670083_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: 0 Corp¢liance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: Q]= County: I Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: l o n 0 Lt I tt^ /
, r Ef
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: Z�
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
WMW
C*apacity
P.
C*attle C►apacity Pop.
Wean to Finish
Layer
airy Cow
can to Feeder p 1 1>0
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D.. $oultr,
Ca acit
P.o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars El
Pullets
Beef Brood Cow
Turkeys
U.kher
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes =No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[] Yes �j`N�o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: 1#- Date of inspection:
t2:
Waste Collection & Treatment
4. Is heavy less
Yes
No
storage capacity (structural plus storm storage plus rainfall) than adequate?
❑
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No[_]
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[2-No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [-]Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes . No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes U 0 l__I NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [3-"U ❑ 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 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes I 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
D<o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rE rNo ❑ 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
ENo ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes oLe"'❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [] No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No NA
❑ NE
25e. Is the facility out of compliance with permit conditions related to sludge? If yes, check
[] Yes
o I_J NA
NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No "❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No [3'koA❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Io Q 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
❑ 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
Q-io ❑ 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
❑.PIS E] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No ❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3`1 0-^❑ 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 'drawin s of facility,to betfer ex` lainsftuations uscFadditional eages as necessar
Reviewer/Inspector Name: Gtvl Q C °1-� i 9
Phone: m7073p�
s
/
Reviewer/Inspector Signature:
Date:
Page 3 of 3
21412015

(Type of Visit: 0 7Routine
pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
sit:
Reason for ViO Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: ly 1 Arrival Time: 2S Departure Time: DIS � County: ,S/{I LO JJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: GJOl1� iRh! . Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number: -0114 q
Certification Number:
Location of harm: Latitude: Longitude:
Wean to Finish
ILMn,-L
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dr, P,�
Farrow to Finish
Layers
Gilts
Non-L
Boars
Pullets
Poults
Other I 1 101 1Other
Dischary-es and Stream Impacts
l . 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'?
Dairy Cow
Dairy Calf _
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes m No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: 1,0 i- Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 21 No ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
s.tll�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑Yes C401
DNA ❑NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
8. 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 Ea"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ZNo
❑ NA
❑ NIE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
CNo
❑ NA
❑ NE
D 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
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YN o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
171/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
bNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectioYlyo
❑ 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 o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: -_j Date of Inspection: jig I 1
24. Did the facilityfail to calibrate waste application equipment as re required b the permit? Yes VN
NA NE
PPq Y P ❑ ❑ ❑
,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 provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
❑ Yes ffNo
❑ Yes ]�No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
IN
ZNo
0
No
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑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 ages as necessary):
'CrL .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
d �A & A &LL
Phond(TJOM� I
Date: 1 IN /I L
/4/2 15

Type of Visit: 0 Co liance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: - Arrival Time: Departure Time: b County: 0 (fi Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �Jy� N �I i� l _t- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design
Cattle Capacity
Current
Pop.
Wean to Finish
Layer
Daill Cow
Wean to Feeder
n-La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Deslgn Current
D�;y P■oultr. Ca aci P■oP.
Layers
D Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
10ther
Discharees and Stream Imoacts
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 ❑ NA ❑ NE
❑ Yes V ❑ NA ❑ NE
[:]Yes rNo ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. 11 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
St cif ture 1, Structure 2
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[—]Yes No ❑ NA ❑ NE
[:]Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 2 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes C�/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
1
❑ Yes %
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [No
❑ NA
❑ NE
acres determination?
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 rNo
❑ 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 �FNo
❑ NA
❑ NE
the appropriate box.
❑ W UP ❑ Checklists [:)Design [:]Maps [:]Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o,' ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - r
k
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25: tf the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
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 ❑'<o ❑ NA ❑ NE
❑ Yes ;,No ❑ NA ❑ NE
❑ Yes ';, o ❑ NA ❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
[3'No ❑ NA ❑ NE
o ❑ NA ❑ NE
Comments (refer a question Explamwany�Y�ES laftsw&s'andlor.any additional,'recommendations or any other, comments.
IUsediawinEso'ffacility:to'betkexfexplain;`situatipns'(useadditionalpages.us`, necessary)
_,.
Reviewer/Inspector Name:
AWLU� _ _ PhA `lip,/IC, t - 13
Reviewer/Inspector Signature:
Page 3 of 3
Date: S
21412015

Type of Visit: (D gRoutine
mpliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: '] Arrival Time: Departure Time: County: qyj.Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
-----•
Onsite Representative: �- pJ�-j;0�m'(
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: nn^
Certification Number: 4
Certification Number:
Longitude:
Design Current.
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
CattleI Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
on -Layer
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
i Dry Cow
Farrow to Feeder
1), . P,oult
C►.a aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Qther
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
r
/No
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
.
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
a-
Observed Freeboard (in):Z.
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmWN9" hreat, notify DWR
7. Do any of the structures need maintenance or improvement?
[:]Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[ No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes Q No ❑ NA ❑ NE
❑ Yes VNo
❑ NA ❑ NE
[:]Yes ❑ NA ❑ NE
❑ Yes /No ❑ NA ❑ NE
[:]Yes �40 ❑ NA ❑ NE
❑ Yes I 4❑ NA ❑ NE
[:]Yes 6Z- ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facililz Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes '� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA 0 NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No. 0 NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes � ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
0 NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�Vo
❑ NA
❑ NE
(Comments (refer to question ft Explain any, YES answers and/or any additions recommendations or: any other comments. I
Use drawings offacility to better explain situ'atipns:(u4e"gddltion2l:paesas,necessary}:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonkq/02M
Date: r
2/4 0;4

':,
Type of Visit: ® Co liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: WRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: M'Tu t z Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
eanto Feeder
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
La er
Jim Dairy Cow
IN -Layer
I
Dairy Calf
Dairy Heifer
DesigVC-Utrok.). 66uirr
ent D Cow
Dr, Pouitr. Ca acNon-Dairy
Layers Beef Stocker
4
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Other
Poults
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ENo ❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No ❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ >o NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

.A
{Facility Number: 6 " ?1 - $ {1 Date of Inspection:
T
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1, Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: {
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
{ yN ❑ NA
V
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
ElYes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
�/o
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o ❑ NA
❑ NE
maintenance or improvement?
/Nc
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Efi ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L_rNIN 9 ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N/o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�
f ,YNo ❑ NA
T'
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
4j4" ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Flo ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"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
No ❑ NA
❑ NE
Page 2 of 3
21412011 Continued

A
Facility Number: -47 T jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit ElYes 21 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 6/N(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 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 FJ'No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes
o
❑ NA
❑ NE
[:]Yes
NVNo
❑ NA
❑ NE
❑ Yes❑
NA
❑ NE
❑❑ Yes YNo
Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Phone
Reviewer/Inspector Signature:
Date:
Page 3 of 3 / 2MI2011

[Type of Visit: Ur�Zoutlne
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:® Departure Time: County: ONA L,bbj Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative: lF A" P8 CP _
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: ZQ ] L&
Certification Number:
Longitude:
ENEENEEMELD_esign Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
La er DairyCow
Deslgn C*urrent
Capacity Pop.
Wean to Feeder
e�
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Farrow to Finish
D . P,oultr, Ca aci P,o
JLayers
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouits
Other
-
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [� No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: jDate 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
Identifier: r A CvaV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3
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?
/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes E2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [XNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pon_ ding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[E]Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes o
❑ NA
❑ NE
Required Records & Documents
WN
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 C�No
[] NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes [C� N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes E;�No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes �10 ❑ 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: 1017
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes C244o NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E. i o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ETNo ❑ 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 <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
QKo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N
Vo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other ebmments�r. � I
Use drawings of facility to better explain situations (use additional pages as necessary). i i fir.
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: d a
Date:
21412011

(Type of Visit (!) 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: I JI a311)
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: 30 Departure Time: County: Region:
Owner Email:
Title:
Phone:
Onsite Representative: GA itf U PLTd� __. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c ❑ 1 ❑ « Longitude: = ° ❑ 0 "
11re-si-011KCHrrent
Design Current
Design
Current
Swine Capacity Population
Wct Poultry Capacity Population
Cattle C►►opacity
Population
❑ Wean to Finish
10 Layer
I D ❑ Non -Layer I I
❑ Dairy Cow
® Wean to Feeder
1 It D*
El Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Feeder to Finish
pry Poultry
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
El Layers,
❑Non -La ers
❑ Pullets
❑ Turkeys
El Beef Stocker
❑ Gilts
❑ Beef Feeder
ElBeef Brood Cow
❑ Boars
Other
❑ Turkey Pouets
I ❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
El Yes
El No
El NA
El NE
[]Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes di ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: 67 —f3 Date of Inspection a3
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:
Spillway?:
Designed Freeboard (in):
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 21 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes d No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [;K o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes I[J No ❑ NA NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes DNo ❑ NA ❑ NE
maintenance/improvement?
IL 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 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 Ej, o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ 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
IZ(No ❑ NA ❑ NE
E�yjqo ❑NA El NE
I No ❑ NA ❑ NE
t.. k Y S £% 8tt�.84r.@A A X"di d'. '# «b - Y �B $e $ A kw p.50.w .. � �
a. i$ 9 gg''VVA#�
.Comments (refer to...questian,#} Explain any YES,answers€andlorany recomriiendationsorgany{ o{th}er:comm�entsg:�
%4':9 Ya Xs¥�;§e"- n%d X e68Y rvdfi%x:.-s$:i'iYx0ky�i$?$°£� .5'�.t..�'i -g$
LJse;drawings of`taeilaty to l eNtter,explain situ$tions:,(use addrtyoi al pages as,necessary).k �,& � yFP �{
gura l,p H
�i _ �..�":k�
�5;� SwOGE SI/2✓FY ,V6CO r 7�
x. a ?
Reviewer/Inspector Name a 1✓ L Phone: 796 g
...
Reviewer/Inspector Signature: Date:
Page 2 of 3 r 12128104 Continued

Facility Number: — Q Date of Inspection 23 1
,Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C�No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E)4
❑ 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
DNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[�N
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
s
I/J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
VYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D<o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes P No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9<0
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
VNo
❑ 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
O'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
,�/
u No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
Additional Comments and/or Drawings: ;
Page 3 of 3 12128104

I Type of Visit i C El
inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral 0 Emergency Q Other Denied Access
Date of Visit: S /h� Arrival Time: ® Departure Time: County: . OAJrL 4k% J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: Art- WAL=jodIntegrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = = Longitude: = ° = I = 1
1
Design current Design Current Design
Swine Capacity Population Wet Poultry I Capacity Population Cattle Capacity
Current
Fopulation
to Finish
❑ Layer
El Dairy Cow
RWean
Wean to Feeder
a ;IYo
❑ Non -La er
I I
❑ Dairy Calf
❑ Feeder to Finish
❑ Daia Heifer
Dry Poultry ❑ Dry Cow
Non-DaiEx
❑ Layers
❑ Beef Stocker
ElNon-Layers
❑El Beef Feeder
Pullets
❑ Beef Brood Cow
❑ Turkeys
❑ , Furkey Poults
❑ Other Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
PCIBoars
Other
❑ Other
Discharges & Stream Impacts
I. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes D'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
❑ NN
❑ Yes
El NA
❑ NE
El Yes
VN
❑ NA
❑ NE
12128104 Continued

acility Number:
Date of Inspection 5
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 l Structure 2 Structure 3 Structure 4
Identifier: LA 6-a�
❑ Yes [`No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Y`
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [� 10 ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ' ❑ Yes V 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 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 [�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 P/No ❑ NA ❑ NE
maintenance or improvement'?
Waste ADDllcation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dN ❑ NA [I 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
m o
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
1J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
ly-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo
❑ NA
❑ NE
Comments (refer to question ;#}: Explain any YES. answers`andlor any recommendations or,, any othertcomments
Use drawings of facility tobetter explain situations. (use a iditional�pages'asnecessary):
Reviewer/Ins ector Name k K i` " ° x 7�k.s # Phone:
P _ . _ t: u s l:G.
Reviewer/Inspector Signature: Date: c�
Page 2 of 3 1 12128104 ' Continued

Facility Number: — Date of Inspection
14e
uired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
J
El NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
YNo
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
4 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
L/I N
[I NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L[✓ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
do
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
La
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
IN
[:3NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
VN
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�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
[� o
El NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
O
Page 3 of 3 12128104

If
Type of Visit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
sit R
Reason for Vioutlne 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: —d kAAW Region:
Farm Name: Owner Email:
Owner Name: I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: le �t �S�L c)
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: c = 1 Longitude: = ° = 1 = {1
Design Current
Design Current
Design
Current
Swine Capacity
Popution
Wet Poultry C«apacity Population
y
Populationcan
to Finish
❑ La er
❑ DaiWean
to Feeder
❑ Non -La er
❑ DaiFeeder
to Finish
❑ DaiFarrow
to Wean
ltry
❑ D
7-Da
❑ Farrow to Feeder
❑NoFarrow
to Finish
La ers❑
BeeGilts
on-aers❑
BeeBoars
❑Bee
❑ Turkeys
Other
❑ Turkey Points
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
ElYesxo
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — 3 Date of Inspection ?� a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes In No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (4/2a60�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.)
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?
eat,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaZo
notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
❑ NA [3 NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
WNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
[Z"No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes
�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
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
WN o
❑ 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
[�/ o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
k �sAs�.�Itk:.:;���'':Fil1r�-�' °•a� 1t l.r'A'v '��.fi ,.,1'i-.. S, ,."''�.
Comments (refer to,,question #); Explain any jyt!,Sg !a}nsFwvrN4tndto any rec m e� lal tgns. ar;aAR,"ther eommegt;Usedrawmgs of facility to betteriexplam sltuations: (usekadditioenal p agespa s,Ineces s a ryj)
%��v7 tx"41 .. �{ii1 i''a` � rY:fi 'M�„A4•lykfd' �eLi bil. h:. ,f ':� h..,- C'M 3Y.
Reviewer/Inspector Name
Phone k 71 — 9341
Reviewer/Inspector Signature:
Date: l 60LOl
Page 2 of 3 1 12128104 Continued

Facility Number: — Date of Inspection 1 3 0
+ Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �Z�J/No ❑ NA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Ch kl' t ❑ D ' ❑ AA ❑ Oth
ec is s 'sign F. er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
lZ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ENo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
V1'4'
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Noo
❑ 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
[3/No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
(/No
❑ NA
❑ NE
30.
and report the mortality rates that were higher than normal?
At the time of the inspection did the facility an odor or air concern?
pose quality
❑ Yes
[ N
❑ NA
El NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑Yes
No
❑ NA
❑ NE
Additional.Commerits,and/ortDrawings: ' :? z. 5: ifs 'i '. } �' ° t� .: px t.a i. ".fit d#✓ � , . � r & , z - + 5 .:: .< <
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection 0 Operatlon Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (2/Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: $uj" Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
G A ie.Y iJA UT6d
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = c = 0 Longitude: = ° = 1 0 {1
�� � �� ��i� ��
�'� Design
' Current
Design Currcnt
Design Current
Swine
Capacity
Pop tion
Wet Poultry C•apacci Population
Cattle Capacity Population
Wean to Finish
F
❑ La er
❑ Dai Cow
Wean to Feeder
2.6a4
2184
n-La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
No
1. Is any discharge observed from any part of the operation?
❑ Yes
E
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E JINo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 1 — `$3
Date of Inspection o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure i Structure 2 Structure 3 Structure 4
Identifier: ! A t,-o.J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `f Z'
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 111 No ❑ NA ❑ NE
❑ Yes L( No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El yes LJ �o ❑ 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 11 Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application _,/
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes lL1 No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes U40 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 ]bs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[(Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
a,, qo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
ElD Yes
No
❑ NA
❑ NE
Co � s�.(re fer t��quest �.�#) -1 M1x�pla n�a �yl� SYanswers and/or�an4,�ecomme��deons; nr' any other comnrents.�:. fififi k= a i
Use drawings�olrafa�rLty�to better�e�xjplalndsitu�ahoyjnys:��(use�additi�o}naltPa es ags�.necess�ajr,Y� : q�$g� :y � � .,� � '��$
��s S 4i. Y; i'^i�i�"- '��1['��r"'.9.R:�i.s';:�:. �Ti�&jY4.ri�'. Mli k��C�re..�'7.�Wy��at�'L%.%.��'Li?r �^�, Y.. •_
�iw.k d... naP..S'�.bS.� r..rt•] �d ,. +l ,. _fr
,) Rkcromood,7 0"TACT So,a sA CA Nrr A6,AvVor+s✓7' k1k_0 ViG Wtt/i
6A T.
Reviewer/Inspector Name va1� 6tU .. Phone: L lie)
Reviewer/Inspector Signature: 9A Date: s* ! o
Page 2 of 3 12128104 Continued

Facility Number: 6 7 -93 1 Date of Inspection J4
e
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 appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes L!1 No ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes ZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ 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? El Yes �.*o El NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes 6dNoo ❑ NA El NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes [ ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes El No WNA
'A ❑ NE
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
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,[J
Cf 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?
ElYes
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
2rNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,�/
LJ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Additional Comments"and/or.Drawings
Page 3 of 3 12128104
Page 3 of 3 12128104

Facility Number '� 3
,r.
"ivision of Water. Quality
I.'Division of Soil".an"d Water Conservation
hOthee' Agency
Type of Visit 600mpliance 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: 3 07 Arrival Time: i S Departure Time: County: d NSLa J%) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: GA fzy Gm T A)
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 4 Longitude: = ° 0 1
• w t
Design C'ur`rent Design ` Cut`rent. Design`; Current
s�Swine..,Capacity; Population, Wet Poultry .. Capacity "Population= . Cattle - Capacity Population,
ElWean to Finish ih ❑ Layer
Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish --
❑ Farrow to WeanD'ry Poultry
❑ Farrow w Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
0-Non-Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
i
Number.:of Structures:
Discharges & Stream impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes [ o ❑ NA ❑ NE
❑Yes
❑No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
N
❑ Yes
Q
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: ] — 3 Date of Inspection
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 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 4 4 CEV AJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes UNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �Ko ❑ 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 environmentaZo
eat, notify DWQ
El7. Do any of the structures need maintenance or improvement? Yes ❑ NA [:1 NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;]'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P40 ❑ NA ❑ NE
maintenance or improvement?
Waste Application , ,�
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LEI i o ❑ NA ❑ NE
maintenance/improvement? ,/
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
t2. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0NoElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
01 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
CY*No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other. comments:.
Use drawings of facility to better explain situations. (use additional pages as necessary):. .
GRo p Y.V-.Lb Veanr6D1 INAMU ,r
T
Reviewer/Inspector Name - p _ - - _._ Phone: 416
Reviewer/Inspector Signature: Date: ']
Page 2 of 3 12128104 ` Continued

Facil1143�Nunnber: 67 — Date of Inspection � a
Re uired Records & Documents ,_,/
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes L.� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes D o ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
D o
❑ 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?
ElYes
0 NNo
ElNA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
ElE'
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑NA
❑NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YNO
❑ 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
9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E 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
CJ 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 Igo
❑ NA
❑ NE
General Permit? (icl discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0"NNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility umber Division of Soil and Water @onservationMWIA
Q Other Agency
Type of Visit Z Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral E) Emergency J0 Other ❑ Denied Access
Date of Visit: / Z Q Arrival Time: eparture Time: D County: 41seg 4J _ Region: �r
Farm Name: TdQ%/{F�PS /Vrr/�SFGZ/ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
�%/�GT� �✓ Phone:
Facility Contact: Title:
r
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator: Qt
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = 6 0 Longitude: = ° = � = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population,
❑ Layer
pQ I ❑ Nan -La et
Dry Poultry
Non-L.
Pullets
Poults
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da 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 AKNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
,ONo
❑ NA
❑ NE
12128104 Continued

Facility Number: (p — S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VNo
❑ 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?:
esigned Freeboard (in): 0
Observed Freeboard (in): 2 Q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ONo
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ;TNo
❑ 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 ZNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ONo
❑ 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 XNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application`? if yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ vidence of Wind Drift ❑ Application Outside
of Area
12. Cro type(s)
p
13. Soi I
type(s)/��_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ONo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes /No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination` ❑ Yes ONo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes P No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes /0 No
❑ NA ❑ NE
�lrl /2 CiJ�cf�/,�o xa/va ov /4,�D/ur �yB�i�� Lao0, no,4,4 445' 4wy0,✓,C
/d 1T7��fs-r L-.Po,� L(J�UI.a Gl�,�. v .��.s.,� /T�'�- �a fps �X/�G?.A..��—�..f/aR,•
-�/9,0 � 9<<� /�c0�4-�,Ec��i✓q� �G o�larrl s� �ir1.� `� ' A' �py&
A107-
/�d,EST
Reviewer/Inspector Name
�— — - Phone: (9110),796 Zlo11
Reviewer/Inspector Signature: Date: /
12128104 Continued

Facility Number:& Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA VNE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall Cl Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA X,NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes El No El NA XNE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA WNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA )zNE
26. Did the facility fail to have an actively certified operator in charge? ElYes ❑ No ElNA • VNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA )ZNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes ❑ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes "'ONo ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ,"No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes XfNo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application) ,.,!
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [I Yes I� No El NA [I NE
33. Does facility require a follow-up visit by same agency? ElYes/ No ❑ NA ❑ NE
Atlditioioal Comments and/or :Drawings:
✓� /7 � /<<D ''� ��'I. , Cr,,��/v7Z �� ' � ��2/4' C.i/� Ti f � is'L. � LC
J:P LA)mP
V)
�co�S� �D ��rC��S, •
N 2y� �
/I rlCy�!/ZAL 7i��NE fly- /)
12/28 04 2042 %
��F

(;Division of Water Quality
Facility Number Q.;DivisWn of Soil and Water Conservation,,
-Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: f ti Arrival Time: t Departure Time: County: aA AP� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative: " At�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 c = ' = Longitude: = ° = 6
Design Current Design Current Design Current
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
❑ La er
❑ Non -Layer
Dry Poultry''
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number pf 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 ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
o
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: 17 — Q 3 Date of Inspection d
';Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): 2
Observed Freeboard (in): L
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 J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0No ❑ NA ❑ NE
❑ Yes [�'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes d ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 7No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) dNo
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes u No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes MNo ❑ 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) 9 W
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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
QNo
❑NA
❑NE
E2(No
❑ NA
❑ NE
EX No
❑ NA
❑ NE
[;rNo
❑ NA
❑ NE
Lim)
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any otbeir: comments. .
Use drawings of facility to better'ezplain situ ahons:�(use additional pages as necessaey):
�.i.� ,eop re Mac NT'Zc-L-1) F6� ,
•
Reviewer/inspector Name - - -FA Phone: Q ros
Reviewer/]nspector Signature: Date: �C
Page 2 of 3 12178104 Continued

Facility Number: — 3 Date of Inspection
Required 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
iYes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Wly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers
❑ Annual Certification
El Rainfall El Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
No
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
[To
❑ NA
❑ NE
24,
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
[344k
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
&r &A
[:3NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
ET<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
2NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L( 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
(�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
[,—Ko
❑ 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
EfNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
u No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Crpliance 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: LI S Arrival Time: j Departure Time: County: ON��LN) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: I Title: Phone No:
Onsite Representative: _- C A WY Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ED' ❑ « Longitude: = ° = 1 ❑
11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
dUoo I X76 [ ILI Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy 1-leifei
❑
Dr Cow
❑
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 E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
El NE
❑Yes
o
El Yes
,❑
(iN
[I NA
El NE
El Yes
Ld No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection 12
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 Structure 2 Structure 3 Structure 4
Identifier: WaviJ i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a�
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?
Cl Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes 2(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t�h at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7N�o
ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
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 ElILI Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑�Evidenrce of Wind Drifl ❑ Application Outside of Area
12, Croptype(s) Wrl CA—r < 01655`3
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%[]
Yes
a o
ElNA
❑ 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?
ElYes
No
❑ NA
❑ NE
'20 TRAl- fsR� P,-P* OFEWTE Oe' rt.+✓�s _146' C-AM6 Wm (-a GUE�.� tz�r'n L
po I'' S_r4spt:c,i_rxoL-) Aa,D CfLOP Ck_os, LWEC1a`(
ReviewerlinspectorNameoH�' (_,L,�+�k�.,.';' Phone: /0
Reviewer/Inspector Signature: Date: 1. o
12128104 Continued

' • rr�--��
facility Number: — Date of Inspection'T`-'
Regurred
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
,.
El NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
zo
❑ NA
❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
17(yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil nalysis ❑ Waste Transfers
El Annual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections Monthly and l"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E1 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L/I No
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ElNo
ZIA
A
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ M-
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LJCo
❑ N
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,�
LJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[,'�<o
❑ 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
PNo
❑ 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 No
❑ 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
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;7No
❑ NA
❑ NE
Additional Comments; and/of Drawin s
12128104

Type of Visit A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
Q Not Operational Q Below Threshold
j� Permitted © Certified © Co (radii' pally Certifiey[L3j 'stared Date Last Operated or Above Threshold•Farm Name:" . ..1 .. ��lV...S. ,( Tf� .eQ..JCounty:...... 1�!{ G .'G�.........................................
OwnerName:........... . /. �'��......./ .... ,� IC�....... ....... Phone No:.................................................................................... .
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
FacilityContact: ................. ................ Title:................................................................ Phone No:................. ..........................
&.Onsite Representative :....t'.......,���Q.,�.............................. Integrator: ..��1���..-....
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude ' 4 it
Discba Zes 8 Stream lrnpacts
1. Is any discharge observed from any part of the operation? ❑ Yes )ffNo
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 gallnzin?
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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes )ErNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;RqVo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ................................... ................................................................................................................................................................................
Freeboard (inches): 35
12112103 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes WNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes �No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ';E"No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 2r�o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 0'1 o
elevation markings?
Waste AaRlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes �No
❑ 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 Animal Waste Management Plan (CAWMP)?
❑ Yes
00
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
J2%
b) Does the facility need a wettable acre determination?
❑ Yes
eNo
c) This facility is pended for a wettable acre determination?
❑ Yes
DINO
15. Does the receiving crop need improvement?
❑ Yes
j2No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ;;�<o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes eNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes dNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [ Wo
Air Quality representative immediately.
Cap, /7&a72 47A( 4rr1,Pr
Reviewer/Inspector Name4'
Reviewer/Inspector Signature:
❑ Field Copy ❑ Final Notes
Date:
f9/i-1 AIN9
/_­'__. _J

1
)Facility Number: 8.3 Date of Inspection
Reauired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes J:;Wo
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
2'No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
C;Wo
❑ 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
01�o
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Lallo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
L'No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
PNo
28.
Does facility require a follow-up visit by same agency?
❑ Yes
C?No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑' io
NPDES Permitted .Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
12'No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit OCompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit oRoutine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number r] Date of visit: L
Permitted [] Certified [3 Conditionally Certified Q Registered
Farm Name: - W4 1�an d5Ao-YUfjl I1.1I117il
Owner Name: Gam+ ar f 7 wq 1'0 �'t
Mailing Address:
Facility Contact:
Onsite Representative: G �' rt 14 e,
Certified Operator:
Location of Farm:
Title:
Time: Z O
Date Last Operated or Above Threshold:
County: 011111110 0 W
Phone No:
Phone No-
Integrator:!'Vi,��ph tg _^at�✓'�
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude e & « Longitude �� �4 L[
3.
Design
Current
Design Current
Design Current
Swine r,
Ca aci
Po "u ation
Poultry Ca aci Po ulation Cattle
@a aci P,o rulation
❑ Wean to Feeder
1 1
❑ Dairy
❑ Feeder to Finish
❑Non -La er
1 10
Non -Dairy
❑ Farrow to Wean
"
❑ Farrow to Feeder
❑ Othcr
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
a
NMI Total SSLW
❑ Boars
Number of Lagaans 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps
0 ❑ No Liquid Waste Management System
Discharges & Stream lmoacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZNo
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 Zj No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection 84 Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ YesNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches): 31
05103101 Continued

Facility Number: — $ 3 Date of Inspection ZB D
5. Arc there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste AADllcation
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ff __❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type $v Qe;�✓\S, vlQa7
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?
Rego fired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20, is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes- XNo
❑ Yes 4 No
❑ Yes /FlNo
❑ Yes FIINO
❑ Yes No
❑ Yes -No
El Yes �'No
❑ Yes ;2No
❑ Yes P No
❑ Yes P'No
❑ Yes /gNo
❑ Yes 7No
❑ Yes gNo
❑ Yes P No
❑ Yes EfNo
❑ Yes )allo
❑ Yes —ONO
El Yes P"No
❑ Yes No
❑ Yes No
❑ Yes gNo
❑ Yes ONO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to,question #} Explain anyXES answers and/or a�nyyr.i commend onsior any. other comments
-
of�l3sedngsfacility o betterex ainsituatlons.1(useradd`iutional pagefstassnq+ecessary) Field Copy FinaNotes
i ...... ,
Iti�S G,
w�,pnrf . tie jA�a�� end Swr��t? ��se gr'e°L i3' Wet( MWeal .
nd re c o,-A s q re hea��t� ke�-� . -Tk",q k
��44e
Reviewer/Inspector Name 5�'2G'y✓,��1 q.- t:v r.. :..�> ors.,
Reviewerlinspector Signature: Date: 2 8 0 3
05103101 Continued

Facility Number: % -- 3 Date of Inspection 2 O
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes J2No
❑ Yes ANo
❑ Yes Vf No
❑ Yes No
❑ Yes "Feno
❑ Yes ❑ No
Additional Commerits;andlor�bravi�ngs '" ... „ * y.. ` V7.
r
w
05103101

Type of Visit .Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit J012outine 0 Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit:
C1 Permitted [3 Certified [3 Conditionally Certified [3 Registered
Farm Name:
Owner Name:
Mailing Address:
3 zb is Time: • 34
N t O erational 0 Below Threshold
Date Last Operated or Above Threshold:
County: DYE'S 1 Ot' i
Phone No:
Facility Contact: /+ Title: Phone No:
Onsite Representative: C �t' Ll on Integrator: _.!!I U4eP1t �
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 6 Cf Longitude 0' 6 [[
Design Current
Design Current Design Current
Swine Capacity Population ,
Poultry
Capacity Population Cattle Capacity Population
Wean to Feeder
2 (QD
-2 3-3
❑ Layer
❑ Dairy
❑ Feeder to Finish
❑ Non -Layer
'I
Non -Dairy
I
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design acopacity -'
❑ Gilts
❑ Boars
Total SSLW
umber of Laizoons.
Discharges _& Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b, if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Freeboard (inches): µ V
05103101
❑ Yes
[2(No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
O No
❑ Yes
Mo
Structure 6
Continued

Fadlity Number: — ?� Date of Inspection I J1�1 6JL'�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ,�No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ZNo
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11, Is there evidence of over application? ''-- rr❑ Excessive Ponding El PAN [I Hydraulic Overload ❑ Yes 0 No
12. Crop type 5Q r�CG ►1 < UV he4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 1zNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes J;27No
b) Does the facility need a wettable acre determination? ❑ Yes VNo
c) This facility is pended for a wettable acre determination? ❑ Yes 7No
15. Does the receiving crop need improvement? ❑ Yes XNo
16. Is there a lack of adequate waste application equipment? ❑ Yes )ZNo
Required
Records &Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
j2rNo
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ONO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
,ETNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
eNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
/E5No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
gNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
gNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
F .
Comments ,(refer to,questton ) �&01ain a'ny'YES a sn wers andlbe a y rec mmendations or any other comments:
FUse1drawings of facility to b er,expl8inxsituations: (use additkmaltp'ages as ecessary} +`' ❑Field Copy ❑ Final Notes
$ 4 r r re l ewe -Va �anf 4;
(ab d��S-
1?e StreB �Se a t�As-{e' GylaL�rs►'s d4cd t,�r-� �� a-r
a�� 1; eAs ; o PI even-� S �o G4 lewl a-�e Ae n i ��d of n a1°P!'eof P*t 4t e _Te -Z'
Tt, e �a G f i -� � L rOjel As A f%e e ol'dS are j v ejj
Reviewer/Inspector Name
Reviewer/Inspector Signature: a5aTewDate: Z
05103101 Continued

J Facility Number: 6,17 — 3 Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes YfNo
❑ Yes ONo
❑ Yes JZ No
❑ Yes Z[No
❑ Yes ONo
❑ Yes JZNo
❑ Yes 'RNo
05103101

'
•i
Division of Water Quality 1 i
Division Water
vl i - >t E.� E
•!
oll and ater Cbjiservatlon' ,'' Sri` 1' t
W
1 ! �M,. !
O er Hgeneyyo- tt [ i IJ
OthO �,h;€ t -.! � 3 �i !
! 1
„!
_A � ' r � ; !r 43 0
e dfi
.� �s�i: `. `�. ..fs,
r. .. ': n : ,.fir i> ,,
:., .,,, _'; .. .. E• ., ti - __ _ h. ,. �
Type of Visit KCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: [i " —C1 Time: QCi Printed on: 10/26/2000
Q —Not-operational Q Below Threshold
Permitted 19Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold
Farm Name: .........1NG.1`C� S .�-•�32' .. .. ... County:...........................................................................
.. ................... .......... 1c U
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
Facility Contact: ..............................................................................'Citle:-.............................................................. Phone No:
...................................................
]MailingAddress: ................................................... ....:.................................... ..........................
Onsite Representative: , , �, .. Integrator: .. T1--� .....I....I.........I......... ..........
.. ......................... -............................................. ............ ..
Certified Operator: ................................................... ............................................................. Operator Certification Number:.............................
Location of Farm:
I'V
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��° Longitude �' �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry_ Capacity Population Cattle Capacity Population
Wcan to Feeder 2LG6 ❑ Layer I ❑ Dairy
❑ Feeder to Finish ❑ Non-LayerI 1 1[:] Non -Dairy
[:]Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds 1 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. II' discharge is observed. what is the cstimatcd flow in gal/min?
d, Does discharge bypass a lagoon system? (Il'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
❑ Yes V No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
KNo
❑ Yes
AiNo
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes &No
Structure; 1 StrUCtUrc 2 Structure 3 Structure 4 Structure 5 Structure 6
ldentificr:.................................................................................................................
.............................. .................................. ............... .............. .........
Freeboard (inches): `3 LA
5100 Continued on back

Facility Number: T� — 3 Date of Inspection Printed on: 7/21/2000
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 ONO
(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?
❑ Yes
D�No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
H. Is there evidence of over application? ❑ Excessive Pond((ing ❑ PAN ❑ Hydraulic Overload
❑ Yes
boo
12. Crop type VeeP�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
A No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�tNo
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
kNo .
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required 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?
9No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
kNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[XNo
22. Fail to notify regional DWQ of emergency situations as required by General Pert -nit?
(ie/ discharge, freeboard problems, over application) ❑ Yes kNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes KNo
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
�v ON06ris:ot de�ciehdc� -*t re noted• d&ifig -thjs;�isit: You WHI- eedVice •rio further. •; ;
�or'res onde' & a�' ' th' visit. • ........
Comments (refer to question #). Explain any YES answers and/or any recommendations or any. other comments.
'Use drawings of facility to better explain situations. (use additional pages as necessary):
Yeef t- f
od'l AL
C,
a� = 1$4 {- ��� 1C_t--�� C'�t��� �'�l�.c�,� , w-a��� C�R.�'� G}--s• a2t �`-�ea---. w
Reviewer/Inspector Namet���
Reviewer/Inspector Signature: Date: 5100

' Faci rty Number: q — Date of Inspection G 7 Printed on: 7/21/2000
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ❑ Yes WNo
liquid level of lagoon or storage pond with no agitation? , \
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 4No
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 N No
'Additionaomments an orDrawings:�To -!!�Av(�- g PL A,
7'
J
5/00

Division of Water Quality
0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit x
Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit xRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: r{,U Time: 4 C} Printed on: 7/21/2000
Qrational 0 Below Threshold
U Permitted Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: .....S:................................................ Count`:...G1^.�IGta.........................................................
.......................
OwnerName...•................................................................................................. Phone No:.......................................................................................
FacilityContact: ..............................................................................Title:................................................................ Phone No:...................................................
MailingAddress: ............................................................................................................................................. ..........................
Onsite Representative:.."`*e................................................................................... Integrator:........ �*4 " 1I.................................
I.................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
F•
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� ��° Longitude �• �� �«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder �j4 I JE3 Layer ❑ Dairy
❑ Feeder to Finish JE1 Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish I Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons JE1 Subsurface Drains Present I ❑ Lag«nn Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed From any part of the operation? ❑ Yes , No
Discharge originated au ❑ 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) [3 Yes ❑ No
C. II' discharge is observed, what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes 4No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 1�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes E�No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .................................... ................................... .................................... .................................... ....................................
Freeboard (inches): ?,)L—
5100 Continued on back

ti Faciyjty Number: — 73 I Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity ol' any of the structures observed? (ie/ trees, severe erosion, ❑ Yes VNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes WNo
(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 O 'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 2(No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [ no
11. Is there evidence of over application? ❑ Excessive Ponding P<PAN ❑ Hydraulic Overload WYes >
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes J4 No
14. a) Does the facility lack adequate acreage for land application, ❑ Yes tTNo
b) Does the facility need a wettable acre determination? ❑ Yes KNo
c) This facility is pended for a wettable acre determination? ❑ Yes fi No
15. Does the receiving crop need improvement'? ❑ Yes ONo
16. Is there a lack of adequate waste application equipment? ❑ Yes ,gNo
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
ONo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
❑ Yes
XNo
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
gNo
21.
Did the facility fail to have a actively certified operator in charge'?
❑ Yes
N No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard prohlems, over application) ❑ Yes VNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes kNo
24. Does facility require a follow-up visit by same agency? ❑ Yes b;�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONo
Nd-y, h idris'ot dtt'icienties were rioted d(Wing �his'visit;- Y:ori wHI-teceiye Rio fufthef .' .
' corres' oridence'abbu* f this visit: •
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
II 1°I �e�t ate nUe yew ►���,(�,
���.\� r���Z,� C�-i-,s�?� �� ��St ►-� Y��cc�J �� ���—��G-., Key
Ly
Se—
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:=_".. 5/00

F*ility Number: — Date of Inspection `1 G4 Printed on. 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor heiow ❑ Yes *0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes X(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 19No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0 No
Additional Comments and/orDrawings;
It V--'1 L-" C'-� '�4 9 L-,-' Ak' <A
5100
J

Revised April 20, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number 6
Farm Name: �+-
On-Site Representative: �--�
Inspector/Reviewer's Name:
Date of site visit: q-1 r�
Date of most recent WUP: —�
Annual farm PAN deficit: '1`57 pounds
Operation is flagged for a wettable
acre determination due to failure of
Part 11 eligibility item(s) F1 F2 F3 F4
Operation not required to secure WA
determination at this time based on
exemption E1 E2 E3 E4
Operation pended for wettable acre
determination based on Of) P2 P3
Irrigation System(s) - circle #:Qhard-hose traveler; _2. center -pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part II, overrides Part 1 exemption.)
El 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 by a WUP.
E4 75% rule exemption as verified in Part 111. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11- F9 F2 F3, before completing computational table in Part 111),
PART 11.75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements. WA Determination .required .because.operation falls one of the eligibility
requirements listed below:
_ Ft Lack ofacreage:whichTesultedin-over mpplicaiionmf-wastewater,(PAN) on -spray.
field (s) according-toJarm'sdasttwoyearsnf-in igation-yecords.--.
F2 Unclear, -illegible, -or lack of information/map.
F3 0bvious�field-limitations -(numerousid itches ;faiiurelo_deductsequired.-,..
bufferlsetbackmcreage; -or25%':of total-acreageaderi fieddn-CAWN1R. indludes
small ;-irregularly-shaped .fields = felds-lessthan-5 acres -for travelers-or..less-than
2 acres for. stationary -sprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in Part 111.

Revised April 20, I999
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
FIELD NUMBER'- hydrant, pull, zone, or.pomt numbers may be used in place of field numbers depending on CAWMP
and type of irrigation system. - If pulls, etc. cross more than one field, inspectodreviewer will have to combine fieids to
calculate 75% field by field determination for exemption; otherwise operation will be subject to WA determination.
FIELD NUMBER' - must be clearly delineated on map. Y
COMMENTS' - back-up fields with CAWMP a cfeage-exceeding °75% of its total -acres and having received less than 50%
of its annual PAN as documented in the farm's previous -two years' (1997 & 1998) of irrigation records,- cannot serve as -the
sole basis -For requiring a WA Determination.:.Back-up fields must,benoted in the -comment -section and must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
./ P1 Plan.. lacks. following -information: ��5 h2s s
P2 Plan -revision may:satisfy'75% rule based on adequate overall PAN deficit and by
adjusting all field -acreage -to below 75% use rate
P3 Other (iehn process of installing new irrigation system):

'r
0 Division of Soil and•Water'Conservaaon Operatran Review
�,'
O Division of Soil'and;Water Conseryahon Inspection
:Compliance r „
ivision of Waterualrt om Nance
i.
-._Compliance
g ,
Er
A ene
onReQa
fr i a(c -,�
�,.. ,3-
w'©Other
JWRoutine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
0 Permitted ElCertified [] Conditionally Certified 0 Registered-10 Not O erational Date Last Operated:
Farm Name: ...."Y. �.....1.`L �T�'2......................................... County:...........�. ........... ............. .......................
OwnerName:........................................................................................................................... Phone No:....................,..................................................................
FacilityContact: .............................................................................. Title:...................................................... Phone No
MailingAddress: ....................................... ................................................................................................................................................................... ..........................
Onsite Representative: Integrator: `�...........
I .! ......
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
A
..I ............... ............................... ................................................. ............................................ ...... V
Latitude • ° Longitude • �� �tz
. ' :. 'rCrrt'
Design Current, Current Dest
eCwin—Capacity Population' a acat Poulation aftle�' Capacity Poiulation.S'.
Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ' ❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
F' ❑Farrow to Feeder
❑ Other
❑ Farrow to Finish '' ° Total Design Capacity
❑ Gilts. ` „� , .
❑ Boars Total'S,SLW
f Sixinber of.Lagoons.. , '' ` ❑ Subsurface Drains Present ❑Lagoon Area JE3 Spray Field Area
Holditi Ponds / Solid-Tra s
g, p ❑ No Liquid Waste Management System
Discharges & Stream Iml)acks
1. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`? ❑ Yes [I No
b. If discharge is observed, did it reach Water of the Stale? (11'yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/tnin?
d. Dues discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [XNo
3. Were there any adverse impacts or potential adverse impacts, to the Waters of the State other than from a discharge? ❑ Yes RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes [XNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): 3S.................................................................I..................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes P(No
seepage, etc.)
3/23/99 Continued on back

Fatality Number: n — (late of Inspection
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 XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes tNo
Waste. AnDllcation
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
VNo
11,
Is there evidence of ovcr application? ❑ Excessive Ponding ❑ PAN
[I Yes
f}]'No
12,
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
rcrNo
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?
RYes
❑ No
15,
Does the receiving crop need improvement?
❑ Yes
gNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
�No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
XNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
bnCYes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
t'No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
0 No
(ie/ discharge, Freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
19No
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
P�'No
0: Rio yiolatiQris:ot dgficiencfes ►vere i>tQte� d riiig (bis'visit. • ;Y;oii'wiil•teb0i*O ti6 furthor
corres• oridence: about. this viisit. : :
C©mments {refer to question #);`'Explain any`YRS answers andlor anyreci of iinendations or any other comments
UJ a drawtn s of:f g aciLty to rybetter;expla�n,situatinns (tin addihonal,pages as necessary)
KQ W �,NQA rA� �T� V�QQCQ
ttrr jj
t 1�� � �►-, SC ��vQ i -4-- Car � ii-c-�5����ti S�� GC►-e��.e.�
Reviewer/Inspector Name1.
Reviewer/Inspector Signature:- Date: clef
3/23/99

Facility Number: — Date of Inspection]
OdOr .JSSneS
26.
Does the discharge pipe'from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
4NO
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
9 No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
MI 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
KNo
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
ANo
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
3/23/99

.0

-. . L
k ❑Division of Soil and Water Conservation [] Other Agency
>`k sion of Water Quality .
kEoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other01
}
Date of Inspection / r>
.Facility Number
Time of Inspection '' 24 hr. (hh:mm)
D Registered fiertified 13Applied for Permit 13Permitted [3Not O erational Date Last Operated:
Farm Name: IAIACC
,rI.11. I,.... . 5 .................4go✓...r County:..........................:.................................................:...
/' ...........�
Owner Name:..�.i A., A � 6/.........�/IL�Y..�+�....................... Phone No:..,�..��C���.......................... ............
FacilityContact: ... ................. ....�....... .....:..:...............:,.:................ Title:.................,..... Phone No: .............................:....
Mailing Address: ..J.�1-, .. .....!?' J ......................................:....... ...:. r:r.. .G...................................... .2 !...7./
...
OnsiteRepresentative:.. 4..QiI.............. g
, ............................. Integrator: .......... 4/. ,........................................
Certified Operator......... ... ... .......... .......... .... .... .................... Operator Certification Number......................
Location of Farm.
.... . ... ......... . . ........
M 1111 ��I ��I 1 Mc
C
Latitude • t ac Longitude + ` "
Design "Current
jCapacity Population 'I Poultry..
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
❑ Non -La
F ,
❑ Other
Des' ' Current
Capacity Population Cattle
`xz
ILl Non-
TotalDesign Capacity
Total SSLW
"Design Current
Capacity; Population
Number of Lagoons 1 H�►lding Ponds: l ly ❑ Subsurface Drains Present �i] Lagoon Area Ip Spray Field Area I
�a
❑ No Liquid Waste Management System
x
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
§2 No
2. Is any discharge observed from any part of the operation?
Yes
Z No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
;14 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
0No
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
tE�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
P�No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
9 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
rO No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0 No
7I25I97
Continued
on hack

Facility Number: 0
-
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ONo
Structures (Lagoons,Iloldine Pods, Flush -Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ifNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft): .................... .......................................... ........ ......... ................ ............................. ..........
..............,.....................
l0. Is seepage observed from any of the structures? ❑ Yes JRNo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes RLNo
12. Do any of the structures need maintenance/improvement?
(If any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............... g_.�.t....................................................f5:..(7............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Fi cilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No. vitilatiohs-ot: de' iciencies. were noted daring this'. visit. :Yoii m' receive n6l 'the'
corresp6Wence about this'visit:• :: .:::: :.:..: .
e:p-" /I il rt,4- . -
❑ Yes R�No
❑ Yes [No
❑ Yes 2 No
❑ Yes Z No
❑ Yes
,QNo
❑ Yes
JO No
❑ Yes
R No
❑ Yes
fM No
❑ Yes
41a No
J&Yes
❑ No
❑ Yes &D No
❑ Yes ® No
❑ Yes ® No
7/25/97
Reviewer/Inspector Name
f Reviewer/Inspector Signature:
Date: /.0 /Z'

Date of Inspection
Facility Number '7 $
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
Certified ❑ Permitted or Ins section includes travel and processing)
❑ Nat Operational Date Last Operated: ......................................... . ........................... ...............................................................................
�. Farm Name: ...... j.jr. 1........ &D5......... N.U.me ........................................ County: ....... OXUt/l(�1.............. _...................... .......................
Land Owner Dame:...�`.2t'a9...... �:L_.�fP9!'l...... ....IFlo.1. ............................. Phone No:.. `1 �. �.`.q4al....................................
Facility Conctact:...t�.1/51IJ....... VfJ.t,C%..................................... Title: ....4.&arwr........................... Phone No: .............
MailingAddress:........ ......t K.......................................................... ........ S.r...EVE............................. zln.........
OnsiteRepresentative:...........,P 11R.............................................................. Integrator: ... M.Vk�..............................................................
Certified Operator: ............. ................................... ....................................... ....... . ............ Operator Certification Number: ... v Mi l................ ...
Location of Farm:
Nun
tee pt<
Longitude
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
� �a.�PrwC. Z
�,r�lJ c�
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 Surface WateO (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?
on
❑ Yes I$ No
❑ Yes 04 No
❑ Yes E� No
❑ Yes [ No
❑ Yes fA No
❑ Yes C, No
❑ Yes 5' No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/3 U/97 maintenance/improvement?
[Yes ❑ No
Continued on back

Facility Number: ... 1'ir......... ....1.3...
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
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (Jjatroons and/or }folding Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
................ .. ............................ ............................ ............................ ............................
............................
10. Is seepage observed from any of the structures?
❑ Yes
KNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
El Yes
❑ No
12. Do any of the structures need maintenance/improvement?
JU 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
19 No
Waste Appligation
14. Is there physical evidence of over application?
❑ Yes
P,No
(If in excess of WMP, o_r+ruinoff entering waters of the State, notify DWQ)
15. Crop type ......CD .w4d...... .......... ![�4 Uc:..................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
FX No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
§& No
18. Does the receiving crop need improvement?
E. Yes
❑ No
19.
Is there a lack of available waste application equipment?
CR-Yes
I&No
20.
Does facility require a follow-up visit by same agency?
,Yes
0 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Certified Facilities Only
❑ Yes
P%No
For
22,
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
JR No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
RNo
24.
Does record keeping need improvement?
E$ Yes
❑ No
CorrirrtentsH{refer to questidn #) Explain any YES answers and/or any recommendations a'r any other comments.'
Usery) drawings `af facility to better�explain situations x,(use additiona pages as necessaF
5• (r•rcY' OA 5154t�k 4•as MOO _ be ev- i r)S-Wl ed. Mr- ; s us;") a,. zy�
0 ') i s ion, 1
l l•/!z. 6oilon a.m% p v. `�.� ln,rulr�ou►f W_���_�} A ` L toym �s6tIJ Lc.
a4 1�.seeele�. re -.0e kt o 6e nse.
igq•C--apas�� Cro 1ti.�t)S t+n+�`+�rcx-. p .
- I • l vl i�ct/ {�p,I�"� C� l �%U�'� br Y1� � <JS2� i'6� � m �l i
?A CeY iPs t! kh ,564 t e1UWe. i(YiJo f jon �tjesly , modmloy d ,
MQ irtj AG 61 `lam Lmll," fify C+ I '�}1 i Yt'f XR6K rtur�s ,
> > t 58
ce. uivtsion q/ rrarer Vuarrry, crater Sjuaury aecrion, racrrrry Assessment unrt 4/.3U/9 /