310809_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: 707wompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-u Referral 0 Emergency 0 Other iC) Denied Access yy�
Date of Visit: Arrival Time: Departure Time: I 1U UU j County: U Region: �J[
Farm Name: Jpy`xs u Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: S �[� h( pt�, Integrator:
Certified Operator: Certification Number: D , 5
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pnp.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
0 Design Current
D , P.oultt Ca act po .
Layers
D Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
it Turkey Poults
Other Other
Discharizes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
D Yes
[:]No
❑ NA
❑ NE
0 Yes
❑ No
❑ NA
❑ NE
❑ Yes
21"N0
❑ NA
❑ NE
❑ Yes
z
No
❑ NA
❑ NE
Page I of 3 21412015 Continued

Facili Number: -021 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? C] Yes �o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?.
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes JEJ'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 ffNo
❑ 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?
0 Yes Z No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ,2 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ' -
❑ NA
❑ NE
maintenance or improvement'?
ems—
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes"Z No
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes ;ENo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of 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 ZNo ❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes .E:fNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J21vo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes_,fnNo ❑ 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 .Ej'No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes T7:1"No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412015 Continued

Fecili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,PNo ❑ 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 ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 No 0NA [] 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?
k
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[] Yes j2 No ❑ NA ❑ NE
❑ Yes'J�no
❑ Yeo
❑ Yes,,E:fNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes T2-�Ko ❑ NA [ NE
❑ Yes No [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Phone:
Date:
21412015,

(Type of Visit: 07
CotYfpliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: DORegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ` Title:
Onsite Representative: JOQAT'hP,N ffLL e((_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: I $ Q 0
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Gurrent
Wet Foultry Capacity Fop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
airy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
DrF P■oultr, @a Tacit P■o ,
Dry Cow
Non -Dairy__
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Dischames and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
C] Yes
❑ No
❑ NA
[] NE
0 Yes
❑ No
❑ NA
[] NE
❑ Yes ❑ o ❑ NA ❑ NE
C] Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4:,1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes No ❑ NA 0 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 environmen threat, notify DWR
7. Do any of the structures need maintenance or improvement`? ❑Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EZ/N o ❑ NA ❑ NE
maintenance or improvement? ell
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JNo ❑ NA ❑ NE
maintenance or improvement?
I L Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[!] o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�rNo
❑ 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 0 Waste Transfe s ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspection ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 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 21412015 Continued

Facili Number: jDate of Inspection:
247. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ 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? ❑YesfNo
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ 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 [�J/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 M/No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ZN
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
FN
❑ NA
[] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Vnminenfs(refto question"#) zplain;aiiy",.}YIaS a"n"sruanyotFiercomments ..�.ia $ f#-v : A �4 !p
t*�:pec C r,#c 1 , ^t' ."
gee
e Orawinks"of}}facrbty�to betteraexpdain;sttuatlons (use :additional pages,as necessary);; �
t i „i�`t .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: k _91U
Date:
21412015
_ 1AP

(Type of Visit: 0 C pliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I 8',,S0 I Departure Time: ® County: DitjPLMO Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ,�r.(p7uAi� Mtt t�2 Integrator:
Phone:
Certified Operator: Certification Number: oug�
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet Poultry
I ILayer
Non -La er
Design
Capacity
I
I
Current
Pop.
Ell
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P'57U-I
Layers
KQXsjign
Cqpwelt
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Beef Brood Gow
Boars
Other
Turkeys
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ]n No ❑ NA ❑ NE
Yes ❑ No
Yes [:]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes Wo ❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No ❑ NA ❑INE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (A 606, )
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): rba
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 0 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 ff No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E/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 E�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 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes /[No
❑ NA
❑ NE
acres determination?
Z"_�o
17. Does the facility lack adequate acreage for land application?
❑Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes 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 16 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? ❑ YesVNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - jDate of Inspection: 'fliq I S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo ❑ 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 eNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes FNo ❑ 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 the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [O-?/No
[:]Yes Q No
[:]Yes ZNo
[:]Yes No
❑ Yes
❑ Yes
❑ Yes
❑NA []NE
❑NA ❑NE
[] NA ❑ NE
DNA ❑ NE
Y0�6❑ NA ❑ NE
9� ❑ NA ❑ NE
❑NA ❑NE
Comments (refer Eo'questi`a`ri`#), Explain any YES answer's'andlor`�ggariy additl`onalirecommendationsi6rYany�otlier comments
a � ,:.;i k'vto Dma raj i I it 3$Jgik':,s M.
UsedrawJngs,offacili.ty�_to�better;explain.sltuations(useadditional; agesdasnecessary)t,t,d,Lt
._-A_ I _ ... k .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�'J'6-41q rA"{
Phonz fro 726 - gg
Date: q A)A i
2/4/2015

Type of Visit: m C pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: I ?�3b -7 Departure Time: © County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative:yb'�LC� -- Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
1 615
Design Current
Design
Current
Design Current
Swine C►apacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wea to Finish
Layer
Dai Cow
an
Wen to Feeder �G
Non -La er
Dai Calf
Feeder to Finish
I Dai Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oultr,
@a aci
P,oP.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other J01
10ther
Discharges and Stream Impacts
dNo
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
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 I of 3 21412011 Continued

Facilit Number: 1 - IDate of Inspection:I/Ij Illy
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
r Structure 1
rm
Identifier:-/1�
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5
[7/No ❑NA ❑NE
❑ No ❑ NA ❑ NE
Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1 �NoD ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Arc there structures on -site which are not properly addressed and/or managed through a ❑ Yes [(No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment l 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 YNo ❑ 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
ZNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
1 L Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes Z
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes YNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 1No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 5 /No
❑ NA
❑ NE
Reduired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes6zo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2 XNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faeilt Number: - Date of -Inspection: C ,, t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Vo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check []Yes [DNA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?] Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �iIo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
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
to
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
/
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
; 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?
❑YesE40_j*�
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Ello
[] NA
❑ NE
Comments {refer to question: #) Explain any.YES answersrand/or :anyadditional recor►imendations,or'anyiother comhients i ; ;
Use' drawinis of facility to better explain situations (use additional'pages'as neces_s`ary)
CL"C TsCk� C
Reviewer/Inspector Name:
1:')Md FARn/ OL,
Phone:`
Reviewer/Inspector Signature: Date:
Page 3 of 3
4

Type of Visit: 0 Compliance inspection V Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0"Routine Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time; ®p Departure Time: 90 County:l7uft-,W Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: J O#Jfi A M�-LU_— N Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 19005
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Foultry Capacity Pap.
Layer
Cattle
DairyCow
DairyCalf
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
Feeder to Finish
DairyHeifer
Farrow to Wean
Design C*urrent
D Cow
Farrow to Feeder
D , Pmoult . C►a aci P,n
Layers
Nan-Dai ry
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Pouets
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 21 No ❑ NA ❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No [.] NA ❑ NE
❑ Yes ❑ o
❑ Yes jo
[-]Yes YNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

s
Facili Number: - Date of Ins ection: P /C5
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 I
Identifier: LA(teatJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3s
Structure 2 Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [2 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ 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 0o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NB
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 tbs. ❑ 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
ZfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[2/Nc
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: -53QI Date of Inspection: 10110113
24. Did the facility fail to calibrate waste application equipment as required by the permit ❑ Yes to ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F?/No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes io ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
[:)Yes of o ❑ NA ❑ NE
❑ Yes C21<�o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
NA
NE
LJ
❑
❑
[No
❑ NA
❑ NE
7['No
❑ NA
❑ NE
eNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES. answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional paves as necessary).
15.) Lry AC 1ACV CP
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (v 9 —?,Sue
Date:
2/ /20 1

Type of Visit: 0 Co Hance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: (, Arrival Time: ® Departure Time: County: �UP1,1 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: M:T, L{ Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Wean to Finish
MI
I La er
Wean to Feeder
1-46 6
Non-L
Feeder to Finish
Farrow to Wean
rallon-L
Farrow to Feeder
Farrow to Finish
Gilts
Boars
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?
Longitude:
Cow
y Calf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
1t)15
❑ Yes ❑ No ❑ NA ❑ NE
0 Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes �gNNA
❑ NA ❑ NE
❑ Yes ❑ ❑ NE
❑ Yes o ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facilitv Number: 71 1 - 969 1 IDate of insnection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
• a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 , Structure 2
Identifier: (A 6<r6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes XNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EYNo ❑ 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 ff No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes CNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C3/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?
❑ s
No
❑ NA
[] NE
15. Does the receiving crap and/or land application site need improvement?
[e
Yes
❑ o
❑ NA
❑ NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
W�lo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
1Noo
❑ NA
❑ NE
20. Does the facility fait to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP [—]Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C31<0 ❑ 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 Inspecti;"Ngo
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

!'I
Facility Number: jDate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ 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
❑ NA
gNo
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
/No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[]Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes 21"No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
3 I. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ETNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes �o
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any 6ther�cominients:
Use drawings of facility to better explain situations (use additional pages as necessary).
is t) LLO E tE E 06D
Reviewer/Inspector Name: UQiJA / 7_6 diAltr ( , { Phone:
Ell
Reviewer/Inspector Signature: L. Date:
Page 3 of 3 JF
r

`Type ,f Visit: GCo�fipiiance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
' T' f
Date of Visit: I q 1 Arrival Time: lQjj Departure Time: ® County: AI G1N Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: V o A/OTPAAJ FYI
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry C**opacity Pop. Cattle
La er Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
a
1/+U
Non -La er
aiCZ Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current Dry Cow
Dr, P,oultr. Ca aci P■o , Non -Da'
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Turke s
Turkey Poults
1 Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
/ 4o
❑ 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 I of 3 21412011 Continuer!

Facility Number: - Date of Inspection: qj
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
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
A(,vv&)
30
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 3 Structure 4
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Structure 5
]�No NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes �No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes rNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) — /
9. Does any part of the waste management system other than the waste structures require ❑ Yes I yNo ❑ NA ❑ NE
maintenance or improvement? T
Waste Anlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive 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 1o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available? yOthyer:
s No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, checks ❑ No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements 5t.►/D Ej"V L
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 Z o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 11 -169 1 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WNo
�o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the,appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
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.c., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes LJ No ❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
❑ Yes 2fNo NA ❑ NE
[:]Yes NNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑No ❑NA ❑NE
64;❑ NA ❑ NE
rN ❑ 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);
z jc #*b✓AL A4E6P hIM6 f9k Z- vac—D 10 klAfAWE
,5.
9AT �_ 6�r N--,-J(° 6-EAJ 6 4 tc. N41.f
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: U ` —�3 8
Date: /1,11/1,
1 1
2141201

k1j
Divisioniof'WaterR.Qu%lity, ;® srF lvkSi$�'i•'i �i x E'i.odi Wa"+
teCuons;
vti
9 DsitkNumber
1 4 on
L�F OtheriA enc �� Fi`t= st � ��-�.
aat +.t4.��9 }f1l; + �i � i�'ii'?. i.sl .� i !.k�ag � G�
type of Visit
'pliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
1eason for Visit
TRoutineO Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: Q Departure Time: County: QU Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: .� Title:
Onsite Representative: V °AAA' M,1L-et— Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 = 6 = 41 Longitude: = n =' = 1
1
'- �..�'t�
a&', :Des ri ,`'t Vurrerititt� �:.�t � ;.�E '� ` 'Desi n � 4aCurrent i s 1 � . i �Desi n
tt� '?.,,t�t,.,�1,t�'. a9: g°
'Current
;...,�i'.:;��.:g;,
Swine,Ri Itz Capacity Population
WetPoultr 3g:'
n; y ,Capacrty�
:.:k:a.,x. 3.
C.t
P atHe * Capaaty
Population;
FC. l�I'6.-�t
_ lk �f rF i,
'nation
-a�t4�.._.:xgo-a.�
i!.�,+M�.at>r.-�..
❑ Wean to Finish
❑ Layer
s
i El
Dairy Cow
Wean to Feeder
1i ❑ Non -Layer
I
I.
El
Dairy Calf
gEl
Feeder to Finish
'
a DrPoultr
s, F°' =l ❑ Dairy Heifer
❑ Dry Cow
i
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Pullets
�;';
❑ Non -Dairy
$ El Beef Stocker
El Feeder
,� Beef Brood Cow '
❑
❑ Farrow to Finish
❑ Gilts
❑Boars
.
kRg`, tuft,
hei
e its rn.,a4>.�..Turkey
��b
s
1 d 2 d
},1Numb!'er of Structures yy�
y
❑ Other
YF: ej :. -$E J'J4'§z+.47{� .a .:t= ..
El Layers
El Non -La ers
El Turke s
❑ Poults
❑ Other
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
El Yes
�❑/No
L'lN
❑ NA
El NE
❑ Yes
No
Cl NA
❑ NE
I2/1$/04 Continued

Facility Number: 31 —g6l
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 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: Uq{-" n
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 26
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environment7tat, notify DWQ
7. Do any of the structures need maintenance or improvement?
ElYes
El ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
WNoNA [I NE
❑
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
(ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L/J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
i
Reviewer/Inspector Name �'���#'ar a Phone: r
Reviewer/Inspector Signature: Date: o
Page 2 of 3 12128104 ' Continued

Fatuity Number: — Date of Inspection /b S
&equired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes E5 No ❑ NA ❑ NE
❑ Yes WNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ON"o'
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspectionss [I Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
I[J N
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
L1 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2rNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�9'
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
I,I No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Yes
El.
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No [I NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
EK ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
o ❑ NA
[I NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
ElYes
�C'❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
❑ NA
❑ NE
Additonai Comments and/or Drawings t F%.Oi-
i
7
Page 3 of 3 12128104

Type of Visit ercoompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: u o Arrival Time: ® Departure Time: County: -'bO P (TIJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: oKf)glq('ma- mm"'-tr'- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= c = 6 = `t Longitude: = c ❑ ' = {1
Design 'Curreni
Swore. , ; Capacity Population , Wet Pobitry
❑ Wean to Finish
® Wean to Feeder
1-two
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ler
Other
❑Non -La e
€, DryPouli
3 ❑ La ers
❑ Non -La i
❑ Pullets
❑ Turke Poutts
�]❑ Other
sign; Current r> ' Design;L' Cuiieni
ra, t •��kdx�s x
iacityq Population; .r Cattle CapacrtyjkPopulation l
❑ Dairy
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cow
❑ DairyCalf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
t it
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
[I NE
❑ Yes
o
El Yes
I ��N
❑ NA
❑ NE
ElYes
J No
❑ NA
❑ NE
12128104 Continued

Facility Number: J; -- Date of Inspection la o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 9No
❑ 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: �-ACIWO'13
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '1%g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes dNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 6No
❑ 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 environmentaltheat, 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 2 o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes U No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 03�o ❑ NA ❑ NE
❑ Excessive Ponding [:]Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Q<lo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes �o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes B No ElNA ElNE
18. Is there a lack of properly operating waste application equipment? El Yes
Yes ❑ NA ❑ NE
Reviewer/Inspector Name - ;. Phone: b L
Reviewer/Inspector Signature: Date: /,O O-
12128104 Continued

Facility Number: 3 Date of Inspection ka p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [] N ❑ 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 (�No ❑ NA ❑ NE
❑ Yes
u N
❑ NA
❑ NE
ElYes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
9'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E io
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
❑ NA
❑ NE
27. Did the facility fail to securea phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EJ'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
®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
EJNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
Q1K0
❑ NA
❑ NE
A�d�ditional Comments and/or Drawings:
12128104
12128104

W
Type of Visit 0 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / 6 Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 o [= " = Longitude: = ° = " 0 "
;�tk 3 za f"K x.
Dest l : Current ` '' rDest n` Current €` ° _' �* 'Design= CSurrent'
1Capai`ty' Population' # Wet Poultry', 4Capag ty Populahon'x��.t},Ca}iacity';Populetiori'S'
❑ Wean to Finish ❑ Layer
(.' ® Wean to Feeder ❑ Non-Laye i
s' El Feeder to Finish } ) _ s',. ,1 a
El Farrow to Wean �� Et,t _`.
D aPouftr 1�
h k+t — z xV�'s- 1 1%
❑ Farrow to Feeder
❑ Farrow to Finish ❑ Layers d: ,
!' ❑Gilts ❑Non -La Non -Layers
❑Boars El Pullets
y ; ❑ Turke s x �..
its
Other ❑ TurkeyPOultS
�� • �Nmb t�o, �tr�
y ❑ Other ❑ Other 44> xx ° � 3{{� 33uyy_ pp,ppyy e jj f [[S ¢prue re4 �s
:RA:ti�`u{]+r5'., �r.YE,
t,.�.k��wE� '''°. '::�;r.ki.�-:`,��i��F.h�:�.�,':'R-�'.�<�_ �qt,,...:.n•`4`:4-:��s 1.�;_���ts�#.:t��o.i. '�d ��' _i'i,,.
❑ Dairy Cow
❑ Dairy Calf
❑ Dai Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑Beef Brood Cow
Discharges & Stream Imeacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LNZ
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 3 — Date of Inspection D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[I NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
7No
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ 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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes YNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 [J No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes LyNO ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ElYes ✓✓ o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
1 sc, vn
t✓ l�dN 30 DQYJ
t tf�r��
Reviewer/Inspector Name t'. �
';o' '�ri 4 7-�v.
. e �,,Ii�l
i t. '. A $h a i `$, i
.� � : k Phone: D
751 JVT
Reviewer/Inspector Signature:
Date:
Ze
Page 2 of 3
12128104
Continued

Facility Number: Date of Inspection / u
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [IYes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
k No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Cade
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El es
V No
El 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
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�No
❑ NA
❑ NE
Other Issues
2$. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ 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
Zf`No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
2No
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
N
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number. g4 l
,11 -
(d Division of. Water Quality
Q Division of Soil and Water Conservation
Other Agency
Type of Visit (ZfCom fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t�utine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i 1�/G/_D% I Arrival Time: f�/� Departure 'fime: County: _DLI ,* Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: .� Title:
Onsite Representative: _r0PJAT9,a Certified Operator:
Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o ❑ I 0 Longitude: = o ❑ , = L{
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
Wean to Feeder 2,666 aAOD
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system'? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes D No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
"
❑ Yes
❑ NA
❑ NE
❑ Yes
VN
❑ NA
❑ NE
12128104 Continued

FaFility 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?
Structure Ir Structure 2 Structure 3 Structure 4
Identifier-,t✓ r
Spillway?:
Designed Freeboard (in): Z.j
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes L' I No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalth at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit`? ElIa 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 V(No ❑ NA ❑ NE
maintenance or improvement?
Waste Ai mlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ld No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
1
El NA
El NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
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):
zQ % um � i.l &vv4 A E12:6v svn� mAIL y 1#6 et F.n .lrF�bo+�u . sj-M/ co��' Fr4 is Qi Z/ �.
/� 1/6Ej dDr ev Cow i X6LV Toast 7M7 I kgr'
So N� .aoo Y�EAac�! �a,e 2 r fy� �✓ 1gc�dr CVE �619— 4 c.c,�kAW6 CoKA) 10PA Y
st /b.r Gov ,� Afre,ze-P. Q*6& .fe'8f��/f o�vL y v6f`s, aivsK2 L srr�ER�ar4
Zalt' /�uml°G�n GoRREGt PAn/ APPe.,6p, Sin
k 7- A1 K 0
Reviewer/Inspector Name , j/ &F /k L L Phone: 7.3ry
ReviewerlInspector Signature:
Date:

Facility Number: — r Date of Inspection
' Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20.
P readily available? If check
Does the facility fail to have all components of the CZesign
WYes
yes,
[I No
El NA
❑ NE
the appropirate box. ❑ �p ❑ Checklists ❑Maps El Other
21.
Does card keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
Waste Application ❑ Week y Freeboard ElWaste Analysis ❑ Soil Analysis ❑ Waste
Transfers
ElAnnual
Certification
El 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
El7
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes
CJ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U<1
❑ NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
A
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[I Yes
�,
Limo ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
[T�o ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�,
o ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo ❑ 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
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
FNo ❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit ,(2rCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,3-Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: %d Departure Time: County: n Region: 6�zl&
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: "Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification umber:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = 1 = Longitude: = ° 1=1 ' 0
Design Current
Design C►urgent
Swine Capacity Population
Wet Polm��PRPUatlon
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder V1Q
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
[-]Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
I J[j Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes +'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
El NE
❑ NA
El NE
❑ Yes
r❑No
El��
YesETNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PTNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes .EfNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �TNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ff 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Oqo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
� f — �
13. Soil type(s) h/
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
,no
❑ Yes No
ICJ
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes ,ErNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes �' o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ONo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments..
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I Phone:
Reviewer/Inspector Signature: / Date:
Page 2 of 3 12128104 Continued

Facility Number: — d Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box.
❑ WUP El Checklists ❑Design ❑Maps El Other
❑ Yes •B'No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes 12No ❑ 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 EfNo ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No ZNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No 12INA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No ZNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes 9No SNA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No ❑ NA
J�rNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes P1 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 Z'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 ;!TNo ❑ 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 ONo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes 2<o ❑ NA ❑ NE
Additional Comments and/or Drawings:
i
Page 3 of 3 12128104

IType of Visit O'Compliance Inspection O Operation Review O Lagoon Evaluation !
Reason for Visit, _C>146utine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
�rmittedOCertlfied 13 Conditionally Certified 0 Registered
Farm Name: ........ ......3 .!�, ��x fv"xaet Y. ..................
OwnerName:.......r ,�1�. P ... .. ! 1Y)!ns..........................................................
f7 Time:
Not Operational O Below
Date Last OperWr4 or Above Threshold: .........................
County: '1..........................................
PhoneNo: .... ..................................................................................
MailingAddress: ............................................................. . ...................................................... ..................................................................................... ..........................
FacilityContact: .................................................... p.......... .............. Title: ..................... .......................................... /Phone No:.......................................
Onsite Representative:......ti.r...........il.Sw.t.rl.'..S....................................... Integrator:...t..K.C..LY.�........................................
Certified Operator: ................................................... ..................... ................... ................... Operator Certification Number:..........................................
Location of Farm:
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude • 4 41
.�Canacytv,'PE►n�ilatinne
can to Feeder
aU CC;?d
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
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 gaUrnin?
d. Does discharge bypass a iagoon system? (If yes, notify DWQ)
❑ Ye2 J oo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes .ET110
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes .8' 0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes
Struct�e I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........................................................................................
Freeboard(inches): �......................................................................................................
12112103 Continued

Facility Number: Date of Inspection %
Ir
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[j Yes rt
.1 seepage, etc.)
.x.
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes JIM
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?
❑ Y6 H4
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes . �o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes Z2-p
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes j� o
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes _.""
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop typea(/V4 z54 4X 0
If
13. Do the receiving crops differ with those designated in the Certified Animal Waste Manag gent Plan (CAWMP)?
❑Yeso
14. a) Does the facility lack adequate acreage for land application?
❑ Yes _,M-f4o
b) Does the facility need a wettable acre determination?
❑ Yes j2mo
c) This facility is pended for a wettable acre determination?
❑ Yes ,0'No
15. Does the receiving crop need improvement?
❑ Yes 10<0
16. Is there a lack of adequate waste application equipment? ❑ Yes IjXd
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes P440
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes„2-Ko
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,�Wo
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 Jb21 "
Air Quality representative immediately.
Field Copy '❑ Final Notes
'5hems 1162. 0 , _Zle�f-2- ez-ve'23 10'r, 0
sG ,C00,-7S6w's le Pla� alla-i-S 4?. G zAr­2 c sl, 7.),
- �1��� rcr�� i•�sr� �i 0ILI
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
12112103 / Continued

Facility Number:'/— Date of Inspection 4
Reayired Records & Document,;
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Ye ! o
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 JR'No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,,-No
❑ 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-JZRo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes 01Wo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ,01;o
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ,j]-No'
28.
Does facility require a follow-up visit by same agency?
❑ Yes fib
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes19-VO
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes P-Mo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

IType of Visit V Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit I&Routine ()Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: 2S D Time:
10 /
Not Operational Below Threshold
©Permitted ® Certified M Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: /e4? ✓ 177 A1,)AC5S' V County: uD4il
Owner Name:
Mailing Address:
Facility Contact:
Title:
Onsite Representative: 42)Ad /
Certified Operator:
Location of Farm:
Phone No:
�Pjhone No:
Integrator: /f//w�j�
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0• 6 44 Longitude 6 66
Design
Current Design Current
Desigm : ,Current
Swine Ca aci
P.o elation P.oultr Ca' aci Po elation Cattle
Ca aci Po ulatio`h
Wean to Feeder
I ZCX
❑ Layer
❑ Dairy
❑ Feeder to Finish
❑ Non -La cr
I IE] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
0
❑ Subsurface Drains Present ❑ La oon Area
❑ Spray Field Area
Holding Ponds / Solid Traps
❑ No Li uid Waste Mana ement S stem
Discharges _4 Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection _& Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inchcs):
05103101
❑ Yes X] No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes a No
Structure 6
Continued

Facility Number: 31 — ? 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?
aDoes any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes E� No
❑ Yes M No
❑ Yes No
Yes ❑ No
❑ Yes & No
WastE AD211cation
10. Are there any buffers that need maintenance/improvement? ❑ Yes Eg No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop type rh e• D e!C
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 O 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
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required
Records & Documents
17,
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
&Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
91 Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ER No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
L3 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
allo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[RNo
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
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments�(refer to.quesho�,#) � ExpiainanyY S answers and/or any recommendations or�any other comments - t�� ::
Use iirawingsoftfacil�ty�to�better explain situations. (use additional pages as'necessary)
�., ,, ,. �, � , vc
„ � ❑Field Copy ❑Final Note
77
AS 40 r/�C�R f
/P•�.ni�t AO `111' eiC /cods G4A
r� i s 6 � l�Jor��►T w/f
D/t �f e!TTiit
/rl��
/g'
2�
3,5� �i�F� is ������o' key
�'✓
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 3
05103101 1 Continued

Facility Number: — Date of Inspection Panted on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes R No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes A� No
28. Is there any evidence of wind drift during land application? (Le, residue on neighboring vegetation, asphalt, ❑ Yes 21No
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 ® No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes M No
Additional omments and/orDrawings:
A.
5100

€ f i f A'
sion of Wiater.Quality,
0 Division of Soil and Water Conservation I
0 Other Agency
• ! E€
_E.," :'.II
Type of Visit Compliance Inspection O Operation Review Q Lagoon Evaluation i
Reason for Visit JA2f Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access I
Facility Number I
Date of visit: [
0 Permitted © Certified Q Conditionally Certified [] Registered
Farm Name: -5� e... e � o S N ..... Sc,,' y
Owner Name:............. `�e.J �....o►.........................1/
FacilityContact:..................................................................
Mailing Address: .........................................................
Onsitc Representative: � 0- u e �'� es
CertifiedOperator:.................................................................
Location of Farm:
1�JTi►ne: Printed on: 7/21/2000
10 Not Operational 0 Below Threshold
Date Last Operated or Above Threshold:
County:. v� /'i`v
Phone No:.. ..................
Title:................................................................ Phone No:....................... ............................
....................................................................yy..��...............j.................................... .............. I...........
....................................... Integrator:..!:.(..{�t.lL.�.......
...................................... Operator Certification Number:..........................................
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 t 46 Longitude ' 6 it
_ u
Design Current Design Current Desiga Current
�_ �vinte . capacity Po ulation Poultry Ca aci Po ulation Cattle CapacityPopulation
lF f Wean to Feeder zz 619 ❑ Layer ❑Dairy
tji ❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑Other ;
iA3 i [3 Farrow to Finish Total D6i& G Paeity'
,q'il, 0 Gilts
El Boars Total,SSLW
Number of Lagoons I0 Subsurface Drains Present ❑ Lagoon Area Iff Spray Field An ,_'
ry ,,,,Ho ";Nnds / Solid Traps 'I I[] No Liquid Waste Management System '
Discharges & Stream Im acts
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?
h. If discharge is observed• did it reach Water of the State`? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure; I Structure 2 Structure 3 Structure 4 Structure S
Identifier: .................................................................................................................................................
......................................
Frechoard (inches): 2-6
5/00
❑ YesXNo
❑ Yes> ' o
❑ Yes �No
❑ Yes No
❑ Yes�dNo
❑ Yes',dNo
❑ Yes,2fNo
Structure 6
Continued on back

Facility Number: slate of Inspection i`11�j I Printed on. 7/21/2000
,5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes ❑'�To
(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 ZNO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 'PINo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ YeszP1No
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,,ZNo
12, Crop type Cd r .�J
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes o
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 �T0
15. Does the receiving crop need improvement? ❑ Yes /❑'�T0
16. Is there a lack of adequate waste application equipment? ❑ Yes)ZNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes �No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes IVNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes p� o
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? ElYes�N0
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 )Z�No
24. Does facility require a follow-up visit by same agency? ❑ Yes ep"'o
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes PNo
�'Vc� yiQl�t ign�s;o� dtfcjencies wire noted• d4rrtn9�bis;visjtf - Y;op will •fee iye 0o ruttb0e • , -
correspondence. a�aut this .visit.
Codments (refer to question #):, Exp>lain 4ny YES answers and/or any recamimendat'tons o'r any oktier ronnmentsz
Use dt rwtngs pf facility to better eiiplain situations {use i3ddttional pages as necessary) , • € „ € 1 E J , ; l 6, ? 3 3g It All,t
F 6 ;1 4 � � v%,,,;( re6a,-dV ei re bv6111 IC e Ga a ,� -jc- 6 � ` •
%fin P104 A�51//7 �D GOr� a 711is ec�/ qs w� �1S beef
i1Se� �S ,peen n rn�vfcrDe � ( fa l �e�3 �C,af not ej �eej
Use
by
.
Reviewer/inspector Name
Reviewer/inspector Signature: Date: 5/00

Facility Number: 31 — Date ofInspection Printed on: 0/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 31No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes f�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 ETNo
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 Z"No
32. Do the flush tanks lack a submerged fill pipe or a permanent temporary cover? ❑ Yes ❑ No
Additional omments and/or D rawin
5100

t
Q Di: viersion of Soil anti Water Conservation
r�IK
r
O'OthAgency:
tiff
(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation i
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number O Date of Visit: Time: �� Printed on: 7/21/2000
Q Not Operational 0 Below Threshold
0 Permitted 13 Certified 13 Conditionally Certified [3 Registered ' Date bast Operated or Above Threshold: ...............
Farm Name: �F Uip5E2 ....... C,ounty:......f...................................................
Owner Name: S EUE T 5 Zq -3Z$1 d r Z98 -SSI Z
T.................... °...............................................................................Phone No: .........................................................................
FacilityContact: ........ Title: ................................................................ Phone No: ..................... I ....................... ......
Mailing Address: .... 6ax 1' 10 4UNTrr4.q.....GL �1 Q Rcf-
.................................. ...............................I............................................................................................... ..........................
Onsite Representative: .5 r t/E So^l G S Integrator: ..„µ,UP, Pl
.............................................................I..............................Y........................................................
Certified Operator:........ S:TEVG..................... �rtb^'65................ Operator Certification Number:.......................-�..............
.............
Location of harm:
o1rrH Ot= 86vtalue.LG-tvc-LvLA-' $Ie 170 rO 1731L- 2T'ON 173/ fro".-ft- TO 1739 r"ur-" Zi4 Rs* III
GU +ei , (5Our1+ SsDr, o,=, 173 5 :
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 3 `f S8 28 Longitude 77 • �6 u"u
Design Current
Swine Canacitv Population
Wean to Feeder
Ztb oo
Z o0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design Capacity Z, 604
Total SSLW -79, ao O
Number of Lagoons ® Subsurface Drains Present ❑Lag--n Area IN Spray field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated 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. II' discharge is observed. what is the cstisnalecl flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 'V No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �jNo
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes V No
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure G
Identifier: ..........7.....��......... ......... ............................. ......... I ....
............ ......... .......... ............. ............. .... ............... ................. ....................................
Freehoard (inches):
5100 Continued on back

a
Facility Number: I — $E9 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 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 ONo
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 t 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 -iIL Yes ❑ No
12. Crop type C; rO, pr58 f 9U2r4degj
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N�No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes 9�40.
16. Is there a lack of adequate waste application equipment? ❑ Yes Ld o
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
k10
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
4LNo
(ie/ WUP, checklists, design, maps, etc.)
Cl
I'no
19.
Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports) -94e
, Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ZNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
t4No
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 E�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 �Vo
�'Ho yi6latigiis or• defciendoi were n(ted. Oitritig t:his'visit' • YoO ;wail •r. eoeiye 1i6 furtl�ttrr • . -
•icorres�ondence.about.this.visi.t�•�•�•.•�•.•.•.• .•. ..•.•........... •. .•......... .•.•.•.•.
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):
wblo SPRAyrNti 14AS 6C4,,'r4.e 0n C,C-4•0 OFC00-14 siNC19-4r+u+ C4%-MG'0u', o0tF4i+"ro,e t+ArS coeeucTG.D A.
f}Mp VAT O t= P,44 Z_o,, O, rj c5 lco,e sr,,r S( �4 rM r OvE �A�uc�T�av P/� PF1 n/
Ait-• NAs P40 FPCE$a%RD QGc r_D5; Aj>vtSGb 7V 0E7,,-j Ai ONC"6.
V
Reviewer/Inspector Name 0-L-71-
Reviewer/Inspector Signature: Date: 111Z 5/00

Facility Number: 31 —go4jl Date of inspection It L Yoao 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 �it/or hplow $4 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4 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 IQ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (ix. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes Eallo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes WNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes JVNo
5100

3 D�vesion of Soil and Water Conservation t]peration
.Division of Slid and Water nse ah 3
0, 9 Cq rV on COm Ito
I)IV1S10n ofate QLl illtj� C o11i�71>i i1Ce-�nSjlCajo
EE ! }
i9 E-4-I'oi� rek'r
OtherAgencyOperati.onRevaew€.,��,�,.�,{f.,.i'1l�.I u..e,ilr,..
Routine OCompiaint O Follow-up of DW ins ection Q Follow-u or DSWC review 0 Other
Facility Number [S Date of Inspection
Time of Inspectimi 24 hr. (hh:mm)
© Permitted Certified © Conditionally Certified © Registered 113 Not Operational Date List Operated .
Farm Name: ... 1 County'y..................................................... `'�............. ........... ..
OwnerName:............................................................... ....................
FacilityContact: ..............................................................................
MailingAddress............................................................ ...........
Onsite Representative: Q^'� ..........................................
Certified Operator: ................................................... I ......................
Location of Farm:
No:one
................................Ph.......................................................................................
Title: ................................................... Phone No:...................................................
.................................................................................. .........................
Integrator:.......d.��471...
Operator Certification Number: ..............................
i
...................................................................................... .. ...................... ...............
Latitude �� �' �•� Longitude a
Design Current Design, , Gu Design , Current
g g rrent
Swine, ' Poultr `
r
�Ca acity Po ulation y,; Ca" `acit Po ulation'' Cattle Capacity Population..,
a
l�ra
€l�F;
Wean to Feeder
UJ
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ME ❑ Dairy
,. ❑ Non -Layer - !' ❑Non -Dairy
'❑ Other
1E
Total 06min' ' Capacity
9 rs
Total��SSLW
IV'ucnber ' f
f La oon Area Spray Field Area
7 � ',Lagoons : � �-, s � , ❑Subsurface Drains Present ❑ g ❑ P Y
H ,
oldtngPondsa Solid Traps � 3, ; ❑ No Liquid Waste Management System
t 7'
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes r<rNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑Yes ❑ No
h. If discharge is observed, did it reach Water of tlzc State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon s ~tern? (If es, notify DW ) ❑.Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes j No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
5lrurlurc ] Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: pp
Freeboard(inches): ............. e—o..............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ict trees, severe erosion, ❑ Yes M$No
seepage, etc.)
3/23/99 Continued on back

Facility Number: Datr• of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
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
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, Freeboard problems, over application)
23, Did ReviewerlInspector 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?
Q yi�la�igris or d fciencie5 wine n* tee ciitring ]this:Visit' York will teoiye 1i6 #'urt.
C ' res�6rideit e. A' k this viset. ,
❑ Yes , No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
]� Yes [] No
❑ Yes P<No
❑ Yes D4 No
❑ Yes ❑ No
tz(yes ❑ No
❑ Yes M No
❑ Yes Jj No
❑ Yes ` No
❑ Yes t9f No
❑ Yes D(No
❑ Yes ONo
❑ Yes 9 No
❑ Yes C�No
❑ Yes N No
❑ Yes gNo
❑ Yes U No
t-ornmentsmi,reter to quesuon°ff1: nxpiain any jma answers anwor any recommenaanons ortany other comments ,
Use drawin" ,of facility to Better ex lairi'situat�ons' use add�honah a es asGnecessa
&s Y P { P g
C� �� Gw� . ��.� � +n.Q.S� t..x.;.,�-� �;Lc,..��„r--- ;p At�. R�vi3-� ►�-2�c�
ReviewerlInspector Name
a �
Reviewer/Inspector Signature: Date:' 9
3123199

Facility Number: ` — Date o#' litspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below AYes ❑ 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 b�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
(ffNo
11
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
KNo
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�q No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Cl Yes
KNo
Additional Comments and/or Drawinp: .<•i.. `,'I , . ' - i . 7 . .
3/23/99

:,+.�,H 3 K t �,-' - '',pk��..:y. $a ya. 3"_.mTMS lx exa�?^wi.'��,iiwt�..h�.•.ke.- .. .. e''v Fx .. x:�'�
Soil Water Conservation
g�R.$
".k��. ! i
(] Division of and 0 Other
k�
i
g£ Division of Water Quality
1
IQ Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
�i—��, Date of Inspection ` z r
FFacility Number
Time of Inspection U=p, . 24 hr. (hh:mtn)
r] Registered 01 Certtiified © Applied for Permit © Permitted 0 Not Operational Date Last Operated:
FarmName: ................. �lC s&........ ........1LO- ................................................... County: ........ 1 1q ii............................................................
5 .t......... � U.U.s.................. ... ......... Phone No:..... �{1Di. � .`. a.
Owner Name: ................................. ...... ............. .................................................
FacilityContact: ...................................................................r.....I.......... Title:................................................................., Phone No:...................................................
Mailing Address: 1 Lam+ t...nk ............................. z S`�r.......
X.......I............s`tr... 1�...��.a1........................................... .
Onsite Representative: ................ 5 c .... s Ac"i ......................................................... Integrator:........fay...........,................ .......
Certified Operator; ............................ .J�at.11t........ ....c>at�........................................... Operator Certification JNumber :....twe.......................
Location of Farm:
......06 ......... .......S Sim. ...... ........... .L.... "13. t:} L...... mi.Us...... U&s ..... 0.......... SPA...i.7.a...............................................................
..... .. ..
Latitude ' ®' " Longitude ' 6 46
�;��, `Design Current
x Design Current .Design Curtretit
xR.....
Swine Capacity Population _
.....£_
Poultry
,Capacity
Population cattle ._Capacity Population
Wean to Feeder peg Loc,
❑ Layer
JE1 Dairy
❑ Feeder to Finish
❑ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
F 7774
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish'
Total Design CAP, actiy Z 00
❑ Gilts
❑ Boars
Total SSLW : 1� Gt�O
u
f
Number of Lagoons I Holding Ponds Subsurface Drams Present LJ Lagoon Area Spray Field Area
{ tF0 No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
EP No
c. If discharge is observed, what is the estimated flow in gal/min?
A
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
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0 No
7/25/97

Facility Number: 31 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagogns,11olding„Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Stricture 2 Structure 3 Structure 4
Identifier:
.............................................................................................................................................
Freeboard(ft): .......................................................................................................................................
10. Is seepage observed from any of the structures?
11. is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes 'P No
❑ Yes P No
Structure 5 Structure 6
................................................................
❑ Yes [�]+ No
❑ Yes ' M No
❑ Yes Q No
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................ UM. ........... t"4.............. ....................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes PI No
❑ Yes [0 No
7 Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes
No
Yes
jL No
❑ Yes
M No
P Yes
❑ No
❑ Yes
0 No
❑ Yes
® No
❑ Yes
P No
❑, No.violations•or. deficieincies:were-itoted-during this:visit.- You;will re'cerve,rro,furtl eir
:. correspOddeke d oitt tt>tis:visit: :
�L. Vie is Ala cc� ►►. �a��l `kl # . i1�UP calls tJ�tla`�-. 1
2z • Aw c..rr,U,-ate. R�,lPl ri+ua5um ww 1 S�oA j� T�ia_ i r. j e[jt7 4,L 4-a C ekrfi�j, p cor
O�CIY+ `g� f, ee4c'v[at, `�' — YID' er.. 6-1a"tr�.
r(, crt1� S6vw � t USZ U 4o- � W)UmA 1, yie�is Covcr `L,..,
[
��� 11 s o �� �e S�a. W ivxA chn JM or- A-e dslri f �1k
-t 7-�co,,�� dwcVlls� � q %�,ul M VV6 -r-vynq �fr 11 a(er-L ( sL"UKP'4 6� 7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

Routine 0 Com laint O Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number Date of Inspection 71
Time of Inspection ZCO 124 hr. (hh:mm)
Total Time (in fractiou of hours
Farm Status: [I Registered ❑ Applied for Permit (ez:1.25 for 1 hr .15 min)) Spent on Review
jgjj Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: .................................. . ....... ..................................................... . ................................ .................
FarmName:........$R.JCS.......tilllJt! ........ �&_ V-n......................................................... county: ......... b4ift..................................... ......... ..............
Land Owner Name: ...........
i ye ......... ...... t`............................. ............ ...... Phone No:...(0....IG.I..z:rl...........................................
Facility Conctact...........15.6p...... RS. ............... .............. Title- ........Darn .................. .... Phone No: .��1 �. g. .', �.............
Mailing Address:.....&x..... Ll ....... A1d(1b!)..ti..r-Vi1....... U.:..................................p1.ra..... ................................. 5.1�.....
OnsiteRepresentative:............... :5 Vka......] aR.S...................................................... Integrator: ....... 6u1��-:4............................ ...............................
Certified Operator: .... �IaC�I .............................. ,tFk4 5............. ...... .......... .............. Operator Certification Number: J....U.. .. �1 .................
Location of Farm:
R1. ... kU.*.... ..i...N c. ,:,...... i .....T, +...r.......arn... ....... 5K.t74p ..............a
. .. .. ? :...Tirr..r�...+r .... a, .. .... . ��. s :... Axxn....t: ... o=. . !a�► .,... � _. �c h,...C.40.c.... n. .r.......... a
Latitude Longitude �• ���
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes R No
2. Is any discharge observed from any part of the operation? ❑ Yes D$ No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) [--]Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes R No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 19 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes KNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 19 No
4/34/97 maintenance/improvement?
Continued on back

Facility Number:.. —
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes M'No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes t5No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes 83 No
Structures (Lagoons and/ojr-Molding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes EjNo
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
4_ -
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvemcnt?
(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?
Waite Application
14, Is there physical evidence of over application?
Of in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....................... Ckrx.\ ....... .............................................. ............... 1�.CI QhS
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
I7. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Cerffled Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes Et No
❑ Yes allo
$4 Yes ❑ No
❑ Yes Q No
❑ Yes JKNo
❑ Yes R1 No
❑ Yes KNo
❑ Yes No
❑ Yes No
❑ Yes JaNo
❑ Yes ($No
❑ Yes CR No
❑ Yes IR No
E� Yes ❑ No
Comments (refer to questian #)Explain any YES'answers'and/or;any recommendations or any othe> comments
Use drawings of facility to better,explajn situatioris: (use additional pages as necessary).
.S"'•. �:i6•�ih
IZ kn/NLY wo,li 6- IGYo,. Sl.ov�c} �c w �owu�. 4 ayr_ s�o�S S, old ire. PSee�ej, 4
ZA '5" fetmX sincX la6el 1Aj3ya,r,' # avib Ae16 $�. La�ao4� t�v+(� lyricya� f es'lrs
56j) be at, si(-eI
Reviewer/Inspector Name , :. w„: 5 . ...
Reviewer/Inspector Signature: Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97