310153_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quaff

-dk
Division of Water Resources
Facility Number i__?� - ® O Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ® Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: j //Ld//7 Arrival Time: Departure Time: County: DUP Region: Wj R D
Farm Name: G, c ha Y-,4 Owner Email:
Owner Name: Z Q m PS 13CO Ce Phone:
Mailing Address:
Physical Address:
Facility Contact: cTa r y\k-5 0 rt�Ge Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Desigu
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
IDairy
Cow
Wean to Feeder
11
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . P,oul
Ca aci
P,o
Non-Dairy
Farrow to Finish
La ers
Beef Stocker -
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
ift
Turke s
Other
Turkey Poults
Other
10ther
Discharges and Stream lmoacts
1. Is any discharge observed from any part of the operation? ❑ Yes ®No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: 77��
a. Was the conveyance man-made? ❑ Yes ❑ No 5j 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
❑ No
[3 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
� No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: ? - 1 S3 Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
[p No ❑ NA ❑ NE
❑ No P NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
® No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
'Fq1 No
T®
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [�3 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): CoaSiR,( &rtrhjcj Gc_S 04cL,), SM, ��, V
13. Soil Type(s): 4-y-j) Le_ -& A [Old `- /�
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes `P No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes IF
No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes [p No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes f� No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [P 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 [gNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

P
lFacility Number:Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 1� No
❑ Yes [: No
❑ Yes T}� No
❑ Yes ®T No
DNA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name: � j MCLr-G [Q Phone:
Reviewer/Inspector Signature: K�a4 a_`�"W Date: I
Page 3 of 3 21412015

Type of Visit: jQ-Co—mpliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: (2Moutine O Complaint O Follow-up Q Referral Q Emergency O Other Q Denied Access
Date of Visit: /%(, Arrival Time: Departure Time: L� County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: !E:1�u &&- e Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder I
INon-Layer
mvekign Curren#
.
D P,oult . Ca aci to ,
La ers
Non -Layers
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Turkeys
Poults
Other
Beef Brood Cow
Other111110 1Turkey
Other
Discharizes and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes J:3<o ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes qo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes F�INo ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes —ET—No ❑ NA ❑ NE
❑ Yes J'1Qo ❑ NA ❑ NE
❑ Yes Ei�o ❑ NA ❑ NE
Page 1 of 3 21412015 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 O'lgo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes [>o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes Feno
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes [No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes L2,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 J:;�o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
D Yes J;;'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �io
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 4�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes -Eno
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes CT No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �3-No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes D.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 CAW -MP readily available? If yes, check
❑ Yes
Lr--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
P2"No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
- [2I<Io
❑ 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

FaciliNumber: 31 - Date of Inspection: Z ,�
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C2-No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [],No
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 _C3—No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 4; is o
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑1 o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [g No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 0 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
se drawings of facility to better e:
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
yin situations (use additional pages as
/dp- �/q
a
❑ Yes 12-No ❑ NA ❑ NE
❑ Yes E'No ❑ NA ❑ NE
❑ Yes [ o ❑ NA ❑ NE
❑ Yes Q'go ❑ NA ❑ NE
O
Phone: Z27"KA; Z�
T
Date:
21412015

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: /n Region�/�
Farm Name: 0;r1w �d-L�( Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �[i (� Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
I ILayer I
Design
Capacity
Current11,Design
Pop.
Current
Cattle C*apacity Pop.
Dairy Cow
Wean to Feeder
I
lNon-Layer I
Da!a Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oul
Layers
Design
Ca aci
Uo-ur c
P,olNon-Dairy
I Dry Cow
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other=EL
Turke s
Turkey Pouets
I Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes Z No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes )E!fNo ❑ 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) ❑ YesNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes�o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: jDate 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 NA ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [;[Alo ❑ 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 5�X ❑ 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 n,No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [;�No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other.than the waste structures require ❑ Yes 9)So ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �-�io ❑ NA ❑ NE
maintenance or improvement? T
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [-].do ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes E�4o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes �l'Jo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ YesTJNo ❑ NA ❑ NE
acres determination? T
17. Does the facility lack adequate acreage for land application?
❑ Yes E]-No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yeso
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E2-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes [allo
❑ 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. 4RIVes _VNo ❑ NA ❑ NE
❑Waste Application ❑Weekly Freeboard [] Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield �20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fait to install and maintain a rain gauge? ❑Yes .4��No
!rN0 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: 31 - S`3 Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2,No
25. Is the -facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ;2No
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 ;2-No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes El"No
❑ NA ❑ NE
❑ NA FINE
❑ NA ❑ NE
❑ 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
5�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
[,jAo ❑ 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
PNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
�"'
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
21"No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
6o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
V o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�,-,-mob t ►� �-r� Z w � 11 �-eu.l�
Phone:
Date: gbo 115-
214,20h

Type of Visit: Z Compliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: lDRoutine Q Complaint Q Follow-up Q Referral O Emergency O Other 0 Denied Access
Date of Visit: Arrival Time:�O_ , Departure Time: o; �Q� County:T�
Farm Name: j— Q ��{yp•,O,.— _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: 646 Ar& p _ Integrator: /
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Region:
Page
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish La er
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Farrow to Wean
Design Current
Cow
Farrow to Feeder
Dr. P,�ult , Ca aci P,o
Non -Dairy
Farrow to Finish
La ers
Beef Stacker
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 P No ❑ NA ❑ NE
❑ Yes f!j No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑Yes
grNo
❑ 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
�no
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
WNo
❑ NA
❑ NE
of the State other than from a discharge?
I of 3 2/411014 Continued

Facility Number: - Date of Inspection: d
Waste Collection & Treatment
4. Is stt)rage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes .2] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes [;3No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1440_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes Z 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 ;!fNo
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes O/ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yesr%� No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes KNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes gNo
❑ 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 9No ❑ NA ❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 6 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2�No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes'1No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
q
❑ Yes E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes HNo
❑ 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 [2"No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes � o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ]rNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ 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 )D No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PrNo ❑ 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)z No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes o ❑ NA ❑ NE
Other Issues T�
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes JZ-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 �To ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. T
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes I' o ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes P o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesNo
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
gNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
g/Wl /3 1.6051de-
11Zly a-V3
S-16l�y 1 �b ' SQ,I Jesf clue d0«
I/ /V NO
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: VIM
Date:
2 4/201

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 16 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: D 2 Arrival Time: 1 C4 LcJ Departure Time: County: Region: W// (Q
Farm Name: 6,f`{� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: % J Title:
Onsite Representative: �`� Ll %L
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
DAurrent
Desine
CaPop.
Wet Poultry Capacity Pop. Cattle Capacity Pop.
inish
La er
Da' Cow
eeder
Non -La er
Da Calf
Finish
Dai Heifer
Wean
WGilts
Design Current
D Cow
Feeder
Di. Point , Ca aci Po ,
Non-DairyFinish
La ers
Beef Stocker
Non -Layers
113cef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
n--
Turkey Poults
H.ffier
I :::J
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 �ffNo ❑ NA ❑ NE
❑ Yes [Z No
[—]Yes n/ `No
❑ Yes No
❑ Yes No
❑ Yes &No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page l of 3 21412011 Continued

Facility Number: - Date of inspection: 43LZ7,117
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
P-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
2] No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�I o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
_2
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
Fe] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
n/ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
[DNA
❑ NE
maintenance or improvement?
Waste Aanlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,� No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
J,_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 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
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fait 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
[lilo
❑ 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. zrYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 7Waste 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 113ate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the perm' . ❑ Yes P No ❑ NA ❑ NE
25 "Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes WNo ❑ 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 [ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ NA ❑ NE
Other Issues
2& Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: __
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �2 No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes ❑' No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes
�jNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
o77 t�� Pi�G�lno�rt� �vl �a.1 �-
rr �__Cb - 190/3 -
�3 rljeA
o '7
t
Reviewer/Inspector Name: 'erzPhone:
Reviewer/Inspector Signature: Date: Z Z
Page 3 of 3 2146011

Type of Visit: Commptiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Z Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 0 eparture Timer County: / �s-, Region: Wl�
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: edd 1— ioc-e
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: f '1 j 13
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish I ILayer
Wean to Feeder I jNon-Layer I
DMg esign Current
Cattle Capacity Pop.
Daily Cow
Dairy Calf
Feeder to Finish
Design Current
De, P,oultt. Ca aci P,o ,
Layers
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharses and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ja R o ❑ NA ❑ NE
❑ Yes [3'No ❑ NA ❑ NE
❑ Yes ,E5—No ❑ NA ❑ NE
[:]Yes ❑'Flo ❑ NA ❑ NE
[::]Yes
No [DNA [] NE
❑ Yes "No ❑ NA ❑ NE
Page I of 3 2141201I Continued

Facili Number: 7 7 - Ds ection: Q
Z 2
Waste C Ilection & Treatment
4.4s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CZNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
Pko
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
)Z'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
S. 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 J�!(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.))
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes eNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
'PA'o
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E�"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ,E5'No
❑ NA
❑ NE
the appropriate box.
[]WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

r ,
Facility Number: - Date of Inspection: Z
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �' o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 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 ZNo ❑ 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 ;�rNo 0 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) T
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or an other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Lip,
Dui
ion f v -� Cis.
a- jQd- fe60r0_ (S
(be s /v /l/
it/e eo0 j1d C lr-lC as,,
opld A l
Reviewer/]nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9V / f ( — 7/%_
Date: Z
141201

Type of Visit: AE)Tompliance Inspection p Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit:_.<>1Zoutinc O Complaint O Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: Arrival Time: ZJ eparture Time: County:�j� Region: ���
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design . C•urrent
Swine C►apacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
La er
Current
Pop.
Design Current
Cattle Capacity Pap.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish[Dairy
Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D . IL I , C•.a aci
Layers
Non -Daily
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
[]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑❑ Yes VZN
Yes
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: -4 jDate"spection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes yrNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[—]Yes �No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ewIVo NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
l'�'
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ZN.
ONA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ZrNo
❑ 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
❑ NA
❑ NE
maintenance or improvement?
'FZrNo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes )2rNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes P No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of 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 Z No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ):a -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 k] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 2 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 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 16 No
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETNo
❑NA ONE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Inspection:
24.pid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P 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? XYes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? E] 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 inunediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes Z] No ❑ NA ❑ NE
❑ Yes ANo ❑NA ❑NE
❑ Yes jo No ❑ NA ❑ NE
Yes ❑ No
❑ Yes No
❑ Yes CZNo
a � '� 3;9 �(K was Md
• ��- �f1Ce_ Y��
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
,5Q10 M f � , cp"ar� a
d-e 5 LS Yk-_k Ow
Cer 4e
7- o �� 1�
tiC,
Phone: ?.k r
Date:
/4/20

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit.,Ooutine 0 Complaint O Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: IV Arrival Time: Departure Time: County: Region:r, OE _
Farm Name d= L '��7xzlf:) Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator
Operator Certifica on Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = 1 = « Longitude: ❑ o = 1
Design
Current
Design
Current
Design
Current
Swine Capacity
Population Wet Poultry
❑ Layer
❑ Non -Layer
Capacity
Population
C►attle
C►apacity
Population
❑ Wean to Finish
❑ DairyCow
❑ Wean to Feeder
❑'Dai Calf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
El Beef Feeder
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Beef Brood Co
❑ Turke s
Other
❑Turke Poults
Number of Str-uct-g-re-s-:111111111111 I
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[--]Yes ; 'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
El NE
[]NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
ElNA
ElNE
❑ Yes
6 No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ W`Up ❑ Checklists ❑ Design El Maps El Other
❑ Yes
El NA
❑ NE
El Yes
,�(No
FJ No
'❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
['lo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Xo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
K
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XrNo
❑ 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 VrNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes [ rNo ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gNo
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
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
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
: -
sV
-� � � e�
yIlq o fl3 . l us
Aga
-7 jXL1fU
I
j
3 /D
/
eK4'f j Ole_,
Ct S
CV
o
SaJI)a
Page 3 of 3 12128104

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?
S►itcture 1 Structure 2 Structure 3 Structure 4
Identifier: f
Spillway?:
Designed Freeboard (in): do
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 VNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes /No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Anulication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ElNA ElNE
maintenance/improvement?
I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes leNo(—NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload El Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) [[[[[[
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Apptication Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
jKNo ❑ 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
ez,No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ZNo ❑ NA
❑ NE
Cd� %t S G_J_e�a cry C45
� s f anva
Ras /ca�ibn � preo&eltf � zj
Reviewer/Inspector Name / Phone: �7
Reviewer/Inspector Signature: Date:
Page 2 of 3
1272811J4 Continued

- �D�;isiontof Water Quality
Facility Number �j iS O Division of Soil and Water Conservation .
Other agency;
Type of Visit ACompliance
Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
O Routine Q Complaint
)� Follow up O Referral Q Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: L) l Departure Time: ® County: Region:
Farm Name:
Owner Email:
Owner Name: _ IA—L—, Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:� —Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Operator Certification Number:
Back-up Certification Number:
Latitude: = c ='
= Longitude: = ° = 6 = ff
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
Pullets
ILJ Turkev PoultsI I I
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
!Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
J�n No
❑ NA
❑ NE
❑ Yes
'A No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

i
Facility [Number: 3 r -� 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: U6009
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes N 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 *o ❑ 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 M No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes W 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 qkNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance/improvement? 0
IL Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA X NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Fleavy 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
ULJ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
9NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
,4 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
WNE
Reviiewer/Inspector Name F -A- b al /V Phone: ':I
Reviewer/Inspector Signature: Date: —W Adr-J/Q
Page 2 of 3 12128104 Continued

Facility Numbcr: — � Date of Inspection
R_eguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
El the appropirate box. WUP ❑ Checklists El Design
g ❑ Desi ❑Maps Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA �NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
i19NE
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
❑ No
❑ NA
NE
25_
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
WE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ONE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
0,NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
No
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
�io
❑ NA
❑ NE
A5) JG W �afjnj (�o�E6c CNCAS> -V *O-L
pmallog N►� � ���s� � . 1C � �� RQC)tA_(SIJ j 79_ 1 q1(W LA�O(A
WUP) w� ►� c �cs Fob M4. ICE A0A4)V �►4
9-EEL
�. ��c� TH11�G WAS �ohr� a�t� w j m�• S���ns�►Aw
Page 3 of 3 12128104

(Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit J9'Ftoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access I
Date of Visit: j
Farm Name: `,�
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Gi G Departure Time: County:
Facility Contact: Title:
Onsite Representative: 1C,C V/�Cl�`.Gr/r j
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other -
�o
Latitude:
Owner Email:
Phone:
Phone No:
lutegrator
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp,es & 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?
Region:
Longitude: = o = 1
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El Yes El No
❑NA
El NE
❑ NA
❑ NE
❑ Yes ONo
[—]Yes -?fNo
❑ NA
❑ NE
❑ Yes ONo
❑ NA
❑ NE
i 12128104 Continued

Facility Number: — Date of Inspection % U
aste Collection & Treatment
s
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Stru/Cure l Structure 2 Structure 3 Structure 4
Identifier:
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.)
❑ Yes -�']No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,ZNo ❑ NA ❑ NE
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? ep
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
T Do any of the structures need maintenance or improvement? ❑ Yes OVo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EJNo ❑ 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 EYNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J:iNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes)2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) G�'�/�l./i1 (A/ %,, S. .(d
13. Soil type(s) 617 /l,5b1%d l
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes .B No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination:
❑ yes ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes T:fNo
❑ NA
❑ NE
Comments, refer to: uestion # E' ' latn:an YE&answers and/or an recommendations or an other=comments
{ . tl ) gP
Use drawings of facility to Better explain situations: {use additional pages as necessary):: y` �;•-�,
Reviewer/Inspector Name
�f Phone: d —% `�
Reviewer/Inspector Signature:
/
G Date: l� '7
12128104 ` Continued

Facility Number: Date of Inspection
/
Wouired Records_& Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
1,�
❑ Yes E No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ❑ No
❑ NA
❑ NE
the appropirate box. OiUP ❑ Checklists esign ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste 'Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking A 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 ZNo
❑ 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?
❑ Yes Z 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 ZNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA ,ZNE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ZNo
❑ NA
❑ NE
29. Did the facility fail to property dispose of dead animals within 24 hours and/or document
❑ Yes ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ZrNo
❑ 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
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
_pNNo
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes J[2 No
❑ NA
❑ NE
Additional Comments andlor Drawin�g/s
eld� Ile
Wes-yk7
hCd���
�� have IeY>
F! e cra
12128104

(Type of Visit f Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit le, Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number /" Date of Visit: %? Q Tune:
lozNoft Operational Q Below Threshold
0 Permitted 0 Certified © Conditionally Certified © Registered Date Last era r Abovv Threshold:
Farm Name: _W_ .. C�.�__—__ �_ _W _ _ County:
Owner Name:
Phone No:
?Mailing Address:
Facility Contact: ..__ ._/_ _ .. _ __Title:.._—__..._.� _ _�__ ./.Phone No:
Onsite Representative: L,�1_ _ ,. Integrator:.
Certified Operator: , . Operator Certi nation Zber.
Location of Farm:
It
❑ Swine ❑ Poultry ❑ Cattle - ❑ Horse Latitude Longitude 14
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes !moo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b_ If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _ /��
Freeboard (inches):
[I Yes ❑ No
❑ Yes ❑ No
❑ Yes -E]No
[]Yes ,. <O
❑ Yes _8'110
Structure 6
12112103 Continued

Facility Number:/ — %s`3 Date of Inspection
a Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes�_P-410
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ,8 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 090
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 2rNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes 0140
I I. Is there evidence of over application? If yes, check the appropriate box bekow. ❑ Yes Vo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type lr 2p _
13. Do the receiving crops differ with those designated in the Certified Animal Waste
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Plan (CAWMP)? ❑ Yes ."No
❑ Yes"te0o
❑ Yes P-i4o
❑ Yes ,Oto
❑ Yes eNo
❑ Yes ,ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below []Yes 0T0
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes eNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,eNo
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 �o
Air Quality representative immediately.
❑ Field Copy ❑ Final Notes
-� dr /� tr/' �Ci C' cf Pi'7 C3 j'j_ Tl� l vZ —� L eke
!K ;0el—ele-)
Alas S zr 0 tom/
lZe 7,Va � rG���� �� s� wall
/ 's l opt. %l
Reviewer/Inspector Name
Reviewer/Inspector Signature:
12112103
Date:

Facility Number: Date of ,Inspection O
s
Reouired Records & Documents
21. Fail to have Certificate of Coverage &. General Permit or other Permit readily available? ❑ Yes ATNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie! WUP, checklists, design, maps, etc.) ❑
Yes No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes WNNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes J3'No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes .2'No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ZNo
28. Does facility require a follow-up visit by same agency? ❑ Yes Jallo
29. Were any additional problems noted which cause noncompliance of the.Certified AWMP? ❑ Yes _12 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) P,"fes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,8'No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes .214'o
34. Did the facility fail to calibrate waste application equipment? ❑ Yes P�No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_ ❑ Yes 0No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1 " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit %$.Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit MRoutine O Complaint ' O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 7 Time:
rO Not Operational 0 Below Threshold
Permitted (-Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name:�./isrT S� / County: /��•t
Owner Name:�Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:ltJ_
Certified Operator:
Location of Farm:
��Phho�one No:
Integrator: ___//[(%Ceti
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0� �� �u Longitude
Design Current Design Current Design :Current
Swine: Capacitv PopulationPoultry Capacity PopulationCattle Ca acrty Po Illation
❑ Wean to Feeder 11 1E] Layer ❑ Dairy
Feeder to Finish % ❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total,SSLW
Nir�ber of Lagoons 10Subsurface Drains Present ❑ La oon Area JE1 Spray Field Area '-
I:IfWdling Ponds / Solid Traps " x
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c, If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatmen
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier. /
Freeboard (inches):
❑ Yes KNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �&No
❑ Yes allo
❑ Yes SNo
Structure 6
0510310I Continued

a
Facility Number: _T/ — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
❑ Yes �No
❑ Yes RNo
❑ Yes ®No
❑ Yes Da No
❑ Yes RNo
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
JgNo
11.
Is there evidence of over application? ❑ Excessive PoCnding ❑ PAN ❑ Hydraulic Overload
❑ Yes
RNo
12.
J
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
&No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
5No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
14 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
RNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
KNo
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
RNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
P No
" :20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
"[ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
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 [&No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
JIB No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comii rents`{refer to ues6o i # Eg latn iin` YES;answeiN and/o an reco..mmendations or an ,other comments
a
Use drwrdgs of facility to, better," explain situations::{use addtttonal;pages as necessary)-
L r ❑ Field Copy ❑ Final Notes
/fl,04,' 4 C:�ire /�f /}tc�voC �flersC�ic� �D'/ /411l�ll
it ; [°��i "::IV7 ` l `,t e As lt
i:elWf 4ve ;emu pia aLa/ X4 .f%t �e �7L f�.t ✓ 4'. s7Z..�
viewernns ector Nameviewerllnspector
ER
Signature: Date:
05103101 Continued

Facility Number: :�?/ —/0 Date of Inspection OZ
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 n No
❑ Yes r3 No
❑ Yes 29,No
❑ Yes Plwo
❑ Yes RNo
❑ Yes ® No
❑ Yes ®.No
Additiogal:Comments*and/orr,Drawings-b �F .. r :: _ 1 y> -XL'
05103101

D1-,-isioii-of Water QuaLhy
-
xt
Q Ihvrsrcii of Soil an&NVater Conservation
-
-
Type of Visit ID Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit 19 Routine Q Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number
Date of Visit: % / Q� Time: /!, Printed on: 7/21/2000
3/ I,S
-J
Q Not Operational Q Below Threshold
19 Permitted ® Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .................
Farm Name: ....7�' L......t�Aool s.......................................................... .. County: ......... f✓..�t&I............................ I..... ...................
....
Owner Name: (�FP ...... .6.{a.,6 4c! Phone No
Facility Contact-
.
............................... Title:....
Mailing Address:
Onsite Representative: �i.
..... ._....................
Certified Operator:
Location "of Farm:
Phone No:
........ Integrator :.......1. ..Arpy y........................
........ Operator Certification Number:,,-..
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� ��� Longitude �• ��
- - -Elesioi, Current Design Current Design. Current
Swine.. .
r .Pa ulatio>a Poultry Capacity population Cattle Ca Po ation
` Wean to Feeder ID Layer ❑ Dairy
Feeder to Finish Z ❑ Non -Layer Non -Dairy
a Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
'x Boars Total SSLW
� tr otl.agoous4 La
Subsurface Drains Present g�n Area ❑Spray Field Area
I NO
Hoag Pt►nds / Sottd �rarrs ` T ❑ No Liquid Waste Management System
�..:..
w„
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 roan -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/tnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .................................................................................................
Freeboard (inches):
5/00
❑ Yes 19 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes R No
❑ Yes ;4No
❑ Yes 14 No
Structure 6
Continued on hack

w ..
Facility Number: 31 — /33 Date of Inspection Printed on. 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 8 No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes H No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10, Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑Excessive Ponding `❑ PAN ❑ Hydraulic Overload ❑ Yes No
�//
12. Crop type CoG( �JQrM,44//
r__ ( a A _Snn•�f �i'.[1v� _ -- --
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
W No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
12 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
I9.
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
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?
(iel discharge, freeboard problems, over application)
❑ Yes
59 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
09 No
0: �'Vo yiolatiQ�is:vr de c.. ...were noted• iiurtng �his:visit: Yop will•reeOW i further
corres ndeRce: atN f this VisiL .. • ........... .
Expiaidany YES answef
/1 # - & 5+ A+# -A f-e- t4 kept G--7 f a 1 a j /r 6.
u_xf wegk-,
-6-id A0+ -ANJ !'e•rM i '("
—To% 5;11 r1a0111.
-� He k&-, �pifed G:sne at
/,
l'�esvlfw xot�+rGSmt-�,�c`s srs�Uh� l�tt 4 covo/
o ►- C'v�'1y o �l er cl Wu 04 /hs� j; /►�lstr .
Otf/o i v— A not- have r -,i4is Laek yam:
%!/4cre- at ref alreJR IX zA.4-k //rrs f l S.am�lla f�7`s,
Reviewer/Inspector Name
Reviewer/inspector Signature: OF
�1101_7 -C-7
Date:
5100

Facility Number: — Date of inspection Z Q Printed on: 1/9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes E4 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 RNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
RNo
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
C.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
RNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
9No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
Q9 No
Additional_Comments .and/or Drawings — +- - =
5100
5100

Dtvtsion of Water Quatity
Q Division of Soil "&Water..Conservatton
m Q-Other Agency.. s
i
Type of Visit r'( Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilit yNumber Date yr Visit: Time: `36 Printed on: 7/21/2000
I --
erational 0Below Threshold
ro Not O
Permitted 0^Certified ❑ Conditionally Certified 0 Registered Date Last Operated or •above Threshold: ............
1 L ....
FarmName: ..............................................................................................................................County:........".... ...-..'1.............................. .......................
Owner Name: .........................
]Facility Contact: ....................................................................
Phone No: ,•.•.,.••,.,•..,.
Title: ................................................................ Phone No:..................................
MailingAddress: (� ................. .,...........-....-................................ ....... . �...... -. �- .....1-�.... ..... ...............� � `Aq�.
Onsite Representative: •V`!!^ E'' Integrator: "
.......................................I.......................-...... r-•. ...................................-----
Certified Operator: •.................... Operator Certification Number:...................... ..................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' °4 Longitude • 4 1z
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population, Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I JE1 Dairy
Feeder to Finish ❑ Non -Layer I L 10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lag-nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is obscrvcd; was the conveyance man-ruadc!
h. if discharge is observed. did it reach Water Of the State? (If yes, notify DWQ)
c. If dischari!c 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
❑ Yes jRrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes IgNo
4. Is storage capacity (freeboard plus storm storage) less than adequate'? ❑ Spillway ❑ Yes XNo
Structure 1 Structure 2 StruL'tUrC SlruCttire 4 Structure 5 Structure 6
Identifier: ....................................................... .
Freeboard (inches):
5100 Continued on back

i
Factitty Number: 3 — ` '3 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 1J 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 VNo
(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 KNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? NrYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 9No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
1. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes "No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N'islo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15- Does the receiving crop need improvement? ❑ Yes Wo .
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
ANo
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
XYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JgNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
IkNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
�(No
Oc/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
)RI No
24.
Does facility require a follow-up visit by same agency'?
❑ Yes
t"o
25,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0: �10 �yiglaiigtis :or• ilefeiencies were notet3- dirritig this:visit: • Y'oi� :w.ill •�eceiye �o #'ui-ther • : •
....
�orresotidence. about thi .visit. .............. . . . . ........ .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use
drawings of facility to better explain situations. (use additional pages as necessary):
o l J�Cc�d v�� ��►-� trr� OC��� 'z���� �'-� 1�.cjc4'-. r'r^�� �"�� b � A,
61
(� [
S�-� L �s►-� mot->� ��.� is ✓ e�--mac, ;\
Reviewer/Inspector Name S1) �e�k `[tQ -3 y5--3
Reviewer/Inspector Signature: ��� Date:
5100

Facility Number: 3 Date of Inspection GO Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AJor below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29; Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes { Wo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ANo
Additional-Comirrients and/orDrawings:
C�� h �.c-.} �-e+r��" e�c� ► tic i � ���=r1 �C3 � �C C. ��
�rl ,
irk
klz'
L
5/00

'. [ Division of Soil and,Water-Conse'rvahon Operation Revaew
r x, (]'Division of Soil and Water Conservation ;Compiiiance lfnspection "
ivision of Wafer au :Corr► hence Tns ection _ W
D Qu tY .., P P z y=�
Other Age 44
- eration Revnew . 7 -
_.. �.. n_n. . . .. r� <
ISLRoutine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review 0 Other
L_ Facility Number Date of Inspection
Time of Inspection Q Q 24 hr. (hh:mm)
Permitted [3 Certified Q Conditionally Certified Q Registered 10 Not Operat
ionalDate Last Operated:
FarmName �� �...................................................... County111-17­1,............................. .......................
Owner Name: ............................ Phone No:
Facility Contact: ......................................... Title:............................... Phone No:
Mailing Address: ................................
Onsite Representative:...Y.�1............................................ Intel;rator:............. ...... 4 f...................................... ..........
Certified Operator:................................................... Operator Certification Number: ........................................
Location of Farm:
Latitude �• �° �•
„ Design Current.
Swine -- .. Capacity Population'
❑ Wean to Feeder
eederto Finish
3 1-
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
.....................................................................................................................
Longitude �• �� �
:. -De
sign Current
-...
Poultry; ; ,Capacity, Population :. Cattle
1❑ Layer ❑Dairy
E] Non -Layer ❑ Non -Dairy
❑ Other
TotaLDesigp. Capacity
...
Total SSL W
Design Cui"rent
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ONO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made:' ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c- If discharge is observed. what is the estimated flow in gal/min?
d. Dares discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): .......................... ........ ..........................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
3/23/99 Continued on back

lFacillty Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(I€ 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 pan of the waste management system other than waste structures require maintenatice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
18_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �qo.V Mions:or• de#ickncies *&i-_ noted• dirrifrtg This:visit: • Yot* Wil1•reeeiye Rio lFurth& • : •
ctirres 6iidence: about tM visit.
❑ Yes XNo
❑ Yes NrNo
❑ Yes ONo
❑ Yes VNo
❑ Yes NNo
❑ Yes =j No
❑ Yes K No
❑ Yes b�No
❑ Yes ❑ No
OYes ❑ No
❑ Yes tff No
❑ Yes �<No
❑ Yes 9 No
❑ Yes No
❑ Yes No
❑ Yes LoSfNo
❑ Yes 0 No
❑ Yes V. No
❑ Yes JXNo
❑ Yes �q No
❑ Yes ,J No
wG;1)e— �5
Reviewer/Inspector Name €i
Reviewer/Inspector Signature:
Date: l l— 20-
3/23/99

Facility Number: 3 = Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below xYes [:]No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes [(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P '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 P''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 , `�'rNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes XNo
kdditionaL Comments an or Drawings ,. ,L
7
3/23/99

[] Division of Soil and Water Conservation ❑ Other Agency
Dtvisian of Water Quality �
Routine 0 Cont Taint 0 Follow-up of DWO inspection O Follow-up of DSWC review 0 Other
Facility Number
E] Registered ©3C`ertified [3 Applied for Permit Permitted
FarmName:..........].. .............................................................
Owner Name: ...... Q...11........................................
Date of Inspection 9=
Time of Inspection FR 24 hr. (hh:mm)
L,] Not Operational I Date Last Operated:
1
County: ...... .............................. ...........
Facility Contact: ........................ Gl......................... ,........................ Title:....-1.
Mailing Address: 19,.
Onsite Representative:...?'?_V N5]-.k
Certified Operator; ......................................
Phone No:
.. ................
Phone No: ` 35- 3S
- y .......... I.........
1
............................................. Operator Certification Num er:...................
Locatiotk of Farm: V .
f
S
Latitude =•0' 0« Longitude ' 01 ="
Design Current Design } Current, Design ,, Current
Swore r. Capacrty:Populakon
x:Poultry Capacity Population Cattle` n Capaerty„Population, w
'
El Wean to Feeder
❑ Layer
❑Dairy
❑Non -Layer
Feeder to Finish
❑ Non -Dairy
❑ Farrow to Wean
'
[I Other £�
❑ Farrow to Feeder
arrow to Finish
.0F
Total Des>Egn Capacity .
❑ Gilts
❑Boars
i z TO al=SSLW
A
Number of Lagoons/Holding Ponds - ❑Subsurface Drains Pres:::]I[]Lagoon Area ❑Spray Field Area
f
Ir NMI ❑ No Liquid Waste Management System
I 1
3
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
2.
19 any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon [I 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
Z No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system`? (if yes, notify DWQ)
❑ Yes
No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[H No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
j9LNo
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
N No
7/25/97

Facility Number: 3 � —
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes XNo
Structures (Lagoons,tHolding„Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
Freeboard (ft)
Structure 1
.................
........... I..., ................
Structure 2 Structure 3
..........................................................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
CTNo
Structure 5 Structure 6
❑ Yes
MNo
❑ Yes
No
9Yes
❑ No
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 ..... Q�.........................................................................................................................................
..,...�.....S
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 Ont
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0: Noviolations: or. ddiciencies.were noted, during this;visit.; You:will Feceive.noltiriher;::
0&0 poddep out this"visit.- : e. about
❑ Yes Ef No
❑ Yes M No
❑ Yes t!f No
❑ Yes K No
O Yes ❑ No
❑ Yes No
❑ Yes No
n(Yes ❑ No
tK Yes ❑ No
❑ Yes tj� No
❑ Yes MNo
❑ Yes X.No
10/ b7\ 1�7\ � ] Q�J s An � 6_v � dTJ�'� � � �y SG� � C-t1{�9«OU.^ei� G�/f7�� -
So► � 2S ti4 V -Q
ati. � i- c 0. 1r51G
�. ,I
, 4,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: j4�J` Date: '9( �3 M Y

Z x u
❑ DSWC�Amimal 'Feedlot OpelrationxReview
�'�� ���y �� �DWQ�Aniilnal Feedlot Operahon�Site InspecEion ��Y�� �`� � ,
Routine OComplaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Date of Inspection q Q 7
3
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
FarmStatus: ❑ Registered ❑ Applied for Permit (ex:I.25 for I hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: .........C(&r..... ............... .................. __...... .... County: ...
rr......... _.......... ......
Land Owner Name: _. �.s tit.. pp 5 ...... .......... _...... ..... Phone No:...L`�l.Q)... z-$ Sf 72-3 's-
FacilityConctact:..._�.�-!�....1�Y�u�.._................ _.. Title: �clar... _..1.................. Phone No.
Mailing Address:..: 1"] .... ?5�.. 5�� . ....— .... ...... ......... -N� ....... ........... Z144 Ra..........
Onsite Representative: ........._ ....... Integrator: MIJ
Certified Operator:.... ' �4`�l ..... ........... .G .J .l.................................. Operator Certification Number: _.... .........
� ...
Location of Farm:
. W _.....�1 e� Ica . 0a 1S
. ..............................._....._....._...................... .......... .................................. ...................... ...... ................ _ ....__..... �}
_43771
Latitude '�" Longitude �•®&®4*
Type of Operation and Design Capacity
1.
' E
k Design Current f 'Design. ICU-rent�� Design Curren#�
Swine 4<Poult :: „ Cattle 4 a �
�Ca _. •. .r3' .......: Ca act Po ulation :-, - Ca aci Pa ulatton'
"51E]
Non-DaiEX
l
t f max. _0 -
Farrow to Wean
' s - E
Farrow to Feeder Tt]tal4DeslgIICap 3 6
Farrow to FinishAMokz
.._
❑Other
Number of Lagoons / Iioldtng Ponds ❑Subsurface Drains Present
��� h' ❑Lagoon Area ❑ Spray Field Area
❑ Wean to Feeder �❑ Layer
Feeder to Finish
3 �
* ❑Non -La Non -Layer
eneral
1. Are there any buffers that need maintenance/improvement?
2_ Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon [3 Spray field [3 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?
3. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ®No
❑ Yes ®No
❑ Yes M No
❑ Yes � No
❑ Yes � No
❑ Yes � No
❑ Yes � No
® Yes ❑ No
Continued on back

Facility Number: .3-l....... —._..11a
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7. Did the facility fail to have a certified operator in responsible charge?
[--]Yes
No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
($ No
Freeboard (11): Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Structure 6
3.S
10. Is seepage observed from any of the structures?
❑ Yes
ER No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
%No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
0 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
I ,
15. Crop type _.. .................................................bru'�1�...�1----- ..----- •........... ._...... .......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
® Yes
❑ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
RNo
18. Does the receiving crop need improvement?
❑ Yes
[& 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
U No
2I. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
;qNo
For C_e_r_tifiedFacilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
24. Does record keeping need improvement?
Yes
❑ No
Comnnents;rv(refer to'quest2an"#) Explain any. YES answers' and/o any recommen"tions'or any other comments.
Use drawings of fyac litty to(bettelr explllainsituations.` iise additional pages as necessary} { • ` . "� .
�. A, VQrrr. S�oA 69- Dui IT avavJ kj& (ocat e3 rulcAr ��(1 PktS . ++ + 1 4
�Z Losaan cj 4ks S4ould be- �nooc.L E1IYwcin c rxc'i or, i npir kic it o � (0'5oo" :Skou'3 (7 e
reteeja , pt f -)oa, �V_Jer•„
cxbps he P6,43 tuna s�ycaj eJ oi� tnr��� lau lr��CJ in .� GA�.�1MP
z`4. sir r'eeer 5 Stt�sJl� ism ta�Oele �y hY�r�.et�—o-�c� ��e�r) numbor
Reviewer/Inspector Name, ��� :._ y, <. E
Reviewer/Inspector Signature: Date: a' 7
_ ;ear— _ -
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

1 Site Requires Immediate Attention:
Facility No. 3
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERAAS-M
VISITATION RECORD
DATE: , 1995
Time-7
Farm Na
Mailing
County:
Integratc
On Site Representative: —
Physical Address/Location:
Type of Operation: Swine -je-- Poultry
Design Capacity: 36 -2 eZ _
Number of Animals on Site:
DEM Certification Number kCE DEM Certification Number: ACNEW
Latitude:Longitude:''" Elevation: Feet
Circle Yes or No
Does'the Animal Waste Lagoon havesufficient freeboard of 1 Foot + 25 year 4 hour storm event
(approximately 1 Foot + 7 inches) es or No Actual Freeboard: ��ZFt. Inches
• Was any seepage observed from e a oon(s)? Yes or Vo Was any erosion observed? Yes aN
Is adequate land available for spray. e or No. Is the cover crop adequate? Yes or�1
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 �eet from Dwellings a or No
100 Feet from Wells? e or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oa
Is animal waste discharged into waters of estate by man-made ditch, flushing system, or other
similar man-made devices? Yes o No if Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specif, acreage with cover crop)? Yes or
61/
TI-m B
C'
Inspector Name
/�'A t
cc: Facility Assessment Unit Use Attachments if Needed.