670023_INSPECTIONS_20171231

NUH 1 H LAHULINA
Department of Environmental Quai

Type of Visit: Compliance Inspection U Operation Review Q Structure Evaluation p Technical Assistance
Reason for Visit: routine 0 Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: i Arrival Time: p Departure Time: ® County: 0h916W Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
s
Onsite Representative:
Certified Operator:
Back-up Operator:
tion of Farm:
Latitude:
Phone:
Phone:
Integrator: h 1
Certification Number: - W `�'
Certification Number:
Longitude:
Design Cnrrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
ED
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
IDairy Heifer
Farrow to Wean
Design
I Dry Cow
Farrow to Feeder
Farrow to Finish
Dr, I;oul Ca i
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other L10ther
Turkeys
Turkey Poults
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 O(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes X No
❑ Yes IN No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

FaciIi Number. - Date of -inspection: GI
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 0No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: {
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes QXNo ❑ 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 10 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 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 X No
❑ NA
[::]NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes >1 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
1W
❑ 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 [XT14o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [NNo
❑ NA
❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
Pq
❑ 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 IN No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and i " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No 0 NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - Date of Inspection-
VJ
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 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?
❑ 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
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
o ❑ NA ❑ NE
Comments (refer to questlon #): Explaf�agny YES answers,,a 1for, any additionul� r mmendations or at other commcnts, � � E:;
Use drawings,offacility to better explain situations: (use a21 pages las necessary). i . =:,. �': -.- _
��wV�,' v�-1:�,�1 `�W12 b`�l 12�(��I� -tip• h�i h fve-eti�ar�C.
PoA 4-D p @-ernes I
cat-eSi 6v �7,nc. 6-low,
� Mee gu�-c: �n.�:�lf�.l%k'1�- �i-�(
dLe'i ("
H C�4 -CJ�V\ -
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1 Phone: g 1 U r[ f Q_ 77 k
Date: Z,1 !
214AO1 S

PLAN OF ACTION(Poa) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
Facility Number: 67-23
Facility Name:
Green Meadows Sow Farm
County: Onslow
Certified Operator Name: Sid Lanier Operator Number: 22046
1. Current liquid level(s) in inches as measured from the current liquid level in the lagoon to the
lowest point on the top of the dam for lagoons without spillways, and from the current liquid level
in the lagoon to the bottom of the spillway for lagoons with spillways.
Lagoon Name/ID:
Spillway(Y or N):
Level(inches):
Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4 Lagoon 5
Laa 1
N
18.5
2. Check all applicable items
Liquid level is within the designed structural freeboard elevations of one or more structures.
Five and 30 day Plans of Action are attached. Hydraulic and agronomic balances are
within acceptable ranges.
X Liquid level is within the 25 year 24 hour storm elevations for one or more structures. A
30 day Plan of Action is attached. Agronomic balance is within acceptable range.
Waste is to be pumped and hauled to off site locations. Bolume and PAN content of waste
to be pumped and hauled is reflected in section III tables. Included within this plan is a list
of the proposed sites with related facility numbers, number of acres and receiving crop
information. Contact and secure approval from the DWQ prior to transfer of waste to a site
not covered in the facility's CAWMP.
Operation will be partially or fully depopulated.
Attach a complete schedule with corresponding animal units and dates fro depopulation
`if animals are to be moved to another permitted facility, provide facility number, lagoon
freeboard levels and herd population for the receiving facility
3. Earliest possible date to begin land application of waste
12/19/2017
I hereby certify that I have reviewed the information listed above and included within the
attached Plan of Action, and to the best of my knowledge and ability, the information is
accurate and correct.
Legrande Lanier Phone: [phone]
Facility Owner/Manager (print)
Date: 12/19/2017
Facility Owner/Manager (signature)

It. TOTAL POUNDS OF PAN STORED WITHIN STRUCTURAL FREEBOARD AND/OR 25 YRJ24
HR. STORM STORAGE ELEVATIONS IN ALL WASTE STRUCTURES FOR FACILITY
1.
Structure ID: Green Meadows
line m = 1299.1
lb PAN
2.
Structure ID:
line m =
lb PAN
3.
Structure I D:
line m =
lb PAN
4.
Structure I D:
line m =
lb PAN
5-
Structure ID:
line rn =
lb PAN
6.
Structure ID:
line m =
lb PAN
n. lines 1 + 2 + 3 + 4 + 5 + 6 = 1299.1lbPAN
III. TOTAL PAN BALANCE REMAINING FOR AVAILABLE CROPS DURING 30 DAY DRAW DOWN
PERIOD_ DO NOT LIST FIELDS TO WHICH PAN CANNOT BE APPLIED DURING THIS 30 DAY PERIOD.
o. tract #
p. field #
q. crop
r. acres
s. remaining IRR
2 PAN balance
(Iblacre)
t. TOTAL PAN
BALANCE FOR
FIELD (tbs.)
column r x s
u_ application window'
Lanier
413
Wheat
2064
6& 17
1407.0
Aug - July
'State current crop ending application date or next crop application beginning date for available
receiving crops during 30 day draw down period.
v. Total PAN available for all fields (sum of column t) = 1407.0 lb. PAN
IV. FACILITY'S PoA OVERALL PAN BALANCE
w. Total PAN to be land applied (line n from section II) = -1299.1 lb. PAN
PDA (30 Day) 2121/00

PLAN OF ACTION (PoA) FOR HIGH FREEBOARD AT ANIMAL FACILITIES
30 DAY DRAW DOWN PERIOD
I. TOTAL PAN TO BE LAND APPLIED PER WASTE STRUCTURE
1, Structure Name/Identifier (ID): JGreen Meadows
2. Current liquid volume in 25 yr.124 hr_ storm storage & structural freeboard
a current liquid level according to marker 18.51 inches
b. designed 25 yr 124 hr. storm & structural freeboard 20 011 inches
c- line b - line a (inches in red zone) = 1.5 inches
d. tog of dike surface area according to design
(area at below structural freeboard elevation) 280000 ft2
e. line c112 x line d x 7.48 gallonslft3 261800 gallons
3. Projected volume of waste liquid produced during draw down period
f. temporary storage period according to structural design 180 days
g. volume of waste produced according to structural design 359521 ft3
h. current herd #F7 4000 certified herd #1 4900
actual waste produced = current herd # x line g = 293487 ft3
certified herd #
i. volume of wash water according to structural design
j. excess rainfall over evaporation according to design
k. (lines h + i + j) x 7.48 x 30 days/line f=
4. Total PAN to be land applied during draw down period
'I. current waste analysis dated 1 10/30/2017
m. ((lines e + k)/1000) x line I =
REPEAT SECTION I FOR EACH WASTE STRUCTURE ON SITE.
(Click on the next Structure tab shown below)
© ft3
280000 ft3
714947 gallons
1.33 Ibs11000 gal.
1299.1 lbs. PAN
PoA (30 Day) 2/21/00

(Type of Visit: 0 Co�ftpliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up , 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 72 ti Arrival Time: �) Db _ Departure Time: ! jl County: Dti3G0 x,) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Sao L AN-T C-_(-
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: '1�2` 0 `i b
Certification Number:
Longitude:
Swine
Wean to Finish
Design
C►apacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Cattle
DairyCow
Design
Capacity
Current
Pop.
Wean to Feeder
ap
Non -La er
DairyCalf
Feeder to Finish
(�
Q
Dairy Heifer
Farrow to Wean
31500
Design C►urrent
D r P,oult , C•_a acity P,o P.
I Layers I
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
113eef Stocker
Gilts
Non -Layers
lBeef Feeder
Boars
Pullets
I Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 DW R)
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 dNo ❑ NA ❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes 0 No
Structure 1 Structure 2
Identifier: LAGV-0 L
Spillway?:
Designed Freeboard (in):
n
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes Z/N o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Fa<o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 21"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 ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑-&o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? dYes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3'<o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes C7rNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Flo ❑ NA ❑ NE
Required Records & Documents
No
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
E2'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
e appropriate box belo
21. Does record keeping need improvement? If yes, ch��Waste
dYes ❑ No ❑ NA
�] NE
❑ Waste Application ❑ Weekly Freeboard Analysis Soil Analysis
❑Waste Transfers
Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
- ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�10
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: 2.
24 Did the facility fail to calibrate waste application equipment as required by the permit? dyes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo ❑ 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 N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes V ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 10 ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes to ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes []Pao ❑ 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
do [DNA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E/N(o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
rDZo ❑ NA
❑ NE
(Comments (refer to question ft- Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
is.) CAGY AMZCATi6k� 6vTXX0C- � - lac rNT 1 rJa+N Zw" I.S rp
SE C,Q , ?Lr- A SE 6 &� rXMc. �'e :P(Lo &t e t TLC P+vCH Ok4 C
at) 30 D To Do st.vb C SurzV &k� a),JD cA ►- s T�onl, c w►AML c
0A `q S 2E) T P L AYv► �►` - S,�ZO Cr' w A S f E AA) A �-\ iLS
�-D 2015. �E S L_(_- CAI RY 3 v OQT HS.
A L- I"LO 1#4 f C CTIL J A N10 1,� E �� E C6 D�
bhn . Fa r neA I ne,Aelmy-, 0 by
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
V, (c '. Phone(91- 16
re: Date: 44 'PL-
2/4/2015

Type of Visit: 0 Cq�pliance Inspection U Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: v�( Routine 0 Complaint Q Follow-up O Referral Q Emergency 0 Other 0 Denied Access
Date of Visit: S Arrival Time: / /Q Departure Time: County: 011& n ,�/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: S—rD LarJXC--(L.
Integrator:
Phone:
Certified Operator: Certification Number: 210Y (p
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder A400
I INon-Layer I
Dairy Calf
eeder to Finish IDDO
Farrow to Wean 3 G UZoo
Farrow to Feeder
Farrow to Finish
Design Current
D . P.onit . C_a aci P,o
Layers
Dairy Heifer
Cow
Non-Dat'ry
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 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 � ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes FZN/o ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Faci ' Number: -
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes el"No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): / 17 K_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
liel
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
M 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
ZN.
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
WNo
❑ 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
2No
❑ 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
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 ❑ 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? Wyes
es [ZfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes .bNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes dNo
[—]Yes VfNo
❑ NA ❑ NE
❑ NA ❑ NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes d o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[]Yes YNo
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes ["No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facilitv,Number: rp - Date of Inspection: ^
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑Yes o ❑ NA ❑ NE
25• Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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?
❑ 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
No ❑ NA
i
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�o ❑ 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 . _
f
Use drawings of facility to better explain situations (use additional pages as necessary).
S&O on cNA06-C-5 ,
Ao
tjc
A RD .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
P }-A AjN1C _A_
Phone: I i b -3 b i
Date: 1 S�
Z, /20I4

Type of Visit: Q Co fiance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: C>outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t Arrival Time: ® Departure Time: County: � Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ST tAl�� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: ' ZLzOq b
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pap.
Wean to Finish Layer
Cattle
Dairy Cow
Design
Capacity
C*urren t
Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Dairy Heifer
Feeder to Finish
10oa
Farrow to Wean
Farrow to Feeder
Farrow to Finish
l Design Current
D . P,oultr, Ca aci P,o ,
Layers
Dry Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Other Turkey Poults
Other�jjffjOther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number:
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ZYes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
jo ❑ NA ❑ NE
No ❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
[:]Yes CZ/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 ❑ 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 altematives that need ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ �/NoYes
❑ NA
❑ NE
I6. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 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
❑ YesVNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. �(Yes []No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes 6/0 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: Uqw
24. Did the facility fail to calibrate waste application equipment as required by the permi ? ❑ Yes � o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes WNo
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes[:�/No
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
N
❑ Yes
❑
❑ NA
❑ NE
[—]Yes �No
❑ Yes [�o
❑ Yes r] No
DNA ❑NE
❑NA ❑NE
❑ 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).
(,,r F4E96AO 2111 jry CALLDrnl� , oA
�i. A/1 �!,�.1-�l� r�tG �N�i �� ��+2 Pt�w��1Gt7�%G' Etc. ►.r�S t��ig . ��SC
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L L", I Phon4 Op 9 6
6n��d Date: 4q
2141201

(Type of Visit: Q YRoutine
mpliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ,3 Arrival Time: Departure Time: 9 Sp County: ON$t,6 LA) Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: STg 1 `J LA OE&R— Integrator:
Certified Operator:
Phone:
Certification Number: a�r,g6
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design C►urrent
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
X
Wean to Feeder
400
1
jNon-Layer
I
Dairy Calf
X
Feeder to Finish
l000 qM
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
3560 3
Design Current
D . P.oultr, Ca aci P,o ,
Layers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ o ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? [-]Yes gNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes dNo ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins ection: 311)11,3
Waste Collection & Treatment
4` Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[1No
❑ 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: UQGab ?J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2.
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
ZNo
❑ NA
❑ NE
waste management of closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment 1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
7No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
ffNo
❑ 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
[2fNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E] No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E]/No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes E/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Dyes ZNo ❑ NA ❑ NE
❑ Yes Er<o ❑ NA ❑ NE
Required Records & Documents
QNo
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
[2rNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections
❑ SIudge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Y o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
[NNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

lFablity Number: M- Date of Inspection: 3PI6
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Uf No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E 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 [:]Yes ENo ❑ 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 E(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
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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo ❑ NA ❑ NE
[No ❑ NA ❑ NE
YNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations:or any other comments.
Use drawings of facility to better explain situations (use additional pages as.necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 3/1) /13
21412011

Type of Visit: O Conppliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a L Arrival Timer Departure Time:® County: O"(,pi,J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative:�Integrator:
Certified Operator:
Phone:
Certification Number: 'DL'ol p
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pap.
Wcan to Finish I
Design Current Design
Wet Poultry Capacity Pop. Cattle C►apacity
JLayer Dairy Cow
Current
Pop.
}�
Wean to Feeder 0 1
INon-Layer
I
Dairy Calf
X
Feeder to Finish pp y00
Design Current
D , Fault . Ca aci_ P,o
La ers
Non -Layers
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
113cef Feeder
Farrow to Wean Ic
00 Cep
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Turkeys
Turkey Poults
Beef Brood Cow
I=
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify 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)
❑ Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
' ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Zo❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: 2_rjjl,
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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes /No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes VNo
❑ NA FINE
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 [2�/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
matn enance or improvemen .
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�Fo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
040
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Yes/NE]
�T
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Rectuired Records & Documents
/
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[]Yes [,3 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ERio
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [-]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes VNo
❑ NA
ONE
Page 2 of 3 21412011 Continued

Facili Number: L2 Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [-]Yes �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 provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes gNo ❑ 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)
[:]Yes d/NNo ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
[/No ❑ NA ❑ NE
No ❑ NA 0 NE
gkNo
NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or anyother comments. •.: ; -s;: ;,
F
Use drawings of facility to better explain situations (use additional pages as necessary):
oiy GCr It",-) CALZCW_ or.l DoWE `3e DA`'3S.
Reviewer/inspector Name:
Reviewer/lnspector Signature:
Page 3 of 3
Phone q /b 1 I9 b b
Date: 0- pi Z
21412011

Factlrty.Numtier:
G
3
fN
vision of
vision of
her Age;
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 11 DO I Departure Time: County: "� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Stbj Y� Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o = 4 = Longitude: = 0 0 ,
$: Design Current x Design Current ,Design Curren
Swine
Capacity'
Poptila"lion Wet Poultry `Capacity Population
-4. ' .. w
Cattle- ".= Cpty papulaon.
a
❑ Layer
s ❑ DairyCow
❑ Non -La er
❑ DairyCalf
El Dairy Heifer
f
DAP° "� . ❑ D Cow
-
❑ Non -Dairy
❑ Beef Stocker
ad
El Beef Feeder
❑ Beef Brood Cowl
�O#her " � '
' � �• y �' � f � A<
-" �`.
.•Turkey
❑Other
N mber:of Structure
❑ Wean to Finish
Wean to Feeder
�kb0
Feeder to Finish
11000
g bti
Farrow to can
3
-gyp
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Poults
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes L No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
[I No
❑NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 7No
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
12/28/04 Continued

Facility Number: � — �3
Date of Inspection 9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into -the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: CA&vuL)
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?;
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed El Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Y" 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes Ca/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 12 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes El No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes F No ❑ NA ❑ NE
l7. Does the facility lack adequate acreage for land application? ❑ Yes N ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes <0 ❑ NA ❑ NE
Comments {refer;to.question #): Explain any YES -answers and/or. any recommendations or any othercomtnents r.
Use drawings of facility to better explain situations: (use :a�dditi©nal pages as necessary);
W AsM ANAL',*' is n G03 1%. 4C TAtfry et/E!L' 3 ^'tc*JVJ• 14Ao Pl _Ef<
60-T -ru Z01o.
Reviewer/Inspector Name �:., ..
�U�1J ;F� C :4`--� �.. ;- < ,., y° Phone:
Reviewer/Inspector Signature:
Date:
�l
►-age Z of s

Facility Number: — 3 Date of Inspection a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes U/No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E3 No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, the the appropriate box below.
Yes
ElNo
[INA
ElNE
ElWaste Application ElWeekly 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?
ElYes
E4
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LI NNo
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Yes
El�
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
h�/No
ETN
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
DIN o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
7No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
��
[] No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 1)To
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional, Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit t(7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 30 Departure Time: I� County: OUSLab.J Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Sa7n&)C4r LJWM!-� 9- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = 4 Longitude: = ° r1 f = u
Design Current
Capacity Population
Design
Wet Poultry Capacity
C►urrent
Population CattleWD
esign Currentwine
apacity Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
Wean to Feeder KW O
® Feeder to Finish 0�00 1300
Farrow to Wean 3'KgC>
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ DairyCalf
❑ DairyHeifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Pullets
❑ Boars
❑ Turkeys
Other ❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from -any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to,the Waters of the State
other than from a discharge?
❑ Yes f No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
INo
❑ NA
❑ NE
El Yes
❑ NA
❑ NE
Page I of 3
12128104 Continued

>F acility Number: b` J - Date of inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes o ❑ NA [INE
a. If yes, is waste level into the structural freeboard? ❑ YesfNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 3,=,_ J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (o
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ief 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 itch eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes YNo
❑ NA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes EI/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
t 1 Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EYN' o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
D No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
P/No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
�No
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #) Explain any -YES -answers and/or any'recommendadous ortany other comments.
y b=Y
Use drawings,of facility to better explain situations (use additional page`s as necessary)
LG l b Fct� tQo R ft n c �,.rr c a-PoTDO Ww 5 J CSc PT FRr s .S Z►j cE ✓E ►�, gE2 , f
S C-N O 1-k ti`'7 - A tb D iJ Q.
c. A S-t C-A L ra6CLA T..i.0 PJ IL'c" -j , t-)L-E n -fo D n k.Mt H-TAJ 30 i7AL�5,
Reviewer/Inspector Name
Reviewerfinspector Signature:
o
T.
Phone:
Date:
io
L
[L/LO/V4 l.WlLLr. uCu

i
Facility Number: Date of Inspection Z. O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WLTP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes o El NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ErNo
❑ NA
❑ NE
-23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ es
ENo
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
VYes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�EfNo
Id No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q4o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
WNo
❑ 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
ENo
❑ 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
rJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�
El
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
L'I No
❑ NA
❑ NE
I2128104

Type of Visit a 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Zr1 G Arrival Time: O Departure Time: County: CPZQhh% _ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address: 1.
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: San i AALLE]2 Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =' =' =]" Longitude: = ° [�J' = "
Design
Current
Design Current
Design Current
Swine
Capacity
Population
Wet Poultry Capacity Population —jLCattle
❑ La er
❑Non -La er
Capacity Population
❑Dai Cow
❑ Dairy Calf
Finish
FE]Wean
n Feeder
]tc
q00 d
® Feeder to Finish
L 0-0 0
S-U b
Dty Poultry
❑ Dairy Heifer
❑ Dry Cow
Farrow to Wean
6fJ 6b
❑ Farrow to Feeder
❑ Layers
ElNon-Layers
El Pullets
❑ Turkeys
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
❑ Farrow to Finish
Gilts
F-]Boars
Outer
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
d No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: ? —
Date of Inspection 1 0
WWate_ Collection & Treatment
4. IT torage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (AC, -OM
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 74
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 54o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes E No ❑ NA ❑ NE
❑ Yes 2 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? El Yes LJ o ❑ NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes L�J 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 11 Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LI No ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. Ela
Yes <o" ❑ 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
0 1
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
IJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
U/ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
DNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;14o
❑ NA
❑ NE

Facility NumberDate of Inspection
Re
fired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
[I NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ENo
[?(No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
lz�o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
No
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Des
Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
WNo
❑ NA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z N
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ll 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
7No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ief discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1[J No
❑ NA
❑ NE
Additional'_Comihents and/or Drawings:
Page 3 of 3 I2128104

Type of,Visit aCa liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine ' 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 4 J.g a $ Arrival Time: ® Departure Time: County: DNSLOW Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: -Tb I A PJ.1kfk_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = Longitude: = ° =' = "
Design Current
urrent
Desi�nffi,urrent REPO,
Swine
Capacity Populatonitry
Capapulation C*attle ulation
❑ Wean to Finish
❑ La er
❑ DairyCow
© Wean to Feeder
Q6
❑ Non -Layer
❑ DairyCalf
® Feeder to Finish
! o�
b
❑ Da' Heifer
® Farrow to Wean r"
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -La ers❑
❑Beef Feeder
EBoars
Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Turke Poults
❑ Other
❑ Other
Number of Structures: I
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?
Cl Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E4K
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 6Ea =3 Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
IJ No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: _LA&%m
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):' 2/3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EYNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
dNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
at, notify DWQ
environmenta7NO
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[:? No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo ❑ 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
C?fNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
[�' o ❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
El
N o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
LJ No ❑ NA
❑ NE
FrC-LD 4 NCrr)S CW-. ,J ? A►-tto CAC, _. - L AgEJ . 0`1 E
21,) d'�fiX1 U Wfb A VC R.A &4 Fn4 r.n s ro c x i!b- A -m .
r
Reviewer/InspectorName n fpU'(�CrL- Phone:
Reviewer/Inspector Signature: Date: Z$ o $
Page 2 of 3 12128104 Continued

Facility Number: (p — 3 Date of Inspection Y o
11
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ 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 tocking ❑ 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? (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 �N. ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes L'J No ❑ NA ❑ NE
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes
01�o
❑ NA
❑ NE
❑ Yes
[(NNo
ElNA
ElNE
ElYes
0"No
ElNA
ElNE
ElYes
El No
❑ NA
❑ NE
❑ Yes
'C J No
❑ NA
❑ NE
❑ Yes
Id No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
AL
Page 3 of 3 12128104

Division of Water Quality
. EEumber L3 O Division of Soil and Water Conservation
.�j - -- — _ 0 Other Agency
Type of Visit
C mpliance Inspection
0 Operation Review 0 Structure Evaluation
Technical Assistance
Reason for Visit
Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit:
S 0']
Arrival Time: $+ ti
Departure Time: County: 6WS&OO Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: SSD to A.) rr_-K _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
«d
1 OU
❑ Farrow to Wean
moo
14,60
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [—] c =]' [�] " Longitude: =] ° 0' =
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
ElTurke Poults
❑ Other
Design
Cattle Capacity
nulatic
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number;of Structures.
=41
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
LjKo'
❑ NA
❑ NE
12128104 Contdnued

Facility Number: 67—a Date of Inspection
' Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
�No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ?.O
Observed Freeboard (in): l
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
��
L�J No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [_�(No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElE I 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 9No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Cj No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
3No
❑ 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):.
AF.p,{ A-? 4f f-y6L,0 5 WAS to" 56wX ►4 kkAS, w *7 t � n/EC n �Xr�G , l• rk E I�iv G Nfs `
wz[ — n16 6 D 6L o ar-rkj& 6 ff.
r a k w F2EE 5>0AW Re CaV E0
Reviewer/Inspector Name I j j I Phone:( I [ - 23 rt
Reviewer/Inspector Signature: Date: ZlyLo
1 ssc � vJ ��i�wvr a v►uinucu

Facility Number:
(�'? — Z3 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes L'I No ❑ NA ❑ NE
❑ Yes C_ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ AnnuaI Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O, NNo
El NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
I' No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
D o
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
[IYes
ET o
[I NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
L� No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [1io ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ErNo
❑ 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
[nNo
❑ 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
2rNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
e o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
UNo
❑ NA
❑ NE
Comments and/or
Page 3 of 3 12128104

=Faeiumber
2_�_ J
Division of Water Quality V.
O Division of Soil and Water Conservation
-
O Other Agency
Type of Visit pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
riRoutine
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: as Op Arrival Time:
Departure Time: County: 6MU Oh% Region:
Farm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative: SZo
Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm:
Latitude: = 0 0 1 ❑ u Longitude: ❑ ° ❑ 6 = SA
Design Current Design Current Design Current"
Swine.. Capacity Population Wet Poultry Capacity Population Cattie Capacity °Eoiiulahon>,
❑ Wean to Finish
® Wean to Feeder
W6
© Feeder to Finish
j6do
® Farrow to Wean
o 0
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
=^ ❑ Other
❑ Layer
❑ Non -Layer
I,
Dry Poultry
T
Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Vv
Numberof Structures =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes L-'I No ❑ NA ❑ NE
❑ Yes
❑ No
Cl NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
❑/No
Yes
ElI(
No
❑ NA
❑ NE
❑ Yes ETNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 0 - k Date of Inspection
Waste Collection &"Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: [,iti&VOA)
Spillway?:
Designed Freeboard (in): 20
Observed Freeboard (in): 440
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes EJ/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 WXo
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes WNo
o El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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 Q No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CJ No ❑ NA ❑ NE
maintenance/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
❑ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ef o ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
o ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes
1__I No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E4 ❑ 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):
at[.) US6 A CEO-r-CFZeD Raw M (M- rnl1.. AA WIT14 rAAJLt A16TEA- To / rAt48x. Pe `
CACH CrEArt. JGEco2o �N GA1�aR>gt � SNEEr CA, LER.i'�f�tA7 75N,
Reviewer/Inspector Name f, u 1 Phone: 10 '7fb .- 7,,G
Reviewer/Inspector Signature: Date: WOOL eb
n__ _ _ram l'I"If O/n/
—'s... F

Facility Number: -a'j Date of Inspection
Re wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WLiP ❑Checklists ❑Design ❑Maps ❑Other .
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ['/-o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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 M'No ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
[2No
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
E!rYes
❑ NIn
❑ NA
❑ NE
❑ Yes
CKo
❑ NA
❑ NE
❑ Yes N El NA El NE
ElYes No ❑ NA ❑ NE
❑ YesY
"o
❑ NA
❑ NE
❑ Yes
EK
❑ NA
❑ NE
❑ Yes
L7 No
❑ NA
❑ NE
El Yes
BN'o
❑NA
El NE
❑ Yes
rJ No
❑ NA
❑ NE
❑ Yes
E'J No
❑ NA
❑ NE
Page 3 of 3 12128104

w
Type of Visit 7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint O Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: / 6 County: OAYSLOIJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: SMID CAK}r6(L �
Certified Operator: t -AA .AfD
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e ❑ � ❑ « Longitude: ❑ ° = 4 = {!
Design Current •R 3;Design * Current a� 3�. Design`s Current
Cap city Population�Vet ou"ltr} Capaci y�on. Cattle @ a ac Po wutation
�Po ulatr .0 P. h 3 P .
❑ Wean to Finish I❑ Layer
® Wean to Feeder LwQ L/O,S ❑ Non La er
®-Feeder to Finish Qpb 72Qnlr
0
® Farrow to Wean 6riWry. ��
bPoultr
ElFarrow to Feeder
ElFarrow to Finish
❑ Gilts
❑ Boars
Other a s°Turkeys
❑ Other `Number of�Structures:
La ers
❑
❑ Non -La ers
El Pullets
❑
❑ Turkey Pouets
❑ Other
❑ Beef Feeder
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes CNo ❑ NA ❑ NE
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made? [I Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) El Yes El No ❑ NA [I 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 E] No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes dZo
❑.NA ❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes El NA ❑ NE
other than from a discharge?
12128104 Continued

D Facility Number: 6i -a3 Date of Inspection c�S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes U<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: LA t"ZDA) t
Spillway?:
Designed Freeboard (in): Z O
Observed Freeboard (in): 2.5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L.Q No
❑ NA ❑ NE
(ic/ 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
L" I No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
L'J 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
V(No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
EeNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of
Area
12. Crop type(s) M ATUA H) a C-_9—Y%A L O A
13. Soil type(s) szk A wo
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
C1 No
❑ NA ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
'
ETNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[--]
Yes
Ko
❑ NA El NE
17. Does the facility lack adequate acreage for land application?
El Yes
..,,
[2 o
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA ❑ NE
CommeNO, (refer�to questEon#� Explara,any,�Y S answers a�ndlor any recommendations or any other comments.
Use draw�ngs�of facility�to�better�egplarn(s�tuahons.�,{use,�additianallpages as necessary):
dl.�n P N D (ZR c.o rt,b Sim j Gr,oD $ A P E_ ,
Re,,iewer/Inspector Name �` "� �35l,s 31wk Z63
;��� Phone: ..
Reviewer/Inspector Signature: ieLA.Date: 3 L oS
1212RI04 Continued

r Facility Number: 13 Date of Inspection Ljl �T
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
❑ Yes 2No ❑ NA ❑ NE
❑ Yes 24 ❑ NA ❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
ICJ No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
d
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
LANE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,��
L_TNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Z'_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
❑'fro
❑ 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
Ehqo—
❑ 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
0-?K
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Q-Ko
❑ NA
❑ NE
ildiiionafComments' and/or Dra' mi gs. v L'St
12128104

Type of Visit JU Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 9KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
FFacility Number Date of Visit: Tiitin e: L.
10 Not Operational O Below Threshold
0 Permitted Q Certified 0 Co/njd�itionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: ..... h`� .....1..! ( /4 � ....e C►7 /'f ._ Count: _ �SLO LtJ_ ......... ------ ----- _..-----_
Owner Name: _. r .. !�' �? .. Phone No: ............... ............
VlafIingAddress: . .................................... ^ .......... ........ _ ...- - - - ....._ ..... ... ` .».».... _...
Facility Contact:
... .......
........W ......... Title:.._...............
..... ......_... .... Phone No: ......__. _........_
Onsite Representative:.
` r �! ...
_! '7!✓ f. ....................�
.. Integrator -1.!Le :n-1691a
Certified Operator . Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude " 4 66 Longitude • 4 "
Discharges & Stream Impacts
1. 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 ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) [] Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................... .. _........... _._.....
Freeboard (inches): Z�
12112103 Continued

)Facility Number: Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes W No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes No
elevation markings?
IN"ante Aanlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes P(No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes XNo
❑ Excessive PPonding ❑ PAN Hydraulic Overload ❑ Frozeen777Ground ❑` Copper and/or Zinc f
12. Crop type \r l /�'Il/1� lh� if Lt"�P�Zr►� !t/J�, i 4 1 C.. 'e" y S L.�E r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
O No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
JVNo
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
R�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
JVNo
Odor issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
gNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
J0No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
XNo
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
gNo
Air Quality representative immediately.
lJ Divn,fR �5 /o '5;0w2G ' > �
FrR_tV&f - �voto eRve:5) 7f;-i-ry B��R�,crop
t.(JJ�-gk4X / R e fZOA R O
F,¢x /779
Ig��}GLf5s5 75 COA)4
I Va
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Field Conv n Final Notes k .
`-o (6,eA"1404 Sap) AAID
><o r, 3/i��o� q/va3.
S.f I 16'/1 s "�
Date:
12112103 Continued

" >F'adlity Number: —Z3 Date of Inspection
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
J] No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
RTNo
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
PrNo
❑ 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?
❑ Yes
VNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
PrNo
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�fNo
28. Does facility require a follow-up visit by same agency?
❑ Yes
No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
gYes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Rf No
32_ Did the facility fail to install and maintain a rain gauge?
❑ Yes
IffNo
33_ Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
,ZNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
I� No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ddiupnalComtnezttsand/orDraw�ngs `� - �-=�� `=` �, wa ,� _
� 3 � 3 � l ®uJ►�,Erz c�a as � l-���F ��� S �- uoc,� S�r.�vF �.t�r�
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(Agoudoy
12112103

f,
L
Type of Visit Acompliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification Other ❑ Denied Access
Facility Number Date of Visit: Time:
10 Not O erational 0 Below Threshold
[] Permitted O Certified Q ConditionallyCertified D Registered pate Last Opera or above Threshold:
Farm Name: �ce-�, "CL-' ✓ `�'L" County: 1'�51�+�-✓ _
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 6 Du Longitude ' 6
Design Current Design Current Design Current
rE01
ine Ca acity P,o ulation Poulfry' Ca acitV P,o ulation Cattle Ca achy P.o ulation
Wean to Feeder ❑ La erFeeder to Finish ❑ Non -La erFarrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Y=.., Total�Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
--- — -- -
Bng Pondsoldi/ Solid Traps ❑ No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): _
05103101 Continued

Facility Number: — Date of inspection 0
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [ yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notih, DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ❑ No
& 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 ❑ No
Waste Application
10. Are there any buffers that need maintenanceiimprovement? El Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12_ Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a gettable acre determination? ❑ Yes ❑ No
c) This facilin, is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment?
Recuired Records S Documents
17. Fail to have Certificate of Coverage &: General Permit or other 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 reviewiinspection 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?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
�© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
_.'_�--..,� _...y; . .z�z•:¢�'T-^�R .-N:. . �'W—T �s� -,ai^ .ds-+ ���^Y.-,.5� � ���.�iXLL$sSa�'w� � �� T �T`�, _,,y
Gommeuts {i=efer to question t`I):'.Ezplairi ally YES snswmvndloratty recommendations or any;other1oomEaenis. r� �
Use drawings of facility to better explain situations :(use additi6iW'pages as necessary) - : ❑ Field Copv ❑ Final Notes
�t �v'"gt— Le vt i 5Srt� .
Reviewer/Inspector Name ..� A+I�.!.c,;
Reviewer/Inspector Signature: Date: A3
05IV310I Continued

Facility Number z3 Date of Visit: 11 Time: 1 d : r�
10 Not Operational 0 Below Threshold
0 Permitted ©Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
GFarm Name: rce.-. M eQ G4d W'C r i'^ 1` 1 L_ County: B ,, S r 0 W
Owner Name: S - (.e G rb, of LG h , L r Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: S'G�.•,EY1 i e ✓ Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ' " Longitude 0 ' 0 "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XfNo
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. 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: f
Freeboard (inches): f
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ;ZNo
❑ Yes ,ONo
❑ Yes ';;�No
Structure 6
Continued

i
Facility Number: — 23 Date of Inspection Z /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
❑ Yes ONO
❑ Yes 0 No
❑ Yes ;ONO
❑ Yes ffNo
❑ Yes .©"No
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'J�jNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload [:]Yes J2 No
12. Crop type _Be,--v-doy N­-X LQO Gfa%^ Dv,, --wed, Fer,...odt..fdd eye I-S, '-C' S,CG'oirT tj%�ql
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes .2rNo I
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONO
b) Does the facility need a wettable acre determination? ❑ Yes ZNo
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16.
Is there a lack of adequate waste application equipment?
❑ Yes ,Ef[No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ZfNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑
(ie/ WUP, checklists, design, maps, etc.)
Yes ONO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes �No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ONO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes JZ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes J2'No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ETNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes .fNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ETNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cummen s (refer:to question #) E41am3any YES answers aniVo'r any'recommeiidattiioApkns of any other ctiii tnents: =� �
Use -drawings of facility to`better ezplain situations: {use additional pages'as necessary) ❑Field Copy El Final Notes
'
�!-is r,Ge reVoel j ktfo '
-I-kcre j'r A on� crajo rsl' -r 2 qnd tj et t+ , Tie odd
A Sw, n F ko wse of r6t- j S e) j w.c� ►1 -"6✓roed, —7 -Lek -ror
yo rt t t f�'pl�s
H
Reviewerfinspector Name ,y-� ►, w� / . / q�Ly r �`. '.
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility Number: '7 — 23 Date of Inspection
Odor Issues
26. floes the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes A_,(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ ,L� I Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ONO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes /ETNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes [--]No
I.Additional'CGin and/or. Drawings:
O510310I

Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: t 2 5 0 Time:
rO Not O erational 0 Below Threshold
©Permitted ©C
er
tified [3Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name (7 +/ ee h 2_G,ti ff,�aW f f Ct t W1 S � Count:
Owner Name: s �' { ""� L'� ' e y Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Phone No:
Integrator: �I — �� 0 W'l
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' • " Longitude '
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min? _
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? [--]Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier_
Freeboard (inches): 7— _
05103101 Continued

Facility Number: 6 1 — Z- 3
Date of Inspection 25 O
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive P1onding [I PAN [I Hydraulic Overload
12. Crop type Cie -,-I 114 c^, S d Bee-, �Di c. H a Sr",q /� � ; n OV,_ r _ xZC A
13. Do the receiving crops differ with those designated in the Certified Ani al Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application? V-SO
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 or other 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?
❑ Yes �No
❑ Yes dNo
❑ Yes,.ErNo
❑ Yes 2 No
❑ Yes fNo
❑ Yes ONo
❑ Yes /E5 No
Yes No
❑ Yes ZNo
❑ Yes ZNo
❑ Yes 2 No
❑ Yes)2T'No
❑ Yes 0No
❑ Yes )No
❑ Yes ,21'No
❑ Yes ONO
❑ Yes ''No
❑ Yes ,2fNo
Yes ❑ No
❑ Yes .,2TNo
❑ Yes 21No
❑ Yes ONO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
.Comments {refer:to question^# `Explsa>xv 1'ES answers andiorssny;recojmnienatons or anv;otlter comments
Use drawtngs of faciltty to better explain s�tuattons» (ase addi�onai"pages°as necessary) _ ❑Field Conv ❑Final Noted -
Z. Z M i' . Lo, rt. f C /'3 �i C�Ip/aG/YI' PeC�/C� � S�[91/�.► -��t.0 t*1J1.� DOh of T �� r ✓�G%�eJ
Dif T rtoTIOArp( OVA i figOt✓vot %faty III .�DO"T� . Wl. �rt,'¢•' Sat1a�
dr'd 6ecjv_re
-{kell �e no-f Gall )'*I hC plelnhea( 4O (agoo',
lcvea sliar4 4; ,-kie , gkid he -Ae14 4herf he d, d ne ve G
Drrty :•^► OGt✓ 0��,•Ge- av� ��F','GP p!.'
Di'fP l,>ir� jC' -IS
V/0160:oh 4C-/,6,-t wt4�
Nb416e dF all enfa�ce.�en} �eSv
hC ! v a +-• ���E 6� g rd W S Q 2-) i— C k e1 O&L
Reviewer/Inspector Name-
.
Reviewer/Inspector Signature: Date: i d Z 5 A Z-
05103101 Continued

• Facility Number: 7 — Z 3 Date of Inspection !O S 4
dog- Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation? v
27_ Are there any dead animals not disposed of properly within 24 hours?
28. Is there anv 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 permanentitemporary cover?
❑ Yes ❑ No
❑ Yes ZffNo
❑ Yes 1FzrNo
❑ Yes JZrNo
❑ Yes (�No
❑ Yes /'[ZNo
❑ Yes ❑ No
Additional Comments andlor`Drawings:;' _ k;
CSvc'-a fl f �i �" '!4'� �Oq CC)Pfe0,�5 LLJeIj k��f TRIP sw;�lP Svc--3e
a ll-A l4 aa� q frect .s l.c�el� rvl an>'cueeR • Q Vergll) �k
bev v"W G �'o �'s o � r� , �? � . Lq n i cr- is level ; t,
�J►�lo►nvvc -fLle1 ,�'or :r�r,'c��-ro=�► .
—Fh e e Ff6 rf s 4'0 r "Fro-Ve Q�LI �4J�'l��l ivl 7�� �q ✓►�►j !
41fe A /eG;G�Qpj
1!� 00.--' 13'• OD
05103101

Type of Visit J6,compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit j&Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
� - Facility Number Date of Visit: 5— Time: G�
Q Not Operational Q Below Threshold
*Permitted © Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ...............
C.
^ o\1
Farm Name:...Q``...1^'........................................... County:.....Q\c,�................................
............
OwnerName: ................................................... ..........
Facility Contact: ..............................................................
Mailing Address: ............................................................
Onsite Representative: ,_ J•.� ���
Certified Operator: .................................................. .
Location of Farm:
Phone No:
Title: ............................................................... Phone No:
.... ......................................................................... ............. ..........................
_.. Integrator:........�...........r
..... f ..............
.... Operator Certification Number :.........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �� �44 Longitude 0 • ° .4
Design` Current
Swine 'Canacity Population
eeder
UOFinish
�VWean
!(jdFeederFinish
F
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holdrng Ponds ISohd Traps - f ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
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) 0 Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P4 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
01/01/01 Continued

Facility Number: 7 --IDL-j
Date of Inspection rf .0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
ONO
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier : .... ............................ .........
Freeboard (inches): .........19.r ............
..................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
)4No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Yes
� No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
[�(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
k{No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
IdNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
gNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydrauli Overload
❑ Yes
;� No
12. Crap type ve�—Z 4a IS41
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
)4No
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
O No
16. Is there a lack of adequate waste application equipment?
❑ Yes
KNo
17. Are rock outcrops present?
❑ Yes
❑ No
18. Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
❑ No
❑ On -site ❑ Off -site
Rewired Records & Documents
19. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
20. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
21. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
22. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
23. Did the facility fail to have a actively certified operator in charge?
24. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
25, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
26. Does facility require a follow-up visit by same agency?
27. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Odor Issues
28. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
❑ Yes �S(No
XYes ❑ No
KYes ❑ No
❑ Yes 4 No
❑ Yes t1 No
❑ Yes XNo
❑ Yes IN No
❑ Yes 9No
❑ Yes XNo
Yes'No�
29. Are there any dead animals not disposed of properly within 24 hours?
❑ P Yes No
01/01/01 Continued

`I Facility Number: `1—� Date of Inspection
Printed on: 1/4/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes h<No
❑ Yes KNo
❑ Yes JVNo
❑ Yes 4No
❑ Yes [ ;No
113 No violations or deficiencies were noted during this visik You will receive no further correspondence about this visit.
Comm
Lise drawtngs,oifacilrty to better explain sxtuat�ons (use:addi#tonaE pages asnecessary)
_ _ r--� Fr_ ❑Field Copy ❑Final Notes
- ice.«.-�:"�' ���vMS'14.K:^-�„-hiv.'-s^'A• �-�•'�j..:..��..,�c'.Sr�iG^C_Si.�e���`-�
'Z3,
4
l sibs) 0&3
k"A .
z r
Reviewer/Inspector Name r w ,
u
Reviewer/Inspector Signature: rADate: e.;L_r? a
01/01/01

EM
Division of Water Quality
= Q Division of Soil and Water Conservation
O 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 ,3 U�ateorvisit: d6 Time: ® Printed on: 7/21/2000
0 Not O erational O Below Threshold
)(Permitted © Certified ❑ Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: ✓22+-•. ' ". sLl SuU .... ......................... Counky:........................................................
OwnerName:.- ...................................... ...............
Facility- Contact: ........
Mailing Address: ...........................
Onsite Representative: _,,..�„•!,,,,,,,,,,,,,,
Certified Operator:
Location of Farm:
........ Phone No:...........................................................
Title: ................................................................ Phone No: .....
............................................................................................... ..........................
Integrator:........(
f....'.........................................................
................................ Operator Certification Number:...............,,,,.......
];
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� �� Longitude �• ��«
Design Current
Swine Canacitv Population
Wean to Feeder
tj pp
Feeder to Finish
cpd
Farrow to Wean
3 0
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I JEI Dairy
❑ Non -Layer I I JEEI] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lag�nn Area Io Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact~
1. Is any discharge observed from any part of the operation?
❑ Yes
Wo
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' dischar,,.e is observed. what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2, Is there evidence of past discharge from any part of the operation?
❑ Yes
XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
MNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Yes
❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identific r:....................................................................................................................
Freeboard (inches): 17�
5100
Continued on back

Facility Number: 47—/J3 I Date of Inspection I printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El Yes
NrNo
seepage, etc.)
6- Are there structures on -site which are not properly addressed and/or managed through a waste management or
N(No
closure plan?
❑ Yes
(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
VNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
gNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
tg�No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
Z5(No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
9rNo
c) This facility is pended for a wettable acre determination?
Oyes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
19�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
CS(No
Required Records & Docume»ks
17. Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
XYes
No
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
bdYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
MVO
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
X No
22. Fail to notify regional DWQ of emergency situations as required by General Permit`?
❑ Yes
b�No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
01 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
0: 10 yMA totis:or- . fici ndic s -were noted• diWi6 this;visit; • Y:oi} will-reeeiye Rio further
rorrespori�ence* 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 explainOM
, s1ituations. (use additional pages as necessary){ -
/oo IF
.2�t-'c\ 1 ��- sae✓. ��— � 1� C��"r t�.� � �-J � C��C-'�-S
c �Chi
c,�--� l x�,-- cr �, r � . ��. �� � G � � 5 +•tee
'AT
Reviewer/Inspector

Facility Number: /' - Date of I nspection Edikl Printed on: 7/21 /2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below Yes ❑ No'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ZNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ;R (No
Additional Comments and/orDrawings:
�� t,.s� �.--�e��-.t,-�� � 7 r{ Yam;; tr. ��,-. �•-CY�Ci a �, �. ►-e�
� ` 5 ll'' Y
vv S (4,
-p
L\- A
5100

w
a
��
y
f
'�
�
r �]
f
�
y
yy�
� ti
/ F�
1 �
`
'
'
i
I�
r 3

_ 0 Division of Soil avd Water -Cons .iti&i '.OPeration Review,
_ .El ,Division of Soil and; Water Conservation' -"Compliance inspection r
ion
of Water Quality _Compliance Inspection
d
Other Agency - Operation Review = - '
Routine 0 Complaint 0 rollow-ue of DWQ inspection 0 Follow -tip of DSWC review 0 Other
L- __ Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted © Certified (] Conditionally Certified. © Registered 113 Not Operational Date Last Operated:
Farm Name: .... �. [ n �!...........�.1°i^...... ..... ...... County: .... ��^��U�!..................................................
Owner Name: ........................._.............
Facility Contact: .....................................................
Mailing Address: ....................
C
Onsite Representative: ..... ✓!..•......•...`:�..'' ��.`r
Certified Operator: ................................................... .......................
Location of Farm:
Phone No:
Title:.. ..........................................
Phone No:
Integrator:...... ..........................
.................. Operator Certification Number
Latitude ���� �•�
Longitude �• �° �
Design Current
_ Design
Current Design
Current
Swine
Ca Capacity y Population
Ca acety
on Cattle Capacity Population,
Population
Wean to Feeder
❑ Layer
❑ Dairy I
CK Feeder to Finish
{}GQ
❑ Non -Layer
.. ❑Non -Dairy =
+
Farrow to Wean
❑Farrow to Feeder
❑ Other
❑Farrow to Finish
..
_
Total Design Capacity
❑ Gilts
-
. ❑ Boars
_ _ :.-- _:
T©taLSSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
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 gaVrnin?.
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes D(No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 1K No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Cl Yes gNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ........�................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc_)
3/23/99 Continued on back

Facility Number:-6 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Al2Rlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
b(No
❑ Yes
Yes
❑ No
❑ Yes
jZ No
❑ Yes
WNo
❑ Yes
9No
❑ Yes
KNo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator. in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
..Rio yiolaiions:or deeciencies were potted during ihis.v.. Yoir :will receive Rio further . .
corresp6iideitce. about. this visit' I • • _ • . • • ..... . . .
❑ Yes (<No
❑ Yes ❑ No
❑ Yes ❑ No
WYes ❑ No
❑ Yes KNo
❑ Yes ZNo
❑ Yes 0 No
$Yes ❑ No
❑ Yes XNo
❑ Yes �TNo
❑ Yes AN No
❑ Yes &No
❑ Yes E f No
❑ Yes [% No
❑ Yes A No
Corrf_nents (refer to question #): Explain any YES answers and/or any-recommendationsor any other comments:- _
z -
Use drawings of #acihty to better explain srtuations (use. addrhonal>pages as necessary) s s
_ ... s . _ ti _ - , ..-_.
m1�50,L_, AQA3 vc�_" 44 6r_� J_��
ak
3/23/99

Facility Number:EQ — Date of Inspection mt!�D
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
XYes
❑ 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
O�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
O 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
NIN o
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
allo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
"Yes
❑ No
tttonal Comments --an or awings:
yI
3/23/99

JUSTIFICATION & DOCUMENTATION
Facility Number_-a3
Farm Name:
On -Site Representative: S1 I bon�,t�—
Inspector/Reviewer's Name:
Date of site visit:
Date of most recent WUP:
Annual farm PAN deficit: ! i. l0 6 pounes
Revised April 20, 1999
FOR MANDATORY WA DETERMINATION
LAII"Operation is flagged for a wettable
acre determination due to failure of
Partit eligibility item(s) F1 Q& F3
Operation not required to secure WA
determinafion'at this time based on
exemption Et E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 3`
Irrigation System(s) - circle #:0hard-hosetravele- 2_ center -pivot system; 3. [ine ,m r-ove syst m;
4. stationary sprinkler system w/permanent pipe; 5. s Ebonary sprinkler system yr/parable pine;
6. stationary gun system w/permanent e`�
pipe;
7. sonary gun system wlportabie pi --
PART I. WA Determination Exemptions (Elic-r-u—TTV -E-Huf r, Pa:=11, ove:4;ces P-a L I ex_m ,4L,
E1 Adequate irrigation design, including map depicting w:.%17--hr4ate:: s. is comrie:e
and signed by an I or P.E.
E2 Adequate D, and D�D_ imc_ ion operating parmeter sheen .cludirrc man
depicting wettable acres, is compiete and signed by 2ri-1 or FIE. y
E3 Adequate D, irrigation ope=- , c parameter shleeef inciudin-c ma- ciepic r►c
wettable acres, is connDiete End signed by a WUP.
E4 75% rule exemption as very in Par Ill. (NO T E: 7b % exa-np n canna, be �-
applied to farms that frl tl-ie e5gibNty checidist in Par 11. Compi=w e5gib5it r
checklist, Part 11 - F i F2 F3, =e<flr: completing cor:zptr"aijonai t ,-tie ir, Part 111).
PART 11.75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination required b�,.��e operation "taus orie o, the eBgUity
requirements listed below:
F1 Lack of acreage mhich Tes: .=_(PAN) onzra=;_
field(s) accordingio l-01 -i11 VEA= " 3erjz-.-
�. F2 Unclear,--illegible.-or laic cu .a r.�--orumap.
F3 Obvious#ield iimiiatiors (rnu:bes;7GrrEseLr�Jir= _
buff er/setback-acre3gv;-or2�-:ct�acre-ace3i i�At1'�hir�ci�d�.= .
small;-irregulady-sheped s,...its - ►=-ids-less-fhan-5 -esJbrt- -err-nr loess �1=
2 acres for stationary --prirkJ r j
F4 WA determination require_, b:-i--aLse CAWPAP credr-sfi (s s c~eag in e'r.Cess
of 75% of the respective f;�Id's --:� cCzage Gs ncted iri F2-L ill.

Facility Number
r ..n.1 r- t...� Z. _urw e
Revised April 20, 1999
cart in. r-iela oy rieia uetermmaiion
of
roio t:xempuan rcuie for WA ueterminaition
TRACT
NUMBER
FIELD
NUMBER'-z
TYPE OF
IRRIGATION
SYSTEM
TOTAL CAWMP
ACRES ACRES
FIELD
%
COMMENTS3
I
I
f
I
If
I
I
I I
I
I
I
f
I
I
I
I
I
I
f
!
I
I
I
I I
I
1
f
I
I
I
FIELD NUMBER' - hydrant, pull, zone, or.point numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system_ - If pulls, etc. cross more -than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBER - must be clearly delineated on map.
COMMENTS'- back-up fields with CAWMP acieage_exceeding475% of its total acres and having received less than 50%
of its annual PAN as documented in the farm's previous -two years' (1997 & 1998) of irrigation Tecords-cannot serve -as -the
sole basis -for requiring a WA Determination.=Back-up fields-must-benoted in the -comment -section and must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
Pi Plan -..lacks.following-information:
P2 Plan revision may-satisfy-75% rule based on adequate overall PAN deficit -and by
adjusting all field. -acreage -to below 75% use rate
�/ P3 Other (ielin, process of gins#ailing new, irrigationrs

Lagoon. Dike Inspection Report
Name of Farm f Facility Green Meadows kMur.phy) 67 - 23
Location of Farm f Facility SR 1105 _-- --
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, aHAV
Embankment Sliding?
( Check One, Describe if Yes )
Seepage?
( Check One, Describe if Yes )
Erosion:
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Did Dike Overtop?
2 / 27/ 99-- Names of Inspectors Patrick Grogan
Janet Paith
< 10 Freeboard, Feet 1.2 - 2.0
T_8,Q Top Width, Feet 8
2 1 Downstream Slope, aH;1v 3 to 1�--
Yes - X - Na
Yes X No
Yes X_ No
Excellent - grass
Yes X_ No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X_ No
Engineering Study Needed? Yes - X _ No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X_ No
Other Comments --Rum ing OR.Sl �+ Feld - --- - � —

Division of Soil and Water Conservation [3Other Agency
Mivision of Water Quality
Ig-Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection /op
Facility Number Z3
Time of Inspection /cS4 24 hr. (hh:mm)
© Registered [] Certified © Applied for Permit otcrmitted JE3Not Operational . Date Last Operated:
Farm Name fiGt Ilil/��uJs �g,L�11'% County: 0 SG£11.�j .......................
.............��........................................................................................................ ................ N...................................... .
Owner Name: ... Z.-. ,,.......2+�ND.............. N eft Phone No: ..... ?% ... 3i�Q...-.9�.�..............................
.......%
FacilityContact. -SAD/ y L9N/6,� Title; SSf MA/t�R(�/Z Phone No:
..-•................................................................. 1�
Mailing Address: ...... :(.f:.S. ....,f ''3...., urt ......•...................... ..........................
Onsite Representative:...... ..LD ?45ty.. `.T..... .... ......... Integrator: ......... lw.(lAw....................................
Certified Operator, .......-L e.. �`'r„�...... � _��i.P,4 (... !!-'/1r�2 Operator Certification Number,.... .z .............
Location of Farm:
A
.Y �H.... .)...................... ... ....................... .
Latitude 13-f Longitude .0• 37 ° ©"
"Design . CU
Swme'' "Capacity °=Pop
❑ Wean to Feeder
. q5 o
❑ Feeder to Finish
opD"
❑ Farrow to We;T,3
560
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number pf Lagoons / Holthng Ponds Q Subsurface Drains Present 110 Lagoon Area Spray Field Area
�` q ❑ No Liquid Waste Management Systems'
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes RrNo
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what "is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes gNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes o
5. Does any part of the waste management system (other than lagoons/holding ponds) require [IYes &NO
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 92'No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ONO
7125/97 Continued
on
nn--back

i^atility Number: 67— 23
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes \o
Structures (Lagomts.liolding fonds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ YesbgNo +
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (ft): ........ a..'...1...........
10. Is seepage observed from any of the structures?
❑ Yes M`o
It. Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes N0
12. Do any of the structures need maintenancelimprovement?
❑ Yes �<N-0
(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 tnaximunt liquid level markers?
❑ Yes X No
Waste Application
14. is there physical evidence of over application?
❑ Yes �R%`a
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type Sj(D.'*?........0 !.......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes 9No
18. Does the receiving crop need improvement?
Cl Yes YNo
19. Is there a lack of available waste application equipment?
❑ Yes %N0
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 \To
22. Does record keeping need improvement?
❑ Yes XNo
For Certified or Permitted Facilities Only
23.^ Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes RNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ,NTNo
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes XNo
0 No.violations or deficiencies. were noted- during this visit..You.w'ill receive no ftirtlzer
correspondence 4 ouf this'.visit:-
4tn a its.(i4er to.question #}: Explain any 'VESanswers andlor`any recntnmeiidations or any, other:4'
e drawines of facility -to bef(er explain situations. (use additional pa�es'as necessary):
7/25/97
Reviewer/Inspector Name}�fQ
oW'
Reviewer/Inspector Signature:At2Date:

;® Routine Q Complaint O Fallow -up of DWQ inspection Q Follow-uv of DSWC review .O Other
Date of Inspection S 2E '
Facility Number (Q 23
Time of Inspection � Use 2 f hr. time
Farm Status:
Total Time (in hours) Spent onReViOs•
or Inspection (includes travel and processing)
Farm Name: .....,,_ County: ---
Owner Name:..s i�l� t S2 Phone No:
Mailing Address - ;
Onsite Representative: --- e- cl-R1¢-1-11N 14 Integrator: Q42434_
Certified Operator _ �r� .r _ Operator Certification Number:___—_
Location of Farm:
0'
Latitude Lonaitude
❑ Not Operational Date Last Operated:
r}•pe of Operation and Design Capacity
Swore
R'"f ,Number wPoultryr dumber
_NuIItlier 3�;
.:
'; ❑ Laver
�Cattie
❑ Dairy
': ❑ Non -Laver
Z ❑ Beef
t
�
M
El Wean to Feeder
❑ Feeder to Finish
arrEl ow to Wean
Farrow to Feeder
Farrow to Finish
Number of_Lsaoaas f¢HoldiiSg Ponds ❑ �x
ask xr�x am R� w
Y��� _" x �: ❑ Lagoon Area ❑ S rav Field AreaMn
Subsurface Drains Present
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
a_ If discharge is observed, was the conveyance man-made?
b_ If discharge is observed, did it reach Surface Water? (If yes, aotiry 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)
. - P. Is there evidence of past discharge from any part of the operation?
M 4. Was 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
maintenancelimprove:,re::t?
❑ -Yes 9Ko
❑ Yes 2"No
❑ Yes Q��No
❑ Yes L[ No
❑ Yes
�No
❑ Yes
E3"N'o
❑ Yes
°
El Yes
No

6. Is facility not Mn compliance with any applicable setback criteria? - ❑ Yes EKO
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)? ❑ Yes [R
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes RKO
Structures (1,agoons and/or TloldinQ Ponds)
9. Is structural freeboard less than adequate? ❑ Yes QKo
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3 Lagoon 4
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses as
immediate public health or environmental threat, notify DWQ)
11 Do any" -of the structures lack adquate' markers to identify start and stop pumping levels?
Waste Application
14. is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15: Crop type L —
T--
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a Iack of adequate acreage for land application? _
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal. Waste Management Plan in anyway?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
❑ Yes EKO
❑ Yes l.il40
❑ Yes [-}'i o
❑ Yes P,t .
❑ Yes EKO
❑ Yes
❑•it o
❑ Yes
62-TG'o
❑ Yes
allo
❑ Yes
D410
❑ Yes
❑tiro
❑ Yes ❑ No
❑ Yes [?' ,o
❑ Yes B"No
❑ Yes I Ta
Reviewer/Inspector Name
Reviwer/Inspector Signature: Date: ?�
cc: Division of Water Quality, Water Quality Secrion, Facility Assessment Unit 11/14196

•
•
Site Requires Immediate Attention:
fa Facility No. G2
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
4 Time: f<j<�
Farm Name/Owner
Mailing Address:
County:
Integrator: Lj
On Site Representative:
Physical Address/Location: 4s �x 1 E?2 & i l e
N 1-Ad 4-
Type of Operation: Swine Poultry Cattle u 5ah.t yvu Ay,rm p,
Design Capacity: 0 S� w Number of Animals on Site: 3 dUo A P` t
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: - Q ° �_" Longitude: `� 1 ' �' D Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(a�;proximately 1 Foot + 7 inches) e or No Actual Freeboard:_Ft. U Inches
VtiTas any seepage observed from the agoon{s)? Yes or Was any erosion observ
ed? Yes or rc
Is adequate land available for spray? e or No Is the cover crop adequate? No
Cron(s) being utilized:_Co"(
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellingsi3Q or No "
100 Feet from Wells? Yet or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or�1o� If Yes, Please Explain.
Does the facility dmaintain adequate waste management records (volumes of manure, land applied,
spray irrigated,on specific acreage with cover crop)? Yes or No
Additional yComm ts: _
L_(iln� - 1ti N p►'k
Inspector Name
Fix Vk i
Sign
-eJ
cc: Facility Assessment Unit
Use Attachments if Needed.

Site Requires Immediate Attention:
Facility No.
_ DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIIAAL FEEDLOT OPERATIONS SITE VISITATION RECORD �1 ! � 4-
DATE: t5 , 1995
Farm Name/Owner:�✓�-
Mailing Address:
County:
'Integrator: AL, 44S4
On Site Representative:
Physical Address/Location: NI ..4 I Vs �`` I i 2 4 r I e
;E7A('�",
Type of Operation: Swine Poultry Cattle `L S� N� �L, , `v"ZXJ4�) P,'Y
Design Capacity: � o Number of Animals on Site:c}vv�jAh� p,` a s ycJ ,�;(l.
DEM Certification Number: ACE DEM Certification Number. ACNEW
Latitude: u ° �,9 ' L{ q " Longitude: —1'1 ° T� ' D __1 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) e or No Actual Freeboard: �Ft' D Inches
• ti4- as any seepage observed from the agoon(s)? Yes or `�� Was any erosion observed? Yes or��
Is adequate land available for spray72,6'A'
or No Is the cover crop adequate? �i'e1a'or No
Crop(s) being utilized: L 6 kA
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? or No
100 Feet from Wells? fe� or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Lane Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing systern, or other
similar man-made devices? Yes oTO) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated,on specific acreage with cover crop)? Yes or No
Additional Comments: 1n_ L �1
l�ii�.. �V • k off'• . Sa l.) C-a N ; c L d L —
Inspector Name
Signa
cc: Facility Assessment Unit
Use Attachments if Needed_

i
OPERATIONS BRANCH - IWQ Fax:[phone] Jul 24 '95 18:14 P.02/18
Site Requires Immediate Attention �V0
Facility Number: _
SITE VISITATION RECORD
DATE: do , 1995
Owner: 4 ,6W r re,z Farm Name:
County: alvf t o4.
Agent Visiting Site:._,�j„crr _ Phone: ,Cf4ol
Operator: • ,14:^ .440-c�.- � _ - _ Phone: 4va��-
On Site Representative: A&6 ,vcwA- Phone:
Physical Address: /ft-.t /-r.*w e5dw-- .rre� -­re�^rdf �V.Cee
Mailing Address: f
Hill Wc
Type of Operation: Swine Poultry Cattle
Design Capacity: _ you . Number of Animals on Site:
Latitude: _ 0 �" Longitude:
Type of Inspection: Ground Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot +8 inches) (5 or No Actual Freeboard: � 9 Feet x Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or(6)Was there erosion of the dam?: CCe r No
Is adequate land available for land application? iXc , r No Is the cover crop adequate? <nDor No
Additional Comments: _Q��c 3 _ ro,,d 6, _ 5 &e J dr e ss .3�,Q"1
G a 11 Al
Fa.t to [phone]
Signature of A
t