670086_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: 0 Compliance Inspection U Operation Review 0 Structure Evaluation U 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: © County: Sla Region: WW
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: C,CrjA K `y
Certified Operator:
l+ t"
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: jc� e) ?.0 4
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current Design Current Design
Capacity Pop. Wet Poultry C►apacity Pop. Cattle
Dai Cow
Current
0p.
Wean to Feeder
2 =JNon-Layer
Dai Calf
Feeder to Finish
Farrow to Wean
Design Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
cit P,o
Layers
Non -Dairy
Beef Stocker
Gifts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Pouits
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3
21412015 Continued

acili Number: -VU jDate of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 13-S-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes W 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 N 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 "f No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes C'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 T No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IgNo ❑ NA ❑ NE
maintenance or improvement? ��iC
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes AyNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ 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): VYK"4j
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
LM No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[X No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
V No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
❑ No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[nj No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1�No
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Facili Number: - Date of Inspect!on:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes IgNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes t No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No gNA ❑ 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)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑Yes No ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [' ZNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
[NNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative? ❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
❑ NA
❑ NE
INd" 0vp� J Oarruf
Reviewer/Inspector Name:
Imo` &
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 111 `� u_ -7 D +
Date: to Iz5
( o
21412015

(Type of Visit: a ZRoutine
pliance Inspection U Operation Review p Structure Evaluation O Technical Assistance I
Reason for Visit: ()Complaint 0 Follow-up O Referral O Emergency O other O Denied Access !!
Date of Visit: Arrival Time: ® Departure Time: County: 4PA.&,0 Region:
Farm Name: Owner Email:
Owner (Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ge"-1-a o4oRi k_4j
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pap.
Wean to Finish Layer
Design C*urgent
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
E]
DairyCalf
Feeder to Finish
Farrow to Wean
Design Current
Dr, P.qultr, Ca aeit Pao
Layers
DairyHeifer
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
TH
Non -Layers
Beef Feeder
Boars
t7ther
Other
Pullets
Beef Brood Cow
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made'?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes ❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes 90
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
El No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Racili Number: - Date of Inspection:
Waste Collection &'Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: u4G06a
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 WNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ YesVNo
❑ 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 D NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VINo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [� ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ZINO ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes F:3' '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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L-]4o ❑ 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

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm ? ❑ Yes �No
❑ NA ❑ NE
Z5. 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 Nd❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[✓/NNo
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
[3/No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
ReviewerlInspector Name:
ReviewerlInspector Signatut
Page 3 of 3
❑ Yes
LJ No
L"J No
ICJ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone 0 b !
Date: 5
21412015

_w
Type of Visit: p Co Hance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance t
Reason for Visit; Routine 0 Complaint 0 Fallow -up 0 Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit: Arrival Time: w P Departure Time: Q County: On 3 10 � Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: r ( Title:
Onsite Representative: l _ plar
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Fop.
La er
.Design C►urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder Z4oa 2 Z
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
i) , P.oultr. C►a aci P,a
Layers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
O.tber
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [ENo ❑ NA ❑ NE
[:]Yes [:]No
[—]Yes [:]No
❑ Yes ❑ No
(:]Yes �No
❑ Yes Q No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

r
F'acili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CE"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2 Structure 3
`Z Tj
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 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? 12/y es ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [nrNo ❑ 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 [V]/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [�fNo ❑ NA [] NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes EE�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? []Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes (No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ENo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes [1/]No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
dYes
[]No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
ff No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio;No
❑ 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
Ei/No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �7o
"❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? Yes ❑ No ❑ NA ❑ NE.
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ICJ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes 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
E3"'No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
/No
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
t❑i ❑ 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:
No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
To ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
D o ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or a.ny additional.recommendations.or.."y, other, comments.,
.
Use drawings of facility to better explainsituations`.(use additional pages as necessary},
p'
�J(OOM 7�`«lr/��LijJ� ff011L I',51CbQ L{�rlte Wtt�r.
P -f c Go , l r T wl P C !J rj
Reviewer/Inspector Name:
p4L. "I` � Qo a � I
Phone: 9I11 /-_
Reviewer/Inspector Signature:
Page 3 of 3
Date: 910 716 71,0�
21412011

(Type of Visit: UC mpliance Inspection U Operation Review O Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access II
Date of Visit: Arrival Time: Departure Time: County: 0^),5U3tj Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: r:'/�_
eLMLQ 1 r k�ay Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 9 � 22,0q
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine
Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dair Cow
Wean to Feeder
p
Non -Layer
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D a Poult .
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Turkex Poults
MLOther
Other
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 0No ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
[]Yes Vo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. rs storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0
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 UNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env' onmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [](No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
7
maintenance or improvement.
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes 2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload [] Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 0 o
❑ 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?
/�o
17. Does the facility lack adequate acreage for land application?
[:1 Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes §No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes Ld 110
❑ 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
D 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 2(N�. '
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes to
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: IDate of Inspection: 14
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25.•Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes dNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
VNo
❑ 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
V/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
dNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
EZ/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ##):. Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
e.qrt GACK� 1(- 146AW- N E Gb S Tu �3f �r3XE 0 , r.KW Cl-oofL.S Tj 134. TwvS p L-A- D
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 3 5
21412011

i ype or visa: �o pnance inspection v uperanon Keview v ,rruciure r.vaivanon ".J i eenmcal 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: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: lk"L1'n
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Currpent
Cattle Capacity Po.
DairyCow
Wean to Feeder
d
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Design Current
Dai Heifer
D Cow
Farrow to Feeder
Farrow to Finish
Dr, P,oultr. C.a aci P,o A.
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[:]NA
❑ NE
❑ Yes YNo
❑ NA ❑ NE
❑ Yes ❑ NA ONE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili ' Number: - Date of Inspection:
Waste Collection &'Treatment /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier: LA &yo
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): so --
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 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C24 ❑ NA ❑ NE
maintenance or improvement?
11. 1s 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?
❑ Y s
[e7No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
VN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
1-1YesJLJ
lac
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Ez�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
th r ri t b
e app op a e ox.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gNo ❑ 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? ❑ YesVNo
[] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili y Number: &I - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. [] Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E(No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
- and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
&No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
CJ 110
❑ 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
[a N
/N0
❑ NA ❑ NE
34. Does the facility require afollow-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 comments.
Use drawines offfacility to better explain situations {use additional nacres as necessarv).
rs) wEE.0 co�JTV4t, N&6Do
Reviewer/Inspector Name:
Phone: `WC116
Reviewer/Inspector Signature:
Date:
Page 3 of 3 1 21412011

F/rr
(Type of Visit: U7Routine
pliance Inspection U Operation Review 0 Structure Evaluation U Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: q Arrival Time: Departure Time: County: CWS&,p Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: G e R.41. fooss'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: -1 1 2-zoq
Certification Number:
Longitude:
Design
Swine Capacity
Current
Pop.
Design
Wet Poultry C►specify
C•urrcnt
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
p 6
Non -Layer
Dai Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Dr. P,oultr, Ga aei
Layers
Current
P,o ,
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
IFETO!
her
Turke s
Other
Discharges 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
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
090
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
�?)N o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facilit Number: - YL Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [] Yes /No NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I1 Structure 2
Identifier: Lq('o'oN
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 26
Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalkhreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J No [DNA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
�1 Y
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ490
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
jNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ 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
DNA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[:]Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facilitv Number: I.q - Vt 7 1 Date of Insoection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
d o ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
ti►e 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?
27. Did the facility fail to loss assessments
❑ Yes
❑ Yes
No ❑ NA ❑ NE
No NA NE
secure a phosphorus (PLAT) certification?
❑ ❑
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑Yes
❑ NA ❑ NE
and report mortality rates that were higher than normal?
YNo
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
o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[] Yes e❑ NA
❑ Yes [� ❑ NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or. any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).
ENT dau2s ? &/ ,D6-C. Z.0I1 f GAn-D � JC5T V"T `�E �oC Cale 'INN
GO
Reviewer/Inspector Name: d Phone: zi
— !
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Ski U4 IW ", ', 'a'3
kactll�tyNumier T�
_,��Di�v4is�on�ofW"a�erQual�ty=! i� ' ,
Type of Visit co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 4 i Arrival Time: ® Departure Time: County: dViL 5L./ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: CG ALD ."AL L Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = ° = 1 = " Longitude: =
\ F rvry f
Design ,Current ' `'�Design, Y C §xCurrent
a.r +t, t tt `.t #to-a'� urrentJ x
Swin a> s' r: ``Capacity 'Popula'tion, et,1'oultry ". Capac►ty P:apalgteon Cattlef„ �� g, I Capacity Population,
n'�R '°..:A'.'7� tI_ �g�iNrfL.e+ra. $ raa3 .} �n..e _Str.ras-,.a��ho..es:. e.,�.-
El Wean to Finish ; ❑ Layer
Wean to Feeder � 0 ❑ Non -Layer
i. ❑ Feeder to Finish a N' f " _ , k
r r
z ❑Farrow to Wean t ;+��-r. , $s +
' Dr Poultn 1
❑ Farrow to Feeder
.x�Y��"�� �y',
,k ❑ Farrow to Finish 3� ❑ Layers
k ❑Gilts l ❑ Non -Layers
❑ Pullets
❑ Boars i, i
1 ❑ Turkeys ,
O r i > k :. "t t =Vj� El TurkeyPoults ,1 n
` ❑ Other �:l� E-1 Other Nukmber'af SEtructures
a3. �s' .t.ry'tT 'i,�,,, :<15 � Tk iri _ e tc..x,..9' n
❑ Dairy Cow
12
❑ Dairy Calf
❑ Dai Heifer
❑ D Cow
❑ Non -Dal
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
❑ Yes
�❑�/No
7
❑ NA
❑ NE
❑ Yes
,L�/No
L7 No
❑ NA
❑ NE
12/28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
t9. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ElOther
❑ Yes L'J No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
,[?
L
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Ei'lgo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ErNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
too ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
C54< ❑ 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
EJ Ko ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
,_.,�
L'SNo ❑ NA
❑ 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
L?No El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104
Page 3 of 3 12128104

Facility Number: — &p Date of Inspection
Waste Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2rNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �a..
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Ycs IQ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /
6. Are there structures on -site which are not properly addressed and/or managed El Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑Yes No [I NA [I NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Epeo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes L"J No Cl 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
L:Nrvo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
;
❑ 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
2K�
El NA
El NE
18. is there a lack of properly operating waste application equipment?
El Yes;7No
❑ NA
❑ NE
Comments -(refer to question #) Explain any,YES answers and/or any rm ecomendations£orffiany other comments i , ``
�e4
Use dr,awings`of. fac€lily to better eaiplam situations: (use additional pages: as;necessary) p� .; a 1 t x,
Ak
7
Reviewer/inspector Name `3�-,�t i;,g } �. Phone: Q 0 qL
, I.
Reviewer/Inspector Signature: 2h4A4 A=Zd Date: L
Page 2 of 3 f 1 12128104 Continued

.1
f01 N 126
Type of Visit CopipHance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address. -
Physical Address:
Facility Contact: Title:
Onsite Representative: 9C- Q_A LD N1G Q LL�-`i
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = { = Longitude: 0 o 0' = «
Design C*urrent Design Current Design
Current
Swine Capacity Population Wet Poultry C>apacity Population Cattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
zo 0
I aDairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder ❑ Non -Dairy
El Farrow to Finish ❑ La ers
ElBeef Stocker
❑ Gilts Non -Layers ❑ Beef Feeder
❑ Boars ❑ Pullets ❑Beef Brood Cow
El Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CAO
❑ 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
[
❑ NA
[INE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
ElYes
No
❑ NA
❑ NE
other than from a discharge?
Page ] of 3
12128104
Continued

' Facility Number: — (D Date of Inspection `[ 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
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 ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [�(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C2(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [2 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
❑ No ❑ NA
[IN E
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
LJ No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
VNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[i ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
° `"" . ❑ NA
❑ NE
Coents (refer ta�yuestion`#): Explain any YE&answers and/or any rkbiyiniendations ur any ottier,comments mm
Use drawings of facility to better explain situations. {use add�t�onal pagesjasinecessary):'
T
Reviewer/Inspector Name 1' i ? :. .", s Phone: d Y
T. ,' .,
Reviewer/]nspector Signature: Date:
Page 2 of 3 / 12128104 ' Continued

Facility Number: 7 — Date of Inspection
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ICJ 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
L2No
❑ 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
2(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
i� o
El NA
[3 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,2NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L" No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�Xo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Q40
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
P<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
CI 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
`E No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q N
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:_ ,
Page 3 of 3 12128104

Type of Visit a7ROUtine
pHance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
a
Arrival Time: 1{
Departure Time: County: Ud/SL0 k.1 Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: G6>+fJQ3i.��
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: F__j ' = ' 0 Longitude: 0 0 = ` = «
ignurrent
111
III milli"' I
Designjji�
n Currentty
Popul�n
Wet Poultry C•apclty Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder 01660
Q
❑Non -La er
I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
El Farrow to Wean
Dry Poultry El D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers [I Beef Feeder
El Boars
❑ Pullets
El Turkeys ❑Beef Brood Cow
Other
❑ Turkey Poults
❑ Other Number of Structures:
❑ Other
Discharees & 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
El NA
El NE
2, Is there evidence of a past discharge from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
C No
❑ NA
❑ NE
other than from a discharge`?
Page I of 3
12128104
Continued

Facility Number: L2— Date of Inspection XL5 0
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: CA&VWt1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �]
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 U/No
❑ Yes ❑ No
Structure 5
❑NA El NE
❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [2 No ❑ NA [3 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 r] Yes L](No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10,
Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
tNo
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ENo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s)
13.
Soil type(s)
14,
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
CI —No
❑ NA ❑ NE
15,
Does the receiving crop and/or land application site need improvement? ❑ Yes
LI No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
O No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application'? ❑ Yes
� o
❑ NA [I NE
18.
Is there a lack of properly operating waste application equipment`? El Yes
7o
❑ NA ❑ NE
eP 1,.ne}.1$A.s.-
Comments (refer to -.question `#) Explain any YES answers and/or any, recommend ations or,`any other comments,, 'V'!, E
Use di arywm s.of.facil€f Ito: better tarn sitriat€ons. use addrt�onal
Y P ( P g Y) ]{3
, � ,f ri- i-, 9E�Y.� £'�..f�v C� x� t'i YFdLcl� �g j,$.♦
3a377 7 77 7 3A 77ZT ut?DArE s-r4Cj<r_JG•,
as> s�►�� �eY a 5,.VO� 3utigE� t� �w ..
,) S n Coot o t 7001 of c-
2� 3 0
Reviewer/Inspector Name uo. �..._ _ _
Phone:
7Y
Reviewer/Inspector Signature: Date:
0
Page 2 of 3 1 12128104 Continued

r Facility Number: `? — Date of Inspection
Re uired Records & Documents ,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes LI No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes j2fNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Mans ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate bo below.
Woil
L3! Yes
❑ No
❑ NA
El NE
❑ Waste Application ❑ Weekly Freeboard El Waste Analysis 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
LdNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
L/j Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
[%Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Cl Yes
[2'*/No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZrNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ 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
ff No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility tail to notify the regional office of emergency situations as required by
❑ Yes
,�/
u No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
["No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑Yes
No
❑ NA
❑ NE
Additional Comments and/or. Drawings
Page 3 of. 3 12128104

In
6'1 I- NO
Type of Visit 6 co Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 3v Departure Time: County: artl i 1. ab&J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: G(- n Ai'qVY26 a
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 =' 0 Longitude: = ° =' = "
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
C►attle C►apacity Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
Wean to Feeder
Feeder to Finish
uodd
0
❑Non -La er
❑ Dairy Calf
Dry Poultry
❑ La ers
❑Non -La ers
❑ Pullets
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Dry Cow
El
❑ Beef Stocker
ElEl
❑Beef Feeder
❑ Beef Brood Cow,
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�o
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑Yes
No
❑ NA
El NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility. Number: 6-j — g{o Date of Inspection o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? []Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ED No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental7theat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes
[o
❑ NA ❑ 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
No
❑ NA ❑ NE
maintenance or improvement?
Waste Avolication
/o
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
❑ NA ❑ NE
maintenance/improvement?
2No
1. is there evidence of incorrect 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 Area
12. Crop type(s)
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
�'N
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
M No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�IAo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Z�7
dova
Reviewer/Inspector Name O k(' � ;e Phone �0 %1 ,1..
Reviewer/Inspector Signature: ti6MAEZ Date: i
...is J

Facility Number: rp — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes WNo ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J ] o El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes LEI 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 V ❑ NA ElNE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes [I NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ �zo Yes ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ld o
El NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
2No
❑ 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
dNo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
. NNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
0 No
❑ NA
❑ NE
Akddittenal,Comm`en'ts=andlorDrawings
Page 3 of 3 12128104
Page 3 of 3 12128104

F� G� 8
! Facility Number
Q) Division of Water Quality `
0-Division of Soil and Water Conservation
„O Other Agency
Type of Visit Co7pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit JO Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 3 , EArrival Time: Departure Time: L� County: — UN W4J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: &ER.A6Q fAo3 LL-t' Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [=]' =' ❑ Longitude: = o =' =
Design" Current Design Current Design: Current
Swine Capacity Population,, Wet.Poultry Capacity Population. ` Cattle Capacity Population.'"
❑ Wean to Finish 10 Layer
© Wean to Feeder 7 O 12r 10 Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean pry Poultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy.
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Coyd
Number of Structures: �I
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
El NE
❑ Yes
El Yes
o ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: & - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 60041)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2b
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan`?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thfeat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes E No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 3 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 Z/NNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ld No ❑ 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 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
LJ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
2 o ❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
Zo ❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
L No ❑ NA
❑ NE
Comments (refer to question.#): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):'
a-tti) Fps Cog I a $ate quAL►�SrS y11��1U E17, SEND t:QP d( Si'�LfGrl,%
,4s u&c.G,
),Reviewer/Inspector Name I — - - -- - - - - -- - - - - - -- — —T - -- -----f Phone: � �1? f
Reviewer/Inspector Signature: Date: 1 6
Page 2 of 3 1 12128104 Continued

Facility Number: l? — Date of Inspection o1
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box b ow. Yes ❑ NA ElNE
❑ Waste Applicat' n ❑ Weekly Freeboard ElWaste Analysis oil Analysis ElWaste Transfers ❑ Annual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E5'No ❑ NA ❑ NE
❑ Yes 04 ❑ NA ❑ NE
❑ Yes D N* o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�qo ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
dNNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ld*N
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
LrJ No
VNA
❑ 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
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
VNo
❑ 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
,,/"
O 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 QNo ❑ NA ❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes Poo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ONo ❑ NA ❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

if
Al
g
�FacilityNumb'er.
Division of Water Quality
O Division of.Soil 'and Water Conservation
--10-Other Agency ,
Type of Visit yCorliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: v A � ival Time: / 3 d Departure Time: County: ftud6j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 4 Ch.A tail
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I Longitude: = o = 1 = 6{
�Desi n Current:: Design, Current ` .Desi n Current,.,.
Swine Capacity. Population Wet Poultry Capacity 1opulation . Cattle Capacity Fopulatioii
Wean to Finish ❑ Layer
Wean to Feeder .9Gm '51 6 ILI Non -La er
Feeder to Finish
Farrow to Wean Dry Poultry
LJ Farrow to Feeder
❑ Farrow to Finish
IL I Boars I 1 11
Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharecs & 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
r.
Number of Structures
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page ! of 3
❑ Yes No ❑ NA ❑ NE
El Yes
El No El NA
El NE
❑ Yes
❑ No ❑ NA
❑ NE
o [:1 NA
❑ NE
❑ Yes
❑ Yes
WN ❑ NA
[I NE
El Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection %
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Struct e I Structure 2 Structure 3 Structure 4
Identifier: M t
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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
L` I N
❑ 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) thn7
t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E24o ❑ 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 [3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ` l No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O/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) O
13. Soil type(s) Q�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�:
1�,--,�" o
El NA
[I 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
a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
d No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2/No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I -r_ - J�/ �� Phone: « 7
Reviewer/Inspector Signature: Date: d I t-
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ W­Up ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L"J No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
❑ Yes N ❑ NA El NE
1-1YesNo ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�No ❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No Y�NA❑
NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ETNo
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No VN
❑ 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
LEI No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
��
B 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
e No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
0-No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
E�No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 6 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 7Routine O Complaint O Follow up O Referral O Emergency O Ott}er ❑ Denied Access
Date of Visit:
I i?3
Arrival Time: I J 1
Departure "Time: County: �c�o�!_ Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ,) Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = = Longitude: = ° = , = {1
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility—
Number: Date of Inspection l S
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LA6W 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?
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?
dyes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
3 No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2rNo ❑ NA ❑ NE
maintenance/improvement?
�Zo
11. Is there evidence of incorrect 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 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) Z e6L8�lj" Cc--') SG 0
.,.__.
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �Ao ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Eryes ❑0No ❑ NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'Yes .+1J N ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? El ';No,A
El NE
18. Is there a lack of properly operating waste application equipment? El Yes o ❑ NA ❑ NE
-73 (r.lo r%�l t— 00 >CT# v, 6>4c , o E OT'y e t J A u_ .
�!
Reviewer/Ins ector Name ' ���,, - '
P� Phone:
IJ �Z 1 .ZZ
Reviewer/Inspector Signature: AA, Date: n
12128104 Continued

f
rFacility Number: (p — Date of Inspection / vs
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WHIP ❑ Checklists ❑ Desi n ❑ Ma s ❑Other
!' p
21.
Does record keeping; need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA ❑ NE
❑ Waste Applic on El Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
El 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
❑ NA El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
VN
❑ N ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
El
NA El
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
No
NE
❑�NAEI
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
ElNA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElNo Yes
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern'?
El Yes
��
O No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
VNo
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
ON E
General Pen -nit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo❑ NA
❑ NE
Additional'Comments and/or Drawings:
12128104

0
Type of Visit 0 Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit OrRoutine O Complaint O Follow up O Emergency Notification O Other
Facility Number Date of Visit:
jd Permitted [3 Certified 1fj Conditionally Certified [3 Registered
Farm Name: L.�eQ,lQ��.....44 ....A.IX.59d , .....................
Owner Name:......... 1J 1�.... .. .. ....,1</. 4.............
Mailing Address:
FacilityContact: ........... ............................... ............ Title:.................... .. ...
Onsite Representative:.!�nfr.. I<tl.1.0.........1Y49&A.X..............................
CertifiedOperator: ...................................... . ...........
Location of Farm:
Swine ❑ Poultry ❑ cattle ❑ Horse
£a 1j1 r!i i gDeS1n ° E� urr
ula
Time:
❑ Denied Access
10 Not Operational 0 Below Threshold 1
Date Last Operated or Above Threshold: .........................
County:....... Ao!=Lr.V..1d..........................................
'Phone No:.......................................................................................
I ........................... Phone No:
Integrator: '.%�.....................................
Operator Certification Number: ..........................................
Latitude a 4 66 Longitude • 4 it
Wean to Feeder Y
tr'.3`E,
❑ Layer
-
-
rph,
❑ Feeder to Finish
-La
❑ Non er
�< E
Y
❑ Farrow to Wean
❑ Farrow to Feeder
.".,�
❑ Other
❑ Farrow to FinishTAB
dc" r
DeSI�
r� erysr € �t
Gilts
❑ Gilts
❑Boars
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?
❑ Yes f 9 No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes ON
❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................... ..............................................................................................................................................................................
Freeboard (inches):
12112103 Continued

Facility Number: — Date of Inspection D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes )eNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ,9No
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 XNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes /NO
elevation markings?
Waste Anolication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Over oad ❑ Frozen Ground ❑ Copper or Zinc
12. Crop typed Z
13. Do the receiving crops differ with those designated in &Certified Animal Waste Management Plan (CA P)? ❑ Yes 9No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determinations? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes [�No
16. Is there a lack of adequate waste application equipment? ❑ Yes 'INo
Odor ]slues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes INO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes J!fNo
Air Quality representative immediately.
�j�A112 &/91-P—W
Reviewer/Inspector Name J
Reviewer/Inspector Signature:
1<,6&,oe0,�, .
Field CODv ❑ Final Notes
Date:
1&1Z/U 1 "rmnuea

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

10
F.
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ZrRoutine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I
Date of Visit:
0 Permitted 13 Certified © Conditionally Certified 0 Registered
Farm Name: ��✓�Ymcble::'7 / �'' fC� `7
Owner Name: Lo Ge V_a lot M0 ble'L%
Mailing Address:
Z$ O3 Time: i2: ZD
Not O er tional Q Below Threshold
Date Last Operated or Above Threshold:
County: 0 h S l 0'J
Phone No:
Facility Contact: Title: I Phone No:
Onsite Representative: to Q W41) 0( a b l e integrator: 1*2'7t! V A_,y —
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` 0 « Longitude ` 06 14
Design Current
Design .... Current Design. Current
Swine Capacity PopulationPoultry
Capa'city PopulationCattle ta'Dieltv Population
El Wean to Feeder
❑ Layer
"
❑ DaiEX
❑ Feeder to Finish
JE1 Non -Layer
I
I
Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design :Capacity
❑ Giits
❑ Boars
Total SSLW
„ " Number'gf Lagoons-,-_,,,, Subsurface Drains Present ❑ ❑ l.a oon Area ❑ S ra Field Area
Holdm Ponds 10 No Uand Waste Management S stem=''
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 I Structure 2 Structure 3 Structure 4 Structure S
Identifier: I
Freeboard (inches): Z 3
05103101
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes -El No
❑ Yes A! No
[:]Yes . 2 No
Structure 6
Continued

Facility Number: Date of Inspection
i
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 0'No
❑ Yes .2rNo
❑ Yes ONo
❑ Yes 2 No
❑ Yes 4)No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,O'No
11. Is there evidence of over application/^? ❑ Excessive Pon/d�ing ❑ PAN ❑ Hydraulic Overload El Yes 21No
12. Crop type B C "✓ of -, (S'n z e- ,S r
di I i i7 '4k ,'-. 0 verse le d(
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑Yes 0 No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ZNo
b) Does the facility need a wettable acre determination? ❑ Yes ZNo
c) This facility is pended for a wettable acre determination? ❑ Yes ,ZNo
15.
Does the receiving crop need improvement?
❑ Yes ZNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes ,ffNo
Reauired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes A No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes ZNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes JZNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 21 No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes M No
24.
Does facility require a follow-up visit by same agency?
❑ Yes �ZNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
[]Yes ZNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�;
Comments refer W,questione#) Explaifi%ify VESganswer and/oi-,;any recommendations,or;any otFier#comments � � E»
drawings of facility butter explain sitiation'st(use�addltionaf pagesins,necessary)_�
❑Field Copy ❑Final Notes
�I1se Ito
Y
ker4 . —T1,C Y-1? L 4 — .S 4r-
ar9An;zcd gr,aj v�c'�'f' -7`i,e- ja�ejoLN aw-�,0'1 sr e{r'¢c, ,'f well
ram. a t,.. e d I"'1 r• {� 0 6 1 y �'Lo� 3 �3 e¢ v� o, d G o n i t-ti tit S -� D �,' i ''� c��� �' e ss
L/ati
Reviewer/Inspector Name �.S-�av�c: �:v,� �rh , � / 3 ..;;;:,; � ,, , °fit ;� . � .:�:;� . • �-�;�
Reviewer/Inspector Signature: Date:
05103101 Continued

f
Facility Number: C, 17 Date of Inspection
PAU 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 drill 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 ,fNo
❑ Yes 12'No
❑ Yes 21No
❑ Yes , /1No
❑ Yes IPfNo
-
❑ Yes ❑ No
Additional Comments and/or Drawings:
r
05103101

3C; E �
A
on'..s�ervatoni
� 31r)"1
!",<ity
.
OthAett3 ' er e
M% �^
yy •' EE
�-. i �� .. .I •.wii ... .,.� ,. .., i
� u, � 3� .e , e� .6 ) �{ 2 f..�Ytir Y d {"' $'
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit outine 0 Complaint 0 Follow up 0 Emergency Nootifiicatioo�nn 0 Other ❑ Denied Access
ilih� Number
Date of Visit: Time. Fac
of O erational Q Below Threshold
0 Permitted 0 Certified 0 Conditionally Certified U Registered Date Last Operated or Above Threshold:
Farm Name: L e 01 O (e, /UC//Sev County: Ghil aw
Owner Name: C.O "' �� +� �� �i Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: 2 ✓' O / e
Certified Operator:
Location of Farm:
Phone No:
Integrator: % yr
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
,:Design Current t 3 Design Current Design Current
�VFlne Ca aClt�": PO ..I118tlOn �f,POUit'a := i Ef r !.
Ca`acity `_I'o ulatian . 'Gattic'= _ - - Ca" lacitr . ':�Po uletion
❑ Wean to Feeder '`'i ❑ Layer ❑ Dairy
❑ Feeder to Finish i ❑ Non -Layer ❑ Non -Dairy 3
❑ Farrow to Wean
❑ Farrow to Feeder ` € ❑Other i t ° , d;l. ` i !° E� , h' 71
❑ Farrow to Finish A ,; �!`
f Total Design Capacity
❑ Gilts
❑ Boars
i , „ Total SSLW ,
Number, of Lagoons , a�1 ,,, Subsurface Drains Present ❑ Lagoon Area ❑ S rsv Feld Area
E sti` ! Fair
s }. - f , ..,y, E Itt F# f ? s.> ! ; e t 'r !`, • a i f
,Holding Ponds I Solid TrapsLiquid° ` € " ! "
. '�f-0' v, ❑ No Waste System
1 4
Discharges & Stream Impact
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:
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ErNo
❑ Yes ❑ No
❑ Yes XNo
Structure 6
Freeboard (inches): 27
05103101 Continued

i
Facility Number: 41 —R& Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,?j`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 p"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 2fNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes IErNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes.,04o
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes j2No
I t . Is there evidence of over application?? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes 2r&o
'S
12. Crop type e - M V d A {y�Gt�f re-N A I / 0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 1No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes �No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ZYes /❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ,B No
Required Recgrrds & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes XNo
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
'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 J2'No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes Rio
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ YesNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 2 No
24. Does facility require a follow-up visit by same agency? ❑ Yes 2 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONO
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
, I'I E N 1'111 E _.. �' 4 .:a E { a,i ff; ; , Jjl. 4 S j ..�. € 3 {E,Y „ v lEi!€ i E . jY �3;i i E .iI E3E 3 3 I i €§ 1,
Comments (%ciersto questttin•f>) ll xplain anyaY $ answees and/or,any recomnieo�atian otiteb,r cow. emft ,€ .',,
jurlatry
�
Use drawings of facility tt► better explainsituations.- (use addltyonalEpages as necessary) (] Field Conv ❑Final Notes
law 4r•e-l-f iV7 44e F�e1d Ana' ��ade 4e
prevent s ejrd ► n� weer in 4k)e F; eld . Alrof N , nj,,b1cj ti3Orx
slo rR y a W ,- k Fla 4 eM u 4,0 lic l p w ,'41-, co a� 1'f►'G 9 4,6a r.
T'/er,15e con-#;,+✓e G-Ar0 S 4e eh'-'%t:..44e Ce.yL- ',P/n
I i•r� f !1 v r..,.... mil..,,! ^�..�..._» ! _ }r`7 17 "�t•� r- € ^s. rn mom,..
Reviewer/Inspector Name �' s'j.4 R q .` -"r, .
Reviewer/Inspector Signature: ' Date: Z-
05103101 Continued

i
Facility Number: 49 — 1 Date of Inspection lil /y/OGI
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
❑ Yeso
❑ Yes'1011
❑ Yes 1No
❑ Yes Ea 'No
❑ Yes ❑ No
❑ Yes ONO
Additional Comments an nY; raWt11Q52.,, ,• �� � � ,_ ,'�� ,.. �. °.3,.�!��'<.,.,�' ��. �n'_ � e`:`�3�. .,�'.;..�� ��` �U
f &e r v,-,e �e u sc - c beg ►nY7
az7 ��e 6fri.��� �►2Xc'-2s; p)eGs� �a �I�G� q►�G! C'eCGc1
t,a rer.q;'.►;�I� PAN e Group.
be Sure �a u Se s4e 0 ►1017 s
k7r el etpr1o'eqq;o-N eYQYI45
i-�
h F-o j¢� ��p��',1�� pv? -AQ �KAe- Me- mfdl�� l'IQs
Vic d c7vl y 2 4D Z AYt ii 175 iS �D� YrI4."611
�G pY: ZaDZ evtanfs bvf .�hovll� kq-ve Vsed 4he
re b ✓� �� f� �a4 2� a r�q 17'" -0 1,0s e eve,l,-f —e .
4h a pl P? �4 ed b e v e ) 4 L, � ><`ctcR'/, � y o► � a' ►-e4e ids
G1 ►^2 ,I'eG 41 y k, eft
Al", �h�avl�aojE �o� �d ��n aC I'yf r. GyPs�erb ,�
apid ev'k h.'� 4,o 7?k? t° a�-� R n� 1�e1j0 yarn
s2'�Q SW t1f 14God/unf' boy eacL► 0( �L►t, /4 Se4 L"'e
POS—;4)''nr and rnq"-k 44e►~+, IVIA oI Merke.-
1�1]
e.
05103101

isron'of Water Quality
S
j
j: DivtslOn of Soil'and Water Conservation �_
�.Other'Agency ,1
i ,.i ri � s i � I I rl i ` it sl a'•f � 4 f �; �l,i I E � �'� !� iii � hi � � g h ,
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 6,Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: L{^� ~Q Time: �r 0 Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
Permitted © Certified © Conditionally Certified © Registered Date East Operated or Above Threshold: .........................
Farm Name: .... L4r.f... .....V!�``J h-.�!.......................................... County:... ............::`..................................I.................
OwnerName:.. ............................ ...................
........... Phone No:.. ....................... ............
FacilityContact: .......... Title: ........................................................... Phone No:...................................................
MailingAddress: ..................................................................................................................... ..................................................................................... .........................
Onsite Representative: .0 ✓hQ� Integrator r;•,\7......................
............................................................................................... b ! �(\ �r
Certified Operator: ................................................... ............................., ... Operator Certification Number:.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 4 46 Longitude S «
Dell Current Desi Current ga gn Design Cerretat
! Spine Ca ad ` Po elation Poultry Ca aci . Po elation Cattle Ca ` cl Po► elation
Wean to Feeder o�0 C� ❑Layer
❑Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
}'> Farrow to Wean
' - Farrow to Feeder ❑ Other
❑Farrow to Finish Total Design Capacity:'
❑ Gilts
;: Boyars TotaUSSLW '
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagnnn Area ❑ Spray Field Area
Holding Poads'L So4d Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ 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 estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes KNo
❑ Yes Pq No
Structure 6
Identifier: ........................................................................................................... .............................................
Freehoard (.inches): a�
5100
Continued on back

Facility Number: — �' Date of Inspection Printed on: 1/9/2001
T. 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 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 [q'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 MNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ff No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ZNo
12. Crop typer+^-�t�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes MrNo
14, a) Does the -facility lack adequate acreage for land application? ❑ Yes MNo
b) Does the facility need a wettable acre determination? ❑ Yes "'No
c) This facility is pended for a wettable acre determination? ❑ Yes EgNo
15. Does the receiving crop need improvement? `Yes ❑ No
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 tPKI No
oe
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 �jfNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes KNo
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 ONO
22. Fail to notify regional DWQ of emergency situ2tions as required by General Permit?
(ie/ discharge, freeboard problems, -over application) ❑ Yes Pj`No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes )4 No
24. Does facility require a follow-up visit by same agency? ❑ Yes I�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ` rNo
�'VQ yiQl� iggs'o� d f eie'rt�ie yr re pQte# ittring t�tjs:v�s�t; Yo> wild Iree iyt? o roth
cories oridence. about tEtIS visit: .
y t
Cotntnents (refer to quest}on #} Explain any YES answers and/or any recomm' tsar or any other court
SiS dra Offaz�i to better,e x p. ( e addMtiogalpiges as noc. S y.) i�,E !jar+.,,�`d
X ialn 3lttlao[L5 US
YQ
^lS•��lC� C7��1C� G+r C��S2lr �Q�`'���CQ.1, �Cl�\�ls i' C� C���P��Q � �-r�11
Reviewer/Inspector Name -CA .. ..
Reviewer/Inspector Signature: Date: 4-3-01 5100

Faciljty Number: — g Date of Inspection ' U L Printed on: 10/26/2000
'Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
IV
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
2$.
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
j 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
O(No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
0 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
9No
Additional omments:an or ra ngs:::
-Tc-� 5-G"A
J
5/00

�Dwis�on of Water Quality
Q, Division of Soil and Water,Conservat,on
?
``
0"OtherAgency
.�� �Ole •v -t ..
E,
t
� r i r �. �':'i� ,'vie �'_ .•i �
i FE3f
Type of Visit Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Dale. of Visit: Time: �O Printed on: 10/26/2000
Q Not O erational. Q Bciow Threshold
Permitted Certified 13 Conditionally Certified ❑ Registered ' Date Last Operated or Above Threshold: .........................
Farm Name: ( 1 � ► Y -J2� County .. �.67t......................................................
V...........................y............................
Owner Name: ................................................................................ Phone No: 6—(P)...2f
Facility Contact: .. Title: Phone No: 33�-`36a-S C� �►1
]Mailing Address:....................................................�... jS..._....jj......................................................................................................................... ..........................
Onsite Representative: ...!`. ,.....I. K.. 15 .............. Integrator:..... ?
....................................................
Certified Operator: ...... Operator Certification Number:
....................................................................................................................................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 6. Longitude ' 4 «
Design Current
Swine Canacitv Ponulation
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I 1 10 Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Ifagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. ll'discharge is observed, was the conveyance man-made'
h. If discharge is observed, did it reach Water of the State? {If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/ruin?
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 Su-ucturc 2 Structure 3 Structure 4 Structure 5
Identifier:.......................................................................... ..........
Frechoard (inches): 1
5100
❑ Yes
9No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes N(No
❑ Yes XNo
❑ Yes ,ZNo
Structure 6
............................ .
Continued on back

Facility Number: ,�q — g'C' I Date at• Inspection
0 Printed on. 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes $fNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 1(�'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 ,4140
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes tOo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes bg�No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes )j�No
12. Crop type L , sq
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes EfNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N�No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
XYes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
D�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?
Yes
El No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
OYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
❑ Yes
NtNo
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?
(ie/discharge, freeboard problems, over application) ❑ Yes b?fNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes k `No
24. Does facility require a follow-up visit by same agency? ❑ Yes XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
yiolalkiQris or dgticllend�e 4 .re noted Boring this;visit; yob*ill reeoive t}o: i'urth�r
• • corres• ondence. about this :visit.: • ' ' • ' • • • • • . - •
Comments (refer to_qui!Won #}: Explain.any YES answers and/or any recommendations or any other comments
:..faclitY to better explain situations. {use additional essaryie.drawin s of a es as ):
AL
0 Q V 5-ia t4�C,
N4 t--,
t roc s-ems : ��L �,.►� � pe_ Lw Ls 4*-k ,L,1 Lq
���� h�►�.ss'1 �� `1� ��'-- 1 �11-P� . ���ie.�5�i�� [ 5-'hct4�cl,i:s� .r
Reviewerlinspector Name
Reviewer/Inspector Signature: Date: la—g-GU 5/00

'Faciirity Number: 6 — Date of InspectionPrinted on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
,Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
[ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
�TNo
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
0 "No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
CR�No
v��•-ir �� j �ir—c� c ��e�� �� $ t-�,,�- r Cc v-►-��— .� f� e.. ir.1
kAR 12S A r�,-) V
sus Sd 9.0 11-NQ JIZ/ �;�� o ►,
VL--'� !
5����,.ss s� rr ca ►-Few 5�; � �s Apr ( t v—
5100
J

::::-- Iq
Revised April 20, 1999
• JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Numb!�!
Farm Name:
On -Site Representative: Uvx\<�w
Inspector/Reviewer's Name:--��-Q
Date of site visit:
Date of most recent WUP:
Annual farm PAN deficit: ` d pounds
Operation is flagged for a wettable
acre determination due to failure of
Part H eligibility item(s) Fl 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 P� P2 P3
Irrigation System(s) - circle #: 1. hard -hose traveler, ..2. center -pivot system; 3. linear -move system;
�4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
stationary gun system w/permanent pipe; 7. stationary gun system w/portable pipe
PART I. WA Determination Exemptions (Eligibility failure, Part II, overrides Part I exemption.)
E1 Adequate irrigation design, including map depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D)D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an 1 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 II1. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part 11. Complete eligibility
checklist, Part 11 - F1 F2 F3, before completing computational table in Part 111).
PART 11. 75% Rule. Eligibility Checklist and Documentation of WA Determination
Requirements.. WA Determination .required .because.operation fails one of the eligibility
requirements listed -below:
_ F1 Lackof acreage:whichresultedin overmpplicationmf-wastewater_(PAN) on -spray.
field(s)accord ing-1ofarm's last-twoyears:of-irrigationzecordS.-.
F2 Unclear, -illegible, -or lack of information/map.
F3 Obvious:feld-limitations -(numerous=ditches;failure-:to:deductTequired.-...
buffer/setbackmcreage;-or25% of#otal.acreageddentifiedin-CAWMP..includes
small; -irregularly -shaped .fields = f elds-less-than 5 acresfor travelers-or.lessfhan
2 acres lor.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 III.

Revised April 20, I999
Facility Number -
Part lll. Field by Field Determination of 75% Exemption Rule for WA Uetermination
TRACT
NUMBER
FIELD
NUMBER',"
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
COMMENTS3
I
I
! I
I
I
I
I
I I
I
I
I
I
I
!
E
I
I
I
I
l
i
FIELD NUMBER' - hydrant, pull, zone, or.point numbers may be used in place of field numbers depending on CAWMP
and type of irritation system. If pulls, etc. cross more -than one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; otherwise operation will be subject to WA determination.
FIELD NUMBER2 - must be clearly delineated on map.'--' l
COMMENTS' - back-up fields with CAWMP acreage.exceeding75% 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 basisfor requiring a WA Determination :_Back-upfields -must-benoted in the -comment section and must be accessible
by irrigation system.
Part IV. Pending WA Determinations -
V P1 Plan-.lacks.following information: � t2llg
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 (Win process of installing new irrigation system):

Lagoon Dike Inspection Report '
Name of Farm / Facility _ Hewitt Farms MArn Z241 6� (76
Location of Farm / Facility SR 1207
Owner's Name, Address
and Telephone Number
Date of inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream SIope, aH:1 V
Embankment Sliding?
( Check One, Describe if Yes)
Seepage?
( Check One, Describe if Yes )
Erosion?
( Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees)
Did Dike Overtop? Yes —X- No
Follow -Up Inspection Needed? Yes _X No
Engineering Study Needed? Yes _X No
Is Dam Jurisdictional to the Dam Safety Law of 1957?
2.129/-99—. Names of Inspectors
tenet Paith
Freeboard, Feet 16„
<_1.0 Top Width, Feet 8
2tQ, Downstream Slope, aH:lv 31ol!
Yes - X No
Yes ,X No
Other Comments
Yes X - No
Excellent
If Yes, Depth of
Overtopping, Feet
T �
Yes X_- No

Lagoon Dime Inspection Report
Name of Farm / Facility
Location of Farm / Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope, aH:1V
Embankment Sliding?
( Check One, Describe if Yes)
Seepage?
( Check One, Describe if Yes)
Erosion?
{ Check One, Describe if Yes )
Condition of
Vegetative Cover
( Grass, Trees )
Hewitt
Farms (Murphy)
22.41_
SK
7
9 / 2Names of Inspectors Patrick Grogan
Paith
3-5' Freeboard, Feet 16"
< 1.0 Top Width, Feet 8
2 to 1 Downstream Slope, xH:1v 3 to
Yes X_ No
Yes _ X No
Yes X No
.� Excellent_ - grass
Did Dike Overtop? Yes X No
Follow -Up Inspection Needed? Yes X -- No
Engineering Study Needed? Yes X No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
If Yes, Depth of
Overtopping, Feet
T r�
Yes X No

Division of Soil and Water Conservation Operation Review ;
Division of Soil and Water Conservation Compliance Inspection:
it -=1 .. = fr ,Nl il� s r IIt': i 7 i c 1 r
' D1VIS1on�Df Water Quality-lCOmpltaii& Inspection! a , � `i �� . �I F ! _` !,f
a !, a f,�� ri ; ,.'=3t�l 3�� i dtf> N5�
'�-Other Agency Operataou Rewew i, { t r !„'' i,. , t
10 Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other 1
Facility Number Date of Inspection (`j
Time or Inspection a1,oa 24 hr. (hh:mm)
© Permitted d Certified [3 Conditionally Certified [3 Registered 113 Not O erational Date Last Operated:
Ae_��A_
Farm Name: ........9LV_jx1�rzx ......................................................... County:.............J,.................................................,
OwnerName : ................................................... ........................................................................ Phone No:.......,...............................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
...................................................
MailingAddress: ...................................................................................
Onsite Representative: tr Q i. ............................................................ ..... Integrator:.......'..........
Certified Operator: ................................................... ............................................................. Operator Certification Number:.,..,.....................................
Location of Farm:
............................................. I ....... ................................................ ... r
Latitude Longitude �• �' ���
Design Current Design • 2, current
' ,.. Design Current,
ltryon,;.CattleCa Capacity Population aty.Po uati: Capacity Population,
Wean to Feeder 9C60 ❑ Layer ❑ Dairy
❑ Feeder to Finish ElNon-Layer❑Non-Dairy
° Farrow to Wean
ty:❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish .#!, Total Design Capacity01
r -a ❑ Gilts.
1, - ,
❑ Boars i� i Totai SSLW
t.
�Numiber of:Lagoons : _ ❑ Subsurface Drains Present ❑ La�omr Area 10 Spray Field Area
Holdink:Ponds'/ Solid Traps ❑ No Liquid Waste Management System
1
Discharges & Stream Im�cts
I. Is any discharge observed from any part of the operation? ❑ Yes �(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
h. If discharge is observed, did it reach Water of the State? (Il'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? (Il'yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes r;(No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;<No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches):.................... ....... ........ ......... ........................... ................................... ....... I........................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes allo
seepage, etc.)
3/23/99 Continued on back

Facility Number: C= Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
KNo
(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
rVNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONO
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
XNo
12, Crop type
13, Do the receiving crops di er with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
91 Yes
❑ No
15, Does the receiving crop need improvement?
N(Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONO
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?
(ie/ WUP, checklists, design, maps, etc.)
$(Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
21.
Did the facility fail to have a actively certified operator in -charge?
❑ Yes
V No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
XNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
C9No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
�'Vo'viglpitiotis:or• ftficjlertci.. wire .. ciirri>r�g th s:visit: Ya�t wii� ee lye o fothoe
.... corres� aiideii& Ao' ut: this visit'
} ` E..v. lse,drac. ..1. E--$o...3
t
tW -JI oL, 01'.2 s 1•--a
5� kols r�o � �� Li s W�.��� � � -4 . GAS �_141
` � ' �',) 0yG�-+.�t - i�
�.� filet e 1/ d , r4 l r
a ��� S�� 1 - �� q1�01
! r r r -- r^**^•.�y — r fit.€ , . s a r—"�
Reviewer/Inspector Name � � � j • � o , 'Q 1• t' .� ,�r �.. -��Q'� �, "�
Reviewer/Inspector Signature: Date: N
3/23/99

Facipty Number: 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 beiow
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?
+�Yecxl
�L9Azlc-"� 91go-Ao.
�� )
��z
C, sP-L-'k
��'t` cam, G `1
LJ D �e
kYes ❑ No
❑ Yes 4No
❑ Yes $(No
❑ Yes [)�No
❑ Yes kNo
❑ Yes ` � No
❑ Yes I�No
yl
3/23/99

4 3 Division of Soil and Water Conservation [3 Other Agency
Division of Water Quality
10 Routine O Complaint O Follow-up of DWQ inspection O Fallow -up of DSWC review O Other
Date of Inspection G
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered *C;ertified (3 Applied for Permit 13 Permitted 113 Not Operational Date Last Operated:
Farm Name:. .................................. .............................................................
AJve County.
OwnerName......... L < rl........................................................................... Phone No:.........:.............. .3 g...... 3. .......................,
�✓A ,CiJ ��✓� f.lti-.
FacilityContact: ..................................... ............. tcvr; � Title:.........•................................... ....... Phone No:...................................................
Mailing Address:.....,. ,......
v............ � % ............•.................•......•.•..............�� ��/:z.�.�•..................I......•.......... .... ..
...........................
Onsite Representative:..... ..............:......... �.. ....................... Integrator:... (� !� !.'"
(
Certified Operator;....... ........ ri.. ........ Operator Certification Number,...J..k 15...!.!p
Location of Farm:
Latitude 0 4 44 Longitude • 6 0"
General
1.
Are there any buffers that need maintenance/improvement?
A.Yes
❑ No
2.
Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
® No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
❑ Yes
I] 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
0 No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
53 No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
O Yes
❑ No
maintenance/improvement?
6._
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
gl No
7/25/97

1
J
Facility Dumber: `? — 00(,
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 5.No
Structures La goons ffoidin g Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes E�[No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):......... .:................. .................... ................ :................
10, Is seepage observed from any of the structures? ❑ Yes allo
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes ENO
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 ........ D-1.._ ..................................................
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 Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the'Perrnit?
0 No.violations or deficiencies were''note'd during this.visit.- .Y,ou.will receive no further
correspondence. about this;viit:
❑ Yes W No
❑ Yes ER -No
Eg_ es ❑ No
❑ Yes No
❑ Yes ® No
®.Yes ❑ No
❑ Yes [Z No
❑ Yes D.No
[l Yes nNo
[RYcs ❑ No
❑ Yes 6d No
,Yes {] No
❑ Yes RNo
"orrinnents (refer'to question #) an .Explain; y 8 ES answers and/or any recommendations or; any d. er comm
;)sents i
e:dr ings of�fucility to better,' explain situations (u, i? additional page4 ds. necessary) ,t f:':
• �• ��a+.��i i� �. S Ci �/'�L.. A /1..�sG.0 �C/�.L.c%1 �r'Y� _r,s-'/ a"a�Ns /•J r �IrY
K/
+
-�� �;1ZZ. ep Cd..
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
/ A.

I(ARoutine O Cum taint O Follow-up of DW2 inspection O Follow-up of DtiWC review O Other
Facility Number Date of Inspection
Time of Inspection : Z 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr .15 min)) Spent on Review
Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑'Not Operational Date Last Operated:......_ ..... ..................... ...... ......................................
_r.............................. _...................................
FarmName: ........ fl.W `�...... KuirlQ....................................................................... County: ....... 6n�f.Qp........... ...... .................. .......................
Land Owner Name: ..�i .. ........1.1........................................................ Phone No: �! !! ).9U134.0�........................................
..... ..... . . . .
r
Facility Conetact........ �,..i.YsS. iv! .........4 it......... ............. Title: ........5�?W1v� T.......... .......... Phone No: ...............
MailingAddress: ...... `t'.IQ...... ...W..................................................................... ... i�44lfiku ..{. C'...................................... u. .........
OnsiteRepresentative: .... L, .Qxlt...................................................... Integrator:... [r1 1fF?...............................................................
Certified Operator: ............ ............. ....................... ........... ._................ ............... ............. Operator Certification Number:..........................................
Location of Farm:
.`j AI .. .l...... A.l'.ra A ....... ....... .. Ali.?:..... .....l - lay...,.... x n . L .... DA... (..... L.` L ......:....... ... JU12". S.. r ....... 4
r!1.....t�l�..R....S7L..��i.l.....%h...L...D:.�IR1l�............................................................... ...
Latitude �• ©��� Longitude 1�3• �®'
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes 4No
❑ Yes q No
❑ Yes $4 No
❑ Yes No
❑ Yes ED No
❑ Yes K No
❑ Yes �No
U Yes ❑ No
Continued on back

FaEiiity Number: ...,........ T ....
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
b<No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
RNo
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
JkNo
,Structure,5lffiagoQisa and/or Holding Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
;,NQ
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
.............,........... ............................ ............................ ............................ ............................
............................
10. Is seepage observed from any of the structures?
❑ Yes
JffNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
KYes
❑ No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
5ONo
Aaste Application
14. Is there physical evidence of over application?
❑ Yes
JRNo
Of in excess of WMP, or runoff entering of the State, notify DWQ)
1waters
15. Crop type ......( 4.o..............................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
E[No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
0:�No
18. Does the receiving crop need improvement?
$1Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
®,No
20. Does facility require a follow-up visit by same agency?
'Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Certified Facilities
❑ Yes
49No
For Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
49No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
;$No
24. Does record keeping need improvement?
C5Yes
❑ No
Comments ;(refer to question,#) Explain any YES answers andloi any recommendations di any other comments
Use drawmgs,ofFfacility to better explam,situat ris. {use additiorial pages;as necessaryl. A � .
.A bWth 5i_+ojj6 be 6vZR arovn� 4xA. V','Se (ocG'1-cci Vu.c,ir <4pn i,� d;vemion.
Q
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arco.s s6 d 6, �_ t�s� �Jot eeic d. I[►'t11 f� 1 1
ik CYVF s�toA oweU sra l ro --a %i(1 weeds .
<Q S i r, +im, s�r&j ,tcorl% "� ( za4;o N P(G"` _,tu1J e-arregporJ. r
wos I: ca+i sn 6Vn - � ou� Reid � A of A=ie�c�s y ww�- I� c�tsrsal�
«.SQ�t t-�or►�ral � � G.'J I r afs h sit W bern A-,_ cAw A A so 1 sa.meL
Reviewer/Inspector Name wow .
Reviewer/Inspector Signature: _ Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97