310843_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

1
(Type of Visit: (' ?Routine
ance inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 3 0 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: l t1 W 5 Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design G•urrent
Swine Capacity Pop.
Design Current
Wet Poultry Capacity Pop.
Design Carreat
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
can to Feeder
I jNon-Layer
I
lf
Feeder to Finish
f
Dai Heifer
Farrow to Wean
Farrow to Feeder
Design Current
10) P■oul Ca aci P,o
Layers
Dry Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
F70ther
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No [:]NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 10 ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - Ds ection: %
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ZfNo ❑ 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 environmenta hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ] N ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ 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
❑ 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
❑ Yes2NO
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
[:]Yes
N ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

f'acili Number: - Date of Inspection: F
24. J)id the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0_9�01] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [:]No Fj`NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No 0 NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes , No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP? ❑ Yes EfNo _Q NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes [D q NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Reviewer/Inspector Signature: ``� 1 ��--� "` Date: 1� l
Page 3 of 3 21412015

(Type of Visit: (? Co=outine
ce Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 2® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 7ff' L" It "f"'
Certified Operator:
Title:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current
Design Current
Swine
C►apacity Pop. Wet Poultry Capacity Pop.'
Cattle Capacity Pop.
We n to Finish
I 11-ayer I
Dai Cow
can to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
7 Y 9
#cc
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Dry P,oultr. Ca aci_ P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turke Pouets
i
Other
I
Other
I I
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ff No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili umber: -31 Date of Inspection: r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes M No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes�No[:] ❑ 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 [a'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 hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yesril�o
❑ NA ❑ NE
8. Do any of the structures tack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive 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
ffNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E <No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ a
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
N
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[/]
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EfNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
gNo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

FaciliNumber: Date of Inspection: L 6
A Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [J No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No 7 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)
❑ Yes E3 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
31. Do subsurface the 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 CAWivIP? ❑ 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
EfNo ❑ NA ❑ NE
Vo ❑ NA ❑ NE
ENo, ❑ NA ❑ NE
E3<o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additionalk recommendations or -any other comments.
Use drawings of facility -to better- explaiwsituations (use additional pages as necessary).
r-C '0 r-c(p, D A
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412014

Type of Visit: (�F"Co lance Inspection V Operation Review (> Structure Evaluation U Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q O#her Q Denied Access
Date of Visit: U19 30 Arrival Time: Q t[ Departure Time: © County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
I I� ti
Swine
Design
Capacity
Current
Pop.
Design CUr:rent Design Current
Wet Poultry Capacity Pop. Cat#le Capacity Pop.
Wean to Finish
Layer
Dai Cow
an to Feeder
Non -La er
I alf
'Feeder to Finish
t
Dai Heifer
Farrow to Wean
wwe7clgn Current Dry Cow
D } P,oult , C•.a aci_ P,o , Non -Dairy
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turke s
Turke Poults
Other
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 2jNo ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes k
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facie Number: - Date of inspection: °
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
I- a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmTNN7-!—��L]
t, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes
NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
❑ Yes
][� r] NA
❑ NE
❑ Yes
No_. ❑ NA
❑ NE
❑Yes
o ❑NA
jNo
❑NE
❑ Yes
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I ❑ 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

737
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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.
❑ AppIication 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?
ICJ 5o ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [:]No NA ❑ NE
❑ Yes
MNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
[❑ NA ❑ NE
rNo
- ❑NA ❑NE
❑ NA ❑ NE
Reviewedlnspector Signature: Date: P 3 O r
Page 3 of 3 21412015

GO
Di'vi'sion afWater Resources
Facility Numlter I�`_J - 9-1 9Division of Soil and Water ConservationME
OQ Other Agecy
Type of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: 36 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 Y Arrival Time: Departure Time: /Q County:. Region:
Farm Name: J�� rpy( g Owner Email:
Owner Name: �E ��l w M S Phone:
Mailing Address: � � J NC_ CA) 1 I l�C—U-CA V 1 LL--E 4 / uc o ws
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: t Zu R,7'13 _
Back-up Operator:
Phone:
Inte rator:
O I on ) Coe?
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design •urrent
Swine Capacity Pop.
ean to Finish
Wet Poultry
La er
Design C►urrent
Capacity Ppp.
Cattle
DairyCow
Design Current
Capacity Pop.
ean to Feeder
W
Non -La er
DairyCalf
eder to Finish $C�
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, RROuI
ILayers
Design C*urrent
Ca aci P,o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
I
Beef Feeder
Boars
IPullets
Beef Brood Cow
thurke
ther
FEI
Turkeys
Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ 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 21412014 Continued

FX81ity Number: LJ Date of inspection: r
Waste Collection & Treatment `
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes `{,TTT/ I No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (-1�}�QOW
Spillway?:
Designed Freeboard (in): / 9. S
Observed Freeboard (in): 0
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require 0 Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding 0 Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus 0 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): SC & (L
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
OWUP ❑Checklists 0 Design 0 Maps ❑ Lease Agreements
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis E]Soil Analysis [:]Waste Transfers
0 Rainfall ❑ Stocking 0 Crop Yield 0120 Minute Inspections 0 Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [] Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNo
❑ NA ❑ NE
❑ Weather Code
Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faiffity Ndmber: 7,1 - $ Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 4 No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below. 'A
❑ 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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
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 Reviewerlinspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ Yes No
❑ Yes 14 No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
❑ NA 0 NE
❑NA ❑NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
Reviewer/Inspector Name: / J/nlq/v0,9 Gq/ G S Phone: `/0 1 ! &
Reviewer/Inspector Signature: QADate: Ia�lI (-II
Page 3 of 3 21412014

Type of Visit: j2compliance Inspection Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: kRoutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: ,IA Departure Time: County: ,�.t Region: L./, OA
ny
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: �tJ�%tl-`y W : A7211
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: i
Certification Number: Lq �
Certification Number:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Gat#le Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Di. P,oult . Ca aci_ P,o
La ers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes �,jam'}-No ❑ NA ❑ NE
�.
❑ Yes [] No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
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 g No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes E�rNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faci11 Number: - Date of Inspection: s 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Z 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 �No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes PrNo ❑ 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 7rNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes P3 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes o
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, eta`.
❑ 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):
r
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )n No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes KN 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 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes gNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 0No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes KNo
❑ 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 Zqo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [-]Yes 121'No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZfNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility-Number:Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes j6No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check D Yes ;6No ❑ 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 5a No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VfNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 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 7 No ❑ NA ❑ NE
❑ Yes JZ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[:]Yes 2fNo ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: •.1 il►�� QW`� Phone:
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412011

Type of Visit: n
mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint 0 Follow-up O Referral O Emergency Q Other �0Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: J E e w, "UU1j10S Inte rator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
� Certification Number: cutu 7 l� c_c_1 �mS _ OHR
Certification Number:
Latitude:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
I ILayer Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
"gn-It . Ca a_ci M Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
113eef Feeder
Boars
Pullets
113eef Brood Cow
Other
Other I
ke s
WTUrkeyPoints
FTOther
DischarlIes 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
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes No
❑ Yes kNo
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑NE
Page 1 of 3 21412011 Continued

Faeflity Number: - Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes bkNo ❑ 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: LACag
Spillway?:
Designed Freeboard (in): ] q�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) 1A
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes WNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental 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 kNo ❑ 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 ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesNo ❑ 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): &s1aN�����
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes 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 LNo
❑ NA
❑ NE
Required Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
E] WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ Waste T fers ❑ Weather Code
© Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections Q Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faeility Number: 1 - Date of Inspection: / f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
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
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
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
39L,
❑ NA
❑ NE
❑ NA
❑ NE
�No
❑ NA
❑ NE
qNo
❑ NA
❑ NE
�No
❑ NA
❑ NE
No
❑ NA
❑ NE
o
❑ NA
❑ NE
No
k
❑ NA
❑ NE
No
❑ NA
❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations: or, any; other. comments.,
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer,gnspector Signature:
Page 3 of 3
Phone: q0 '7H (0 _7S D4
Date: q/I9/
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Beason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i9 i Arrival Time: Departure Time: County:
Farm Name: �`� �(��NrV Owner Email:
Owner Name: n {�.(Z �/J IL,(—[ A pA Phone:
Mailing Address: p1V s A)G u j 1 \ 1 C3cuLO v, U-E , TG Q gs 1
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator: U'�) 1 [_(_1 P M S
Back-up Operator:
Phone:
Integrator:
acl
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
• • r
Design Current
Swine Capacity Pop..
an to Finish
Design Current
Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Cattle Capacity Pop.
DairyCow
Weto Feeder
Dairy Calf
der to Finish
[tF
Dai Heifer
row to Wean
Design C►urrent
1) . P,oult , Ca aciP,o ,
La ers
D Cow
row to Feeder
to Finish
Non-Dairow
Beef Stocker
ts
Non -La ers
Beef Feeder
ars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes �No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes No
❑ Yes o
❑NA ONE
❑ NA ❑ NE
❑NA ONE
❑NA ❑NE
❑NA ❑NE
Page I of 3 21412011 Continued

Facili Number: 31 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1A No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes allo ❑ 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? 9
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0"
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): �'� C3rG(z- [ P ! ee9t�!t
13. Soil Type(s): S i�7►/
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes M No ❑ 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
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
y
� No
❑ NA
❑ NE
the appropriate box.
T'
QWUP ❑Checklists Q Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O�No
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis Q Soil Analysis
❑ V/aste Transfers
Q Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections Q Monthly and V Rainfall Inspections
Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: - $y3 Date of Ins ection: 19 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
o
❑ NA
❑ NE
Yes
kNo
❑ NA
❑ NE
❑ Yes 10 No
❑ Yes VkNo
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
[DNA ❑NE
❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes &o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary). _. ;* '`
1JY- F LX) l `S
°/d
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q/6 1 %-13d '
Date:
21412011

Type of Visit )0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 ]d Arrival Time: �± � Departure Time: County: Ll A/ Region:
Farm Name: �� FA Mg Owner Email:
(' 1k 'dRFr-3ta? S C�
Owner Name: Phone: Cr-)to)43v-4(P40 CGS
Mailing Address: ���� ! C `'t &L1f $U1 L� 1V� � R V &
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �� LA_�)I cc-, A m � Integrator:
VyI CIA i9 M S oY,d1C3
O1 &`�
Certified Operator: Operator Certification Number:
Back-up Operator -
B
ack -up Certification Number:
Location of Farm: Latitude: = o Longitude: = o = 6 =
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design
Cattle Capacity
Current
Population
❑ Wean to Finish
JEI Layer
❑ Dai Cow
❑ Wean to Feeder
❑ Non -Layer
I
❑ Dairy Calf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Dry Poultry
❑ Layers
❑Non -La Non -Layers
❑ Pullets
T
Elurke s
E-1 urkey Poults
1E1 Other
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
El Beef Stocker
❑ Beef Feeder
El Beef Brood Co
Number of Structures:
❑ Other
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?
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
DNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 1 — Lf 3 Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Cl Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (P�GOey��
Spillway?:
Designed Freeboard (in): 15.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1)(J No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No (3NA ElNE
maintenance or improvement? �/A
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soi.
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ElApplication Outside; of Area
12. Crop type(s) 5c(A ezl 1�
El NA [I NE
❑ NA ❑ NE
13. Soil type(s) Rt ,&
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
4No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
14No
❑ NA
❑ NE
Comments•(refer to question:#) .:Ezplain an} YESYanswers�and/or any«recominendat�onsgeran otfier comments. _
.fie .�ytia*. -e�b
;Ilse drawings of facility to better'explain situations: -.,(use, pages as necessary) .
�-a ". �. , . e.. r^ S-�` ...: ,m ; , _ ,.* er::;. ,:� N. ''. Wit- ,d a
- a'.�:�".:.e. ..�«.#,`f..x -i ..?:�'�-� ...x-.r:.srC...,. _._fir r ,. .-:d'"".+".. ".�.,+
i
nn T
Reviewer/Inspector Name :`j:5 wrr � . Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Nomber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes : No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [I Yes -No ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists El Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
IB No
❑ NA
❑ NE
3 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑/aste Transfers ❑ )/nual Certification
0 Rainfall {] Stocking E] Crop Yield 0 120 Minute Inspections El Monthly and V
Rain Inspections,,( 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(J No
' `
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
-Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
Cl NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,�(I No
❑ NA
❑ NE
Other Issues
Y
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fait to properly dispose of dead animals within 24 hours and/or document
ElYes*19No
❑ NA
[I 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
0 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
ONo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 0 No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Comments and/or Drawings: H '�
5L-L'&D6C SLA.6 06LA
C_XC_ PAPa �)kj ao)a
Page 3 of 3 12128104

Type of Visit 3&Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit '.Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: ® Departure Time: County: C i Ai Region:
Farm Name: + J\ ,` AzmS Owner Email:
r Cw�910-
Owner Name: 3 w' c1 Rm S Phone: 9X:)-939-`I [o_4d
Mailing Address: 0 N C H I I ( I Riagx=p U I L-c-r , I UC g g-S I R
Physical Address:
Facility Contact: t f Title:
OnsiteRepresentative:
Certified Operator: r d1.4� ` w I u'i A r
Phone No:
Integrator:
Operator Certification Number: r a
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = 0 = & Longitude: = o = ` =
DesiguC1.rrent
Swine Capacity Pop on
Wet Poultry
Design Current
RCapacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
JEI Layer
❑ Dairy Cow
❑ Wean to Feeder
IEJ Non -Layer I
I
❑ Dairy Calf
Feeder to Finish
Dry Poultry
❑ N ers
❑on -La ers
on-Layers
❑ Pullets
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
El
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cod
I
Other
❑ Turkeys
❑Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 'XI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
L,�No
❑ NA
❑ NE
12128104
Continued

Facility Number: —
Date of Inspection 1L13TJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
` ,,Structure I Structure 2 Structure 3 LA
Identifier: C ooN
❑ Yes �No
❑ Yes ❑ No
Structure 4 Structure 5
El NA [I NE
❑ NA ❑ NE
Structure 6
Spillway?: n
Designed Freeboard (in):
Observed Freeboard (in): 5�
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 kNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes No ❑ NA ❑ NE
I I - Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes k No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [:]Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) FOQ.�STC�It/
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes -\ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes O No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes )4No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes S�No ❑ NA ❑ NE
t- omm_ ents refer to uestion # Ex iatn an YES answers and/orr " ".`recommendations or an other co�ttments �' �
( q ) P y y. � F.,
g,"affacili ,.
Use drswm gr
n ty�to;:b'etter"ezplaipsitaations: {useraddtttonal pages as necessary):4 �a�
Reviewer/Inspector Name
}
�'F}j11f� Phone: k (-
Reviewer/Inspector Signature:
Date: at !Q5
12128104 Continued

Facility Number: l -$C 13 Date of Inspection 1 r O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP 0 Checklists 0 Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ I to Transfers [IAkual Certification
❑ Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes] No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
y] No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
12128104

40 Division of Water Quality /
Facility Number O Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit a Routine 0 Complaint 0 Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Mio Arrival Time: 8d d Departure Time: �7 County: DLPLZ-01" Region:
Farm Name: I Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative. _56224 Q.%L�=ja r-%f Integrator•
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
S O
_
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: == r Longitude: [� o= d 0«
Design . Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharzes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current;
Cattle Capacity Population.1. w'i
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef StockeI
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
a
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 f dNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes
El Yes VNo
❑ NA
❑ NE
❑ Yes WNo
❑ NA
❑ NE
12128104 Continued

Facility Number: 31 — IR3 Date of Inspection
Waste Collection & Treatment ,�,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ld 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: J, 46-4VA/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental ilyfeat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes WNo
o ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,�(
9. Does any part of the waste management system other than the waste structures require ElLJ Yes 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
DNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
No
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
ElYes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UNo
❑ 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 jahw ,k_� Phone: 13 d
Reviewer/Inspector Signature:9ALAamd'aDate: 6-7
IZi-161u4 c.onanuea

ElYes D No [INA ElNE
❑ Yes E No ElNA ElNE
I.Vacility Number: 3) — Date of Inspection 1 9 ab o
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Mans El Other
11-1
21.
Does record keeping need improvement? If yes, check the appropriate box below.
LiYes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EI No
[I NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,❑'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Cd o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
eNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
d 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?
ElE 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
,,��,,/
[�'1vo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
d] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
PI/No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Division of Water Quality
k Facility Number O Division of Soil and Water Conservation
- - - Other Agency
Type of Visit
Inspection
Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
VC,opliance
Gd Koutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Q Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: '
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
" ❑ Wean to Finish
"° ❑ Wean to Feeder
EAFeeder to Finish
] Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phone:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = [= 1 =1 Longitude: [= ° = i
Design Current `",Design
Wet Poultry Capacity Population "Cattle -Capacity,
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
urke Pouets
other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Daia Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Conj
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes E/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
❑�No
El Yes
El Yes
[ ,"NN
❑'No
El NA
❑ NA
[-INE
❑ NE
12128104 Continued

Facility Number: — $�
Date of Inspection �_ J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: 1A Gyrcv✓
Spillway?:
Designed Freeboard (in): 19, IF
Observed Freeboard (in): 3/
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
0 Yes 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA - ❑ NE
Structure 5 Structure 6
❑ Yes o ❑ NA ❑ NE
❑ Yes ld No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thyeat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Zo
El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste AnDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RrNo, NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Q L 44+ 6 J S G a
13. Soil type(s) � 6 ase STatJ
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E IVo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L_I N ❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
L 7 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
LI No ElNA
ElNE
18. Is there a lack of properly operating waste application equipment?
ElYes
a<. ❑ NA
❑ NE
Comments (refer to question #): Explain any YES.answers and/or any; recommendations�or any othercomments.
Use drawings of facility to better explain situations. (use additional pages as necessary): .
rV
Reviewer/Inspector Name �G N � .�jfy��} E L11� Phone: 9i D� / �16 — % r3 �$
Reviewer/Inspector Signature: Date: -0 `1
Page 2 of 12178104 Continued

:Facility Number: — Date of Inspection
lReguired 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 To ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Rainfall ❑ Stocking
❑ Yes dNo ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
Cj`No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E, N��o
❑ NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
I<No
ElNA
ElNE
26. Did the facility fail to have an actively certified operator in charge?
El2 Yes
o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�O NA
El NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Ulq-o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑'loo
❑ 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
E3-Ro
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
�/
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
CJ NoNo.
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
O Igo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
(Facility Number �'7' Division of Soil and Water Conservation
0 Other Agency
Type of Visit O Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 2� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival. Time: Departure Time- ounty:
Farm Name: S Owner Email:
Owner Name: _RR� Lc -'rcz-zq m s Phone: _
Mailing Address:
Physical Address:
Facility Contact: �.� Title:
—Z Onsite Representative: �0R RU •Z�Oftfy,,-S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator:
Region:
. r�r2ms
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o =] ' 0 « Longitude: ❑ ° ❑' 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
Turketj
❑❑
Turkey
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Daia Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 'A No ❑ NA ❑ NE
❑Yes ❑No
DNA
❑NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes ;!fNo
❑ NA
❑ NE
❑ Yes Z 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?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: Ab
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes )!I No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ONo []NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ,YJ 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 ARplication
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 XNo ❑ 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 Wind w/� LEI Evidence of Wind Drift ❑ Application O side of Area
12. Crop type(s) .�Q/� C40A (fi%� T� � � k3?� D(Js���
13. Soil type(s)��_�
_
'❑
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2fNo
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes XNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
...:�--c-Y.tr..
❑ Yes ErNo ❑ NA ❑ NE
Reviewer/Ins ector Name r ' r �.
p Phone:
Reviewer/Inspector Signature: Date: ell 19
I2/28/04 Continued

• Facility Number: t3 ft13 Date of Inspection /S 8
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes WNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ZNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes.
0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P(No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
XNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;Z 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
�ZrNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
❑ 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
12128104

Type of Visit *0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number / Date of Visit: Q7 Time: LJ
Nat O erational 0 Below Threshold
Permitted 13 Certified 0 Conditionally Certified [3 Registered Date Last OperatedorAbove Threshold:
Farm Name: C��f�'S County: 1C/4'PL Z/t/_
Owner Name: �g L�{(`S� _- Phone No:
Mailing Address:
Facility Contact: Title: j�,�,, Phone No:
Onsite Representative; + ' ReIntegrator: fREMAZ-- M '4:>`t 6#1Qbe D
Certified Operator: Operator Certification Number:
Location of Farm:
[Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 6 « Longitude ' �° 0
Wean to Feeder U Layer U Day
Feeder to Finish 8 _ ❑ Non -Layer I I❑ Nvn-Dai
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish ota1 Design C►apacity
Gilts
Subsurface Drains Present
No Liquid Waste Man
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area IU Spray Field Area I
❑ Yes jCJ No
❑ Yes /❑ No
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes No
❑ Yes �No
❑ Yes P1 No
Structure 6
Continued

Facility Number: 31 —f3 Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type .beR m uDR (r orj-(RDL ("RkZ iE). �5h) arc, a&zo
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan
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?
❑ Yes VNO
❑ Yes �No
❑ Yes VNo
❑ Yes &No
❑ Yes No
❑ Yes � No
❑ Yes �No
)Vag S EED
WMP)? ❑Yes
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes 9No
❑ Yes ❑ No
❑ Yes A o
❑ Yes No
❑ Yes Y(I
o
❑ Yes ANo
❑ Yes �(J No
❑ Yes �7r_-fNo
o
Yes
❑ Yes XNo
❑ Yes eNo
❑ Yes No
❑ Yes //No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments {refer to `question #j ExpWii any YES answe �andlo a re o epdahons or an o er comme'gn S 1 r
, 1 Y y s..
Luse, drawings. of facRiWto hetter explathuations .(use addthoaal pages asanecessary)
Field Copv ❑Final Notes711 �,
Mr
15)CDO -zajuE To �_PK Op-j Gv-rra2 Vg
SPK F�F�gS. JrOm>-NJ�--66FkMaDA -riv SPRAyF�F�-AS,
��:a�T
6a,?x � o Ap ptv L zM F-. �So�� EST � �
LED Fop- 1p RArice q rn S.o' �t �G0�1'1MF_,J4 N° iylo�Pr /4&v /,$" 1
Reviewer/Inspector Name
Reviewer/Inspector Signature: x Date: O
05103101 Continued

Facility Number: -3 — Date of inspection 4Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes VNo
❑ Yes ONo
❑ Yes [VfNo
❑ Yes ZVINo
❑ Yes XNo
El Yes XNo
❑ Yes ❑ No
Additional Comments and/or Drawings:.
J
EA�S ��R� �u3r��R Ls kF-rPrr3G- F-Ek,-yE�P�oAl2�
`
RCFC�DZOG-5, Sr P— FR om ConnPL-zP�r-�-'E-:F�5C-��c7'`4
00 PEEP UP -r,4c
o�C ; D� FR{l\-
Ju U
O5103101

��1`Tl.9iVfi�ahty
'' E� �,,DIvtO$ oiNl andater COIISeri�a{�QA
(Type of Visit ,JD'Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Malt dRoutine O Complaint. O FoHow up ()Emergency Notdication O Other ❑ Denied Access
Facility Number 3 3 Date of Visit:
D Permitted 0 Certified 0 Conditionally Certified 13 Registered
.-V^td
Farm Name: ..............................------.... �?... -a ......I-- ..............
J.Owner Name: e n�
Facility Contact:
Title:
W-775—j Time: ! :5S
10 Not Operational Q Below Threshold
Date Last Operated or Above Threshold:
County:
PhoneNo: ................................................. ........... ......... . »...._ �.
Phone No:
MailingAddress: ............................................... .................
r
irf
t........................---..........--•-"-..................Onsite Representative:2e....v.V '"1_1 Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 66 Longitude • 6 64
Design
-Swine,., ` . capacity.Population,
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
rl Farrow to Finish
Boars
Design Current
Poultry -Capacity Po' ultiidon . Cattle
❑ Layer ❑Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity C
Total SSLW
r'
Numf)er of i.agoons ` ❑Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
Holding PondsI Solid Traps. ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. 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 S
Identifier: ..............1.............................................. ...... .
Freeboard (inches): 3 J
S/00
❑ Yes allo
❑ Yesj2lqo
❑ Yes _ETNo
n 1a
❑ Yes No
❑ Yes-Z"No
❑ Yes jj�No
❑ Yes j2 No
Structure 5
Continued on back

1
Facility Number: [ 3 Date of Inspection f% Q
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
0 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 XTo
(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 X4o
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes 0"No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 'No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes Flo
11. Is there evidence of over application? ❑]E^xcessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes�No
12. Crop type ge -Ynvd oi l a rt l ^ s 1(a✓>~.2-? , Y-,- i. / I z; - G4 I,I
_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ffNo _
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
'Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes .ETNo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes_ZNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) [I Yes_,E]'No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) -z'Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at,the time of design? ❑ Yes .1allo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes -0 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes JZNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ,EJ No
24. Does facility require a follow-up visit by same agency? ❑ Yes'ONo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes .ff No
IQ yiQl�t nor. trleieocie �rote ' were � �li�rr-ing �his:v�s�ti Yop wig! t�eeeipe �o �u>�r�tr
_corres�oncience abwut ti><BY isit.... - ... • . .
Comments (refer to question#):yExplaurany YES answers and/or any recom meuclpttouus.or any either tamrrruentai �
Use:dra�v mp of 4diity to better explain`sibotiuns.. (ruse additional. pages as neeessary).
__..
A. s
Gv�rcn 67 ��ar�"� And( iS 70 e b jQ� Saah. Gnc,o rlee,4S ?a
6e ev�,�v�ep� aid f-,�ol,�a�e�n•�s ►�t�de �s vt�eG�ssar`j, I✓f�. W11;ti►�,s sQys
-r�►+lofS �va1 C�q�ia�2'[
lq t'�eeb�9^d e6o,-&S Oeed �0 6efj tsh Lt wee��
q 60 L/e) 4L,e u-id ,tee G �r� R I-e
Reviewer/Inspector Name LJA
Reviewer/Inspector Signature: _ `kz Date: 5100

� 1
Facility Number: Date of Inspection M
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 ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes _L314o
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
34. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes —P'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ff No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
.AdditionalComments an or' . rawt
J
5/00

9 Division of Water Quality
Division of Soil and Water Conservation'
Q Other Agency
Type of Visit 101compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: i C.15 Printed on: 7/21/2000
Q Not Operational Q Below Threshold
0 Permitted © Certified E3 Conditionally Certified E3 Registered Date Last Operated or Above Threshold•
Farm Name: .............. V......... \, e"' � ?"�T� .................................... County:.... ...1a. �-�....................................................
`. ..
Owner Name:..............
Facility Contact: .............................................................................. Title:...
:Flailing Address: ...............................................................................................
Onsite Representative: �� ,..L�t..............
CertifiedOperator: ................................................... .......................................
Location of Farm:
Phone No:
............................................... Phone No:.............................................
.................................... I ............... ..............._... ..........................
..........
Integrator:.... J- �r- ................................. 1.........................
Operator Certification Number:
AL
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��«
Design Current Design Current Design Current
Swine Ca aci Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag��nn Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
10 Spray Field Area
Discharges & Stream ImIRact5
1. Is any discharge observed from any part of the operation?
❑ Yes .KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b_ If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed. what is the CS01TIMCCI flow in gallmin`?
d. Does discharge bypass a lagoon systern? (if yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
t9rNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
WNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
5dNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ...................................................
Lq Lr
3
Freeboard (inches):
5100
Continued on back

Facility Number: — Date of Inspection 0 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
bR�No
closure plan?
❑ Yes
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
kNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
gNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
21allo
Write Ayglication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
W No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
ONo
12. Crop type
13. Do the receiving crops iffer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
r?fNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
''No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement'?
byes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
tKNo
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 �Oo
19.• Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes CFrNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 91 No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes jSrNo
22- Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ENo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes 21 No
Awf
24. Does facility require a follow-up visit by same agency? ❑ Yes n No
25. Were any additional problems noted wbich cause noncompliance of the Certified AWMP? ❑ Yes [9 No
0; Nd-viQiafigris;oir deficiencies *i re h6fed ding this;visit;- Y64 wi�1-i•eceiye rio further :
,correspondence: about: this :visit. ::::::::: ' : ' : ' :: ' : ' : ' ::: ' :::: ' : ' :::::::: ' ::::
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
St 5-0 V--Q
L V­z —e--V'0k1V L kl� L C 31�\A
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

Facility Number:"-S1 — Date of Inspection 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 iYor hielow ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the iagoon? ❑ Yes N0
.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 4No
Additional Uomments and/or urawings:
cL-, A"tr �p C-NKft t-e
&JZC--43 ave-
►J
5100

-O Division of Soil and Water Conservation =•Operation Review
13 Division of Soil acid Water Conservation -Compliance Inspection
Division. of Water Quality,- Compliance Inspection
OtherAgency - Operation Review
JIi Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other �
Facility Number Data of Inspection ?Jib 122
Time of Inspection 11k0o 124 hr. (hh:mm)
[] Permitted P Certified r0 Conditionally Certified © Registered [3 Not Operational Date Last Operated:
Farm Name: � �. t '� ... County:......Dif.............................................................
Owner Name :....................... ...T.1 ........ i��ifir`i.............................................. Phone No:..L° 10.. Ai- 1G..--............-......
FacilityContact: .............................................................................. Title :................................................................ Phone No:...................................................
Mailing Address: .....—Z—P.......N.G....t6...q,....tll...........................Lu.LAL... ..&R.............................................. Zn
Onsite Representative: .... .....zY.�. M-N....,-................................................................ Intel;rator:...............................................................
I1 ,
Certified Operator: ..............-......... ...... la.Ria ................................ Operator Certification Number: ......111M.....................
Location of Farm:
E-1
r..........................................................................................................................................................................................................................................................................� .
Latitude Longitude
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish JE1 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity Z3>i4
❑ Gilts
❑ soars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps JEI No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If dischar-e is observed. what is the estimated flow in aal/min"
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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?
Structure l Structure 2 Structure 3 Structure 4 Siructure 5
Identifier:
❑ Yes [A No
❑ Yes [P No
❑ Yes ® No
❑ Yes ® No
❑ Yes Q§ No
❑ Yes ® No
❑ Yes N No
Structure 6
Freeboard (inches)........-.�?`I............................................................
1 /6/99
Continued on back

Facility Number: Sj — Date of Inspection X q
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes W 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 Eallo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes I@ No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings? ❑ Yes MNo
Waste Application
10. Are there any buffers that need maintenancehinprovement? ❑ Yes No
11. Is there evidence of over application? ❑ Ponding ❑ Nitrogen El Yes fO No
12. Crop types*v.!.............S.1.......................... ......................................................... ............................... ..............................
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [W No
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes 156 No
15. Does the receiving crop need improvement? ❑ Yes RNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 0 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? Q Yes U No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
@ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
[PYes
El No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
54 No
21.
Did the facility fail to have a certified operator in responsible charge?
ElYes
0 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
1A No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
O:1VA:viaJatlOII3 or. deficiencies Ai .wei a noted during s.visii. * You will'reiceive'tar hiriiiei- :::
• : • eofresporideiiee: abouf this visit.: .. :::::::
Comments (refer to question #): Explain any YES answers and/or any recommendatiotis-or.any other comments. = Use ft5wings of facility to better explain situations. (use additional pages as, necessary)c
7, C(1Avw, e�r o Ue� � �w �s ©►• +Lt o — diG W�41 S of 44, (C, cMv. 4
$. be, CO.K U e-� a W a x 5 or. R d a e o PS -,E-P 4.
I
lot. CGrrtt �Nt j s6.o�11 lop. Wx.,LU 0A sStral rtecv l
Reviewer/Inspector Name ,
Reviewer/Inspector Signature: �� % f Date: z a. kit 11/6/99

❑ Division of Soil and Water Conservation ❑ Other Agency
ElDivision of Water Quality
10,Routine� 0 Complaint O Follow-up of DWQ inspection 0 Follow-up of DSWC review O Other
Date of inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
13 Registered t.Certif;ed E3 Applied for Permit © Permitted JE3 Not Operational Date Last Operated:
Farm Name y -�7 County. ,r
............................................. ............................... ........................ .......................
Owner Name: Phone No: �a` `��O-" 1..1!2...........................
..... ..
Facility Contact: .................................... ....................... Title: Phone No:
elo�1_0 'I
Mailing Address:..............................�.....Kc....4...`..1... � � �.......... W ...........1...... `\1................4.. ............ .........................,
Onsite Representative:... Integrator: ....... 0�- -�, ..............................
Certified Operator-,
...... Operator Certification Number, .........................................
Location of Farm:
. -- ----------------------........- -- ---- ----........--
Latitude 0 ' 46 Longitude • 4 49
Design Current "
Design Current
Ilestgn ;Current
5vv�we' Capacity Population - PoWtry
Capacity Population Cattle.
Capac!ty Population ;
❑ Wean to Feeder
, ❑ Layer
❑ Dairy
Feeder to Finish 0
❑ Non -Layer
"]EI Non -Dairy
❑ Farrow to Wean
❑Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity,''
'm� ❑ Gilts
❑ Boars
"Total SSLW "
.
N►imb� of dolts ! Hr ltit YPonds'
�'
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
4,
:<
❑ No Liquid Waste Management System
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
9No
2.
is any discharge observed from any part of the operation?
❑ Yes
XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
A No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
7No
c. If discharge is observed, what is the estimated flow in gal/min?
t�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
VNo
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
MNo
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
ElIB.
No
maintenance/improvement?
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
lifNo
7/25/97

Facility Number:.3 — 3
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lag_oons.11oldinn Ponds,.Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Identifier:
Freeboard (ft):
Structure l
................ .
Q.3
.........I .........................
..
❑ Yes IXNo
❑ Yes 'R'No
Structure 2 Structure 3 Structure 4 Structure 5 - Structure 6
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 maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of1WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type b ............ r�.......................................................................................................
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?
0_ No.vitilations.ot: dericieincies.were.n6tid_iluring'this:visit.: You;will ieceive.ito�ftirth�er
: correspQndehcefi outthis:visit:-:.:
❑ Yes 19 No
❑ Yes WNo
IXYes ❑ No
❑ Yes 9No
❑ Yes N No
❑ Yes t& No
❑ Yes [XNo
(Yes ❑ No
❑ Yes ONo
❑ Yes Nf No
❑ Yes t!(No
❑ Yes 15No
❑ Yes ANo
❑ Yes [�(No
❑ Yes A No
1�) ll ' ,., ���� •�5�-� lam+-e. c1�e� 1� o+-� � �. 4-c-
c
Y +'a- �
��If z �.,�.�� ,,- �� w�srr- SO LI All L_�
�-O C.'�'_i l�cr,► �� [ t
`^� �� � 7/25/97

•
Site Requires Immediate Attention
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIIOSITE VISITATION RECORD
-DATE: !N 1 - .1995
._ Timp: ` ` �" (3
Farm Name/Owner:
Mailing Address:
County:
Integrator:
Phone: . _02- - )*0 V-
On Site Representative:
Physical Address/Location:
Type of Operation: Swine V Poultry
Design Capacity: 07-95a " %D,f " Number of Animals on Site: �
-Z/
DEM Certification Number: ACE DEMLCL.e�rtification Number: ACNEW
Latitude:Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche Paggoon(s)?
r No Actual FreeboarPY I� t. Inches
Was any seepage observed from Yes Was any erosion observed? Yes o(94
Is adequate land available r spray Ye r No Ise the cover crop adequate? Yes or No 14
Crop(s) being utilized: nll e,2�>
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings? es No
100 Feet from Wells Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yer N s If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific ,/
acreage with cover crop)? Yes or No %
Additional Comments: �'�44 d"%D
GL�
Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed_

a
NNE i m❑ Division of Soil and Water Conservation ❑ Other Agency QA;
pw 4�Division of Water Oualtty �.
10 Routine 0 Complaint O Follovi--up of DWO inspection 0 Follow-up of DSWC review O Other
Facility Number Date of Inspection l JQI,31 i1
L­ �
Time of Inspection � 24 hr..(hh:mm)
©Registered. loCertified © Applied for Permit © Permitted 113Not O erational Date Last Operated:
FarmName: .......... �i.,A ...... n,....I............... County: ..... ;:........................................ .... I..................
Owner Name: .....�.� Ghf.............. skLti.mns.................................
Phone No: .... NQ)..-vir ......................................
Facility Contact: ... `�trfa�.......w il.�.iiaaks1....................... Title: ........ 9.gkt............
Mailing Address:...... Z d L°......S�tl�'ir `.... .... `f� .'�'�.� 4..........
Onsite Representative:.......eYY �1........Wjl�jtGxj.S�...{..r.....................
Certified Operator; ............. .. . 1 ......... IN4.i1��uZ15.......
........
...
Location of Farm:
.. Phone No: �5G4..1.z`i'.�.7 S ..........
........... I... ..... &V..6.tlALT...hk.......................................... ....� � .....
............... Integrator:......... . b ........
Operator Certification Number,...) j .'W j.......
Latitude ' 4 0" Longitude • 6 41
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes A[ No
2. Is any discharge observed from any part of the operation? ❑ Yes fi3 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (if ycs, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes
AM No
❑ Yes
to No
❑ Yes
�a No
❑ Yes
,® No
❑ Yes [9No
Yes ❑ No
❑ Yes CA No
❑ Yes RLNo
Continued on back

i
Facility Number: -3 } — $
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaPoons,liolding Ponds,Flush-fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure ? Structure 3
Identifier:
Freeboard (ft): ........... : .....
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes Od No
❑ Yes ELNo
Structure 5 Structure 6
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
NVaste 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 ......... kOUM.W.r............... ....... t
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
2t. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certil-eed 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?
0' No.vioiatioins.or deficiencies.were noted -during this.visit.- You:rvill receiven&f6riher-
:���eti�respQndenceaboutthis:visit:,..�,...�..,.•........:. ... .�.:.,,,..,,..�.•....�, .:, ,:.,.-.-...•.�.:.
❑ Yes '4No
C5Yes ❑ No
',Yes [:]No
Yes ❑ No
❑ Yes ® No
❑ Yes KNo
❑ Yes ® No
H Yes ❑ No
❑ Yes R,No
IRYes ❑ No
❑ Yes &No
09 Yes ❑ No
❑ Yes RLNo
❑ Yes ,�d No
❑ Yes JR No
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be u�d�ul- �•. tnr9�c„ slwvl� he. �n cev����►t� filar,.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Adz- __Z_, A)1 1 Date: