla�1 l>rot,,��
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes_j No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
yiolaiigris. ..... n... were noted during #.... s. ...... i-e. . . ...further: :
correspondence: about. this .visit:...
Comments°(refer, to question'#)- Explain any YES answers -and/or any recommendations or,any`otlier c
bseAr-awings'of facility.to better explain situations. (use additional; pages as necessary,: -
tte -faG; I,'+L7 , ree orris tint CI -UPS aee tjcI1 kerj.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ,05No
❑ Yes"ONo
❑ Yeso
❑ Yes/No
❑ Yes ZEYNo
❑ YesXNo
❑ Yes gNo
❑ Yes No
❑ Yes ),21rNo
❑ Yes.,eNo
❑ YesIT-wo
A6
Reviewer/Inspector Name
Reviewer/Inspector Signature: AAAA7,k_ Date: S-/lY%/ 0 1 1 5100

Facility Number: Date of Inspection 5 1 00 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 AYor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes',�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes J21110
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.) ❑ YesXNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,�No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
•
5100

VDivision of Water Quality
i
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of V`isit: ime: /ter' Pitinted on: 7/21/2000
Q Not Operational Q Below Threshold
APermitted 0 Ce tifyed 0 Conditionally Certify d 0 Registered Date Last Operated o •kbove Threshold:
FarmName: ...... ......L............//lrt:............................. County:.......... (.............................. ...0 ...........
OwnerName: ............. ...... Phone No:....................................................................... ............
................. ................
FacilityContact: ...................................... ........ itle:....6']N'..'�{/................................. Phone No:...................................................
MailingAddress:.... ........................................................................................................................................................................ .........................
.........................
Onsite Representative:.... �^ e 1 .................... ...Yi'. .U............................ Integrator:.................? .
Certified Operator: ................................................... .............................................................. Operator Certification Number:...........
Location of Farm:
AI
d Swine []Poultry []Cattle ❑ Horse Latitude �� �' 0°° Longitude �• �`°
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
[5Wxeder to Finish 2 2, ko0 ❑ Non -Layer I L I[] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imuacts
1. is any discharge observed from any part of the operation? ❑ Yes N&o
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)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Stwcturc J Str,*ure 2p Structure 3 Structure 4
Identifier: ............<<..............3�..u
...................................................................................... .............
Freeboard (inches):33
5100
Structure 5
❑ Yes
❑ No
❑ No
❑ Yes
❑ Yes
No
❑ Yes
No
❑ Yes KNo
Structure 6
Continued on back

1 Y
Facility umber: — ' Date of Inspection"erve?
( Printed on: 7/21/2000
5. Are them any immediate threats to the integrity of any of the structures oees, severe erosion, ❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes 1W 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 [dNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes dQ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes Wo
Waste Application
10. Are there any buffers that need maintenance/improvement? Cl Yes ;E�No
11. Is there evidence of Qver application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type Aff , '1�a
13. Do the receiving crops dihfer with those designated in the Certified Animal Waste Management Plan (CAWMP)? []Yes XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0'_No
b) Does the facility need a wettable acre determination? ❑ Yes Vj�No
c) This facility is pended for a wettable acre determination? ❑ Yes jl�,No
15. Does the receiving crop need improvement? El Yes R(No
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: o yiolatidtis:oir• de#3cienctes •were noted, during ihis:visit'.• Yoit will r' eceiye �iti further ;
correspondence. about. this visit.
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 necessa SmIt (4,0
❑ Yes YNo
❑ Yes 4No
❑ Yes ONO
❑ Yes V No
❑ Yes .12fNo
❑ Yes (YNo
❑ Yes dNo
❑ Yes g1gO
❑ Yes [$No
❑ Yes L% No
VV%-
�S� z
��- W . T
Reviewer Spector Name 7" e L! at%,
Reviewer/Inspector Signature:
Date:
5/00

Facilit- Number: — , Date of Iuspection U Printed on: 7/21/2000
(id�ir'Issues
26. Does the discharge pipe from the confinement building to =storagend or lagoon fail to discharge WOW helow
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
v�E
❑ Yes )(No
❑ Yes <'<NO
❑ Yes lk<,—O
❑ Yes 900
ElYes
Wes ❑ No
Additional omments and/orDrawings:
AL
5100

�j
0 Division of Soil and Water.'Conservatron-'Operation•Review
13 Division of Soil and Water Conservation .Compliance Inspection W
Division of Water Quality ;Compliance Inspection i
Other A enc -_ - _
3: g y:-,Qperation:Revtew _
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 Date of Inspection 27
I ime of Inspection j' 24 hr. (hh:mm)
® Permitted 0 Certified J3 Conditionally Certified [] Registered © Not O erational Date Last Operated:
Farm Name: ................ ID
.) ve�%.....•�•�i r•! County:....,pp_.!.!'�...........-.....-............ .
r RR ! U ....
Owner Name: ..............C—Co n fl r4k VY Phone No:
........................................................................ ............................. .---.....................................................
FacilityContact: ............................. Title: ................... ............................................. Phone No:...................................................
'Mailing Address:................/t..........-................-gg..............-.....-....-..................................................................-........................................
Onsite Representative: L�0 Y1 Tit?! r Integrator: p�! SAIPL je......................................................
Certified Operator:................................................................................................................ Operator Certification Number :..........................................
Location of Farm:
..........................................................................................................................................................................................................................................................
Ji
Latitude �° Longitude
Design Current
-,_ Swine, Capacity Population
❑ Wean to Feeder
® Feeder to Finish
Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
IVumbeC-of I,"agoons �. ❑ Subsurface Drains Present IFEILagoo. Area ❑ Spray Field Area
Holding Ponds / Solid Traps y" ❑ No Liquid Waste Management System
Dischar_Zes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No.
❑.Yes IgNo
❑ Yes X No
❑ Yes JKNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: f Z
Freeboard (inches): 3 j ...........................................................................................
5- Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes M No
seepage, etc.)
3/23/99 Continued on back

4
Facility dumber: Date of Inspection }0 2
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ;j No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
T Do any of the structures need maintenance/improvement? $1 Yes ❑ No
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 ;g No
Waste Armlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes X No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes 9 No
12- Crop type 6 e r --) uda Cen4eel jed Grc zc 6,-4 t k,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15- Does the receiving crop need improvement?
❑ Yes X No
16. Is there a lack of adequate waste application equipment?
❑ Yes X No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes D9 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
09Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
JK 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 'Z No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes IM No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
24. Does.facility require a follow-up visit by same agency?
❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
VIOIaEkOi15,OI de#icle[3C3.S WLIVoted (14H FIIg thls.vlslt. • Yoi� Wlil•I'eb�iye ii0 fuI'thetr •. •.
....
orres 6fidei c' e. ah4, ti this visit.... ' .: ' .. ' ' .' . ' ..:: ' . ' ' ' • ' ' ' ' . ' '
Comments (refer toquestion 4) Eitpla n any -YES' answers and/or, any recommendations oT any other coinments
_ _
W
Use drawin of facilityto Better explain situations. use additional a es -as neces`sa -'
_G
�..Ge>7-i ��ve -� �`•Fer�S -�� veq��� bare g1'eats er, aa�, �2,
15. G.-e�vs Ire ;n excelkn4 cer.d JV tall
►r�. �f�; 1, L.Ayph+IDes� Oo �f
i� • Q LVeeklj -r rQ¢�n�rG� feVetr,
Reviewer/Inspector Name fi - ` O r>' e�:�� t°�5Dd ex�
Reviewer/Inspector Signature. Qy• L..�•� Date: f0
3/23199

1Facility�Number: P — / Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Pq 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 M No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 9 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 JX 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 99 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 19 No
Additiona omments-anor_ _swings:'
W
3123/99

❑ Division of Soil and Water Conservation [3 Other Agency
0 Division of Water Quality
ICKRoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection] Fi
Facility Number 3
Time Of Inspection 33p 24 hr. (hh:mm)
© Registered 0 Certified [3 Applied for Permit © Permitted Not O erational j Date Last Operated:
Farm Name:... �b^.IRL •1`C! -�- ... ...... County:... ll�.
. ............... ................................................ .
Owner Name:................................................................................................. Phone Na:
�.e,✓� .. ............... .... .t` .6 .` ..% `f
FacilityContact:..................................................ty............................ TTiitle[:................................................................ Phone No:...e..............................................
Mailing Address: •r9,1•nl..... l'��� •...�.�4k. �1 �1�LJ
.... .............................
OnsiteRe resentative:-�L-'- 2`r Inte rator ..............................
p 1.-. ... _........ g ...
Certified Operator: ....... ........................................... ............................................................. Operator Certification Number,...---...........-----------...
J22tion o arm:
....... ...
�-y A
ti `r'�.e`^.C?,...�.••i.....1�......�/....lY�...����..1� 4r�...........r�....... ...... .............._.......................
•4. ......
Latitude 00=1 0" Longitude 0• =' ="
- Desi - Current
-
r `"°Desi Current
Design Current
lI
Somme",: -• Capacity Population '-:. Poultry `Capacity Population Cattle
',Capacity.Population v;
❑ Wean to Feeder
❑ Layer
❑ Dairy
eeder to Finish
(�
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
;.
El Farrow to Feeder
❑ Other
-
❑ Farrow to Finish
: Total Design Capacity
❑Gilts
❑ Boars
yF
TotalYSSLW
Nu>tniierbf L ans # Ho�lding 1'orids
�-
❑ Subsurface Drains Present
❑ Lagoon Area ❑ Spray Field Area
Q
❑ No Liquid Waste Management System
4
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 9No
2. Is any discharge observed from any part of the operation? ❑ Yes O No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes bj No
b. If discharge is obsen ed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes R
No
c. If discharge is observed, what is the estimated flow in gal/min? ^RA
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes "No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes V0 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes CqNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

acility Number: e3 l —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes KNo
Structures (LaeoonsAoldine Ponds, Flush Pits, etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Ed No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):......... 3.,,.-< ............................ .......... ................................... .................................... ......... ........................... ....................................
10. Is seepage observed from any of the structures? ❑ Yes NfNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
[X No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
[)(No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
KNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
[gNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop typeJ........................................................... ........... .......... .........-
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[VNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
9No
18.
Does the receiving crop need improvement?
❑ Yes
[(No
19.
Is there a lack of available waste application equipment?
❑ Yes
[XNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
[(No
21.
Did Reviewer/Inspector fail to discuss review inspection with on -site representative?
❑ Yes
[$'NO
22.
Does record keeping need improvement?
gYes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0• No violatiohs' �o' c deficiencies were-noted,during this,visit - You.will receive- no•further- . -
:. corresO iidehce: tatiout this: visit::::: :
CIL, 6o .
r
❑ Yes 0 No
❑ Yes [R No
❑ Yes k[No
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: a �j`_���� C� Date: \ 0 p r-?( -17

DSWC Animal Feedlot Operation Review P
® DWQ Animal Feedlot Operation Site Inspection
(Routine 0 Corn laint 0 Follow-u of DW ins ection O Follow-up of DSWC review Q Other
Date of Inspection 0 4
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered JaCertified 0 Applied for Permit 0 Permitted JONotOperational Date Last Operated:
� f
Farm Name: ..... R1.0.....- -.ti. ....... x.r......+:�.................. .......... I ............ ........ County:... .>a...a..,-s................................... .,...�,�
Owner Name :..... f- e—o-rn........................... ...t. .u......................................... Phone No:... ..L. )..... .5. .. .. .�i .........................
Facilitv Contact: Title Phone No:
Mailing Address:.... Z..�P........ '�-4 .......... ... r....h1c..................... .�.. ...
Onsite Representative.:...1_ .�.a........ /4.r.�.k.u..................................
Certified Operator:....�..e ..o.. ......X..-...........a..,r.........
Location of Farm:
IntegratE►r:..... e:.;r.. .4 .' r.............................................
Operator Certification Number:---1_z..l,.Y.................
Oxv... 1.A..s1.`�.....,�. t......A. �?.."1... a . ... 1.......wM.,..ix.....s c..�t..i....... i r±.. -
........ }..._.. 1--'-.... ............
..t .ki o 4-�.....- .. ..�.. ..Q..b.-.................................................................... .
Latitude ©' ° .9 Longitude • 55 ` "
Design Current
Swine Capacity Population
❑ Wean to Feeder
25�Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons I Holding Ponds
Poultry Capacity Population Cattle ..:.Capacity. Population
❑ Layer ❑ Dairy
❑ Non -Layer I I I JE1 Non -Dairy
❑ Other
Total Design Capacity Z 9 0
Total SSLW
I❑ Subsurface Drains Present Lagoon Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, dicl it reach Surface Water? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gaUmm?
d. Does discharge by ass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
Spray Field Area
❑ Yes 0 No
❑ Yes ffNo
❑ Yes lJ No
❑ Yes E9 No
❑ Yes ES No
❑ Yes 'Z No
❑ Yes [K No
❑ Yes 91 No
❑ Yes RNo
7. Did the facility fail to have'a certified operator in responsible charge?
7I25/97
❑ Yes H No
Continued on back

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 91 No
Strueiures_(Laeoons,llolding Pands, Flush fits, eta
9. Is storage capacity (freeboard plus storm storage) less than adequate? El Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft):....... .:.25............. ........... ..........
............. ................................... .................................... .................................................
10. Is seepage observed from any of the structures? ❑ Yes 19 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? N Yes ❑ No
12. Do any of the structures need maintenance/improvement? ® Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify 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 aNO
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............... r......:sk....wi..---.... .rLv 2i
.. . .......................
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 19 No
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24, Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violitions or dericiencie's.werenotedduring' this'.visit. You.will receive no ftirther,
correspondence about this:visit:
® Yes ❑ No
❑ Yes ® No
CK Yes ❑ No
❑ Yes 5? No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes 5& No
Comments (referjo.gtiestion #) Explain any YES answers and/or any„recommendattons,or any-kother.comments.
Use drawings of facility to better explain situations (use addttionat pages as necessary)
W .�
I1•j�2_ "oS5ay. Lv w¢Y.ram t`td— 1�q\130�1 2—ILc��o� T►.�se� c�
i_" 1� 04 D-'• A env e a 4 • `J �J
t
fit s c o 4t. B 1p_- v&.0- �z a Y-s yr e.a
A mat" I-L s"_wf FAQ e,-014,ti o� ►�ao� Waji
N aT o „1. 4
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 5 d -f

Site Requires Immediate Attention:
Facility No. I I - '� J
C'©A.JT# CT - 40f DIVISION OF ENVIRONMENTAL MANAGEMENT
LL ANIMAL FEEDLOT OPERAT 0 S SITE VISITATION RECORD
Ale`�rlGh S DATE: e5 z I , 1995
P e &rrn S Ti e: l0 30
P Pre;,
Farm Name/Owner:Lae H u / Lt C lL ✓�!
Mailing Address: l
County:
Integrator: Phone:%
On Site Representative: C le_t Phone:
Physical Address/Location: ZiIrzvCS
Type of Operation: ' Swine tZ Poultry Cattle
Design Capacity: O Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ° S Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 L<�
4 h27 storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard:Ft. Inches
-e 0Was any seepage observed from e a oon(s)? Yes o Was any erosion oserve 9 des or
Is adequate land available for spr y? es r No . Is the cov crop ad quate? Ye or No
Crop(s) being utilized:ol
Does the facility. meet SCS minimum setback critena? 200 Feet from Dwelling e or No
100 Feet from Wells? OY4 or
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or- spray -irfigated within 25 Feet of a USGS Map Blue Line? Yes or o
Is animal waste discharged into waters o e state -by man-made ditch, flushing sysiem, or other
similar man-made devices? Yes or o If Yes, Please Explain.
Does the facility maintain adequate w to management records (vpwmes of manure, land)pplied,
spray irrigated on specific acre ge with cover ;cryo)9 Yes or o k5n2Additional Comments: �j11-�ti N 11/!� A I
mF91IM
N-f- h4,I/r— fr"i,
�i � e m1 n. V% n l tn�. i s � n � kit� 10 1 6 v V," a � UPR � �h
Inspector Name
1k
cc: Facility Assessment Unit
Use Attachments if Needed.'