090025_INSPECTIONS_20171231

INSPECTIONS
NUH I H UAHULINA
Department of Environmental Qual

bD PC-©0 r 7
ivision of Water Resources
Facility Number - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operatoo Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint ollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 ii Arrival Time: ,' o Departure Time: County: 9.L
Farm Name: �r/m IT 2�1zaV�kInf,,7-d-F Owner Email:
Owner Name: AAX f S'J O/S Phone:
Mailing Address
Region:
Physical Address:
Facility Contact: Title: Phone:
1101,
Onsite Representative: Integrator:
Certified Operator: ���.-�-- Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[Layer
Non -La er I I E
Dry Poultry
Layers _
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Bee Brood Cow
❑ Yes ❑- No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes allo
❑ Yes Eg-No
❑ NA ❑ NE
❑ NA ❑ NE
DNA ❑N1
❑NA ONE
❑ NA ❑ NE
Page I of 3 21412015 Continued

FacilityHumber: - Date of Inspection: —3— /
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA EaNE
D. If yes, is waste level into the structural freeboard? ❑ Yes [D 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
❑ 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
g NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
E_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 Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[] Yes
❑ No
❑ NA
RNE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
,ENE
❑ 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 Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
® NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
ONE
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
E� 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
ONE
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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23• If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'?
❑ Yes ❑ No
❑ Yes ❑ No
[] NA aN E
❑ Weather Code
❑ Sludge Survey
❑ NA ENE
❑ NA a NE
Page 2 of 3 21412015 Continued

4r Facili Number: I - I Date of Ins ection:
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 aNE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey D 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 the drains exist at the facility? If yes, check the appropriate box below
'M Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
�ZNE
❑ Yes
❑ No
❑ NA
[aNE
❑ Yes
❑ No
❑ NA
fZ NE
❑ Yes & No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
® Yes ❑ No ❑ NA ❑ NE
Yes [:]No
❑ Yes RNo
Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Goininen'ts ��l
sy YEaoanyadditional recommendations or any other comments.
n tr.'MaS^as;z .r,se+.drawines ofMill to betterkezulain,situationsl(useaadditionallga es=as�neceasary)
�1� /�r��Ylr�irds�— %—e An lrf'
�3�—`DO� ��� Jay`✓ k,� � `-',"-
L(I i•�� � J� ,� O
7,_r42V !l/
/ v xp4 Gk, dot/ a
311w'r
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
i
Phone:
Date:
21412015

UDivlsion of Water Resources
Facility Number - � Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit: ompl ace Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral 0 Emergency Q Other Q Denied Access
Date of Visit; Arrival Time: / i3 Departure Time: / .}L_!� County: �•�
��
Farm Name: . iJ�ii' )i'x? U61 r j�,.,r�y� % Y! vner Email•
Owner Name: &21%( ; A-"-►. -6 =12_0 Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Low,", r Phone:
Onsite Representative:
Certified Operator: �`�jm j �i►Y�-•
Integrator:
Region: 112� 6
Certification Number: / 2-237
Back-up Operator: Certification Number.
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non --La er I I El
_ury routrr
Layers
Non -Layers
Pullets
Turks
Turkey Pou
Other
Design Current
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?
Longitude;
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ZLNo
[:]Yes 5g..No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

r Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? r7r Yes O.No ❑ NA ❑ NE
. a. If yes, is waste level into the structural freeboard? ❑ Yes ®.No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): J �_ C}-
Observed Freeboard (in): / / f / 517
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
1-3
❑ Yes C5,No ❑ NA ❑ NE
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 ❑ Yes No ❑ NA [3NE
maintenance or improvement?
Waste'Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes allo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, Check the appropriate box below. ❑ Yes allo ❑ 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): ,g22 —
14. Do the receiving crops differ from those designated in the C WMP?
❑ Yes
gNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O 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
S 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
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
MNo
❑ 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 Z No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes C' No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [RNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FaciHt Number: -
24. Did the facilityfail to calibrate waste application equipment as re required h the permit? Yes No NA NE
ppq Y P ❑ � ❑ ❑
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes fo 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:
r
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ 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 ; No ❑ NA ❑ NE
❑ Yes jZ No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. 0-yes
rM
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
AfAb
Ntl—
o ❑ NA ❑ NE
Eallo
❑ NA
❑ NE
MNo
❑ NA
❑ NE
O_No
❑ NA
❑ NE
Comments (refer to question #), Explaln any YES -answers and/or,any additional recommendations or itny other comrrtents.
Use'drawin saof,fuclllty t'd betfer.ez lain situations`.(use additional ages us necessa } a v ^1
r�-
1
619
�
�n
0
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9ja �f33�
Date:
21412014

I
jType of Visit: i&'C-ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 4�= Arrlval Time: . Da Departure Time: , County: Rs r.lc,
Farm Name. rr aeri/ice
dills C-/'rest /,�s7���� r� caner Email:
Owner Name: i i �. 1, Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: to ; J(;&�'� ;9 -4 ZLM I !
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region: EZZ
Integrator:
Certification Number:
Certification Number:
Longitude:
10esign Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
D P,oultr
Ca aci
P.o
Non -Doi
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
TurkeyPoults
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?
[:]Yes ELNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
Yes
No
NA
NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Yes
[:]No
NA
NE
2. Is there evidence of a past discharge from any part of the operation?
Yes
R No
NA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
CB_No
NA
NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facility Number: Date of inspection: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes eo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes F;�.No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?. -
Designed Freeboard (in);
Observed Freeboard (in): 13
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I� 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
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 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): C92r n
13. Soil Type(s): ,, `y op
14. Do the receiving crops di ff r from those designated in the AWMP?
❑ 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
R No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z 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
EaWaste 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
® 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
21412014 Continued

Facility Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes eNo ❑ NA ®NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes ❑ No [DNA E&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 [3 No ❑ NA ❑ NE
2T Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ® No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
C] Yes
0 No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
allo
❑ 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?
aYes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or;any additional recommendations or any other comments.
Use drawings of facility to better -explain situations (use additional pages as necessary).
f v
n18+ 1 d- 'x
T-G -2; rT D jrr "r
r.
u ; `r Ta 1e V;erum
T �i / �vulrr �T�arf
z�-T �---
�,/O/ Q�r. � ldJ6z,3 I�PN rp� �0 �L� �7� 1. f/y/" i �^- L f��>�� �/•^~�!4`� 0� �'e
Reviewer/Inspector Name:
Phone: `210A33--33CO
Reviewer/Inspector Signature: T Date:��/�
Page 3 of 3 21412014

t 3 EMIVlsion. of Water Quality
Facility Number - ® O Division of Soil and Water Conservation /
O Other Agency �.
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Grk"outine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ,' 3 D I Departure Time: v County: d___ Region: ©
Farm Name-, / ] 7r �Gt Oyliter Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Integrator:
Certified Operator: Certification Number:
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
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
LL
aer
Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Pouets
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dg Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 2g,,No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes ❑ No
[:]Yes ❑ No
[:]Yes Qt No
[:]Yes ®-No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page l of 3 21412011 Continued

Facil' Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 91
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
2�.No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
C&No
❑ NA
❑ NE
8. 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
5�.No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
WNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[3 Yes
g] 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): ebr,, -
13. Soil Type(s): r p Z•1 h !� r�-
14. Do the receiving crops differ from those designated i 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
g No
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
LX No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
MNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ER 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 RNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej�,.No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes gLNo
❑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 5?�No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 12 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
No
NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes ?❑ No [] NA [] NE
[] Yes allo ❑ NA ❑ NE
❑ Yes
C5 No
[] NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[RNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use dr•awinas.of facility to better explain situations (use additional pates as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
pia/ O f �- 'V ,-- f-L,-
O
Phone: gyp —��3�0
Date: f 3--49-1 /�/
21412011
Page 3 of 3

M
91NIvision of Water Quality S� v
Facility Number ` - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:© Arrival Time: t7 a Departure Time: ; O County:
Farm Name: p�rt,s c� ✓`"YL Owner Email:
Owner Name: _ W + IS, S 8 jeo's Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Title: a1ooi"✓ Phone:
Integrator: f)fu,ip
Certification Number:
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Pullets
Poults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Region:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes E&No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes 2 No
[:]Yes O No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

FaciU Number: Date of Inspection:
-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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): � 9
Observed Freeboard (in): '-';P—C) j 9
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E@ 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 [Z—No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 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 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 M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [RNo ❑ 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): CQPii / W/ire-:j'_ /.Sfv.r—a—,.s
13. Soil Type(s): r--
14. Do the receiving crops differ from those designated in t e CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
n No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
Aik
jj No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
MNe
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ANo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes gLNo ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes R[ No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

10acUlty Number: -_j Date of Cns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? DYes M No
25. is the facility out of compliance with permit conditions related to sludge? If yes, check Yes J No
the appropriate box(es) below.
Failure to complete annual sludge survey D 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
29, 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 D 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?
DNA D NE
NA DNE
[] Yes
Z No
[] NA
NE
Yes
Eg No
NA
NE
Yes ®,No D NA D NE
Yes MA NA ❑ NE
Yes Q No D NA ❑ NE
® Yes
U-No
D NA
D NE
❑ Yes
® No
D NA
D NE
❑ Yes
® No
D NA
❑ NE
❑ Yes
R No
❑ NA
D NE
Comments (refer td question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings 4lieffity to better explainsituations (use additional pages as necessary).
em—
d`S��u�'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Phone: 9'fp w 33 zo
Date:
21412#11
Page 3 of 3

i �. � Z - I a -Division of Water Quality ? ,41 t flr
Facility Number - v2 O Division of Soil and Water Conservation 10
Q Other Agency
Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for, Visit: O Routine O Complaint O Follow-up O Referral O Emergency ® Other O Denied Access
Date of Visit: -Arrival Time: rp{� Departure Time: ; 3 J County: v-.` Region:�O
Farm Name: 5 / a/x4 6 _ Q,�p'i „ n--//- Owner Email:
Owner Name: . �U j 1 I *t de -R,, S II Orm5 Phone:
Mailing Address:
f
Physical Address:
Facility Contact: .0,0174141 Lan Title: /j�,0 4-r/ Phone:
Onsite Representative: '� - Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current Design Current
'Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharees and Stream Impacts
La er
Non -La er
Pullets
Other
Poults
Design Current
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
Yes
[] No
NA
FM
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[] Yes
[:]No
[] NA
NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Yes
No
NA
NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
Yes
No
NA
NE
2. Is there evidence of a past discharge from any part of the operation?
Yes
No
NA
® NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
No
El NA
g.NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

* Faciii: Number:Date of Inspection: —-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ® NE
❑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 (M,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 n-NE
8. Do any ol-the structures lack adequate markers as required by the permit? ❑ Yes []No ❑ NA N 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 CAINE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [] No ❑ NA toNE
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 l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes []No ❑ NA [M 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 [DNA ® NE
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.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment'? ❑ Yes ❑ No
❑ NA � NE
❑ NA ® NE
❑ NA ®`NE
❑ NA ®NE
❑ NA g NE
❑ Weather Code
❑ Sludge Survey
❑ NA MN E
❑ NA �VE
Page 2 of 3 21412011 Continued

4. IV, .. ., 4'6 lwlit ?—+YJ iiYtrvl-.. J• �,. — . ... ,,. ,i ._ ,. .. • • .n y� w. 5... r ♦ _.
Facilit Number: Date of Inspection: Y
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 En 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? [r] Yes 0 No ❑ NA © NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA Ej 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ® NE
[:]Yes ❑ No ❑ NA ® NE
❑ Yes ❑ No ❑ NA ® NE
[]Yes ❑ No ❑ NA Ejg-NE
❑ Yes ❑ No
❑ Yes No
.FrYes ❑ No
❑ NA ONE
❑ NA ❑ NE
❑NA ❑NE
Comments(referto. questib,n..#):-Explain any YES answers and/or.., any, additional recommendation s,or-any,other•comments.
etter_ex lain situations (use
c additional a es:as neeessa
Use drawings of facili to b
Na�r , W ,• �--- ,6 r F o � � To L o o �— ct�' C 6�-�,�Tr v ��`,�-- fd � � � ,v �- cv '(��.57`�.
l� y� ,'//�3� lam'/Gl/�?l^� f�.7a{ uTal- i �r.r �ihCar � jA/vj,�r'SS
��!`'�� I f` !a � ��/aeeJ'.'rp 8•� i1 � 5 �+ it � ��� �o r�a� %'!CG �evt �t"vr r�
'4_//1� or'n ,rre 9
7--,P Grp o f� Q•f !"ram ° �--�1
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: j�G , 307 4'
Date:
21412011

'i�'- ..-
ivislon of Water Quality
u 'OFacility Number ®- ® 0 Division of Soil and Water Conservation
0 Other Agency
Fype of visit: Wcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 10 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: In Region:
Farm Name: ,SV o /- 5tr-&�_ J— Iq Owner Email:
Owner Name: _ _LL.1 I h i a_ rk,__ 1� _ ,,�Ti �o Y/,V Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:r
Certified Operator: s �_-
Title- Phone:
Integrator: zWLc
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop,
[ILayer
Non -Layer
Discharees and Stream Impacts
Foul
Non-L
Pullets
Pouets
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dair
y Cow
Dairy_Calf
Dairy Heifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
I. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
® NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
0 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
5D-NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of ins ection: 1p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
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
E� No
❑ NA
[?NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
® NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ 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): rrt %vim/r-� �,$'E'Lj6, .r..-.�
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
rM No
Kil
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
5a 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 [or land application'?
❑ Yes
❑ No
❑ NA
kdal NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
® NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
f:71 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ 1-case Agreements
[]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
[] NA
JZ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
C�_NE
Page 2 of 3 21412011 Continued

rFacility Number: H - Date of Inspection; ` `~j:7-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA CNE
❑ NA L NE
❑ NA ®. NE
❑ Yes ❑ No ❑ NA Eg NE
❑ Yes [] No ❑ NA ® NE
❑ Yes ❑ No ❑ NA � NE
❑ Yes ❑ No ❑ NA [S NE
❑Yes []No
❑ Yes JZ No
❑ Yes JZ No
❑NA ®NE
❑ NA ❑ NE
❑ NA ❑ NE
NeAraw'lngs.of
mments (refer to -question #): Explain any YES :answers and/orwany additionalrrecommendations or:;any other'commn nts.
facility to. better: explain situations '(use additional pages; as,necessary):
�- _ W, p Q r1 rl,DM13
t ►-`,A,.Oe,
/ - eau_S-e Z)� � ! ! ' b Lr
yrJc
r-W r,.,L fit& /r 7;Lt d�
aPr1L t ,tJ u 1( �`G G i t1 _ l3L
004
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9)0 _q3 ___15 0
Date: / D / —ep__e) i `3.-
21412011

UDlvision of Water Quality
Facility Number - p2,j 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit; UCampliance Inspection 0 Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0-0ther 0 Denied Access
Date of Visit: Arrival Time: gip© Departure Time: ' 3 O County:
Farm Name: _� // o/'�yt S /!f'L/--' y Owner Email:
Owner Name: GCJ 1 i �� d ��- 12" S7-0rrrG5 Phone:
Mailing Address:
Physical Address:
Facility Contact: r1'tT12rlf%
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Title:d�Zvyf�
Integrator: 1 oe
Certification Number:
Region:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
[4Layer
Non -Layer
Design Current
Dry Poultry Capacity Pop,
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify 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?
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ❑ No ❑ NA �JNE
[:]Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
[:]Yes ❑ No
[—]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA
❑ NE
❑ NA
21 NE
❑ NA
gLNE
Page 1 of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4, is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
ONE
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 ofany 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
M.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
E�-NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
Z 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
[gNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
MNE
maintenance or improvement?
11. is there evidence of incorrect land application? Ifyes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
�NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes
❑ No
❑ NA
U21 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
C&NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
Z[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
D NA
JZ�NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
ONE
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
E�NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
[&NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
t3.NE
Page 2 of 3
21412011 Continued

Facility Number: pate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA R) NE
' 25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA In,NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ® NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No ❑ NA L3-NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ® NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes ❑ No ❑ NA fD NE
❑ Yes ❑ No ❑ NA E�[NE
❑ Yes ❑ No
❑ Yes No
jKYes ❑ No
❑ NA ® NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to question#): Explain any YES Answers and/or any.. additional recommendations or any other. comments:
Use drawings of Facility to better explain situations (use additional pages as necessary).
NF11 iA) .e- xt— 6 r Fd --T -o
7',9,vfc_ G k/1r'S
��r� �,,,,,� �re-v'`✓�-�--' 1�?-rant' uP��c� h r r- �t�e� �� y��` 'rrs s
w
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Phone: �eo
Date: 2 -2--
214/1011
Page 3 of 3

a
Type of Visit:Co-mpliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: outine O Complaint O Follow-up Q Referral 0 Emergency Q Other 0 Denied Access
Date of Visit; Arrival Time: ,r p Z)Departure Time: FF/3MICV07County: Region
Farm Name: f-rVI 5 a / — Owner Email:
Owner Name: Y-7" Phone:
Mailing Address:
Physical Address:
Facility Contact: / Title:/ _ _ Phone:
Onsite Representative:_ Integrator: 4c
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design
Current
esign
Curre
Swine C•apncity Pop.
Weltry
t Pout
Capacity
Pop.
Cattle jjjjtQ1=apaczIt­V='P0P.
Wean to Finish
ILayer
Dairy Cow
Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
CurrC[it
Dry Cow
Farrow to Feeder
Ur, Poultr,
C•.s aci
op.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Pouets
TO
Other
Discharues and. Stream impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes M No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
[:)Yes
[:]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
[:)NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ER No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
0 Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of -Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[]Yes
2LNo
] 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): 3a
5. Are there any immediate threats to the integrity of any of the structures observed'?
❑ Yes
,0 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
EZ 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
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® 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?
❑ Yes
[2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
[2�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
allo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fait to have the Certificate of Coverage & Permit readily available'?
❑ Yes
0 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E[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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:)Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 21412011 Continued

•[Facility Number: - pate of Ins ection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [&No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ® No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes � 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 the drains exist at the facility? Ifyes, 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 Reviewerllnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑NA []NE
❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes r--q No ❑ NA ❑ NE
Yes ❑ No [DNA ❑ NE
El Yes No
[]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to questitin-#): Explain anySYES aiiswerc si'ntUt►r any additional recommendations n'r anyrothcracomments t Y T.;
Use drawings'of facility to better`,eXplain �itui<t�ons;(use ailditionalpage4,as necessary). ;;, ,Pr.� xia'j_,
Reviewer/inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Phone: qJP—/f33-330C>
Date: 44 /�-
21412011

Facility [Number
04, vision of Water Quality J#_6 4' 1/
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit �mpilance Inspection (94Yperatlon Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �'�v Departure Time: '37% County: Region:
Farm Name: fin' Owner Email:
Owner Name: ��� i l� i az� �:?„!�r+��S Phone:
Mailing Address:
Physical Address:
Facility Contact: LTitle: / Phone No:
Onsite Representative: .!5*,-� Integrator:
Certified Operator: _ �S— — Operator Certil3eatlon Number:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finisl
❑ Wean to Feed(
❑ Feeder to Fini;
❑ Farrow io We.
❑ Farrow to Feei
❑ Farrow to Fini
❑ Gilts
Other
❑ Other
Back-up Certification Number:
Latitude: = 0 0 6 = I{ Longitude: = ° = ' 0 1I
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
===]❑ Laver
❑ Nan -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Cali'
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:FT
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
LkNo
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
IW8104 Continued

� L '
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
B<o ❑ 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
I&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
RNo ❑ 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
RNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
CR 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
[RNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
RNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
L,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
i `J
13. Soil type(s) *r7,_� 4Xo �l5oia3 ��SiGri'S LJ7�,rti /7a�w
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Wo
❑ 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
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
allo
❑ NA
❑ NE
�U ?v ,SL, ?- fl�YliZgf Q � Ar�l� Cil�sy �y�o.� u/l IrSS
Reviewer/Inspector Name ��'G� T� Phone: ,,�T jjd�Gl~33�n
Reviewer/lnspectorSignature: Date. -
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes 1?�No ❑ NA ❑ NE
20, hoes the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes RNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. RI..Yes AV ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard J&Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
0 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
C&No
❑ NA
❑ NE
❑ Yes
[9No
❑ NA
❑ NE
❑ Yes
[R No
❑ NA
❑ NE
❑ Yes
E2 No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
I,No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
L&No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
A�d`diliuniii�Eomments and/or Dr'�`awiitgs:
12128104
12128104

FactliOl 4umb;' O
pivlsluri'of Soi
Dther, Agency,
-,
Type of Visit CCommp�pliance Inspection O Operation Review O Structure Evaluation O Technieal Assistance
Reason for Visit 0.1 outlne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Dale of Vigil: Arrival Time: Departure Thne: ��'. County: Region:
Farm Name: 6 ✓r7-1 Owner Email:
Owner ,Name: W f } 1 ate-'— 15 T lm S Phone:
Nlailing Address:
Physicul Address:
Facility COntaCt: 'Tille: Phone No:
Onsite itepreseniative: Integrator:
Certified Operator: OperatorCertince4ion Number:
Back-up Operator:
t.ocwtion of farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
El Farrow to Wean
❑ Farrow to Feedei
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude: ❑O ❑' ❑u Longitude. =o =1 ❑"
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
T _Tl 10 Non -Layer
Dry Poultry
Other
Discharees & Stream lin� Imets
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was (he conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai ' Cow
❑ Dairy Calf
❑ Daig Heifer
EfDry Cow
❑ Non -Dairy
EJ Beef Stocker
❑ Beef Feeder
Bee ❑ f Brood Co
Number of Structures: HI
h. Did the discharge reach waters of the State? (if yes, notify D WQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑Yes ®No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes El No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
SNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Dale of inspection r5 fl—
Woste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes NNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure ,l Structurc 5 Structure 6
Idenlilier:
Spillway?.
Designed Freeboard (in): /
Observed Freeboarcl (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
19 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
9 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
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
9 No ❑ NA ❑ NE
maintenance or improvement?
'I nste AURlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
�9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. fA Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) (- #�rvt
13. Soil type(s)
let
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
59 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑
Yes
® No
❑ NA
El NE
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
2No
❑ 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):
11 m��►�Hc vv���[,� ��- ten. �a�l,Sr��r���rrfro�
fY
- ,fit r GCl L i ri y Dd it
%rL YZ)N sr Yea s,
Reviewer/InspectorName v�r Phone:ADO
Reviewer/InspectorSignature: Date: c3-30m�0/0
IF 12128104 Continuer!

w
j
1 -
t.
Facility Number: — Date of Inspection
Required Records & Documents
` 19. Did the facility fail to have Certificate of Coverage & Permit readily available? 3 Yes [3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ayes ENo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 13 Yes ❑ No ❑ NA ❑ NE
® Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes nNo ❑ 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
® 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
0 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
O No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
❑ No
❑ NA
❑ NE
A°ddltianalxCamniCnts`and/ar Di swings {
earn-d-p-vl-_T�1 pwin.3 T id ga Cor•rY
r� T
7
Ii t'
ryvYJ To-�-
t J j
F h e l4ms Drr'���il+ror.
rrr/,rc,rYG � OcrlY�/�%w L(Ji�l /`rc�•. tJOD
c�
12/2&04

Type of Visit Q Compliance Inspection Q Operation Review 4V'Sinrcture Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint dFollow up O Referral O Emergency O Other ❑ Denied Access
Dale of l'i-il: '- -'� Arri►�aI Timc: D! 0 Departurc Time: ('otmty: she`'~ Region:
Farm Name: ?'/h�:(W-`r-. eZa) ✓i,, i�^^"" Owner Entail:
OwnerName: �A % UI i Phone:
Mailing Address:
Physical Address:
Facility C onloct: I'il'Ic; Phime No:
Onsite Itepre%eninlive: Integrator:
Certirted Operator:-s��►"t't Operator Certifrcation Number:
(tack -up Operator:
I.,ocation of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Back-up Certification Number:
Latitude; =o =I ❑16 Longitude: a0=1 ❑u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
iI JEJ Non -Layer
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
DischarEes A Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
u_ Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai � Cow
❑ Dai Calf
,
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: Fql
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 ❑WQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes [&No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
C7 NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Eallo
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
12128104 Continued

i`
Facility Number: Dale of Inspection
Wngte 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 Stricture 2 Slruclure 3 Structure •1
,Yes ❑ No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
titructure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): %g / %' 19, /91- H
Ohscrvcd Freeboard (in): ,- f2�/ f:4-!"::�
S. 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 tRNo ❑ 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 [K No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [5¢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 54 Yes El No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ��-�'
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes 5 No ❑ NA 2!�NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA E.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 Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
5KNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
ENE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination i [I Yes
❑ No
❑ NA
9 NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
0 NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
CK No
❑ NA
O1?
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):
one A9r
+ rj
'f 6 e YL�s b,4��rr i jJ 0 w r" b rr �t�'} i Ile, /"ai na rr W 5 0'i 2t C's
f
7&
Reviewer/inspector Name Phone: a o
Reviewer/inspector Signature: Date:
' ' 12128104 Continued

r FT
Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA �lE
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 ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
ERNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
ONE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
CRNE
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
V NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
[9NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
ERNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
[3NE
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
E9NE
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
5,NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Ryes.
❑ No
❑ NA
❑ NE
A`�d�dilfonal Comments �ndlor.D�ra�wings:
►�� �� E (� `�u� D f ~ D tlY�_Wrs
r I
P eq If `OP�Ot
Calt - o
`f ►^ lie
ti-e Lo 17
12128104

,s ;, , , .. .' .:,+ ,. ; ., b3.+ E , r.. ..., sq, �,. r �� ` /!►�.�e-��iq' l' f W h; � �` °� � a, � 3aaal�E IiE?Es�9a t ? to J� G z
Factli.Number-
umber �„•o:' Soil a� nvdQ Wr Cn, cserve atl' eaas
O Other Agenc 1,�
r.• :` ..: li'.. ..:.. ., .. ya...4.1 a9,n�f
c•
Type of Visit &Catnpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint ollow up O Referral O Emergency O Other ❑ Denied Access
Date nrN,igit: r 0 ArrivaI Time: Departure'Time: 1f :� County: Region:
Form Name: � Lt s ✓ `%-,!�4,,,,,,,, Owner Entail:
Owner Name. ►` ��: ct,.-�— 2 �ToL&Z Phone:
Mailing Address:
Physical Address:
Facility C:onlact: � 'Title,
Onsite Representative: jn-�►'—
Certified Operator: _:rAL �
Back-up Operotur:
Location of farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feede
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Phonc No:
Integrator:OF
/71 ur
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑O ❑i ❑11 Longitude: =o ❑' = U
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I ❑ Non -Layer
Dry Poultry
Pullets
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
❑ Dai Cow
❑ Dairy Calf
Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Ca
Number of Structures: 122
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
i~. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA UgNE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
Z NE
❑ Yes
❑ No
❑ NA
9 NE
12128104 Continued

" Facility Number: — hate of Inspection a
Waste Collection & 'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA 59.NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stnielure I Stricture 2 Structure 3 Stnio ure 4 Structure 5 Structure b
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 Q&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 2�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 UNE
8. Do any of the stuctures lack adequate markers as required by the permit? []Yes
❑ No ❑ NA X,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 IR NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
®, eNE
[] Yes
No ❑ NA
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
J9 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10%or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drill [I Application Outside of Area
12. Crop type(s) D or �--
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�6No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
t ❑ Yes
9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
JR No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
19 No
❑ NA
❑ NE
.Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
/jot � � �5 7 "�.�pr a--- alas Ta /�V' 4Z/ 1�0 Ile- vie 4t) � 1'r�xta•t�� �`�' l�
�'�a�rUrpr +� �
re, diV. cr �' �.rdfar-r dv�-u� �r -,./-."aXr«ate
corK �
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date: 6 &;. Zg
I2/29/04 Continued

,�. Facility Number: Or Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
❑ Yes RNo 0 NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes gNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
[Z NE
Cl Yes
❑ No
❑ NA
® NE
❑ Yes
❑ No
❑ NA
®NE
❑ Yes
R No
❑ NA
❑ Yes
91 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
® NE
❑ Yes [FNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ® NE
❑ Yes ❑ No ❑ NA ONE
❑ Yes ❑ No ❑ NA [9NE
❑ Yes RNo ❑ NA ❑ NE
[]Yes ®No ❑ NA ❑ NE
A'd�dltnna�Cam"� m nts and/or .Drawings:
U-):� ���19 �� �sN— aj
>io cf_ D Lj
T
12128104

f,
r .,
ion of.Water Quality and
'Facility Number �� O Division of Soil and Water Conseryation
!/
O Other Agency
Type of Visit
om��pllance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
e-Routine () Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: •- G-D Arrival Time: '_Do Departure Time: County: v` Region: r!
Farm Name: r] i^rYJ.�, / ri�?'t- L �d Owner Email:
Owner Name: 57—eem f Phone:
Mailing Address:
Physical Address:
Facility Contact; Title:
Onsite Representative: 4rkz� ,,-
Certified Operator: , - -��-
Back-up Operator:
Phone No:
Integrator: �ri��Mr - -- _.
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e = 1 0 Longitude: ❑ 0 0 I ❑ "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[]Layer
1 ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey 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?
Design Current.
Cattle Capacity Population,.',,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
l
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow,
i
Number of Structures:
W1.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3.. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
- ❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[&,No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

Facility Number:
Date of Inspection=a' i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[RNo ❑ 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): / 9
Observed Freeboard (in): / 2 ./91 a 1 D a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R 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
0 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
R No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
JR 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
JRNo ❑ NA ❑ N E
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
to No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
19Yes
WIN40o ❑ 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 Drifi ❑ Application Outside of Area
12• Crop type(s)
13. Soil type(s)
0
v
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
IgNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
UNo
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[RNo
❑ 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):
WI-3/� o/�
_4
Reviewer/Inspector Name Phone: 9LV0 f33-3,317a
Reviewer/Inspector Signature: Date:
rrsLarvq t onanuea

174cility Number: — Date of Inspection19
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. RYes []No ❑ NA ❑ NE
E9 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [:]Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
LKNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ER No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
q No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
m No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
[0 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
RNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[a 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
[2 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2 No
❑ NA
❑ NE
Add itlonal°;Comments
Page 3 of 3 12128104
Page 3 of 3 12128104

Type of Visit t3�<o­mpliance Inspection Q Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit outlne O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date'of Visit: 3 �./Arrival Time: Departure Time: I //.,OOA County:
Farm Name:Pla":►N , / Do.— �( Owner Email:
Owner Name: �,� ! Lx41$_— e`L7_5_e 2J Phone: _
Mailing Address:
Physical Address:
Facility Contact: AVf Title: Phone No: _
Onsite Representative: %�p7Integrator:
Certified Operator: �� ��'"'� —��1 Operator Certification Number:
Rack -up Operator:
Location of Farm:
Back-up Certification Number:
Region:
Latitude: = = { = Longitude: = e = 4 = «
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
C•attic Capacity Population
❑ Wean to Finish
airy Cow
❑ Nott-La er
airy Calf
❑ Wean to Feeder
® Feeder to Finish % ©0
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
E]Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑.La Layers
❑ Beef Stocker
ilts
Non -La ersPullets
❑Beef Feeder
Roars
❑ Beef Brood Cow
❑ Turke s
Other
❑ Turkey Poults
❑ Other
El Other
Number of Structures:
Discharees & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 nf'3
❑ Yes IgNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[WNo
❑ NA
❑ NE
❑ Yes
JR No
❑ NA
❑ NF
12128104 Continued

ra
Pacility Number: — Date of Inspection l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,@ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier:
Spillway?:
Designed Freeboard (in): %/ �/ % �119L
Observed Freeboard (in): JZ p23 �? 421
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IN 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 R No ❑ NA ❑ Ni:
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 CKNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes No ❑ NA El NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [9No ❑ NA ❑ NE
❑ Excessive Ponding ❑ hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil typc(s)
0
v
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5? No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JS No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
10 No
❑ NA
❑ NE
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
M No
❑ NA
❑ NE
'Comments (refer to question #): Explain any YES,answers and/or, any rccnntmendati66s or any other comments. „
Use drawings of facility 6 better,explai.n situations. (use additional pages as necessary): t.
ReviewerAnspector Name €� -�/ 3 (' - Phone; 3 Z�DO
Reviewer/inspector Signature: Date:
D�
.-S. i .J ,r ,, 9"cu

Facility Number: — Date of Inspection
Required Records &_Documents �
19. Did the facility fail to have Certificate of Coverage & Permit readily available? 0-Yes IV El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment`?
❑ Yes
12 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
R No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 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 CAWNIP?
❑ Yes
I, No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
allo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 l .
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit'? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
R No
❑ NA
❑ NE
Additional Comments anal/or Drawings-
Oz
v444- �
Page 3 of 3 12128104

• Division of Water Quality
Facility umberEHIO Division of Soil and Water Conservation ` u.
O Other Agency ;
Type of Visit &06ompliance inspection
Reason for Visit outine O Complaint
Date of Visit: 3-/ *-07 Arrival'rime: .'O� Departure Time: ' �� County:
Farm Name: 1 a1 (11— Owner Email:
Owner Name: ! .' a�^"-' ��-r'o f'M S. Phone:
Mailing Address:
Physical Address:
O Operation Review O Structure Evaluation O Technical Assistance
O Follow up O Referral O Emergency O Other ❑ Denied Access
Region: —,�
Facility Contact: WA gAJ- t.-ArA 0, Title: I Phone No: q)Q'��_ ,o.-91(
Cam! r
Onsite Representative: Integrator:
Certified Operator: _ ��— Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feede
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: 0 0 0 i= Longitude: ❑ o= d=
it
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
} ❑ Non -Layer I F=�
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current.
Cattle Capacity Population-,
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Eq No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection "D-
` Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): _ „l
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 XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes M No ❑ NA ❑ NE
❑ Yes (9 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ® Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IS No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes (0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes t, No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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,
v le11
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
VXNo
ElNA
[INE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
EgNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[9 No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
JB No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
094 'D40,E1h.�-r.- �� �" >�r- s
Us-j� e
M u r p� XAu j
Reviewer/Inspector Name
Phone: gjp--b(33-3 �Dd
Reviewer/Inspector Signature: --
Date: 4/ S290?
12128104 Continued

;racility Number: Date of Inspection —O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ANo ❑ NA ❑ NE
20. Does the facility fail to have ail components of the CAWMP readily available? If yes, check ❑ Yes 10 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. KYes ❑ No ❑ NA ❑ NE
-Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking JZ 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
13 No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
19No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
® Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
N 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
K 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
19 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
RNo
❑ 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
ZNo
❑ NA
❑ NE
33,
Does facility require a follow-up visit by same agency?
❑ Yes
U No
❑ NA
❑ NE
Comments and/or Drawings:
'5�7 /,lot r. __7 PF, C9 fz�cm_� C�_ez Y1, 9A/,., -7,- Fn,,-
&-;-7 74 der/
A�y
'Y40 Crap / i t4 O� s rn y'flu r 11%7 lerrL IGe D�►,S,
12128104

Type of VisitC,ommpliance
Inspection
Q Operation Review 0 Structure Evaluation
Q Technical Assistance
Reason for Visit
E Koutine 0 Complaint
0 Follow up 0 Referral 0 Emergency
Q Other ❑ Denied Access
Date of Visit: IL_� Arrival Time: CJ Departure Time: County: &" Region: LLB
Farm Name:�-�..,5 rm.5u t rr�-� y Owner Email:
Owner Name: W i A I I a +�n _ 1J �D +' N1 S - � - _ Phone:
Mailing Address:
Physical Address:
Facility Contact: emi n Title:
Onsite Representative: SQ-w�---
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
n°
Phone No:
Integrator: '&fu 4g
Operator Certification Number:
Back-up Certification Number:
Longitude: 0 ° 0 4 M ,g
Design Current
rrent
DesigWPopuINtq
Design Current
Swine Capacity Population
Wet Poultry Capacon
Cattle C•apty Population
❑ Wean to Finish
10 Laver I
I
❑ Dairy Cow
❑ Wean to Feeder
10 Non -Layer
❑ Dairy Calf
Cj Feeder to Finish 2M
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Farrow to Finish
❑ Layers
❑ Gilts ❑Non -La ers
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Numher of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes MNo ❑ NA ❑ NE
❑ Yes
'0 No
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
MNo
❑ Yes
4 No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

1 Facility Number: Date of inspection 6
• Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 5,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Z o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 19Tg
Observed Freeboard (in): �j _ C-� 2>
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JR1No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 9No ❑ 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 19 No ❑ NA ❑ NE
9. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes RNo ❑ 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/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [&No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
04 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No,
❑ NA
❑ NE
1$. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question.#): Explain any;YES'answers, and/or, any, recommendations or'any other comments j
Use drawings offacility to better explain situations:(use�additlonatpage4.as,necessary)
r r,
f C-op
�p
uSZ afjja/�Ddb/ra�3a.tiD�m-
I �
Reviewer/Inspector Name Phone: 9"I D—y 3.3po
Reviewer/Inspector Signature: Date: 7— O a (�
ruge z of 1 .1Zi-,aiUlf t.ununueu

i Facility Number; — Date of Inspection
' Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? []Yes JZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes ®.No ❑ NA ❑ NE
the appropriate box. ❑ WOp ❑ Checklists ❑ Design
g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes 10o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ElSoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking gCropYield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/[nspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
[:]Yes
®No
❑ NA
❑ NE
❑ Yes
14 No
❑ NA
❑ NE
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
fiQ No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑Yes 04No ❑NA ❑NE
❑ Yes E No ❑ NA ❑ NE
[]Yes (RNo ❑ NA ❑ NE
❑ Yes LgNo ❑ NA ❑ NE
[]Yes
rk"n�No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Additional Comments and/or Drawings: .
Page 3 of 3 12128104

I
Type of Visit V Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: F61V4/ate Region: 1540
Farm Name: t:t%J ►� 14 S� rA4- S `� Owner Email:
Owner Name: ltlr/z bd _Sr�nr_wt 5-- _ _____ _ Phone:
Mailing Address: 267 STD t'w15 ROG.A
Physical Address:
Facility Contact: 'title:
f/-� L�
Onsite Representative: c tj L a A/
Certified Operator: I!✓illid_ _____ _ _�d�'ftitS
Phone No. -
Integrator: /YIW D1114 �110 C_j
Operator Certification Number: 1993 7
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =e 0I =1{ Longitude: =o =S =
11
Des,i n Current Desi'id n Current `
gg,..
Swore° Capacity Ptopalation WetPoultry ti' Opacity Pop Mahon
MDi n Currentr
Cattle Capacty APppulation
❑ Wean to Finish
T❑
Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La et
❑ Dairy Calf
Feeder to Finish
/
`
ryElD
Owl.,
,f
�`
❑Dairy }-leifei
❑ Farrow to Wean
Cow
ElFarrow to Feeder
: ❑ Non -Dairy
❑ La ers
❑Non -La Non -Layers
El Farrow to Finish
El Beef Stocker
❑ Gilts
� El Beef Feeder
❑ Pullets
❑ Boars
❑ Beef Brood Cow
❑ Turkeys
Othe P
Number of Structures:
10Turke Points
❑ Other
❑ Other
Discharges & Stream 1_ mpgcts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
® No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
.9 No
® NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
Z NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
IN No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

;. Facility Number: 17 1 —2 S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
CffNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes
❑ No
DdNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 0—
Observed Freeboard (in): Z 7 Z. (o 27 2 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® No
❑ NA
❑ NE
(iel 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 ofthe stuctures lack adequate markers as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
®No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Dritl /❑ Application Outside of Area
12. Crop type(s) Cen-Aj , 5ot,Ir
�7Can/S li�%G,�w
13. Soil type(s) Aa
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes B No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes X No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre detcrmination`i❑ Yes ®No ❑ NA ❑ NE
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 [M No ❑ NA ❑ NE
Comments,(referao quest:16414 Explain any YES.,answers;:and/4r any.recommendatialls"or any Ofheraaomments, ''•
1yii�%�,dr4wi6gi4fyfa6llty ta`lbetter explain situ`attions. (use acldttional pn es as�necessary) '��"'p '
�SfeT;k.,.. u.k .,.. .�. . Yn } _. i ..:Y Y ._. ...,i..Y.r.�c 1�''+.Ts�.". i..�.,-.�: •'! 1'Ys[s. �. ...
Reviewer/inspector Name �y ' S Phone: a �Isr` /S�
Reviewer/inspector Signature: Date: /0-r/ — 49.i-
12/28/04 Continued

Facility Number: Q — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes m No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to'calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
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?
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
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
IN No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
21 No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
IN No
❑ NA
❑ NE
❑ Yes
IN No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes K No ❑ NA ❑ NE
A iIIii ina it.. en`ts and lor'DrawI gs
", ; , 'r �"°
r w '
12128104

IF
I7ype of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit • Routine O Complaint O Fallow up O Emergency Notification O Other p Denied Access
Facility Number Date of Visit: Time: 1 ; o0
0 Not O erational 0 Below Threshold
13 Permitted © Cerdf`ied © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold:
J ` F"Ro
FarmName; -STa�::r.�:t..Jt..............Q»'�........,.�.a.y.............................. County: .��a.........._..» ....»».».......» . »...._............
OwnerName: ..».............. s %eaen ................ ' Phone No:..»... � �. .........».»....».
Mailing Address:..». » ..»» »»S cx Casa Qac ._. _ ..�% � .,ol'Q. »» A/L» » » �. .�. .._ ... _ ......
FacilityContact: ». ,G.Sr. w_ a!a .. __.w». Title:._._-._—_ ......._..»»..»..._._. Phone No:.„» 9/O �. ^�`$
Onsite Representative:..».».�!a7 LA'S .._ ..... _...... .._ .. Integrator: .��R�.►f.... _..._ .»._. __.. ..
Certified Operator:._ ........ ....._.. ......_.... ... .......». ».»_...»...._... Operator Certification Number:... L9.` j_ _._M_.....
Location of Farm: �✓,' /�,'a..,
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• ��
Discharges - Stream Impacts
1. Is any discharge observed from any part of the operation? Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field 01 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 0 No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 1M No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes M No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes m No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
12112103 Continued

Facility Number: q' — ;Z S Date of Inspection 11 • �a'f I
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 ❑ Yes 0 No
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
!-13r o-0fr' v 4o sr 42 dry -741
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Mues
17, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes j] No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Field Conv ❑ Final Notes
wa.A-c 6 L.,,j ksc 4& 3 � 4 rtwgjad_ 1iuc.
IA,J a.:'�'t wAr CCU TC.iNC40P- QtipA +L r^o
f .f /KT a � Si+Ce, C.f,cora 4p aj w.uC'fL
I�-� lJCdaC toiq iwr t�toDla +�r��, Tt.i-b W42 FGhb,s4AL OtU4V q 1V+�1l Derr KRIS ����sQ
tic rtl+w"ec�ll 1M.(9Gi:fioos�.Q aQ �proPt•t1 W`1��:w� �� I1u.1��_
?n' a"a• dss�}NO!,'h 7 sReviewer/Inspector Name :
Reviewer/Inspector Signature: Date: l/-Q-oq,.
12/11Z/0-3 continued

Facility Number: c�r _.7rI Date of Inspection / - • O
i
Re uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 9-MO,
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 2-N*o
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑T-me6ear6- ❑ AMMysis ❑ Soil Sampling
10-/8 —.? 2.1 7, 3 2.11 >, / s•�7 > 3•Y, � 7, 3,91 3.2 --P -�>.7,17 �. s� .7y � y
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
29. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
[14taekmg-Porm [:]Crop Yield Form [ )Rwu€ell ❑
❑ 120 Minute Inspections ❑
❑ Yes ❑ No
❑ Yes ❑ No
® Yes ® No
JZ1 Yes [:]No
❑ Yes ❑ No
P-T'es ❑ No
❑ Yes ❑ No
❑ Yes 2-56
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103