820705_INSPECTIONS_20171231

NUH 1 H UAHULINA
Department of Environmental Qual

Type of Visit: e"Compli ce Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Dunne O Complaint O Fonow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ; Or? Departure Time: County: 5- Region:
Farm Name: �"1d ra/wr_- 5 _ Owner Email: _�"�
Owner Name: _ �t,r a l�u�• c.� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title- Phone:
Onsite Representative: /r Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Dn Current
Current
Design Current
Swinea
Capacity Pop.
w
We# I'ouiry Cnapar�ty, Pop.
Cable ,:. Capacity Top.
c
Wean to Finish
airy Cow
Wean to Feeder
of fl
3-
Non -La er
I
ai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
:, Dees�ign
Current
Dry Cow
Farrow to Feeder
D , Poult ..
Ca aci
Po
Non-DaITY
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Finish
La ers
Gilts
Non -La ers
Boars
Pullets
Turkeys
Otber
Turkey Points
Other
Other
�I .
onrnrnvwC.a�il� I...,Ywa.a.':...:FAiiG�.+'."i•inr,SB�ru. YLWLM.:
�nrv:ib,inrame, ..
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑Yes UNo ❑NA ❑NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes El"No
[:]Yes E3<0
❑ NA ❑ NE
(]NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
DNA ONE
Page 1 of 3 21412015 Continued

IFacik Number: Date of Ias ection:�-
i Waste Collection & Treatment
• 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ffNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [3"No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ` L
Observed Freeboard (in): 71.5_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0-1�o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [ /] 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 ❑-1�_o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes D­K o
❑ NA
❑ WE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes E] 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): 0e. 57-r
13. Soil Type(s): Nr2ril 1: /CIO_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E No
D. NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[�fNo
❑ NA
❑ NE
acres determination?
11. Does the facility lack adequate acreage for land application?
❑ Yes
EfrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[E]No
❑ NA
❑ NE
R aired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[] Yes
[]rlo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes
EEI-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 [3No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Q Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections 0 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 C3 N ❑ NA [] NE
Page 2 of 3 21412015 Continued

Facitity Number: _ Date of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes El -No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ETNo ❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No [] NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ej
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[j]"No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
EfNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ffNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
[? No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E] No
❑ NA ONE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�o
❑ NA ❑ NE
Comateots (refer to question #) Explain any. YES'answers;"d1or any additional recommendations or any other comments.,y,
UsC dAaWiII of faciL to better, ex lain situations'(ase:additional pages as..necessary). �' 4
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Phone: 2--)a- 303-8/S1
Date: / '-7- - I ;?-- k-
2/4/201 S
Page 3 of 3

Type of Visit: r Compliance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j(�/ /17� Arrival Time: Departure Time: j '.s�4r• County: �R"►"'t_]o"' Region:
Farm Name: —Lamb f `Qilti'tf
Owner Name: 1,/ i ws Liz
Mailing Address:
Physical Address:
Facility Contact: - k!^ts L4r,,: Title:
Onsite Representative: ' r
Certified Operator:
Back-up Operator:
Location of Farm,
V
Owner Email:
Phone:
Phone: , f
Integrator: PreST�iSI?
Certification Number: OD©
Certification Number:
Latitude: Longitude:
Design Current
Design
Current
Design Current
Swipe Capacity Pop.
Wet Poultry
Capacity
Pop.
Eat1le
Capsclty Pap.
Wean to Finish
La er
DairyCow
Wean to Feeder p
Non-Ler
a
DairyCalf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder D P,oul Ca aci P■o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Turke s
L Beef Brood Cow
-
Other
Turkey Poults
Other
Other
Discharges and Stream Imoacts
I. Is any discharge observed from any part of the operation?
❑ Yes
E� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[] No
NA
❑ NE
h. Did the discharge reach waters of the State? (if yes, notify DW R)
❑ 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
oFI NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
EP No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[EL No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facility Number: Date of inspection: /2
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 T❑ No 9NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes QPo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[N No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify D"
7. Do any of the structures need maintenance or improvement?
❑ Yes
0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[P 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 AE;Vla,.J.
Window ❑ Evideence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �7'��4SS\i1 11 �yL-• C-.� o-,a�
13. Soil Type(s): t ,- I —%Uo Ar-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
P9No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
® No
❑ NA
❑ NE
acres determination?
T
17. Does the facility lack adequate acreage for land application?
❑ Yes
[A No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Renuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
W No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�j 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 [11 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [;R N
[DNA ❑NE
❑ Weather Code
[:]Sludge Survey
❑ NA ❑ NE
o ❑NA ❑NE
Page 2 of 3 21412015 Continued

Facility Number: L- Date of Inspection: ZlIzIn
A Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes P No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes F No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ No
❑ NA
❑ NE
Conimenit y oany outcomments: 3 "' ysing er to question;.:#): ExplainanyYES answersan �dloran additioualrecommendationsr er Se',;: � t F u
of faciii. to better explain sjtuations . ttse;additional� es as-necessa
draw Use
Reviewer/Inspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Phone:
Date: "17- 7
2/4/20l S

I ype of visit: 0 Compliance Inspection V Uperation review V Structure Evaluation V Technical Assistance I
Reason for Visit: *Routine O Complaint O Follow-up O Referral p Emergency O Other Q Denied Access
Date of Visit: Arrival Time: Ogg Departure Time: �County: SA?e�S OAAegion:
Farm Name: T r'a yll s Owner Email:
Owner Name: Ta,*v.,eS [ay4 Phone:
Mailing Address:
Physical Address:
Facility Contact: Z_4z_X1l" Title: Phone:
Onsite Representative: U Integrator: PR,9S7_A(r_9
Certified Operator: Certification Number: 2a iF53
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Desi n Current De ....
g � sign Current
Design Current
Swine
Capacity Pop... Wet Poultry Capacity Pop.
Castle C•apaeity Pop.
Wean to Finish
La er
Da' Cow
'] Non -Layer
Wean to Feeder
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Dr P,oal Ca aci l',o .
Non-Da'
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream lm acts
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)
❑ Yes [A No ❑ NA ❑ NE
❑ Yes [:]No
[—]Yes [:]No
LPI
NA ❑ NE
yNA ❑ 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 V3 NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? [—]Yes No ❑ NA ONE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

V7
r

FaciliNumber: - 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
09 NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 �T"
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
I %
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
Pm No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Q9 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
Y� 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): �Wm & I
13. Soil Type(s): B'iAJp
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Dn No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�3 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Vg No
[:],NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
MNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Re uired 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
1P
❑ NA
❑ NE
the appropriate box_
❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste. Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [J�No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 0 No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: _ Date of Ins ection: Zi t{
t �
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes 0 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? 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 pen -nit 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 ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes E�7No ❑ NA 0 NE
❑ Yes P No 0 NA ❑ NE
❑ Yes [;g No ❑ NA ❑ NE
[—]Yes �§ No ❑ NA ❑ NE
❑ Yes J�] No
❑ Yes rN No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Comments (refer to ggesdon,##.) .Explain any YES answers andlori anyiadditionai recommendations or any other comments.
Use drawings of facility to better explain situations (use additidnal-pages as necessary).
C 62440gl
Reviewer/Inspector Name: P10" A"iP
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: ! I ) b
2/4M'15

Type of Visit: 10 Compliance Inspection O Operation Review p Structure Evaluation p Technical Assistance
Reason for Visit: 10 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access _
• I • I I .I
Date of Visit: (`yj /K//5 Arrival Time: Departure Time: County: e5;1"4-7*50q'1 Region: 1W
Farm Name: "f am AILS Owner Email:
Owner Name: 3CLw1es L go46 Phone:
Mailing Address:
Physical Address: Facility Contact: jj� SQ ►�e5 C�-o-b Title: Phone:
Onsite Representative: U
Certified Operator: 14
Back-up Operator:
Location of Farm:
Latitude:
Integrator: P/e�j(hL 972�cr'
Certification Number: .20 ?
Certification Number:
Longitude:
- Design Current
Swine -Capacity Pop. -
Wet Poultry ..
Design
-Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
Wean to Feeder
WO
Q -I
Layer
INon-Layer
,
D . P,o_ulC_a
Layers
NOD -Layers
Pullets
Turkeys
,Turkey Poults
10ther
_ _ -
I?esign
act
Current
P,o
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Cow
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes ❑ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No � NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
[3 No
6 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
IP
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

acili ` Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) Iess than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No NA ❑ NE
Struc e l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3311
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [P No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TT
6. Are there structures on -site which are not properly addressed and/or managed through a [:]Yes EpNo ❑ 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 No [] NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes [�J)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 Accepta le Crop Wi dow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop m T e(s):�
/ V ph—
13. Soil Type(s): _L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[P No
[] NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
`f No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA]
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(�No
❑ NA
El NE
the appropriate box.
T
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes PNo
❑ 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 W No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �}No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Eacility`Number: jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes q No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check [:]Yes [P No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes (P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes jA No ❑ NA 0 NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes E�$ No ❑ NA ❑ NE
❑ Yes [0 No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Yes No NA 1NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question '#) Explain any YES answers and/or any additional recommendations or any other C6mki' ntit. R
Use drawings of facility to better:ezplam"situations (use additional pages as necessary):_
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9/0-V.33 33(�10
Date:
Z14/20I4

Type of Visit: 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine Q Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q = m Departure Time: / �+�a,�,� County:S .SQ/� Region: /`+�
Farm Name: Law, 19 fa,, m
Owner Name: �J QYyLQ.S �21�k,�
Mailing Address:
Physical Address:
Facility Contact:Title:
r�
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone: ll�
integrator: Tres
Certification Number: f. O p ,S
Certification Number:
Longitude:
I)aign Gu. en t Design Current
Design Current
Swine Capac�tyPop. Wet Poultry Capacity2.Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
D ' Cow
D ' Calf
Wean to Feeder
3 Q
Non -La er
Feeder to Finish
Da' Heifer
Farrow to Wean
Desigp-..Current
Cow
Farrow to Feeder
P.oul Ca aci P,o
ers
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
-La ers
MN
Beef Feeder
Boars
ets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
DischarPes and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
7�
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
MI No
❑ NA
❑ NE
of the State other than from a discharge?
TT
Page I of 3 21412011 Condnried

Facility Dumber: - p Date of Inspection: 9 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: '
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2u
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
W No ❑ NA ❑ NE
❑ No P'NA ❑ NE
Structure 6
❑ Yes N No ❑ NA ❑ NE
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 [5g 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 [P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[� No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes FO No ❑ NA [] NE
❑ Yes 50 No [] NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes [;g No ❑ NA ❑ NE
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes K No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [�A No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [yj No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins action: q
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
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.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
[)a No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
N] No
❑ NA
❑ NE
❑ Yes 0 No [DNA ❑ NE
❑ Yes M No ❑ NA ❑ NE
D Yes P No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
� No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
(PNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
� No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations.or any other comments. F ,'
Use -drawings of facility to better explain situations use additional pages as necessary).M`'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: '�/0-LI33-3 300
Date: 3
2/4M11

I"
rype or vent: 1W q omptiance inspection tJ uperanon tceveew t) btructure t;vaivanon V i ecowcai Assistance
Reason for Visit: * Routine 0 Complaint Q Follow-up Q Referral 0 Emergency O Other Q Denied Access
Date of Visit: +� > 12
Arrival Time: rw Departure Time: !O County: A4r Q0k/ - Region: 20 Farm Name: La �yV1 f � Owner Email:
Owner Name: Jame_ s LO rl Phone:
Mailing Address:
Physical Address:
Facility Contact: UQ.ryws �Q rr.�p Title: Phone:
Onsite Representative: Ll Integrator: 4-qr
Certified Operator:
Sack -up Operator:
Location of Farm:
A
Latitude:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Current Design Current
Pop: Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pep.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
1
jNon-jaer
Dairy Calf
Feeder to Finish
Design Current .
„I] . PoW Ca aci P,o
Dairy Heifer
Farrow to Wean
Dry Cow
Farrow to Feeder
Non -Dal
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Brood Cow
Otnc
I
I 10ther
Turkey Poults
Other
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyances man-made?
[] Yes ® No ❑ NA ❑ NE
❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
D No
J�g 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
P NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
09No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
(A No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3
21412014 Continued

FaciliNumber: jDate of Inspection: 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Q§ No ❑ NA FINE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes] No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify 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 D Yes ® No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ® No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs_ ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
K No
❑ NA
❑ NE
❑ Yes
� No
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
❑ Yes �j No ❑ NA ❑ NE
❑ Yes Qg No ❑ NA ❑ NE
❑ Yes 0 No [] NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
❑ 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
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: SZ - Date of Inspection: j
24. Did the facility fail to calibrate waste application equipment as required by the permit?
[:]Yes
[ No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[ No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
5g 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
❑ Yes
EqNo
❑ 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
[5D No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
® No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
® No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[0 No
❑ NA
❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[5] No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
P No
❑ NA
❑ NE
Comments:(refer to question #): Explain any YES answersiand/or any additional recommem ndations or any other coments y "
Use drawings of facility to better explain situations (use additional pap -es as necessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 91'9—Y33- 3f0Z7
Date: Z V11
21412014

I1 ype of v Isit: w uomptiance inspection V Vperation Review U 1tructure L' Valuation U Technical Assistance
Reason for Visit: 0 Routine 0 Complaint O Follow-up 0 Referral 0 Emergency 0 Other O Denied Access
Date of Visit: Arrival Time: Departure Time: : f(JFljv. County: �Q/J Region:
Farm Name:—[Z?r Owner Email:
i1
Owner Name: :Jc g Limb r � Phone:
Mailing Address:
Physical Address:
Facility Contact: ua-mes t" Title:
Onsite Representative: it
Certified Operator:
11
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: 2�8�
Certification Number:
Longitude:
' lj u`Y `:.'�' I Y � wLA'ir[' � ate' •y'�'�s�'
q�` Designs Current Design�Current Design Current
Swine �`Cap`ac�tyK.,;�'�Pop '� Wet Poul#ry Cap �tyl'op� Cattle Capacity Pop.
,_
- - -
-
Layer Dairy Cow
Non -La er
I
Dai Calf
Dairy Heifer
Farrow to Wean
and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑Structure ❑Application Field
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
❑ No
�] NA
❑ NE
❑ Yes
❑ No
� NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑Yes ❑ No 0 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 ®r No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2011 Continued

Facility Number: 0-70 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [R NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: T
Spillway?.
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes `l4 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0 No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify 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 (E 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): (7w $` ( 2erm u 6Lm s
13. Soil Type(s): NOA - 4&,,-4I
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [)§ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes ® No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes 50 No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
[] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
® No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
® No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Q No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes © No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes (�j No ❑ 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 ® No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of fast 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 ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes © No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ®No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
® No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
® No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
❑ NA
❑ NE
Comments (refer to:question ft Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 910`�.�' co
Date: AL110 Z
21412011

Division of Wafer QuaEity
Facility Nurnr L ��"J - '7� ®pivision afSoil and Water Conservation
� tauter Agency
Type of Visit: 0 Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time; Departure Departure Time: County: SR'h4fSoA) Region: _
Farm Name: [fib 6%y-��:s Owner Email:
Owner Name: �Q. ,e_S La Phone:
Mailing Address:
Phvsical Address:
Facility Contact: 5(-:nos�Atl Title: Phone:
Onsite Representative: t( Integrator: �n_Q. e_
Certified Operator: A Certification Number: �o9S3
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
sgn Current
Design Current
Design Current
Swine �Capaciry Pap,
Wet Poultry
Capacity Pops.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
3�
Non -La er
x_
DairyCalf
DairyHeifer
Feeder to Finish
Farrow to Wean
Design �Curreli
Cow
Farrow to Feeder
D . P,oult ,
_Cap aci -.�P.o
Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turke Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No Do 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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes [:]No
[—]Yes U] No
❑ Yes %] No
�NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Wacility Number: - r/p jDateof 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
�0 NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
_
Observed Freeboard (in): i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
R] 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
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
Crop ❑ ❑ Window
Evidence of Wind Drift Application Outside of Approved Area
❑ Outside of Acceptablj!
b—e� /
12. Crop TYpe(s): CaSTQmJ4 ( -ma � SIk . 6ynL O
i
13. Soil Type(s): af'T`rr Ik-fjo)4_ _ --
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [,N No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ( No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes Co 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 El Checklists []Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1W 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
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facilt •Number: - ry 5 Date of Inspection: R 2-3 9
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA Q NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No [] NA ❑ NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
25. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes 0 No ❑ NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ® NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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 CAW"?
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 K] No ❑ NA 0 NE
❑ Yes RjNo ❑ NA ❑ NE
❑ Yes [K No ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes R No
[:]Yes ® No
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
[DNA ❑ NE
Comments (refer to question ft Explain any YES answers:andtor any additional recommendations or any other comments.
Llse drawings of facility to better explain sitaatians {use additions! pales as necessary). -. -
Fy ct gad— A*-sm -
&64 4r�-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q10—q33-33op
Date: k3 11
21412011

Type of Visit &Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit G':routine Q Complaint 0 Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: >'� t% CountyRegion: �_
Farm Name: rar- t'­ Owner Email:
Owner Name: T�= -OPS Lim _ _ Phone:
Mailing Address:
Physical Address:
Wr
Facility Contact: Title: _OWHY✓ Phone No:
Onsite Representative: Integrator:���� c_
Certified Operator: _ t�Operator Certification Number: A-6�13
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = u Longitude: = u 1:1 , Q u
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ We to Finish
❑ La er
❑Dai Cow
We to Feeder
C>
❑Non-La er
❑Dai Calf
Elan
Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow Farrow to Finish
Dry Poultry
❑
❑ D Cow
ElNon-Dairy
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑Beef Brood Cowl
❑ Boars
❑ Pullets
El Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
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 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
R No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[3 No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: JV — Date of Inspection O�
Waste Collection & 'Freutment
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 Strtictmr 2 Structure 3 Structure •1
❑ Yes CNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Sir+rcture S Structure G
Identifier:
Spilhviy?:
Designed Freeboard (in):�^
Observed Freeboard (in): T S�
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.)
b. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
KIo ❑ 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
gNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
4No ❑ 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
o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Dyes
No ❑ NA ❑ NE
maintenancelimpkovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes
R 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) ,,tJ I00 ef31' i..,V/
13. Soil types) of o A
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ES No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
9No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C.No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C&No
❑ NA
❑ NE
Comments (refer to question i): Explain any YES answers and/or any recommendations or any other comments,
Use drawings of facility to better explain situations. (use additional pages as necessary):
A.
Reviewer/Inspector Name Phone:D-j- 00
Reviewer/Inspector Signature: Date: �" i� D%
12128104 Continued

Type of Visit Q-Compliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit outine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: /D Arrival Time:Departure Time: ounty: Z'"" Region:
401,
Farm Name: a-,22 Owner Email:
Owner Name: !f Z=!!-mA Phone:
Mailing Address:
Physical Address:
Facility Contact: Title- Il/l rtr Phone No:
Onsite Representative: _6-et-, Integrator: -R-r�'1��►e_
100
Certified Operator:� Operator Certification Number: 42aSe'A�
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ` 0" Longitude: = ° = 1 0
Design
Current
Design Current
Design Current
Swine Capacity
Population
Wet Poultry Capacih Population
Cai#le
Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder
Ologc:N
❑ Mon -Laver
❑ Dairy Calf
Feeder to Finish
❑ Dairy,Pfeifer
❑ Farrow to Wean
Dr3 i'oultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dai
El Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
El Non -La ers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl I
❑ Turkeys
Other
❑ Other
E]Turkey Poults
❑ Other
Number ofi Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure [] Application Field ❑ Other
a_ Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
[:)Yes P,No ❑ NA ❑ NE
[I Yes
❑No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
R No
❑ NA
❑ NE
❑ Yes
2 'No
❑ NA
❑ NE
Page I of 3
12128104 Continued

Is
Facility Number: Date of Inspectionr-
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): gzq
Observed Freeboard (in): it %
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed
❑ Yes
NJ No
❑ NA ❑ NE
tbrough 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
XNo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit'!
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. 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
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes EINo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Totai 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) p .,,..„
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 JQ No ❑ NA ❑ NE
17, Does the facility lack adequate acreage for land application? ❑ Yes C.No ❑ NA ❑ NE
18. Is there a lack of property operating waste application equipment? ❑ Yes [.No ❑ NA ❑ NE
Comments (refer to question: Expisitt aoy YES answers and/or any recommendations or any other comments
Use dra►tiingi oifacility to better egp ( pages Yry)i "2
lain situations: use adduhonal a es as necessa�
Reviewer/Inspector Name „` i �,. _ v; Phone: L�� 33Ja
Reviewer/Inspector Signature: Date: t7
Page 2 of 3

Facility Number:&gDate of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 1)3-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. ❑ W'Up ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes &No ❑ NA ❑ N E
❑ 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 D§ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 10 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
tZNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JS 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
29 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
® No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CO No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Z No
❑ NA
❑ NE
Additinnat,Cimments and/or Drawings
Page 3 of 3 12128104

L
Facility Number: Date of Inspection r -D
!teed Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (R 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 ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [KNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbrealkers on irrigation equipment? ❑ Yes ($No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ 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
P,No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
5d 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
N 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
t ,No
❑ NA
❑ NE
General Permit? (iet discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
R[No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2-No
❑ NA
❑ NE
Additional Comments and/or Drawings: I
12129104

f
ion of Water Quality
Facility Number Q Division of Soil' and Water Conservation,.->
In Other Agency
Type of Visit
ompli nce Inspection
a Operation Review 4 Structure Evaluation
O Technical Assistance
Reason for Visit
outine O Complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: _ Arrival Time: f p Departure Time: p: p0 County Region:
I or
Farm Name: �--6L' %"r Owner Email:
Owner Name: C�/ w g-S "m, _ Phone:
Mailing Address:
Physical Address: /) `
Facility Contact: r�azml L � aryl d Title:
Onsite Representative: srrr►�
Certified Operator: - Se�,e _
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: Are,�.,a�
Operator Certification Number: ��-K
Back-up Certification Number:
Latitude: ❑ c = 1 = u Longitude: ❑ ° ❑ , Q "
O
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ aver
❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
ElPullets
LiTurkeys
❑ 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
El Dairy Cow
❑ Dairy Calf
El Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
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
El Dairy Cow
❑ Dairy Calf
El Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
e. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes RNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[.No
❑ NA
❑ NE
❑ Yes
[&No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
{ Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [SNo ❑ 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?: q
Designed Freeboard (in): C9 1
Observed Freeboard (in): �3 _
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ®,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 KNo ❑ NA ❑ NE
8. 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
10 No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
J9 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) 1'2� ILL- U."rs �
_
13. Soil type(s) 1`
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
J& No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
J,No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
f.No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
allo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
®.No
❑ NA ❑ NE
Reviewer/Inspector Name I I Phone: 33 '.33� o
ReviewerlInspector Signature: Date:
Page l of I 121251 4 c.onnnuea

,y
Facility Number: Date of Inspection
a
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J4 No ❑ NA ❑ NE
the appropriate box. ❑ WjUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
2l. 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 V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CK No ❑ NA ❑ NF
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes f4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
!4 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
[9 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
M No
El NA
[I NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Ed 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
ES 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
DS 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
BNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Cr-Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 6-compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I Arrival Time: 13 Departure Time: ,' r77­1 County- Region:
Farm Name: !i , 1 A far r'! l Owner Email:
Owner Name: ��-tars _ 2t [rom b _ Phone:
Mailing Address:
Physical Address:
Facility Contact: U��fj �� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 4&e5-3
Back-up Certification Number:
Latitude; = e = s = u Longitude: E-1 o =1 = N
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Populations Cattle
❑ Wean to Finish
Wean to Feeder D
El Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ lather
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design :Current
Capacity+;: P©pulation
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State": (If yes.. notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes KNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
❑No
❑NA
El NE
❑NA
❑NE
❑Yes
El No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
J4 No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
r�Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
•S No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): {S(i
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
MNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
5jNo
❑ 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
JK 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
J ] No
❑ NA
❑ NE
maintenance/improvement?
I I. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes M No ❑ NA ❑ NE
whi
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [--IPAN > 10% or ] 0 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) ZYl d / UC! e;a+ _
13. Soil type(s) A]2AI — —
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
U,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
P No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
fiD No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
M-lslo
[I NA
[3 NE
I Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
1 Use dra,^ ings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: `)`/Q eD_— 3 34DO
Reviewer/Inspector Signature: Date: & 7

Facility Number. — 49 Date of Inspection
y4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [_-]Yes Jallo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;9 No ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 19 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
;KNo
❑ 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
KNo
❑ 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
Ca No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
® No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
J9No
❑ 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
4No
❑ 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
Dd No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
CgNo
❑ NA
El NE
Additional Comments and/or Drawings:
12128104

I
Type of Visit '$-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: i D Departure Time: County: Region:
Farm Name: . _ 1-,,xa1 6-.e, _ Owner Email:
Owner Name: t��s��s Phone:
Mailing Address: /022 Ca �L ;Z,- /e_ ga� C L- irn T D n 4L vv��51
Physical Address: `
Facility Contact: �" 4f �st»y 4 Title: Phone No:
Onsite Representative: sr�, -c . Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = c 0 f = Longitude: = o = 1 = u
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes R1 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
5� No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
I? 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
4 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 adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
®No
❑ NA
❑ NE
other than from a discharge'?
Page I of 3
12128104
Continuer!

I' I Facility Number: �ps
Date of Inspection -4
Waste Collection & Treatment
` 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes [X No ❑ NA ❑ NE
❑ Yes K No ❑ NA ❑ NE
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
fZNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
fi4 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
C&No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
[gNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
� No
El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
qNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
QNo
❑ 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 [I Application Outside of Area
12. Crop type(s) —1G�f -!-
f 9
13. Soil type(s) `Aza14-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ kNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[-]
Yes
C,No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
g No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XLNo
❑ NA
❑ NE
6?;&dFar-"N_ t 9'a-0-04
Reviewer/Inspector Name y �p Y..- Phone:
Reviewer/Inspector Signature: 46 Date: (a --.$~ �;g
12128104 Continued

Facility Number: Date of Inspection --a
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [3 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [9No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C9No ❑ 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
EKNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
z No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JKNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Z No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
q No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ 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
LgNo
❑ 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
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
®,No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
&No
❑ NA
❑ NE
„
Addihooal Comments;andlor.Drawings:
12128104

M
m 4 e Division of Water Quality x�
Factl>Ety Number. a �DS� O Division or soil and Water�'Conscrvation
Q Other Agency
Type of Visit ® Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit ® Routine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: 7t %1QS I Arrival Time. Departure Time: County: ar-�,�sraw�l Region: FRO
Farm Name: �.-.a w. )ta t�nrr,� Owner Email:
Owner !Name: J o. rw 4 _1b � o w. b Phone:
Mailing Address: — V 7S? G o. 1 c.,A HIA c i f j4 a v N C,, a 9 3.?g _
Physical Address:
Facility Contact:
Title:
Onsite Representative: L a..��
Certified Operator: J CL V-% C L
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: _f C s 4 0,
Operator Certification Number: dt vr3
Back-up Certification Number:
Latitude: =U =I =111
Longitude: =0
=4 ❑
di
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
30 0 ❑ Non -La et
❑ Wean to Finish
® Wean to Feeder
El Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Other
❑ Other ---
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
DischarjZes & Stream Impacts
1. Is any discharge observed from any pan of the operation?
Discharge originated at: El Structure ❑ Application Field El Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑
DairyCow
El
Dairy Calf
El
Dairy Heifer
❑
D Cow
ElNon-Dai
❑
Beef SLocket
El
BeefFeeder
❑
Beef Brood Covd
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)
?. 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 [V No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[M No
❑ NA
❑ NE
❑ Yes
[ No
❑ NA
❑ NE
12128104 Continued

r..-
Facility Number: 8a —17 Date of Inspection 6/17
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): 412
Observed Freeboard (in): !i '
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
56 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
�O 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
(M No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[9 No ❑ NA Cl 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) lac r "% K.94- 5 — o l l G V. e ., — trJ V Gv S e
&A
_
13. Soil type(s) Na 14
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?
[M 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
® No
❑ NA
❑ NE
— — atociqliutyesttottob:trnh.e%5,s�.t#k�t.)G-eti�FrA�`'yr�`EeY'raz'z:p'usp.'illaautnt sar-3tna-u-i y%�a"_�Yt+.jCg�yEi'StE_St.s:�L:a�.:tib(. n„iuC sxsr.we e-. a.r. ds.., darntida/nYo.i. a_r, l anaarIt'Ly'.ec'�trto).�"a �asoryrnn
g
pyesameedry7
ments.
3;' _ �..a�' .-,x _ �s.�,� P✓.Y. aR. v.
1pa�..t1,t,*­L a.'.� 4-\:.i a\er.q✓S�.r�
*'� c. L..J tc_� S • 5 �+naC ►na! O►Q 1. D b%^ t
eL3 s.alb Qa faoDsa%oale_ as Ar4�%.c t• tad-CJ oLAA? Ce,�-Ei•,4.c Area
� w+ � r o .► s 6 c..+ w...w .� 4 S� t y�.
Reviewerllns ector Name c^
P Phone:
Reviewer/Inspector Signature: Date: s / / 7/ Ds—
12128104 Continued

y..
Facility Number: _ ,1 — "ypf Date of Inspection Ss'17 /RJ
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [9 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 N 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
❑ No
® NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
0 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
[X 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
[A 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
[)2 No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Q No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
V] No
❑ NA
❑ NE
A,�tldihonal�„Comnaentss$nd%OI�I11rSWlilgs .. n�w�` . r , ,w x �iw �.;a, k.,:. `-r.�s..„ I' �
S1 kdkg L C a �s•%I& r
0 CA ""M tti . r O {o 1
12128104

a,
.= ■
Type of Visit ® Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint O Follow up O Emergency Notification to Other ❑ Denied Access
Facilitn Number
Date of N•ixir: 3'�.3'a Time: QAh►
rO Not 012erational 0 Below Threshold
tip rermitted 0 Certilfied U Conditionally Certified 0 ReKgistered Date Last Operated or Above Threshold
Farm Name: L o,S County- — S027'"' On F/?O
Owner Name: TOLag6 Phone No: J`d ` Si J -
x f� '7 S7 G-ur% H y C!.' a Al L e g 37
Mailing Address: rues ,,,
7a.n rs i u wb �►"�! rJ 5' y 4 8
Facility Contact: nr v_ Title: Phone No:
r I(
Onsite Representative; T.-++f Integrator: &c io4e poem all
Certified Operator: ___TQtW?es L LQ.. k Operator Certification number: --
Location of Farm:
P wine ❑ Poultry ❑ Cattle ❑ Morse Latitude �' �' Longitude �a �• �'
Design Current
Swine rnnnritr pnnntatinn
PlIkean to Feeder
130,10
❑ Feeder to Finish
❑ Farrow to wean
❑ Farrou- to Feeder
❑ Farrow to Finish
❑ Cilts
❑ —Boars
Design Current Design Current
Poultry Capacity Population Cattle Ca achy Population
❑ Laver [] Dain,
Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons �JLJ Subsurface Drains Present IL1 Lagoon Area ILJ Sp-y Field Area I
lioi Ponds I Solid T - ` dmg raps � ©No Li uid Waste Maneaement Svstetn
Discharges S Stream acts
1. Is any discharge obsrnmed from any pan of the operation? ❑ Yes L'J No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other DI
a. If dischame is observed, was the convevance man-made? El Yes L'1'NO
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑Yes LlNo
c. If discharge is observed, what is the estimated flow in gallmin? --
d. hoes discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes Q o
2. Is there evidence of past discharge from any part of the operation? ❑ Yes [allo
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0'No
Waste Collection 8 TEMtment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Svillwav ❑ Yes [9NO
Structure I Structure 2 5trucntre 3 Structure 4 Structure 5 Smicnsre 6
Identifier:
Freeboard (inches): 7 r�
05103101 Continued

Farib y Number: Ag — 7OS7Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0-l�o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 01�0
(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 ❑-,' O
Q 8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes
Waste Application f
10. Are there any buffers that need maintenance/improvement? - ❑ Yes L31 o
H . is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes Blq(—)
12, Crop type (j
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes e-5o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [` -Ko
b) Does the facility need a wettable acre determination? ❑ Yes O go
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 El -No
Required Records & Pgguments
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WVJP.rchecklysts, desLgnin etc.)
19. Does record keeping need improvement? (ie/ irrigation, freebo d waste analysis & soil same el reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified A WMP?
❑ Yes Elwa
❑ Yes Elmo-
0 Yes Elw
❑ Yes El -No
❑ Yes D-fo
❑ Yes RVo
❑ Yes �o
Cl Yes GNO
❑ Yes Q No
0--No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
meats (refer to quesflon#f} "Elgin any YES'iinswers and/or5any�recommena3atro�s�or anyother"coinme>its.
t
t.Co
l!§e,drawings,of9facHrt3 to better e�zplain situahons: (use addrieonal pages ss necessary} field Copy
❑Final Notes
IEv�le. k, �.�RS l I ,e Id T ° l'[�►rOV� /`(lls.�n�
171Prove �.'S Caus)luf' j ond, sir. 6.,6 A&t c;Ppl,fc� I,'rr,e accotJ:,g
7tc ,'s
.5 a,Y iesd,
Fri., lan/(s
!7 Mr, L4,4 lee elo9 44 yfnerc,( eer. 3 arar� Lv� �� �,,'s �+oc.se
R eeef)16 aon{ weft
4— ]' Ale rl c f � � � oap
=51 LO,/r/'
H,
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
3 - J. -@
05103101
Continued

,N
❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality ,
10 Routine C Complaint O Follow-up of DWQ in5 ertion O Follow-up of DSWC review O Other
Facility Number
Date of Inspection
CJ
Time of Inspection 24 hr. (hh:mm)
❑ Registered Ce-rtified © Applied for Permit Permitted Not Operational I Date Last Operated:
FarmName:...... - ...� ..... fl'� ...... �.�'...................... ............... County: ................. ---...---.........................
Owner Name:............... .... ...
..................}...... A..................................... Phone No: ............. vQ.n52 I...1.CV- 1 ................
Facility Contact: ............. Glenn ...... C.jj[-kr.j......... Title:....----..................
Mailing Address: •--...----.ttrl.....(TI�. �. .......... . p �... .......................
Onsite Representative :............... ................. ......................
Certified Operator:.............. !? ......... .......4,03L-------------
Location of Farm:
..... ........... I................... Phone No:..............................................-----
............ui.ny at ......... 1..00.................... ........Q. Ie
Integrator:..................... .......
Operator Certification Number: ... .......... .Razo
0
"o
Latitude =10
4 69 ' Longitude • ' 0"
Current Desrgn q 'Current Design Current n
Swrrre, d Capacity Population Capacity' Population Cattle Capacity i Population
,
„ :Pputtry . „;
Wean to Feeder a
-Jo El Dairy -
❑ Non -Dairy
nCapac�ty- °
0 Boars
ota! SSLW -;
mber of Dons J Hol Ponds ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Ez.No Liquid Waste Management SystemC.x.wi
`
Layer
K ❑Feeder to Finish
3
❑Non -Layer
[I Farrow to Wean
❑Farrow to Feeder
❑Other
❑ Farrow to Finish
HD estg
,"""`..,, '".` . .. - .� •� _
❑ Gilts
-
General
1. Are there any buffers that need maintenance/improvement? ❑Yes KNo
2. is any discharge observed from any part of the operation? ❑Yes � No
Discharge originated at: ❑Lagoon ❑Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑Yes � No
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ) El Yes
`l /�No
observed,c. If discharge is aerved, what is the estimated flow in gal/min? /"/
d. Does discharge bypass a lagoon system? ([f yes, notify DWQ) ❑Yes O(No
3. Is there evidence of past discharge from any part of the operation'? El Yes XNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes jgNo
S. Does any part of the waste management system (other than lagoons holding ponds) require ❑Yes �No
maintenance/improvement?
6. Is facility not incompliance with any applicable setback criteria in effect at the time of design? El Yes X1140
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes ANo
7/25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closets?
Structures LLagoon-s.Holding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
❑ Yes I No
❑ Yes P(No
Structure 5 Structure 6
Identifier: ...................................
Freeboard(ft) ..... `� 11...................................................................... ............. . ».... ._......__..... ............_.. _..
10. Is seepage observed from any of the structures? ❑ Yes 9No
IL Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes O'No
12. Do any of the structures need maintenancelimprovement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an inunediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes RTo
JVaste Application
14, Is there physical evidence of over application? ❑ Yes PiNo
(If in excess of WMP, or runoff enteripg waters of the State, notify DWPj ti
15. Crop type _....... ......._ Z...... , IfYU&F. Fi..... � '1.... L7Ut/L. � ......
........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
LYNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
KNo
18, Does the receiving crop need improvement?
PqYes
❑ No
19. Is there a lack of available waste application equipment?
,r
44 No
20. Does facility require a follow-up visit by same agency?
❑ Yes
[KNo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
)4N6
22. Does record keeping need improvement?
❑ Yes
Po
F Qr Certified or P_eEMjtted Facilities Only
23. Does the.facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
K No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
KNo
C7: No.violations, i r deficiencies.were,nated-du' ring this.visit.: Voa.will recei"ve.no f6rthier
: co& pQddencei A obt this:visit: ;
r 1 j
Reviewer/Inspector Name.
Reviewer/Inspector Signature: Date; / LQ Y 22