670042_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

(Type of Visit: Q Co pliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: [_V 56 County: OAIJLO�l Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Gf &Lc 921 C14 C" `L—
Certified Operator:
Title:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator: Q
Certification Number: 99 (] � 23
Certification Number:
Longitude:
Current
Design
Current
Design Current
Swinemcsesign
paci
Cattle Capacity .."..Rd'
Fl—wean to Finish
Layer
Dairy Cow
Wean to Feeder
Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D , Ploult ,
Ca acit
P,o m
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
rhCIO!t�:er
Turke Poults
'11Other
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 ❑N DNA ❑NE
❑ Yes !__I No ❑ NA ❑ NE
❑ Yes Flo ❑ NA ❑ NE
Page 1 of 3
21412015 Continued

jF%Fj Number, r, - I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): I
Structure 3 Structure 4 Structure 5
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?
[/J No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No (DNA ❑ NE
❑ Yes [Z/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm�to
threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 E/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 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
0 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
El Yes
[ o
❑ NA
❑ NE
acres determination?
17. 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
V
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Othe :
es record keeping need improvement? If yes, check the appropriate box below.
[/Yes
❑ No
❑ NA
❑ NE
�21.
ste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Wo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
'7(No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

F li Number: -07E jDate of Inspection: Vullgo
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
[ 'o ❑ NA ❑ NE
25.*Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
�T ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus lass assessments (PLAT) certification?
❑Yes
Io ❑ 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
ZNo ❑ 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
ENo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Zo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes .
�(No ❑ 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 explaiiaa situations:(use addltional.pages as necessary). =
fo
TIC 18�'n' in,4 FS6 LA�
NCW D.7-C, AOjQ DC_S-rQV 11_ n/ A�►�'
Reviewer/Inspector Name:
Reviewer/Inspector. Signatu
Page 3 of 3
�J6h /Y Ffi 9da L' Phone:0/0 ` 7
/I to dA // 1�
re: Date: & %6
2/4 015

IL
Type of Visit: W XoUtine
ante Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I f Arrival Time:---t-' Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: (� Title:
Onsite Representative: f-G kt io -- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I I ky2,)
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
t
C:_'J
Design
Dai Cow
C►urreut
Wean to Feeder
bnA i�O
Non -La er
Dai Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,ouI
Layers
Design
Ca aci
Ct
P,o ,
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
I 113eef Feeder
Boars
Pullets
Turkeys
urkey Pouets
Other
113eef Brood Cow
Ot
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes ✓ No ❑ NA ❑ NE
❑ Yes 02"'No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: -
Date of Ins ection: 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D/No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [9'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 [EfNo ❑ 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 O No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E:fNo ❑ 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 []rNo ❑ 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
[ 4No
[DNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[ffNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
V❑�No
❑ NA
❑ NE
IS. Is there a lack of properly operating waste application equipment?
❑ Yes
ErNo
NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
D'No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other-
��Yes
.oes record keeping need improvement? If yes, check the appropriate box below.
❑ No
❑ NA
❑ NE
[21.
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
�No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E]r/No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Faciliumber: - L1 -z---1 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? E❑ 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 Er NA ❑ NE
Otber Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes EEfNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E3-<o ❑ NA ❑ NE
❑ Yes [1] No ❑ NA ❑ NE
❑ Yes Eg" To ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes dNo
[:]Yes 6-N'o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers:and/or iiny additional recommendations of any other comments
Use drawings of facility to better: explain situations (use additional pages as "necessary).
—2k. Q�liP��ft' hct`� F�'P ��s l`✓°4�` �� Nl l��aPn jfn �•HrMo �Plt�s,
0 6h'-�- a jlI gevl 3 k, 5 ,
&A ���� 30 �aYS Se,,+ ID
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
3Oj a S/$ Srna-f, D (.v,Rr
Phone: 119 -1 Yl: 13Q�
Date: 3 ZV'6
21412014

Type of Visit: (J7 Co liance Inspection O Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: 0MJL6ys/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: CAtiL &T[,.f l Log— Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Design C►uerent
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
X
Nan -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , l;ouItr. Ca aci P,o
I Layers I
Dry Cow
Non -Dairy
jBeef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
I
jPullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes []No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes Ei/No ❑ NA ❑ NE
[:]Yes E2/No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: (p -9 Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Lwr4y/�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
C2rN-o
❑ 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
2fNo
❑ 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 reat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
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
CZ No
❑ NA
❑ NE
maintenance or improvement?
,
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No DNA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VN
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectioWT�'
❑ 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 ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes d�N ❑ NA ❑ NE
25.'Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Efyes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes &!rNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �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?
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)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[—]Yes hTo ❑ NA ❑ NE
❑ Yes [T No ❑ NA ❑ NE
❑ Yes [;I- o ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [—]Yes E3 o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 6•a "o ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use'drawines of facility to better explain situations (use additional pap -es as necessary).
,� & ) , �_ r wP evFL� 0 ( i IfG eV20
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
4IM- I )?Ecoos.
Phone flb)77K _
�W
Date:
214 Oil

Type of Visit: a Co fiance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 771 Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Ao-t, BoI c N 6L�2= _ _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop:
Wean to Finish
Design Current
Wet POUItry Capacity Pop.
Layer
Design C*arrant
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
=WeRiRn Current
10), P,ouitr. C►a aci 1;0
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /X0 (DNA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 6<0 ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 21412011 Continued

lFaciAty Number: -
Date of Ins action:
Waste Collection & Treatment
4. Is s orage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5
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?
E�r/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes I&No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [—]Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes 0No ❑ 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 hTo ❑ 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 J 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?
rw"9p
❑ Yes tE��No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
TTTT
17. Does the facility lack adequate acreage for land application?
❑ Yes �-' -
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ YesVo
❑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 VNo ❑ 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 gyNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facir4ty Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ YesVNo
❑ NA ❑ NE
It
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 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 EDeKo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes E o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes JZJ <10 ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes T❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �O/[_] 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 sitnahons:.( `" ' nse;addittouil:pages as.necessaiy.)..:
Reviewer/Inspector Name: ',-7d> IV TAakl, _ Phone:
Reviewer/Inspector Signature: LL44 Ad&U I Date:
67
Page 3 of 3 /4/10 1

Type of Visit: QFZRoutine
pliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 3l 1131 Arrival Time: Departure Time: County: vL,oW Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: FAOLL RATCHUML Integrator:
Phone:
Certified Operator: Certification Number: uokl _.
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
]Non
-Layer
_E]
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
Dr, P,ouIt . Ca aci P,oP.
Layers
Non -Dal
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
FTOther
Turkeys
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Fpcility Number: ( - qT7-1 jDate of Inspection: g 13 T-1--
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
(A 6dW I
315
Structure 3 Structure 4
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?
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [3/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env' onmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes aN 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 EJ/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes QNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes CdNo ❑ 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 0 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 21"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes FEI� o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes 7,No
o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need i provement? If yes, check t appropriate box below. Zyes [:]No ❑ NA ❑ NE
❑ Waste Application Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ��N(o
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

F cili Number: KI - 477 jDate of Ins ection: It Ilkli
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 ppropriate 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 [DNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes EkNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Rcviewer/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 DA-0
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
[:]Yes 2/No ❑ NA ❑ NE
❑ Yes 2�o
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as .necessary).m -
/ Au�c�-IS�'S rrl.ssSF1� F�s� ?i �vN►1Pt,� FV�l�.I' uSCf} �� v.�vl NatG1�Fn—
�v��l
jUolr6 sOPV6Y NA Ens r'9 VC- CWC DJ 73a loA�f,
Reviewer/Inspector Name: +IN r"W'StIt- A Phone--7) g11
b f
Reviewer/Inspector Signature: Date: -31 i
Page 3 of 3 V4MI J

L
Faclltty";Num. 1 er i
i� -...
Type of Visit (
Reason for Visit
Date of Visit. E3
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Division`of Water Quality,`
:Division of Soil and Water. Conservation
Q Other Agency`
�hpliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
,Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Arrival Time: '3 0-1 Departure Time: County:Region:
Facility Contact: �aQ
Onsite Representative: O i1 L ' rJffa bLPA,
Owner Email:
Phone:
Title: Phone No:
Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = e [� c 0 N Longitude: = ° = 6 = u
_ d}
r Design Current-Design:,,Current k a_ Design _ _ Current;
$wine ;< , Capacity.tlPopulaton VVet Poultry.. Capacity%Populatton Ca..ttle an oPl %tY t act P on;;
❑ Wean to Finish
Wean to Feeder
6
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
ElGilts
❑ Boars
f ; ❑ Layer y; ❑ DairyCow
❑ Non -Layer ❑ Dairy Calf
❑ Dairy Heifer
-Dry Poultry„�r;,. � Y
Dry Cow
_ ❑N D '
❑Other
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Points
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
on- ary
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
"Number of Struct
Yam«
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
❑ o
El Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Fqcility Number: —
Date of Inspection
Waste Collection & Treatment
4 : Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Struct re 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
eat, notify DWQ
environmentaZNo
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
Na ❑ 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
C E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA ❑ NE
maintenance/improvement?
WNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
Cl Yes
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ 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 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
3 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
s.
Comments (refer to question #) >Egplain:any YES answers andlor any,recommendations or any other comments
-Use drawings of facility to better explain situations (use additional pages as necessary) rs�
S�tJ� Pt -MO AL— g 10 oA ANO 4- QdAL
46.E Ao Gf7 C AVV AAtZf,
Reviewer/Inspector Name _- j,�,/-�L11�„ �' Phone: ..
Reviewer/Inspector Signature: Date: '� 3b 1t
Page 2of3
12/281W rontinued

LFacility Number: (p'] — I Date of Inspection o
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design El maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Cade
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑4o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E 3/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?
El Yes
,❑2/No
L]No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q40
❑ 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
KNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E' No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
yo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

'*r
1'f t
Type of Visit Crh
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: r� Departure Time: County: _-0AALAJ Region:
Owner Email:
Physical Address:
Facility Contact: Title:
Onsite Representative: EAfLL &T L14 (c,,40 •
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: = o u
IDesign Current
Design
Current
Design
C*urrent
Swine Capacity Population Wet Poultry
Capacity
Population
Cattle Capacity
Population
❑ Wean to Finish ❑ Layer
❑ DairyCow
id Wean to Feeder i1 ` ❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ Layers
❑ Beef Stocker
❑ Gi1ts ❑ Non -Layers
❑Beef Feeder
El Boars El Pullets
❑ Beef Brood Co
❑ Turkeys
Other ❑Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharees & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 2 No ❑ NA ❑ NF
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
O o
El NA
El NE
❑ Yes
7No
❑ NA
❑ NE
12178104 Continued

Facility Number: — Date of Inspection
SWaste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ffNo
❑ 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: (AG1a01-J
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.)
No
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes U
❑ 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) eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q4o ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [N ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes 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
ETNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L✓ 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?
El Yes
dVNo El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[I Yes
❑ NA
❑ NE
Comments (refer toquestion;#}: Explain.any YES.answers andlo an y:recommendations ar nv other comments
Use drawings of facility to better explain situations.'(use additional pages as necessary)�g a ,t
^ar.an F--w..._ P' 4t+rc 4 s +ra -' kEc. "uZ4AL
l 5,) UCATE Ca G A N p ?&&fAvr,
a r) 1,10vt .Styx r; F now , t.� omzd & VA dl,
2L, P06 Crgt_T[I/Lp7.I60 0506 c.ovtD Wa-r gWb [.ASi W!6,
D6 AWIJ6T ail C.A.-d VT-MOX A l'► WE-M n ►,&.f&JT,
Reviewer/Ins ector Names c� ti
PN+Vd;°:C�412Oi%6,1-t;�W. Phone: ID 796--73
Reviewer/Inspector Signature: Date: ;j -7 IO
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection S D
'*Required Records & Documents /
19. ' Did the facility fail to have Certificate of Coverage & Permit readily available? Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑'No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
Q No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
E1 No
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
2 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
"' s
❑ No
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ryes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes❑
VN
NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[I NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ 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
EKo
❑ 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
[)10
❑ 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
QUo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
Z2No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 I2128104

i
Type of Visit Cj TRoutine
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: /()tS-7 Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: E A ILL. BAT (_14 L t_0Z
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = 6 0 g 0 Longitude: = o= 4=
Design
CUTrent Design
Current Design Current
Swine Capacity
Population Wet Poultry Capacity
Population Cattle CapacityPopulation
Wean to Finish
❑ Layer
I
I
❑ Dairy Cow
Wean to Feeder t)
10 Non -Layer
I
1
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish ❑ Layers
El Beef Stocker
❑ Gilts ❑Non -La Non -Layers
❑ Beef Feeder
❑ Pullets
❑ Boars
El Beef Brood Co
❑ Turke s
Qther ❑ Turkey Pouets
❑ Other JEI Other
Number of Structures:
Discharges & Stream pacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
[I NE
❑ Yes
El YesEl
NA
FNo
❑ NE
El Yes
❑ NA
❑ NE
Page I of 3
12128104 Continued

Facility Number: % — Date of Inspection
[
Waste Collection & Treatment
4; Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �?
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
CfNo ❑ 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 environmentayth eat,notify DWQ
7. Do any of the structures need maintenance or improvement?
ElYeso
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
O 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
2/No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Dll�o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes UNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes RNo ❑ NA ❑ NE
M. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ENo ❑ NA [:]NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 7No
El NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
) ) SLVO" . V"( Y
Reviewer/InspectorName %I_ro 9A/ Phone:I'/Q} 7Y6-73gY
Reviewer/Inspector Signature: Date: 2.W112
Page 2 of 3 12128104 Continued

Facility Number: &'I — Z Date of Inspection
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ElYes
n No
[INA
ElNE
❑ 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
[2No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
dlNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ s
�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
0Yes
❑ 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
U No
❑ 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
[I 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
El Yes
�,�
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
VN9�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes2
❑ NA
❑ NE
Page 3 of 3 12128104

61
Type of Visit (2 ,(Compliance 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: S t'fl Qg Arrival Time: 0 3 0 Departure Time: County: 41Nser49-1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: GAOLi- 6A1C4EL0A- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = O = 6 Longitude: = ° = t = "
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
We to Feeder ��
❑ Non -Layer
❑ DairyCalf
❑ DairyHeifer
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish ❑ La erg
❑ Beef Stocker
Gilts ❑Non -La erg
El Beef Feeder
❑
Boars Pullets
❑ Beef Brood Co
❑ Turkeys
Other ❑ Turkey Po Its
❑ Other ❑ Other
Number of Structures: 1I
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 IQNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
U<3
❑ NA
❑ NE
❑Yes LfJNo El NA El NE
Page I of 3 12128104 Continued

acili Number:
h' Date of Inspection 3 4 6
ti
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ffNo ❑ 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: iA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t�hr at, notify DWQ
7. Do any of the structures need maintenance or improvement? [IYes
L N El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? Cl 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
L'I No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L.<
❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
LJ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
dNNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EI/NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E No
❑ NA
❑ NE
0,) ►m-Eb To p SLUDGE !ggV6y' i✓M_N/ .3o pAY5 S'&VP col°" To DWa ALOYJC, �
Ci91..L16lzl�'T� N .
Reviewer/Inspector Name ] f T/ - a �, j Phone: 19 d- 73 K b
Reviewer/Inspector Signature: Date: S Od
Iugc 4 of .+ - _. _— ... `.....__..._.,_

r
Facility Number: % — y Z Date of Inspection t
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP []Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L'J No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes LL No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Do ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
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 ❑ No ❑ NA ❑ NE
Yes ❑ No ❑ NA ❑ NE
❑ Yes EPlo ❑ NA ❑ NE
❑ Yes C3,<o ❑ NA ❑ NE
❑ Yes [( o ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes EJ N ❑ NA ElNE
❑ Yes No, ❑ NA ❑ NE
❑ Yes X
El NA ❑ NE
El Yes No ❑ NA ❑ NE
Additional,Comments. and/or,Drawings:.-:'
Page 3 of 3 12128104

Type of Visit
pliance inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
7Routine0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: 1 :31191627 Arrival Time: �} ao Departure Time: County: ONSL L,,l Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [=] o [=] ' = Longitude: = ° =' =
Design Current
Design Current
Design C►urrent
Swine Capacity Population
Wet Poultry C«opacity Population
Cattle
oopacity Population
❑ Wean to Finish
❑ Layer
❑ Da Cow
® Wean to Feeder "1 7 (o
l
❑ Non -Layer
❑ Da' Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
El Gilts
❑ Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other I
❑ Turkey Poults
❑ Other F
umber of Structures:
Discharges & Stream Impacts
. 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 D<o ❑ NA ❑ NE
❑Yes
❑No
❑NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
No
❑ NA
El," NE
ElYes
L' No
❑ NA
❑ NE
12128104 Continued

FaeSlity Number: 'i — q-L
I Date of inspection 3 0
a
t Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2<o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LA ►J
Spillway?:
Designed Freeboard (in): EO
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L�J , .�
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
2�Jo
❑ 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
ErNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [rNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes [:�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application �,�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes Ell o ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ErYes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[T No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Pxo
❑ 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
Cllfgo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
["lo
❑ NA
❑ NE
IComments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
11.) ZaNE 3 WAD -`a—(- ovE2 APF Fa/- =T4 SaCL t`jPE • FGC-q56 GC- CAR.ff!c)x. -i'g9'kC_
-Z'ON ES 14 A 5 3 PAoJ gZATE5-
,24j C,ALzaAAT_jo o✓ i% a(= Vo YOL t-j_tT W xrA ?,v gDA` S . ?(-C-AS4= -FAu--
Reviewer/Inspector Name ;4H L. Phone:` ?6 f _F (, - 7?>n
Reviewer/Inspector Signature: 00& Date: 3 t 1
l/�//+V/VT 4VIEEE/LNGLi

`Facility Number: (�7 — Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E3NNo [INA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ElYes B ivo ❑ NA ❑ NE
the appropirate box. ❑ VAN ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑�Yes [21 No ElNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ER/yes ❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes E N'o ❑ 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
❑.l+t
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[Wo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0-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
C_�JNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
I�Wo
❑ 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
ELDlo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[�No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Facility Number G1
v Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 6 Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S 0 Arrival Time: Q60 Departure Time: County: dAJ944i41 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: EAR- 1947CIA EI 02- integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Sack -up Certification Number:
Latitude: 0 0 ❑ , Longitude: ❑ ° ❑ .
Design Current Design, Current Design Giifrent_
Swine Capacity Population Wet Poultry Capacity Population Cattle - Capacity..Population'
❑ Wean to Finish
© Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other ­
` ❑ Layer
is
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co;.
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ['No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ N
❑ Yes
❑ NA
❑ NE
❑ Yes
L✓J No
❑ NA
❑ NE
12128104 Continued

1Fa ility Number:
Date of Inspection LJL�L�ti J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: trr` GOO
Spillway?:
Designed Freeboard (in): Zo
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes dNo ❑ 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 �dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yesio El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) /
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E)44o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes WNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 3 L N, ) F W ) C, 5
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[No
❑ NA
❑ NE
,"No
❑ NA
❑ NE
❑ NA
[I NE
,T'No
L2N
El NA
El NE
L No
❑ NA
❑ NE
Comments (refer to question#): Explain. any YES answers. and/or any.reeummendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
} ljpAgM 1.1Uj0 Forte Ntrw SaL3n f'CT ANb aco S;L p rer i3`? 240a, Q��a
poo T k C ONE [LdEL Ft U br ji,oAo.
dl.) w ANj _00ZNCs .L&p_ I_- (ads PUT StA n-T 4Nr) STdP1_- " Zyv*_S foa— CA C 14 SO L
SE Z0WES, hots aw TAC FULLS r06C04(k d-ki (Ra4vVoA F-rL- 114XS YCAP-.
Reviewer/Inspector Name F ':51W o 1"� 1Z�% (,(r Phone: `! /0 )i G — % a
Reviewer/Inspector Signature: Date: s 19 Ja(,

ff acility Number: 1 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? Q Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check E Yes ❑ No ❑ NA ❑ NE
the appropriate box. Ld ❑ ❑
Ur ❑ Checklists ❑ Design Maps Other
2 L
Does record keeping need improvement? If yes, check the appropriate box below.
2 Yes
❑ No
Cl 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
U/ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
E NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
lJ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
*No
lA
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o ❑ NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
ELT
EI 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?
El Yes
//
2 o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
2<o ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[�o ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L,14�0[1 NA
❑ NE
Additional Comments and/or Drawings:..
Page 3 of 3 12128104

Type of Visit (3rCopliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: i a3n Departure Time: County: d)U, Lj Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ?��— All4R—
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
LJ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
0
Latitude:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
J� ❑ Non -La et
Other
❑ Other —
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
JE]Turkey Points
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: = ° = ' 0
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: ='
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
o El NA
El NE
❑ Yes
❑ Yes
WNO ❑ NA
❑ NE
❑ Yes
DINo ❑ NA
❑ NE
12128104 Continued

Facility Number: — 7i Date of Inspection U S'
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?
�/
S77tructure I Structure 2 Structure 3 Structure 4
Identifier: CA600A/I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 36
No ❑ NA ❑ NE
ZI NOo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
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 thrpat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E Zo
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes U ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
2 No ❑ NA ❑ NE
maintenance/improvement?
1 I . 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 Drifl [:]Application Outside of Area
12. Crop type(s) Q 6ff.L-T1 tJYi�{j fE
13. Soil type(s) A-/Va 1LFa C4� 6A Ym CAD L
_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
EfNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
ENo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
UT'N' o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[I NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes
VX'o ❑ NA ❑ NE
ofi } nost Do I" RAx.,�Cau, Z03SPEGLA1+1• V-ZLi— o-j; mQO-Tr-4L•=ry, F�-r:'m • a�
SU as, 16 06 uLoP-?a-E1D wnrrU 1s 14A646 ST[
Reviewer/Inspector Name _& e t . " Phone: L �IJ 3 �5 � 3101 x tP3
Reviewer/Inspector Signature:
Date: YZIO$
1 L'/ lyV/V'I l.V/{LN/ NGN

Facility Number: Date of Inspection I YI S/per
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
❑ Yes Zo
❑ NA ❑ NE
El Yes ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Application El Weekly Freeboard El Waste Analysis ElSoillAA aiysis El Waste Transfers
El Annual Certification
El Rainfall u Stocking El Crop Yield El120 Minute Inspections L� Monthly and V
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�
❑ NA-
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L✓J No '
❑ A
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
2A
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VN.
YNA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNA
ElNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
ElNo
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
VNo
El NA
[I NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
[ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
ZNq,
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
/No-
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
Aid"dEtioioal Conments and/or Drawin s
12128104

Time:
1Z Permitted [3 CCertified© Conditionally Certified 13 Registered Date Last Operated or Above _Thhreshold.
Farm Name: /��Lr.-!..[.eEllr..._......___ ..... County: ..4!/VSGfJY�I......_.........._ ..._
Owner Name:.....__Ja�'sg&----._._. �!��._ _ � ._ � ... Phone No: ...........
Mailing Address: --. ............ ............ ......................................
Facilitv Contact: .......... _ .......?_ . .� ._.... �_ Title:Phone No:
/
Onsite Representative:..lC'•E/ _ Integrator: �Sf—�I�� D...... ...
CertifiedOperator: . . ............. . .......... . . ........ _.. _ ...._.. _ .............._.... Operator Certification Number: ............................
Location of Farm:
a
Uj swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� ���
�CcviP
ArWean to Feeder
[] Layer
❑Dairy
-
Feeder to Finish
-
❑Non -Layer
P
❑ Non -Dairy
w
Farrow to Wean
❑Other
Farrow to Feeder
�+ !
x Total DeS3gn'pgCtty
Farrow to Finish
Gilts
Boars
s�TotaISSLW
Discharges & Stream Im[tacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes JZrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes XNo
❑ Yes G!fNo
Structure 6
Identifier: . �............ �.---- .. _ . __...
Freeboard (inches): 3�
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,
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 heaIih 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 maintenancetimprovement?
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? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified
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?
Waste INfanagement Plan (CAWW)?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within'24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes �(No
❑ Yes /No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 7T No
❑ Yes gNo
❑ Yes )z No
❑ Yes JZ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
[:]Yes XNo
❑ Yes J?fNo
❑ Yes ;dNo
❑ Yes 0 No
❑ Yes )No
:Comments°(refer to quesLan #) F.xplam-any YE.S answers sncllor aay:ie�mmenrdations or;any other con4meatsr � G '.
>:Use dra�wurgs of face�ty to better exglam situatrans (nse�addrteonal pages as,aecessary) k ❑ >~ield Copy ❑Final Nates � ' � '.
e.
2vo 3 �tqkr
Gls� 1.8 /wl`IODO �
Ida-
„ � 1
pxav�111 zr zz
9
Reviewer/Inspector Name
ReviewedInspector Signature: Date: B
12112103 Continued

Facility Number: Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) ❑ Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo
❑ 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 ZNo
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes JA No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
JoNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 10 No
28. Does facility require a follow-up visit by same agency?
❑ Yes PKNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes )eNa
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes Ao
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 'Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I QZ
Date of Visit: 3 f i 03 Time:
Not O erational QBelowThreshold
0 Permitted
0
Lj Conditionally Certified Li Registered
Date Last Operated or Above Threshold: _
Farm Name:
`
En
� f 1
13 cO r 11ie Ior t" , Pen
_ County: Q s1 rots''
Owner Name:
�c►. r
I j3qA G L e-1 o --
Phone No:
Mailing Address:
Facility Contact:
Onsite Representative: Fe^ r► .Sal cli e I ° --
Certified Operator:
Location of Farm:
Title:
�v1 Phone No:
Integrator: !" �G[-rG�.� �roG►t'l
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0° " Longitude 0' 6 Du
Swine
Design
Ca acity
Cures' ent Design Current Design Current
1',o ulation Poultr Ca aci P,o ulation Cattle Ca aci P,o ulation
❑ La er Dairy I
❑Non -La er ❑ Non-Dairy
TOtai DesigTotal SSLW
Feeder
o Finish
rfeeder
to Wean
to Feederto
Finish
Number of Lagoons�� ❑ Subsurface Drams Present ❑ La oon Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Li aid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes effNo
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 L/I No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches): Lid
05103101 Continued

t
t Facility Number: 6 17- -Z 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
2No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
�No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
pNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
P No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONO
Waste Application
XNo
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
;�No
12. Crop type re.^--UVdw 14a y , FeSC UG uA y , CQ /h , Soyea 0 s - --
.-
13. Do the receiving crops differ with thos designated in the Ce fled Animal Waste Management Plan (CAWMP)?
❑ Yes
f 2fNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
JZNo
b) Does the facility need a wettable acre determination?
❑ Yes
ONO
c) This facility is pended for a wettable acre determination?
❑ Yes
RNO
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
El Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
)allo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP, design,
❑ Yes
JSNo
(ie/ checklists, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
j2fYes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
00N o
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
❑ Yes
JZNo
(ie/ problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
5�`No
24. Does facility require a follow-up visit by same agency?
❑ Yes
JZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
"ONO
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
T. Po
Co maients.(referto_questioii #) Eicplain anv YES apswers and/vr;aay reconttnet►tlatut©s_or anv yther comments.
Use drawings of facility to better explain st#trattons (ase additeonal pages as neeessary}• El Field Cony ❑ FinalNotest
_. �, � x
_
QtJ2r'ci���-��P fia/'^'L 1S ill mA lg4°t►')ee1 . �ke� iJ a. good G,-vp OK,
-res c ve qnd Ae be,--u,,4or J'j- <444 ; 4c, green yi Aeae i r ^ 9ood
s�,.\x �-�? -TAe
at L�eil 1��9 �i�'Ji;_q 'Crop • .swine
1
h ors,5(? gre0t A' -A 4ah �s well wt.a-)t c✓red, Over�llr fete �Cdrds awe
well keels T1,v,^e is no wrsle <A^\1o[e t,J;-� „1 &0 �a -r �`
`` % CGonf .n eA l
Reviewer/Inspector Name I A -
Reviewer/Inspector Signature: Date: 3 /
05103101 Continued

" Facility Number: 62— Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Coxhment`s,and/or Drawings: '
❑ Yes ❑ No
❑ Yes ONO
❑ Yes JZNo
❑ Yes J21140
❑ Yes .3 No
❑ Yes j2fio
❑ Yes ❑ No
ayp1� ;6t, eveco ,
�P sL) ccve sq Pple s w %h,h (04 da s e/' ex/9 'r✓a4,&n
eUen-�s J' Q co�r� ocA 4n 4ako sam j s ever 6b AC s.
-rka.' k ye t4 -40 '- Vo - e-gor I S �0 WLA "',qa ''A i 4 e rct r�'-V
�o©d order. /
O5103101

Drvrs><on of Water Quality ;
Q Division of Soil and Water Conservation m
Q Other Agency =_
(Type of Visit 0 Compliance Inspection Q Operation Review O Lagoon Evaluation I
Reason for Visit '0 Routine O Complaint O Follow up O Emergency Notification O Other © Denied Access
Date of Visit: r� $� Time: �O Printed on: 10/26/2000
Facility Number �a
Q Nat O erational Q Below Threshold
*Permitted E:] Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
{ 5
Farm Name: 'r �... t V ........... County: O.�"1 1�'t..................................................
...........
Owner Name: ............................................
Facility Contact: ............................................
Mailing Address:. ...........................................
Onsite Representative: „ . ........
Certified Operator: ....................................
Location of Farm:
Phone No:
..........................................................
............. Title: ................................................................ Phone No:.................................
.............................................................. .... ............................. t.............
.................
.........................
Integrator:..., �S
.................................................................... Operator Certification Number:....
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 1; Longitude • 1 66
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder nw ❑ Layer I 1 ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I I JE3 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JE3 Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps I JE] No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
{(No
Discharge originated at: ❑ Lagoon ElSpray'Field ❑ Other
a. If discharge is observed, was the conveyance man -trade?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
❑ Yes
❑ No
c. II'dischar,,e 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
MNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
kNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
RfNo
Strucaure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
IdentiFier: .......................................... .................................... ....................................
....................................
Freeboard (inches):
5100
Continued on back

i
(Facility Number: 1 Date of Inspection 7/21/2000
Printed on:
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 0�`No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? VYes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there eviden a of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �`] No
12. Crc .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes fi�rNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? []Yes ❑ No
c) This facility is pended for a wettable acre determination? []Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes JXNO
16. Is there a lack of adequate waste application equipment? ❑YesgNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
WNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
El Yes
�No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
UNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes jj�No
23. Did Reviewerlinspector fail to discuss review/inspection with on -site representative'? ❑ Yes No
24, Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
�VQ yiolaiicjris:off defc..... were noted dirrtng this:visit: Yost wit. eeeiye Rio further; • . -
icorresponcience about. this visit. • .. . . . • . . • . ....
Connmeiits (refer to question #) Explain any YES 'answers and/or any recommendations.or any other coi invents. - 5
Uservdrarvings of faciihty to better explain_situations: (use additiaeal pages as necessary)
o
s-t ���� t'��1� c� -1 e oT �t`te c�` A,�-
�� Cr•��lh'--QZ �:�c�P��_�--� 1+ "i\��� At, t.��' GLCc dlsC[i
Reviewer/Inspector Name _ r.
Reviewer/Inspector Signature: Date: 1_3—QLX—UV 5100

Facility Number: T) — Date of Inspection 3 'a$ loPri,td on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 , j 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`j No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes No
{ Additional omments and/orDrawings:
`. G'`c`.,2r— l'--� ,prc,C esS Z}v� GCS���-� ���I Q 5 LT 1►-�-i
I L zI
5100

P''�ti� \
Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number jv - Operation is flagged for a wettable
Farm Name: acre determination due to failure of
On -Site Representative: w Part 11 eligibility item(s) F1 F2 F3 F4
lnspectorlReviewer's Name:
Date of site visit:
Date of most recent WUP: _J '�_
Annual farm PAN deficit: 9�5494 pounds
Operation not required to secure WA
determination at this time based on
exemption El E2 E3 E4
1 j Operation pended for wettable acre
determination based on 0 P2 P3
Irrigation System(s) - circle #hard -hose traveler, 2. center:pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; b. stationary sprinkler system -w/portable pipe;
6. stationary gun system wlpermanent pipe; 7. stationary gun system w/portable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D)D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE.
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed bya WUP.
E4 75% rule exemption as verified in Part Ill. (NOTE:76 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational table in Part 111).
PART 1I. 75% Rule .Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination .required .because operation .fails -one of the .eligibility
requirements listedbelow:
_F1 Lack -of acreage-:.whichTesulted in:over,-application-mf-wastewater,-- (PAN) on:spray_
fields) :2ccordingiotarm'sdasttwoyearszf�rrigaiion-xemrds.
F2 Unclearjllegible.­ .or lack of information/map.
F3 Obviousfeld limita#ions-(numerous ditches;faifureto:deductTequired _
buffrer/setback�acreage;_or26%:of#otal_acreageddentified:in LAWMP. includes
small, --irregularly -shaped felds =. fields :less#han 5 -acresfortravelers-or.lessthan
2 acres -for:stationarysprinklers).
F4 WA determination required because CAWMP creditsfield(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part III.

Revised April 20, 1999
Facility Number -
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
FIELD
TYPE OF
TOTAL
CAWMP
FIELD
COMMENTS3
NUMBER
NUMBER'-2
IRRIGATION
ACRES
ACRES
%
SYSTEM
e3Sd
l
l
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. crossmorefhan one field, inspector/reviewer wiff have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination.
FIELD NUMBERZ - must be clearly delineated on -map.
COMMENTS'- back-up fields with CAWMP acFeage-exceeding'75% of its total.acres -and having received less than 50%
of its -annual PAN as -documented in the farm'sprevious-two years' (1997 & 1998) of irrigation -records; cannot serve -as -the
sole basis -for requiring a WA Determination. -hack -up fields -must -betioted in the,commentzection-and must be accessible
by irrigation -system.
Part IV. Pending WA'Determinations
P1 Plan :lacks. following :information:
P2 Plan -revision -may_satisfy-7.5% rule based on adequate overall PAN deficit -and by
adjusting -all field.acreage#o-below 75% use rate
P3 Other (ie/in process of installing new irrigation system):
1

pi
Routine O Com taint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number Date of Inspection O0
Time of Inspection ICJ 24 hr. (hh:mm)
Permitted 0 Certified
[3 Conditionally Certified © Registered
113 Not O erational Date Last Operated:
Farm Name: ........1�`^].!�
L
.......
1..��"�" . ........
County:.........C�C`!.............................................
.6
OwnerName:........................................................................................................................... Phone No:
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:..........................................................................................................................................................................�........................ ..........................
Onsite Representative; -low t1....................................... Integrator: ...... ��i.......... ...................................................
Certified Operator : ............... .................................... ............... .............................................. Operator Certification Number:..........................................
Location of Farm:
Latitude ' & 64 Longitude 0 6 46
Nur�beref Lagoons - ❑Subsurface Drains Present 11OLagoonArea ❑ re Spray Field Aa
_.
Holding Ponds / Soltd Traps ' ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Od No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes El No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes NNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes INNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J?No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ................�
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes VNo
seepage, etc.)
3/23/99 Continued on back

A Facility Number: 49 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence over1a plication? ❑ Excessive Ponding ❑ PAN
12. Crop type r b, C1 <614
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there'a lack of adequate waste application equipment?
Required Records & Documents
17.. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20: Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
i'Vo yi t icjris;oi- dgfcieucies -were p0ed- 00ing �his;visjc - Y:oh rviii-tOe i*e iio fuilhtr ; ;
icorresponc eirce abaruf this visit_ ... .
0
❑ Yes ONO
❑ Yes gNo
❑ Yes VNo
Yes ❑ No
❑ Yes N(No
❑ Yes D'No
❑ Yes )<No
❑ Yes ❑ No
❑ Yes ❑ No
j5Yes ❑ No
❑ Yes XNo
❑ Yes N'No
❑ Yes XNo
❑ Yes ❑ No
9Yes ❑ No
❑ Yes WNo
❑ Yes R(No
❑ Yes P,No
❑ Yes Q'No
❑ Yes [)(No
❑ Yes kNo
Pic
t x,t ;��
. L t Ccit-ice C�tl o �1
w c�ie �� �.- (tip
Reviewer/Inspector Name '
Reviewer/Inspector Signature:
Date: S�

;i Facility Number: r) — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
4
34. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes , 6rNo
❑ Yes [(io
❑ Yes PNo
❑ Yes [)(No
❑ Yes O(No
❑ Yes [� No
❑ Yes KNo
do W omments -- - _
,� :; ,1
ur; raw�ngs•77
NIS
-1"V�- Ly
S
�
� �' p Y

E3 Division of Soil and-Water,Conservation 'Operation Review
: anon -;Compliance lnspectton
my - M =
Drv�sion of Svi and water ConserY
DiWsi_on of Water Quality Compliance inspection
OtherAgency, '-Operation=Review:Y-
® Routine O Complaint Q Follow-up of DWQ ins ection Q Follow -tip of DSWC review Q Other
Facility Number�'7 �f�. Date of inspection L 3 q / r` 99
Time of Inspection 11000 124 hr. (hh:mm)
© Permitted k Certified [] Conditionally Certified 10 Registered JE3 Not Operational Date Last Operated:
Farm Name: ....CAIQL......81 TGf EGO!Q...... A���..................................... County:..�N-?................................ 41e, ......
OwnerName....... L......... A T..G%� ...................................................... Phone No: ............................................
FacilityContact: ............................ ...................................._........---- Title: ................................................................ Phone No:...................................................
Q
Mailing Address: ... ..'�r .y.............(!�................................. y...NC............ �..7.v..............
Onsite Representative:6!�rc/f�c ae rr �j QQ,pf�,
............................................................................... Integrator. ...... .
Certified Operator:,,, �, � •,...;Bff � ,, , Operator Certification Number:...P7 �J�f�
............................................. ....... ................
Location of Farm:
'COM.....................o.......................---.............._...........................................................................................................................................................----.......................
...........tif/.........................................................................................................................................................._....................__._....---...............................................---.
LatitudeLongitude �•®j�"^ _' —
Design Current"=Design Current; Design Current
Swine Capacity Population. Poultry. Capacity Population cattle Capacity Population T
Wean to Feeder
I OO
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of;Lagoon& - F ❑ Subsurface Drains Present ❑ Lagoon Area
HoldrngrvrcPonds / Solid Traps �' `> ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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. Discs discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Spray Field Area
❑ Yes )�No
❑ Yes ❑-No
❑ Yes ❑ No
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:
�10
Freeboard(inches):................................................................. .................................................................... .............................
........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes ❑ No
❑ Yes ,(No
❑ Yes X,0
p' ❑ Yes i' 0
Structure 6
❑ Yes )<No
Continued on back

Facility Number: &7 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 12-729-
closure plan? ❑Yes YNo
(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 'ANo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes *110
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Anolication
IQ. Are there any buffers that need maintenance/improvement? ❑ Yes kNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes Nkfqo
12. Crop type -4 e15Ctu2._
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,VNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Wo
b) Does the facility need a wettable acre determination? ❑ Yes o
c) This facility is pended for a wettable acre determination? ElYes No
15. Does the receiving crop need improvement? ❑ Yes •SNo
16. Is there a lack of adequate waste application equipment? ❑ Yes V'No
Re aired Records & Documents
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?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes gNo
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 IV No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes Nzno
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes b�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes XNo
24. Does facility require a follow-up visit by same agency? ❑ Yes VRO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes PONo
0: �10 yi6l466iis;ot- clef cie dte were potted i tt&ig �bis'visit; • Yoi} will-teceiye -rio fuith'
correspflridence. about this visit. .. . ... . ... .... .. . . .. .
Comments (refer to gpestion #): -Explain any.YES answers and/or -any recomnuendatYons or-ariy other comments W -a
Use W
drawings of facility to better explain'sttuatiiins ,(use add> honal pages'as.necessary) x
Reviewer/Inspector Name
Reviewer/Inspector Signature. ;r Date: /Z 3/1 1 l /Zbhl
i
`�� 3/23/99

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes Wo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �KNo
28. 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)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes D'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 ,ZB640
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes WO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ,11k ❑ Yes ❑ No
3/23/99

(::�7� `q2-
Lagoon Dike Inspection Report
Name of Farm / Fatuity E4d & Bat helor camolls
Location of Farm / Facility SR 1206
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, xH:1 V
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 )
9 / 29/ 99 Names of Inspectors Patrick Grogan
Janet Paith
3' Freeboard, Feet 22"
< 1.0 Top Width, Feet --)a
_ 2 to I Downstream Slope, xH: Iv 3 to I _
Yes X No
Yes X No
Yes X No
Excellent - crass
Did Dike Overtop? Yes --X No ' If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes X No
fr
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X .No
Other Comments Pum"ins'in process and on the last pull. Water may h&ve
flowed * to the lagoon._ - -

1/
Lagoon Dike Inspection Report
Name of Farm / Facility Earl & Batchelor CaMQlls
Location of Farm / Facility SR 1206 _
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, xH:1 V
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 )
9 / 2199 Names of Inspectors Pg1rick Grogan
Jana Paith
3' Freeboard, Feet_
< 1.0 Top Width, Feet 10 —
2 to ,l Downstream Slope, xH: Iv 3 to 1
Yes X No
Yes X No
Yes X No
Ex llent -
_ Did Dike Overtop? Yes X No If Yes, Depth of
Overtopping, Feet
Follow -Up Inspection Needed? Yes X No
Engineering Study Needed? Yes )C No
r
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes X _ No
Other Comments Pum�}ing h process and on the )ast pull. Water mU have
flowed into the jaeoon._

E3 Division of Soil and Water Conservation 0 Other Agency
UDivision of Water Quality
outine O Cum laint O Follow-u of DWQ inspection OFollow-up of DSWC review O Other
Date of Inspection
Facility Number
Time of Inspection J 24 hr. (hh:mm)
D Registered ErCertified 0 Applied for Permit © Permitted 10 Not Operational I Date Last Operated:
1L .r
Farm Name:...:.. ................. / G.�-/....—......,t4 ��xtflr Caunty:..........>f......................................................
OwnerName : ................................................... ................................................................. .. Phone No: .�t....................
Facility Contact:
...�r.�..�.......... 2. L'raxitle:.......... ,r.X..�L ......................... Phone No:
Mailing Address: !0s'V..r1&14�................p. 2.5.e4_11.....3..........................I...... ...2SS7�
Onsite Representative:......`1�°� .................. �i' .�rlt t7C ................. Integrator:..........P r .�.��`►....................
Certified Operator ?� SG ..i%02. ............. Operator Certification Number;...g p!�.
Location of Farm:
Latitude • 6 46 Longitude 0. 11 "
Wean to Feeder
17 7Ffo
f%
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes [5 No
2. Is any discharge observed from any part of the operation? ❑ Yes RNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes I1 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes c9l 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 J0 No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
® No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
Yes
❑ No
maintenancelimpro vement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7125/97

oa
hacih'vy Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (LaQoons.NoldingPonds- Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure L Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):........�:?.A...................... ................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
RNo
11,
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
�No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
WNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
t&No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
f
15. Crop type ................11.'...t.................................................... p.-k]......................... ..... ..........................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes allo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18. Does the receiving crop need improvement?
fiq Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
EZNo
20. Does facility require a follow-up visit by same agency?
❑ Yes
P�No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
R No
22. Does record keeping need improvement?
F Yes
❑ No
For Certified or Permitted Facilities Onl •
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
O No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
®CSCes
❑ No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
UNO
0: No.violations-or. deftcieiteies.were-noted,during this" visit.: You.will recei�e:no.ftirtiier,:,
: e6rrOgOhdence dbouf Ehis:visit.• : : : ' ....
-5pz 41
�-�r
� "U -j arm+ �)1 qj
r
ve.Acl W/ to-1 p talfc- Rel�lrl (, 9 i ems►-. 5 TIP u.� /�✓
441 OF fz444&,C,.- A
ReviewerAnspector Name r
Reviewer/Inspector Signature:
Date:

C/ 41 I
FORM IRR-2 �, Lagoon Liquid Irrigation Fields Record RECEIVE0 �
`Z— 9 q 9 �la�l' 0 �, 199j
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
One Form for Each Field per Crop Cycle
Field #
RI ro v—
1 i C.
G.� w * 1 1, L . 14 4I" W �T
Irrigation Operator
Irrigation Operator's
Address
Operator's Phone #
Facility Number I -
From Waste Utilization Plan
Crop Type Recommended PAN
Loading (Ib/acre) = (B) 57l
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11)
Date
(mm/ddlyr)
Irrigation
Waste Analysis
PAN'
(11511000 gal)
PAN Applied
(lb/acre)
(8),x (9)
1000
Nitrogen
Balance"
(lb/acre)
(B) - (10)
Start
Time
End
Time
Total,
Minutes
(3) - (2)
# of
Sprinklers
Operating
Flow
Rate
(gal/min)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gal/acre)
(7) / (A)
B=
eK C7
u
1
7 e., .0
47
Ga s
P
.
n4.
4
CA
yy
J
o
Poo
Ige�T
r
ezz,
©dnn
7+r�e)
rryry+
Xg
r M
,04
4Q e
o Q
�� C,i
t1+
r+t.
.�. I. wi
-�
d
Q D
CL
J -
W"
'L.
n—
C -
Crop Cycle Totals �
Owner's Signature Operator's Signature
Certified Operator (Print) te d/"� Operator's Certification No.
" NCDA Waste Anaylsis or Equivalent or NRCS Estimate, Technical Guide Section 633.
Enter the value received by subtracting column (10) from (8). Continue s+iblracting column (10) from column (11) following each irrigation event.

! 0.1 e r611
RECE I V LD OCT6 t 199a
,.z,,
FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
Lagoon Liquid Irrigation Fields Record
One Form for Each Field per Crop Cycle
Field #
Z --
Facility Number -
-r Irrigation Operator
Irrigation Operator's
Address
Operator's Phone #
From Waste Utilization Plan
Crop Type ,� Recommended PAN 7
.L��,� t tt Loading (lb/acre) = (B) a -
(1) (2) (3) (4) (5) (6) (7) (8) (9) (10) {11)
Date
(mmlddlyr)
Irrigation
Waste Analysis
PAN'
(lb/1000 gat)
PAN Applied
(lb/acre)
(8) x (9)
1000
Nitrogen
Balance"
(lblacre)
(B) - (10)
Start
Time
End
Time
Total.
Minutes
(3) - (2)
# of
Sprinklers
Operating
Flow
Rate
(gal/min)
Total Volume
(gallons)
(6) x (5) x (4)
Volume
per Acre
(gal/acre)
(7)1(A)
B= C
r1,!Jy'.
�i' mil' ,..
a
t—
3c7
i 'no
2
P,
l IL
�IA7
/ Ya
FIc -
- `
0,, .
a-
d
7 -
ie'o
�
-�' �
�; �-mow•,
� � d �
% ?
�•
/= F 1 _�
Crop Cycle Totals
Owner's Signature
Certified Operator (Print)
Operator's Signature
Operator's Certification No.
" NCDA Waste Anaylsis or Equivalent or MRCS Estimate, Technical Guide Section 633.
I I
'" Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) following each irrigation event.

FORM IRR-2
Tract #
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone 9
-- I C1 9 V CI�; E0 OCT a q lase'
�L�
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
Facility Number -
Irrigation Operator
Irrigation Operator's
�- Address
Operator's Phone #E
Frorn Waste Utilization Plan
Crop Type Recommended PAN Laading751
~
(lb/acre) = (s)
M f91 1141 fat Al rfl 17) IM rn1 fin) f11i
Field #
L Yj CC • ZSS
Date
Irrigation
Waste Analysis PAN'
PAN Applied
(lb/acre)
Nitrogen Balance'
(Iblacre)
Aof Sprinklers
Volume
mmlddlyr
Start Time
End Time
Tota!
Minutes(gapons)
operating
Flow Rate
Total Volume
per Acre
(gaUacre)
(lbh 000 gal)
rat K re1
(f3) • (70)
(3) - (2)
(gal/min)
{6) x (5) x (4)
t�}
1000
�r
A
p�+
.91 O- CIO
CZ
`•
V
!
'•j
rL coo
G/ &
o:
o
o
ti srs�
f7
- ik <p
/ O d
dPL
4.
ftAD
I3
L' o a
� c�
�
�
`- �
v
00
_7 oD
r) ,�L
_L
d
1
C'v
GV
I
or •.y 1:3
tnd
!
"Oa
,_
TZ
Crop Cycle Totals { i
Owner's Signature Operator's Signature
Certified Operator (Print) .� C- Operator's Certification No.
r
1 NCDA Waste Anaylysis or Equivalent or NRCS Estimate, Technical Guide Section 633.
z Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) following each irrigation event.

4:4c
FORM IRR-2
Tract N
Field Size (acres) = (A)
Farm Owner
Owner's Address
Owner's Phone #
E C E'. ® OCR 0
Lagoon Irrigation Fields Record
One Form for Each Field per Crop Cycle
Facility Number
Irrigation Operator
Irrigation Operator's
Address
Operator's Phone a
From Waste Utilization Plan
Crop Type Recommended PAN Loading !
(lb/acre) = (B)
ftl f21 fAl rdl rrl rat M rat 141 flnl fill
Date
mmlddlyr
Irrigation
Waste Analysis PAN'
(tb/fi]oo gal)
PAN Applied
(lb/acre)
_(a) x (s)
1a0U
Nitrogen Balance p
(lblacre)
R . V0)
Start Time
End Time
Total
Minutes
(3) • (2)
N of Sprinklers
Operating
Flow Rate
(gal/min)
Total Volume
(gallons)
(6) x (s) x (4)
Volume
per Acre
(gal/acre)
A
Q
�1
'
0
f
©to
/� •• /
/
72, 6 �J G)
,e;
)-L du
l" a
L/ �..
�C
/
o
t
Z6 Da
6 Go
NL!
Js-r
I
0
aQ
"L
G
Crop Cycle Totals I t
Owner's Signature . Operator's Signature
Certified Operator (Print) Operator's Certification No.
I-I�-S�.-?2
I NCDA Waste Anaylysis or Equivalent or NRCS Estimate, Technical Guide Section 633.
x Enter the value received by subtracting column (10) from (B). Continue subtracting column (10) from column (11) following each irrigation event,

FORM IRRA Lagoon Liquid Irrigation Fields Record cOCT p G 1998
For Recording Irrigation Events on Different Fields
Farm Owner Facility Number -
Irrigation Operator 1
Tract #
Field #
Date
(mmlddlyr)
Crop Type
Field Size
(acres)
Irrigation Time
Number of
Sprinklers Operating
Start Time
End Time
Total Minutes
♦!
— DI:
%
f
Q
, D
C)+
j .. #'
a
- e
I
R-v
7-2
DR: 11/97

FORM IRR-1 -
Farm Owner
Irrigation Operator
Lagoon Liquid Irrigation Fields Record RECEIVED OCT 0 f 199&
For Recording Irrigation Events on Different Fields
Facility Number -
•
b.
®Field
Size
.
•
-Irrigation.-
,l !1"
IR !1"
• 11 I
mm
!
r
•
r

® Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection ILL
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours �•
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel and processinQ
❑ Not Operational Date Last Operated:......_ .... .................. _............... ......... __..... ......... ....._.
Farm Name: �r4(1 County: L?.Jd.�P..) _.. ....__...,
Land Owner Name ............ .. Phone No:..�
Facility Contact:.... !!e.�.. _ ��?fr rC l .y ._.....�_.. Title: Phone No:
Mailing Address: _,..>2�.....
t.Li�-�....._.!i..�i _..........._._. ZSX.
p Integrator �i4+eR-0
Onsite Re resentative: +�,,... t.,�i7CfrL�. , ....
IN
- �e ��di� ._ ... Operator Certification Number: Certified Operator:....�.1:� 2C� ...................... }�!�..............�....._........_.. p ��..........._...
Location of Farm:
j.�iJ iu.._.....
...........
�......_............... � ...._.............................--------..............................�........._---------................ 4
........................ __............................... _.................. ...-•----....... ......... .._.... . - ... -...... .......... -.... � - .......
_...._ ..-.........� _.... . �
Latitude Longitude �• �C';
Type of Operation and Design Capacity
Design Current Design>' z Current DesignCurt^ent
.£h z < x .
�Swtne.x P N Poul M Cattle
F Ea act . Pa elation trY. Ca act Po ulahon . k Ca act <Po `ulittou
Wean to Feeder `,�❑ Layer❑ Dairy
❑ Feeder to Finish ❑ Non La er ❑ Non Da
Farrow to Wean
Farrow to Feeder x Total Destgd Capacity _ 4
Farrow Fini:,.,.. �' I
AD tosh il",
,r.�. W
'0 Other
.. ..:.,. ,.._ ::;m� .....,,._.,..r. ,.ham„•. . A,.,
N Numlrerof Lagoons f Holding P ds ❑ Subsurface Drains Present'
❑ Lagoon Area ' ❑ Spray Field Area
H.. g P Y
4
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b..Ifdischarge is observed, did it reach Surface Water? (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)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes of o
❑ Yes Mo
❑ Yes Gr o
❑ Yes [ENO
❑ Yes
Q'l�o
❑ Yes
MNo
❑ Yes
�Io
❑ Yes
[Wo
Continued on back

r
Facility Number:.(1 �... —... ..._
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7_ Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures a o ns and/or Holding Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
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 an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste -Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes Q'No
❑ Yes �fo
❑ Yes E'No
❑ Yes Q-'Ko
Structure 5 Structure 6
15. Crap type .:..... .... ........... ............ ........ T...`�. ....... _.................. ....... ...........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
Cominents,(refer ESawaor"nreaoonetsto question'oExpmnndayecommntinsrayohrcommen
l
Use'drawtngs of facility to Better explain situations` (use additional pages as,necessary}
❑ Yes pfir
❑ Yes E�No
❑ Yes []No
❑ Yes 0'90
❑ Yes 0.'90
❑ Yes ❑.Pdo
❑ Yes [+}'No
❑ Yes [a -No
❑ Yes 01�0
❑ Yes O'Fo
❑ Yes B No
❑ Yes aflo
❑ Yes G o
l "�' ❑ No
W_ -OXCHCc a wt tl f5,,— --t-0 Z..,Xc, r
Reviewer/Inspector Name..'a
Reviewer/Inspector Signature:
I�1 M� Y ��I�111��1�11��11
Date:
IIII II
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cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention: N d
Facility No. ' 77 V z
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 , 1995
Time: r�
Farm Name/Owner: EARL B 4 TG/H 6 L o AF
Mailing Address: 1 8 dx a �q c.�lLrar,t s �
County: 0 +j 5 ow
Integrator. _ Gfle2at-4-.s _ Phone:
On Site Representative: _ f%or>e- _ _ Phone: _ ]L? y - y�VV
Physical Address/Location: Yes�.i�:/s__ % — e4f _- soG� s�
Type of Operation: Swine Poultry Cattle
Design Capacity: I - 7 is _ Number of Animals on Site: % 7 76,
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3y y7 ' �I Longitude: 27 �7 '. Elevation: �.1�7 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) L7 or No Actual Freeboard: —Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or'N Was any erosion observed? Yes o lr o
Is adequate land available for spray? es r No Is the cover crop adequate? Yes or No
Crop(s) being utilized: .
Does the facility meet SCS minimum setback criteria? 20O Feet from Dwellings?1 Ye or No
100 Feet from Wells? jesor No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes orf�
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 o 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
Additional Comments:
Pn
Inspector Ndme
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

•
•
OPERATIONS BRANCH - WQ Fax:[phone] Jul 24 195 18:19 P.14/18
Site Requires Immediate Attention rya
Facility Number: Z- Vz
SITE VISITATION RECORD
DATE: - ,7-4cly !E _ 1995
Owner: /= t 13v: err_ t o•c Farm Name: r
County: U t c o
Agent Visiting Site: e1 Phone: /pj i- y Zc
Operator: -z5atz r3 r� .� t..� _ - Phone: L21,b jz *-
On Site Representative: kr 9 Phone:
Physical Address:
I/'
Mailing Address:
Type of Operation: Swine
Design Capacity: 17 7 6
Latitude: _-0
Type of Inspection: Ground
Poultry Cattle
Number of Animals on Site: 774
Longitude: O
Aerial
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hoar storm event
(approximately I Foot +$ inches) IG or No Actual Freeboard: �_ Feet Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes yeas there erosion of the d:rm7: Yes o715)
Is adequate land available for land application? es r No Is the corer crop adequate?. 6r No
Additional Comments:
Fax to [phone]
SUZ134ture of