820448_INSPECTIONS_20171231

2 V
NUH f H UAHULINA
Department of Environmental Qual

k.%14 91�-o<<t
of Visit: (><ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
on for Visit: Gel routine 0 Complaint 0 Follow-up 0 ReferraI 0 Emergency 0 Other 0 Denied Access
Date of Visit: f�
Arrival Time:
Departure Time: i cw
County: iz(
Farm Name: ,/�(�flit
`� (S
Z J1A L S
Owner Email:
Owner Name: I (
Mailing Address:
Physical Address:
Facility Contact: 8"e� Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
c, 6) jJ1 e--
Latitude:
Phone:
Region: rl166
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design h1--urient
Swine Capacity
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Wet Poultry
l a er
Non -I a er
D . P,oult ,
Layers
Design
Capacity
Design
Ga aei
Current
Pop.
Current
Po
Design Current
Cattle Capacity Pap.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
101 Other
Tur ey Poults
Other
I Other
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? [:)Yes ��NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a_ Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ ❑ 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 G]r<A 0 NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters Yes -No ❑ NA ❑ NE
P ❑
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Farili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
0 Yes
❑ No C]-?M— ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
[�­❑ 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
�❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
I..t�- ❑ 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
[3,N� NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required butlers, setbacks, or compliance alternatives that need
❑ Yes
[c-Alamo❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes B'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): rh - 11'ez+ �G., G ,,..._,ge'-''((.1���
13. Soil Type(s): (,)6,(-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑'l o—❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Eff-56­❑ NA ❑ NE
acres determination?
17. Does the facility Zack adequate acreage for land application?
❑Yes❑
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ls�.v ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
0 N!__O NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
❑ NA
VNo
❑ NE
Page 2 of
21412015 Continued

F'acjli ? E - Date of inspection: / , 6G
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E -Ko— ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0,NT—❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes -[Z4- V" ❑ NA ❑ NE
❑ Yes [U-Mr❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [J_Ne---❑ NA ❑ NE
❑ Yes QC] NA ❑ NE
❑ Yes ®-N6-- ❑ NA ❑ NE
❑ Yes
ED-No
❑ NA
❑ NE
[:]Yes
C]-W
❑ NA
❑ NE
[-]Yes
D Tl o
❑ NA
❑ NE
u_d�e s',A
q � -P,
Phone:
Date:
21412015

t ype of visit. k-rcompliance inspection V uperatton Review u ztructure e;vaivatton U t ecnnical E►ssistance
Reason for Visit: (EMoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:LL66a 11 Arrival Time: Departure Time: County: s r "f Region:
Farm Name: TAt"r'k rr �e't .' �L ru wri Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: A Q V-&--tftle: � Phone:
Onsite Representative: < < Integrator:
Certified Operator: f _T�D w. -S Certification Number: 9-7 -�' S g
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design GttrrentSwittepacop..
ED7R,'�trrent
Wet Poultry
Capac►ty�.�:; rop.,
Cattle ,'. Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
I
jNqn-Layer
I
alf
Feeder to Finish
oZw
�-
,
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
r
D . P,otii , as
Ca act
Po - .
Non-Dai
s
Farrow to Finish
Layers
Beef Stocker
;S
Gilts
'7
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
ii
Turkeys
di ilr j "I
i1 .
iOther
Turkey Poults
F.
Other �I,ry
Other
•
u c .
'h - ..:r �::nnY..e:ur.ru.rruxurwa um: ,�e�arc�i�waxeavw
_;nwm�seu:::Mannaiarc..::�: i�
uururuunrwY. ..±-..
DischaEges and Stream Impacts
1. Is any discharge observed From any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
❑Yes 1q_o_ ❑NA ❑NE
❑ Yes ❑ No [�NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
❑ Yes
❑ No
dNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
0 Yes
Ej_No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EdNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facil' Number: - t4 Q Date of Ins ection:
P4 d. {
3aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑-#t>✓
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
L.E"A
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[]'ro
❑ 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
EJ-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
[ o
[] NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ o
❑ 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 Ibs. ❑ Total Phosphorus 0 Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s): `5 o ! 1 ✓'o
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes
PNo
❑ 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
[9-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑'iVo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[3-No
❑ NA
❑ NE
Repaired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑-1 o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
D No
❑ NA
0 NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
EfNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soii Analysis
O Waste Transfers
❑ Weather Code
❑ Rainfall ❑Stocking Q Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
[]Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[-No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [2'1�o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facilky Number: Li C4 Date of Inspection: ZZAtoo /
24: Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[3N-55
❑ NA ❑ NE
the appropriate box(es) below.
Ej Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
& o
[] NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑-lqo
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[Erl o
[] NA ❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[�No
[] NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[] Yes
[jj<o
❑ 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
[]"f o
❑ NA ❑ NE
El Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes
ff—No
❑ NA ❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ff_No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Fj`No
❑ NA ❑ NE
Gotumen`ts r�efe�'to° uestivn # Ex ]am sio' AYES"ausevers' and/or an acldrteonal rercrmmendsflaiis or any other comments
Use�drawin of fa il� to better�e tabu _st#nations, use addEtJonal es as neCessary
I
Reviewer/Inspector Name: _V:� i
Reviewer/Inspector Signature:
Page 3 of 3
PhonAIO" �3r3 3
Date: It H v V
214/1Ul S

Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Type of Visit: O'7Routine
liance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: Q Complaint () Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Q L Arrival Time, Departure Time:Mmn County: C� h�_ Region
Farm Dame: ���ev —LV - Owner Entail:
Owner Name: v W f Phone:
Mailing Address:
Physical Address:
Facility Contact: tr k �CSCs Title: Phone:
Onsite Representative: (( Integrator: G —S
Certified Operator: JI j Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design. Current ,;;� �' Design=Cnrrenf° '3' Desig
urrSwinePop. ,�,e#PoultryCaaciPp
CattleCapaciPop.
La er
Non -Layer
Current q,
Layers
Non -La ers
Pullets
Turkeys � - -
Qtlter Turkey Pouits
Other Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at. ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D W R)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? ([f 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?
gill Dairy Caw
Dairy Calf
Dairy Heifer
D Cow
Non -Da
Beef Stocker
Beef Feeder
Beef Brood Cow
Myc
QD
.
❑ Yes B-Nu `❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []'No
[:]Yes d No
(�;�A ❑ NE
F_LNA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/1015 Continued
Type of Visit: O'7Routine
liance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: Q Complaint () Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Q L Arrival Time, Departure Time:Mmn County: C� h�_ Region
Farm Dame: ���ev —LV - Owner Entail:
Owner Name: v W f Phone:
Mailing Address:
Physical Address:
Facility Contact: tr k �CSCs Title: Phone:
Onsite Representative: (( Integrator: G —S
Certified Operator: JI j Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design. Current ,;;� �' Design=Cnrrenf° '3' Desig
urrSwinePop. ,�,e#PoultryCaaciPp
CattleCapaciPop.
La er
Non -Layer
Current q,
Layers
Non -La ers
Pullets
Turkeys � - -
Qtlter Turkey Pouits
Other Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at. ❑Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify D W R)
c. What is the estimated volume that reached waters of the State (gallons)?
d_ Does the discharge bypass the waste management system? ([f 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?
gill Dairy Caw
Dairy Calf
Dairy Heifer
D Cow
Non -Da
Beef Stocker
Beef Feeder
Beef Brood Cow
Myc
QD
.
❑ Yes B-Nu `❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []'No
[:]Yes d No
(�;�A ❑ NE
F_LNA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/1015 Continued
❑ Yes B-Nu `❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes []'No
[:]Yes d No
(�;�A ❑ NE
F_LNA ❑ NE
NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 2/4/1015 Continued
Page 1 of 3 2/4/1015 Continued

Facil' Number: rZ jDate of inspection: G
Waste Collection & Treatment
�. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[:]No
E3-N'X- ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a`
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑11ro
❑ 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
E30K6
❑ 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
Rio
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑<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
[ o
❑ 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?
I I. 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): CW U
13. Soil Type(s): V t
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes �o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Quo' ❑ 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 2'1�o ❑ NA ❑ NE
[:]Yes C�,l�o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [a Yes �o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2-1ffo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections El Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes �o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? r] Yes �o
�'1❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFaciy& Number: iv
I Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes []' Ilro ❑ NA ❑ NE
r �
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check El'N Yes D ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e_, discharge, freeboard problems, over -application)
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
EB o
❑ NA
❑ NE
❑ Yes
[f<o
❑ NA
❑ NE
❑ Yes Lal�o ❑ NA ❑ NE
❑ Yes I. o ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility9 if yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
Cali
b;11 dvyy (J n (.)e)tr . j oo
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[DOf�o ❑ NA ❑ NE
[B o ❑ NA ❑ NE
E5 ❑ NA ❑ NE
M No ❑ NA ❑ NE
Ce( Gtja-;
Phone: 3
Date: of Iva,
21412015

M�q -�_Ct �) ec_ I s a /)
Type of Visit: aCompflance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q-1koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: s� Region:
Farm Name: t c 4., f L Owner Email:
Owner Name: t ` `�j�'C�� Phone:
Mailing Address:
Physical Address:
Facility Contact: c aV4 ' Oh1j
le: Phone:
Onsite Representative: 1 Integrator: Vx 0 _
Certified Operator: i Certification Number: - 3Z
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Wean to Feeder
&Z
INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dairy Heifer
Design Current Dry Cow
D . P■o_ul C ci P._a Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
IPUIlets
Beef Brood Cow
Milli
Other -
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance than -made?
[:]Yes [DXo ❑ NA ❑ NE
❑ Yes ❑ No [ 19A ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
[a"RA
❑ 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
ErNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[]'Vo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ejo1Go
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: - Date of Inspection:
-Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2]..W ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes [—]No [alA ❑ Nl~
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ NA 0 NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [a'l*o 0 NA D 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 C3 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes ff 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 [31N"o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes [ff"No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [2'�o ❑ NA 0 NE
❑ Excessive Ponding 0 Hydraulic Overload ❑ Frozen Ground [j Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs. ❑ Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window E3 Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
G
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
C3 o
NA
❑ NE
❑ Yes
[jNo
NA
NE
❑ Yes
[2fNo
NA
❑ NE
Yes
dNo
❑ NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes ❑/ `No NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis 0 Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" 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 dNo
[]NA ❑NE
❑ Weather Code
❑ Sludge Survey
NA ❑ NE
�NA ❑NE
Page 2 of 3 21412014 Continued

lFacility Number. - Date of Inspection:
14. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ERIC
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ['J<o
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes [�<o
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Ergo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Name: 1
Reviewer/inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NNE
DNA ❑NE
❑ Yes E]'go ❑ NA ❑ NE
❑ Yes [2,-IQo ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [I --No ❑ NA ❑ NE
❑ Yes Ef r o
❑ Yes ❑r'1GIi
❑ Yes ETNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: t
Date: {, $ E)g
21412014

Type of Visit: (3).C6mpliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: ( koutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: cc Departure Time: County: Region
Farm Name: 1+ Q� l e of Owner Email:
Owner Name: Q ICAQ Lk.�4 Phone:
Mailing Address:
Physical Address:
Facility Contact: (,1/� �9'� Title: Phone:
Onsite Representative: �� Integrator: KE
Certified Operator: Certification Number: t 9 i4ef
Back-up Operator: Certification Number:
Location of Farm:
Latitude; Longitude:
Design gnrrent Design Cetrrent
Design Current
Swine Capacity Pop.. Poultry Capacity Pop.
tyPo
Cattle Capacip.
Wean
to Finish
to Feeder
Farrow to Wean
Boars
r'o 0
Farrow to Feeder
Farrow to Finish
Gilts
Discharges and Stream Impacts
I . is any discharge observed from any part of the operation? Yes P�go` ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field Other:
a. Was the conveyance man-made? [] Yes [] No [r]NA. ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R) Dyes ❑ No E51T^A ❑ 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) D Yes [:]No [�KA NE
2. Is there evidence of a past discharge from any part of the operation? Yes 0N0 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters Yes <o NA D NE
of the State other than from a discharge?
Page I of 3 21412014 Continued
Discharges and Stream Impacts
I . is any discharge observed from any part of the operation? Yes P�go` ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field Other:
a. Was the conveyance man-made? [] Yes [] No [r]NA. ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DW R) Dyes ❑ No E51T^A ❑ 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) D Yes [:]No [�KA NE
2. Is there evidence of a past discharge from any part of the operation? Yes 0N0 ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters Yes <o NA D NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

I�V�11
Facility Number: -tf Date of Inspection:
Waste Collection & Treatment
�. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �o ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No [ ❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ 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
[✓rNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[3"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
Er'No
❑ NA
❑ NE
maintenance or improvement?
1 I . Is there evidence of incorrect land application? If yes, check the appropriate box below. 0 Yes P ' o ❑ NA ❑ NE
❑ Excessive Ponding 0 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): r w
13. Soil Type(s): 14wt*-,, V t u
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[�JXo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E2,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�lo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;•No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
QKo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
f-4-o
❑ 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 l='1 o
❑ 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 Erl�o
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Q^No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

7
Farifi Number: - Date of Inspection:
24- Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L1J�"' o [:]NA E3 NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No 041C'A ❑ 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 [BNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [jNo ❑ NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately_
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i_e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E3 No ❑ NA ❑ NE
❑ Yes QI�o ❑ NA ❑ NE
❑ Yes [r]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes dlNo
❑ Yes Ild o
[—]Yes [
❑ NA Q NE
❑ NA ❑ NE
[DNA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. Use drawines of faciiiity to better eaalain situations (use additional Dates as necessarv). I
oc,-r
j�GLllr6J�tO'�l -- 1.4
Reviewer/Inspector Name: 111
Reviewer/Inspector Signature:
Page 3 of 3
�cT t3
Phone: 4 3 ofe
Date: l 2-Alp) 1
21412014

Type of Visit: GWomphance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Gatoeutine O Complaint O Follow-up O Referral O Emergency O Other 0 Denied Access
Date of Visit: rrival Time: Departure Time: l—I e.t7" I County:
Farm Name: t-0 4k P 4ye4l tj— Owner Email:
Owner Name:_ W 1tTt=t'."W _ Phone:
Mailing Address:
Physical Address:
c
Facility Contact: 1
k QL✓." Phone:
r
Onsite Representative: Integrator:
Certified Operator: V Certification Number:
Region:
Back-up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
e
Design
1.0
Curren'-_ Design Current .
Design Current
Swine 5, ;
Ca ace
Po Wet PoWt Ca, act Po h , s
� rY P i tJ P
Carrie Capacity Pop.
iU
Wean to Finish Layer
Dairy Cow
Wean to Feeder
�, Non -La er I
Dairy Calf
Feeder to Finish
Farrow to Wean
Design
Dairy Heifer
D Cow
,* �Curre
Farrow to Feeder
} �`' - +" «D yP,nulCa act iP6
Non -Dairy
Farrow to Finish
-; Layers
Beef Stocker
Gilts Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
F Turkeys
Other
a� Turkcy Poults,;
Other
Other
Dischart=_es and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [gXo ❑ NA ❑ NE
❑ Yes ❑ No
[:)Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [::]No ❑ NA ❑ NE
❑ Yes [11,?o` ❑ NA ❑ NE
❑ Yes "v' ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [!t7q_o_0 NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 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
[aTjg_❑ 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
UPW-❑ 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 environ tal threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
[�1 [_] NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[Z�� [DNA
❑ 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
Ej+ff - ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes-
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 1. J4,ro ❑ 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): C S
13. Soil Type(s): (so
14. Do the receiving crops difker from those designated in the CAWMP? [—]Yes [,4>o ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ &Ko ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes [�o ❑ 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 [9-i5 ❑ NA ❑ NE
❑ Yes E3<o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes To ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3,N-6 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �6•�' " NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [::]Yes o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: jDate of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ejb� NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes L0,3o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [-]Yes [ji'o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes ID'"" ❑ 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
�o
❑ 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
®.N-o
❑ 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
Cd..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
EaXo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[a -No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
4No
❑ NA
❑ NE
Reviewer/Inspector Name:
Reviewerllnspector Signature:
Page 3 of 3
Date: I„�f
21412011

i 'la'kk x'-�-
(Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1[� ack to Arrival Time: [�`-5� p.r� Departure Time: f j ; County: o7g perr,n
FarmName: �Owner Email:
Owner Name: ��C�{j ��o �� Phone:
Mailing Address:
Physical Address:
Region: F20
Facility Contact: kj�, �E CF Title. G wn€K Phone:
Onsite Representative: q Integrator: M W
Certified Operator: _ q�(] 1„]� ����(J _ Certification Number: �9 3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
'gn
Destc' C'pa en
g'CN
' gn
C� ent
Design Current
Capa _ty p
MF7� .
iVet Poult , 1
ry iy
p.
Cattle_ Capacity Pop.
Da' Cow
Wean to Finish La er
can to Feeder
Non -Layer
Da' Calf
Feeder to Finish Epp
i _
Da' Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
D , P,oul
La ers
Non -La ers
Pullets
Turkeys
Caaaei
PLo P.
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify-DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes C3 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes
❑ No
❑ Yes
E2"No
[:]Yes
E�(No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: `a, - L AA% jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[2rNo
❑ 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
[TNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[SrNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes
Eg,4o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E2'154o
❑ 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): �Qn . �.,31,�R ,.s �O�Av`S LjA
13. Soil Type(s): � 7 G R I R A
14. Do the receiving crops differ from those designated in the CAWMP? [—]Yes [QNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [—]Yes [2'-io ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EgAo ❑ 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 31f4o ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ENo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:V'Iqo
❑ 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
EIA4
❑ 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
[ lNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[ "N' A
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - LAI=A6 DInspection: 10jNqL17_
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E314o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [ To ❑ 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 [DINo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 52"NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Jallo ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
[]Yes (No ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
❑ Yes E]/N'o
❑ Yes [E No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/inspector Signature: Date:
Page 3 of 3 V 21412011

iype of vtsft: tgtc_ompltanee inspeetton U operation Review U btructure Evaluation U Iecttnical Assistance
Reason for Visit: '0 Routine Q Complaint 0 Follow-up O Referral 0 Emergency C) Other () Denied Access
Date of Visit: 191111/= Arrival Time: j , Departure Time: I a County:, Region:
Farm Name: �Vh `�7eu L,�,�PJfoek r Owner Email:
Owner Name: � [jQ tvhl�T]f� — Phone:
Mailing Address:
Physical Address: 1670 w11 I P-0L ► Aies,1(
Facility Contact: R iwh-1,111-ga_Title: a }✓/)*- Phone:
Onsite Representative:
�y�+ Integrator: H—B
Certified Operator: Rlp AA W hi 1 1t7Certification Number: 147913
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Uesign'" Current
Design
Current
Design Current
141
Swine Capacity .Pop:
U4'et^iultty
Capacity'
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -Laver
Dai Calf
Feeder to Finish
QQ
lit575-
Dairy Heifer
Farrow to Wean
Design
Cfirrent
Dry Cow
Farrow to Feeder
D . ` Ppultry
Ca aci
#Io
Non-Dai
Farrow to Finish
La crs
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
I
113cef Brood Cow
- x
Turkeys
Other
TurkcX Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other_
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [S No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[] Yes
CR No
❑ NA
❑ NE
❑ Yes
C"No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili ' Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
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
allo
[DNA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
8] Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
t'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
CR-No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes RNo ❑ 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): !`A . )VVhezi Solb&d( j {}
13. Soil Type(s): C�Qi
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
R—No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
"Yes
❑ No
❑ NA
❑ NE
16. Did the facility tail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
IT Does the facility lack adequate acreage for land application?
❑ Yes
0 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
CRNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
K3'No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
RNo
❑ 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
U No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
0 No
$2 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 CR No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fRNo ❑ 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 N-NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes
� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility tail to notify the Regional Office of emergency situations as required by the
❑ Yes
C'No
❑ NA
E] 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
tR No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
[2 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
El NE
7. Pk0-(k o,, cc�w sea C b�-er� on 0 lajaon. 660Jab rn41*?9
l6s P�e I�m� U ��f �71a`j� n�eG� t
Not hi ucli rla�%
Yra� c�dr�-� l:rs um U-e-`� e��e wP , �� h �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
T019n schnpi+
n
Phone: Q 33 3
Date:
21412011

• Facility No. Farm Name Ivh+fi��� f Date
III —
Permit COC OIC� NPDES (Rainbreaker PLAT Annual Cert)
Pop.
Type
Design
Current
FB
Drops
Lagoon
1
2
3
4
5
6
7
Spillway—
tv f
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft-3,
Ratio Sludge to Treatment Volume
1r102MI"A
ikctual
Soil Test Date S41 �C��lp Wettable Acres --' RAIN GAUGE
pH Fields p �^ WUP v Dead box or incinerator
Lime Needed (} ` , fNk Weekly Freeboard ✓ Mortality Records
Lime Applie / 1 in Inspections
Cu-I Zn-I L 120 min Insp.
Needs P 0-a Weather Codes
Cron Yield Transfer Sheets
EmsNAmtjj
-
r 1 1 1
•��--���[Y��
•
i ��IliLJ
�r 1�
l
-?0 J
Pull/Field
Soil
Crop
Acres
11f, PAN
Window
Max Rate
Max Amt
w
.
�
a
� r�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
App. Hardware

OF
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Ot Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I Arrivall Tiim�eJ:, Departure Time: County: --' hH Region: �^V
Farm Name: fiPl� �1dQf I plc-+L }, - Owner Email:
Owner Name: ryh�d Phone:
Mailing Address:
Physical Address:
,,,, ee L�;�-� n�rreA �•'V
Facility Contact: _�I��LI L �h±_-if Title:
Onsite Representative: --LL 1 , ( 1�►tGIJ .�y�
Certified Operator: R! V1 T i MP14
Back-up Operator:
"[ 'V
.Uv3 i3l►a ° Phone No(2 Lo �A �—
Integrator• I I—B
Operator Certification Number: 103 _
Back-up Certification Number:
Location of Farm: Latitude: [� 0 0 A r-7 il Longitude: 00 = 6 =
dl
Design Current
Swine Capacity Popul
Design Current Design Current
Wet Poultry Capacity P.opuiation Cattle Capacity Population
❑
Wean to Finish
❑ La er
❑Non -La er
❑ Dairy Cow
❑
Wean to Feeder
❑ Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Poultry . ❑ Dry Cow
❑ Non -Dairy
❑
El Beef Stocker
❑Non -La ers
El Beef Feeder
❑
Farrow to Wean
❑
Farrow to Feeder
El
Farrow Farrow to Finish
❑
Gilts
❑ Pullets
ues
❑ Turkeys
❑ Beef Brood Co
❑
Boars
_
Other
❑ Other
❑ Turkey Points
❑Other
lumber of Structures:
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes
5JNo
❑ 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
CR: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 1 of 3
12178104
Continued

•' Facility Number_ $a— �U1� Date of Inspection L.l� ,lLL1J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
❑ Yes [JNo ❑ NA ❑ NE
❑ Yes ❑ 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 CSkNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [5kNo ❑ 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 rS'No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
UNo
❑ 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
RNo
❑ NA ❑ NE
maintenance/improvement?
11 _ Is there evidence of incorrect application? If yes, check the appropriate box below. ayes
❑ 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. Croptype(s) CDrn . Wbf SGVbff s
13. Soil type(s) 61143 bonD i
;� C '1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
UNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
QR No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
allo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
[RNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
5J-No
❑ NA ❑ NE
Comments (refer to question ##): Exptain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
•
608
3 fIry
Reviewer/inspector Name ► , s 6 , Phone �(} —
Reviewerllnspector Signature: Date: G S
Page 2 of 3 v 12128104 Connnuea

I
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes C*No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C5VNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
tR No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
jj_jNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
allo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
allo.
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
N 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
Pallo
❑ 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
5Tio
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
RNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative'?
❑ Yes
CTNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E'No
❑ NA
❑ NE
g�"
Additional ComiEnents and/or Drawn s• .71
AL
y� VlA%t che.
o� Se I -�►, �s �a �s i n -f�e�-Pv-�ir i I
e- av ma be.ab7e o
r spa) f'rcn, cry a rariom itJji Jy 7
9
was. 41e rr" `G calr'b ad,-ssl ,Ewve &he b ►�
�' s �9p Py�k not- back yef,.
Page 3 of 3 12128104

r Facility No. t;-A y L Farm Name _ N� L� _ - Date 1 t0 (S 10
Permit COC OIC� NPDES (Rainbreaker PLAT Annual Cert )
FB
140 Drops
[Ar
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
j
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
zj-j
O f,ti 3 r -it: :, 'k I , .[fjtn P, .w nT_-i- — 1 I . I IC4- 7 t� 4-�14-
Calibration b2te
Design Flow
Design 11WActual
+-------
Width
Soil Test Date �D 01 r
pH Fields
Lime Needed
Lime Applied
Cu-I ✓Zn-I ✓
Needs P vo
Wettable Acres
WUP j
Weekly Freeboard
1 in Inspections
120 min Insp.
1 Weather Codes L.
RAIN GAUGE
Dead box or incinerator
Mortality Records
.t r_
�r�
•
IS.
..•
1
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike J),0
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lb/ac; Zn-I 3000= 213 Ib/ac
19 f/
App. Hardware

l/ 13,Z;qS //-23-- Zao 9
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: //-/7~ O 9�± Arrival Time: %O.'[X�s},� Departure Time: County: S"� `a�1/ Region: ltfAEO
Farm Name: 'W4*` e- 14 i Ve.57405A Zt J— Owner Email:
Owner Name: W41144-1ll Phone:
Mailing Address:
Physical Address:
Facility Contact: ROIS-11avel (✓A' 7Ly/'c�I�d Title: i9w"� Phone No:
Onsite Representative: RIG 4 a Y� �i✓k i t f + c. (d Integrator: Mu 2 4�j - &YU "J N
Certified Operator: 91e-Aao d [.✓`iris d Operator Certification Number: P7993
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: E__1 o = t = Longitude: = o = 1
Design Current
Wign Mrrent
Design
C•nrrent
Swine Capacity Population
Wet Poultn�y Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
I
Dairy Calf
Feeder to Finish 00
Dry Poultry
Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
I
❑ Farrow to Feeder
El Layers
❑ Non -Dairy
El Beef Stocker
❑ Farrow to Finish
❑ Gilts
Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Turkeys
❑ Beef Brood Co
Othe
irkey Poults
❑ Other
Number of S#ruetures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ONo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
ETNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
OINA
❑ 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
ErNA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ONo
❑ NA
❑ NE
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
ETNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

d •a
Facility Number: 82 — 2110 1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): s
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
2<o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
B 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
El Yes
,.,
a<0
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
El,
r7 No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElLJ Yes
,,�
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs El 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) 6 hn/ — W L11 -1- — Sa 7 b'4 n1
13.
Soil type(s) 9 a G o A
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[I NA
❑ NE
15_
Does the receiving crop and/or land application site need improvement?
El Yes
�El"NNo
NNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
L' No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
2<o
[INA
[INE
18.
Is there a lack of properly operating waste application equipment?
ElYes
BNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers -and/or any recommendations or any other comments.
Use dtytro better explain: situations (use ational pages as necessary):
Co+'nr U-L -f-o L is s-K o ,.r Date- S�oTd s q r-oe,A, /� foom A,�
Ra.',.r .,,, "4s b-,,— d'G4� Zcu Ir-v dh S�fs �. �% t Suomi
eLn_r i+_{e:.d cZ t.stir; -� f t+.r rrcfo'
6a acy Oc'LV-,/ G-ocd r�_-_C.e rd s
i
Reviewer/Inspector Name Re s; 4 � Phone: 910. �--3 3.3300
Reviewer/Inspector Signature: Date: (1-17— Z40
12128104 Continued

Facility Number: 82 — lam$ Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes IJ'No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes C] 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 LJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ErN.
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E NNo
[I NA
El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L7No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
MIN o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
ET'No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ETNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes E3,<o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Bl10
❑ 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?
El Yes
�/
ETNo
❑ 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
0 No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ETONo
❑ NA ❑ NE
12128104

Type of Visit CnZu"tine
nce Inspection Q Operation Review ()Structure Evaluation O Technical Assistance
Reason for Visit �_A0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: �� ' Ob Departure Time: ; County: Regior
Farm Name: ��( i ✓ r 4� #� Owner Email:
Owner Name:
Phone:
�► G�lnirrf
Mailing Address:
Physical Address:
Facility Contact: dr Title:
Phone No:
Onsite Representative: f Integrator: ✓
Certified Operator: 9zle4nd Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: =1 o Longitude: = o = ,
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population C1
❑ Wean to Finish
❑ Wean to Feeder
�eeder to Finish OCR
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkev 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?
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker'
Beef Feeder
Beef Brood Co
Number of Structures: s'z.
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 RNo ❑ NA ❑ NE
El Yes
El No
❑NA
El NE
❑Yes
❑No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[3,No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
Page I of 3 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 ONo [DNA ❑ 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): / 2
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
A 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? KYes
❑ 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
® No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application'? If yes, check the appropriate box below. ❑ Yes
.I No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) ` .
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
® No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
®No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
& No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
S t4_3 +
Reviewer/inspector Name 1Z��i Phone: S 7c;,
Reviewer/Inspector Signature: Date-
5 C < t1i *r�w vt a.wssar+sscw

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes %No ❑ NA ❑ Nt-
20. Does the facility fail to have all components of the CAWMP readily available? 1f yes, check ❑ Yes ® No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, cheek the appropriate box below. faYes ❑ No ❑ NA ❑ NE
JEJ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis O Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes JRNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes @ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25. Did the facility fait to conduct a sludge survey as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
2& Did the facility fail to have an actively certified operator in charge?
❑ Yes
HNo
❑ 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
[B No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
® No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
® No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
JO Yes
❑ No
❑ NA
❑ NE
Additional.'Comments aii&/,or Drawings:
du��
lJ
Page 3 of 3 12,,28/04

FacilitvNumber Duie(if Visit- 3 a`f a Time:
ro Not Onerational—_0 Below Threshold
ermined Certified ❑ Conditionally Certified ❑ Registered Date Last OperaV or Above Threshold:
(� 1SOM
Farm Name: wh! T'*i t rd 1' iv=y{-a e_/1C � County:
Owner Name: �"� �+A t / Phone No: 914 - 93 — _ g; a
Mailing address: _� 7� �Cnes I'� � • /vGw `�*1- /'s rr OY344
Facility Contact- 64"'J W4li1` f-I j Title: Vw�'e Plyone?`o-
�{
Onsite Representative: ^15�f��d ul��1 i,t �d _ Integrator: _
Certified Operator: �U'd fN�.+'1 t' C r� Operator Certification Number: /%8 3
Location of Farm:
wine ❑ Poultry ❑ Cattie ❑ Horse Latitude Longitude �� �• �"
Design Current Design Current Design Current
Swine Ca acitV Population Poultry Ca acitV Population Cattle Capacity Population
to Feeder ❑ Laver PO
Dairy
ceder to Finish 2oa ❑ Nan -Laver Non -Dairy
❑ Farrow to wean
Farrow to Feeder ❑ Other
Farrow to Finish Total Design Capacity Ja'0v
❑ Gilts
❑ goy Total SSLW
Number of Lagoons I! Subsurface Drains Present
Holding Ponds / Solid Traps Q 10 No Liquid Waste Management
Discharges & Stream lmoactc
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lasmon ❑ Sway Field ❑ Other
a. If discharge is observed.; was the conveyance man-made?
b. If discharge is observed, did it reach Rater of the State? (If ties. notify D WQ)
c. If discharge is observed, what is the estimated flow in eaUtnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Wasit ColltEtion R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ SDillwaY
Structure 1 Structure 2 Structure 3 Structure 4 Structure
Identifier:
�lvo
❑Yes
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ Yes
❑ No
❑ Yes
U-No—
Structure 6
Freeboard (incbes):
05103101 Continued

Facility Number; a — Date of Inspection 3 o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(It any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type L kAeqx`
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14, a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
)(squired Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists. design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes Q_Vo
❑ Yes [9416
❑ Yes
M111-
El Yes No
❑ Yesr
❑ Yes L`i No
❑ Yes No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes t_1 No
❑ Yes 01<0-
❑ Yes L N__Oo
❑ Yes [moo
❑ Yes 040
❑ Yes ,QX'o
❑ Yes L N
❑ Yes L! No
❑ Yes No
0 No violations or deficiencies were noted [curing this visit. You will receive no further correspondence about this visit.
CommeNt (re[er to�question #i)Explatn any YES answers and/or -any recommen'iiations or any..oth ,coinff s
w n Ica .
Use'drawtugs of fac". y, to;betterlexpli" situations: (use addthonal pages hs necessary) Freld Copy . ❑Final Notes
���..� _ .._ .. :_ Ate .� . e,x.0 ;� •- - -*- _-�: �
Reviewer/]nspector Name
Reviewer/inspector Signature: AU Z Date: A'
05103101 Continued

Facility Number: ,'L — 944 Date of inspection �o
Odor Lss=
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28, is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon?
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
t�NQ
❑ Yes
❑ Yes
�'Fo
❑ Yes M1Vo
❑ Yes
B'Na
❑ Yes
Now
❑ Yes
,E
Lea
0510 101

U
Type of VisitCompliance Inspection 0Operation Review 0 Lagoon Evaluation I
Reason for Visit ,Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facilit- Dumber Date of Visit:
Permitted to Certified [3 Conditionally Certified 13 Registered
Farm Name: �� BSc 1. �c�_ *[ _
Owner Name: a Slr �n^� Lj} ,, -L" d'4
Mailing Address:
i 1I Oa Time: I [ : 3d
rO Not Operational 0 Below Thresholdi
Date Last Operated or Above Threshold:
County: srn!
Phone No:
Facility Contact: K �C_L,r �'-� ``��c�C Title: Phone No:
Onsite Representative:•t Y 4*Ll Integrator: M c t�w
Certified Operator: Operator Certification Number: iq1?lr _
Location of Farm:
Swine ❑ Poultry ❑ Cattle [:]Horse Latitude ' " Longitude 0 �• ��'=
`Design' Current
:aKrue
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑Farrowto
❑ Gilts
❑ Boars
T : Design Current Desxprt -. Current
1'outtrvCapaciltv Population.,:Cattle -" Ca achy-.:PopnEation
❑ Laver ❑ Dairy I[0 Non -Laver Non -Laver "_ ❑ Non -Dairy
❑ Other -
Total Desire Capacrt;
i'0tal $SIL
Nuitnber of Lagoons ❑ Subsurface Drains Present ❑ La oon Area ❑ Spray Fie 1d Area
Hoidixig Ponds I Solid Traps ❑ No Lit�uid Waste Management System
Discharces & Str. earn Impacts
l . is any discharge observed from any part of the operation? El Yes INO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -trade? ❑ Yes ❑ No
b_ If discharge is observed, did it reach Water of the State? (if yes. notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated dozy in galimin?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ) ❑ Yes Cl No
2. is there evidence of past discharge from any pan of the operation? ❑ Yes lNo
3, Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & JEeatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Ye No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): 4t3
05103101 Continued

Facility Number: g - Ug
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffets that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type i�ieccJlS . LONle d-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
B ouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WliP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard. waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow --up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes %No
❑ Yes 0 No
❑ Yes Of No
❑ Yes No
❑ Yes No
❑ Yes 10 No
❑ Yes It No
❑ Yes CgNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes *o
❑ Yes tA No
❑ Yes OfNo
❑ Yes
M Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
[� No
❑ No
No
No
M No
[P No
No
No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
ments;(refer tolgnest%un #)=Explaut any 1t'ES'srtswevs and/or atiy resom><stcndait�ons ur apv"atiter commt#s.-42
Use drawings of fa¢t�tty'ta bctEer, exp3atu situations. (ase addtzioniil pages as necessary)
-:� _-
❑Field Conv ❑Final Notes17
ReSwe- -�o liSe e zti:ns rna11 -is W�"n.
CJCaAA'11y _Xrr
�m.Lisreet
Irg,
�3
Reviewer/luspector Name �ctt�L . -° s-
Reviewer/Inspector Signature:
Date: Q
O5103101 Continued

W
Facility Number-. 7
a -qW1
Date of Inspectinn
-QAo--r Issuer
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storaec bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
El Yes ❑ No
0 Yes do
EI Yes No
[I Yes Ig No
AJ
El Yes LM No
❑ Yes INO
❑ Yes [I No
Additional Comments and/or Drawings:
05103101
05103101

Type of Visit • Compliance Inspection O Operation Review Q Lagoon Evaluation
Reason for Visit tB Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number FjZ Date or visit: /O Y o/ Time:��
Q Not O erational 0 Below Threshold
(� Permitted ®Certified [3 Conditionally certified-yRe�gistered Date Last Operated or Above Threshold:
Farm Name: .... � ��,� �5! !✓€./� � . ` .. „. ...... ... County:.... 5-09
Owner Name: ...... ...1�%�� ... !. ..... _..�.. ._ Phone No:.._r .. �_ ._. .. ... ......._.
Facility Contact: ..... Phone No:
Mailing Address:...... 7D.. / ,�•�-/....rrS�!)
Oiisite Representative: ....... l.eC....Gt/!�`t7d Integrator,•
Certified Operator:.......... G�sc . ....... 01/�� _ __ Operator Certification Number:.....,.............
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & 66 Longitude • �' �44
Desiga..; Cam
Swrne Ca ci :`:Pa nla
to Feeder
PWean
Feeder to Finish
zo•�
2�
❑ Farrow to Wean
❑ Farrow to Feeder
:''.;
❑ Farrow to Finish
❑ Gilts
El Boars
Niirnbe�.of Lagoons `;�
Holdu>tg Po'n& Solid Traps _
C
t .. Current .:, , -Design-.. Current ;
,
on• ,.: > >r9.. :Ca aia .; Po nlstion Catde Ca acit '._Po-- ltitwi,'°
❑ Layer 10 Dairy
7 ❑ Non -Layer ❑ Non -Dairy
❑ Other
Total`Msign Capacity
Total SSL-W- -
Subsurface Drains Present JP3 Lagoon Area . ❑ Spray Fidel Ares
�..
No Liquid Waste Management System r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes 9No
3
❑ Yes KNo
❑ Yes UNo
❑ Yes M No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ,M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;R�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: .............. Zf ,�................ ..........,........................................ ......... .................................... .................................... ....................................
Freeboard (inches):
5/00 Confinued on back

Facility Number: — f/ Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
JNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
Mo
(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
JUNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
RNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
KIo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
Kyes
wo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
CRNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
X. No
b) Does the facility need a wettable acre determination?
❑ Yes
KNo
c) This facility is pended for a wettable acre determination?
❑ Yes
Flo
15. Does the receiving crop need improvement?
❑ Yes
KNo
16. Is there a lack of adequate waste application equipment?
❑Yes
�No
Required Records & Documents
17. Pail to have Certificate of Coverage & General Permit readily available?
❑ Yes
10 No
I8. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑ Yes
RNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
E�J-No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[RNo
22. Pail to notify regional DWQ of emergency situations as required by General Permit?
Oc/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
E9 No
24. Does facility require a follow-up visit by same agency?
❑ Yes
[[ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
MtNo
ski viola iQris:or defeiencies were oofe# d�ing tbis:visit; • Yoo w3l-te-ceiye 0o fug titer : .
rot -respondence. about this visit~ ...:.. . ......................................: -
im nts (refer to _qum _go #) EupL-uio any YFS atvswers apd/o
�kdrawt+ngs of faedUty.tv_'6etter_expIAjfi Aftiations. (use additiobu
Reviewer/Inspector Name -,
Reviewer/Inspector Signature: Date: l� D/ _ 5100

! �
Facility Number: Date of Inspection O D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes JR[No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 15No
- a
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes C&No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes [§ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? EDYes ❑ No
ho _.-.:flmmegts,an or rawtngs•
J
5100

W. :--.,-..
x _ Ja Division of Soil and Waier'Conservahon='O'
Divisioiicof Soil aril Water'Conservafibm- Compliance Inspection
- Division of.NVater-.Quality _- Compliance Inspection x t
E Other _Agency - Qperation Review
14D Routine Q Complaint Q Follow-ue of DWQ inspection Q Follow-up of DSWC review Q Other
LFacility Number Date. of Inspection 1! TZa+o
_ Time of Inspection L 2 ; a a 24 hr. (hh:mm)
© Permitted ❑ Certified © Conditionally Certified [3 Registered JE3 Not O erational Date Last Operated:
Farm dame:
Owner Name:..................1`r.- �•.........G✓:.ls_.1............-.-......................--..---
Facility Contact: . lch�.t� � / itle
hailing Address: A<7D .• /�Aw*..1r•�
............................... ............
Onsite Representative: AGC.A! ,
Certified Operator: .a.; .. h/�'�"•E!I' ..............
......... ....................................................................
Location of Farm:
—C;uucity:........ f� .fir` ........... ........... .... I ...... .... ........
Phone No:.pl� �p� %�.r�..
................................ _.......... .....................
................................... Phone No:...................................................
A.�,.,.G.,. vc...21F��.............
Integrator:. •,�
...................................................
Operator Certification Number:
................................................................................................................................................... .............................................................................................................
........................
Latitude �` �� Longitude
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
Zp
/Z00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I❑ Dairy
❑ Non -Layer I❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area JEI Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System _
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ElSpray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
h. I I' discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in imlhnin?
d. Dees discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes JR No
❑ Yes JR No
❑ Yes ,3 No
❑ Yes M No
❑ Yes MNo
[]Yes No
❑ Yes JoNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ........................ .......................... ......... ................................. .................. ............ ........ .................................... .............................
I/6/99 Continued on back

I
Facility Number: 8L Date of Inspection _ Printers on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ® No
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes KNo
❑ Yes ,Ej No
❑ Yes gj No
❑ Yes )j No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes �R No
12, Crap type Sa ,t ,
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes j$No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PEtNo
b) Does the facility need a wettable acre determination? ❑ Yes {ANo
c) This facility is pended for a wettable acre determination? ❑ Yes 0 No
15. Does the receiving crop need improvement? ❑ Yes IVNo
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available`!
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WU�, checklis s, design, maps, etc.)
19. Does record keeping need improvement? (icl irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/discharge• freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
:: �Vci yiolafigris.0 dgficienc;ies wire ngted iiuririg this visit: Yoi� will tre4eiye e�rther
rorres�o deixe. about. this visit.. • . . . . . . . . . . . . . . . . . . . . . . . . . .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
f�— ha..< 906'r"I axf -�- REcae C6-
❑ Yes ® No
❑ Yes ,l No
❑ Yes WNo
❑ Yes�10
❑ Yes MNo
❑ Yes A No
❑ Yes ❑ No
❑ Yes No
❑ Yes ® No
❑ Yes ® No
A,
ReviewerAnspector Name
Reviewer/Inspector Signature: 'Oy �Date: ///%1z-:2-:1d 5l00

Facility Number: Z — ,j/
Date of Imspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
�J Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
"
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
WNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
Q No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
A No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
9 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
&Yes
❑ No
J

A . -
DSVVC Animal: Feedlot Operation�Re e
ip > �, k '
rx3 DWQ Animal Feedlot Operation Site Inspection
,z
.' ..,r,v `tea, { �.: �, �s�� � ,..i c'� .:s.-.'�',i�. �`%k �i s � u��r��s.; `�ae,.,,Cai�,, . "F:+a. �3r_. .:'fir e.'� 5`�, „� >•.,
Routine O Comnlaint O Follow-un of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours �
Farm Status: ❑ Registered ❑ Applied for Permit (ex:I.25 for I hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection jincludes travel and processing)
❑l Not Operational Date Last Operated: .... ._.... .... . ..... - .... ... .. _ ..._....._ __ r _. .� ....
Farm Name: 11.At. _,�L.E 1 .. _ .� ... -- County: S!4�!,,�-4! .�.......... _....
Land Owner Name:..�!.���. ��!�"Ii �i�. ,_. � .. Phone No: 3_9 131., 7-....._..-
Facility Conctact:.......... ....._ ......_..... ��..// Title: ......... ................. .......... _......
— Phone
+ No:....__'Se!r'�
Mailing Address: JcE..-N C.�
-/ dr/C....0
Onsite Representative Integrator: A J. .._ .. r.. �.... _.... .
Certified Operator:
Location of Farm:,
II
Operator Certification dumber:
Latitude • 4 u Longitude • L�4 0
Type of Operation and Design Capacity
4,
. Desi n CurrentI)est h; Current Gutireut
x-Ca age Pd 1llatr6n,? Poultry, . Ica.. acity Po` Ulat�anCattte C©gam `£
>s Po ulatioW.w"
Wean to Feeder La er `: ❑ Dairy
;SEeeder to Finish 12..00 Non -La er ❑ Non -Dairy I
Y
Farrow t0 Wean fi
Farrow to Feeder p 41,
ta1�D s gn Capacity
nlln Farrow to Finish
Other ' �
Number of L. Dons /Holden Ponds ❑Subsurface Drains Present __..
#x A; ga
v w�a, �,$'� ,�. xRs: -`i4 v,, -,ter,,
Lagoon Area Spray Field Area
General
I . Are there any buffers that need maintenance/improvement?
2., Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d- Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenancelimprovement?
❑ Yes ANO
❑ Yes �No
❑ Yes *o
❑ Yes Q�No
❑ Yes Wo
❑ Yes �No
❑ Yes A No
❑ Yes XNo
Continued on back

a
Facility Number .. _ —4041..
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes E(No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lavoons and/or Holding Ponds,
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Str7ucture 1 Structure 2 Structure 3 Structure 4 Structure 5
/ _.. — Z l ..
10. Is seepage observed from any of the structures?
I I . is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
Of in excess of WMP, or runoffentering waters of the State, notify DWQ)
15. Crop type . CQr�_ [. k 0 �, B Eta- w S.._._.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
I"or_Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes No
❑ Yes No
❑ Yes KNo
Structure 6
❑ Yes *WO
No❑ Yes
❑ Yes P(No
❑ Yes WNO
❑ Yes gNo
❑ Yes A o
❑ Yes �o
❑ Yes
❑ Yesj No
❑ Yes o
❑ Yes No
❑ Yes ' I a�o
❑ Yes KNo
❑ Yes 05�No
Corrtments,(refer to question Explain any YES ins wers'and/or'any ,recommendations or any other cdmments.
Use drawings of facility to. better explain situat�ans'.(use::ailditt6nal pages as necessary): y =
�..
_ .c..
Mr. W k"'has wor&4 ' w)fk N12C,5 � e�-`f7�is--�r►y+ c'erf i�� Q�Sa• Q
3
Reviewer/Inspector Name
Reviewer/Inspector Signature:
cc. Division of Water Quality, tVXter Quality Section, Facility Assessment Unit 4/30/97

I0
Type of Visit EY-C ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ( Arrival Time: Departure Time: County:
Farm Name: U ` ✓l e_ Owner Email:
Owner Name! 1 4 14A;-1—A Pi`2_ �- Phnnw
Mailing Address:
Physical Address: ,',, -r
Facility Contact: � i A&,1J Vj � rI Title:
Onsite Representative: !28M de
Certified Operator: 5 atdcg
Back-up Operator:
Region:
Phone No:
Integrator: filuedL
Operator Certificati /nNumber:
g3
Back-up Certification Number:
Location of Farm: Latitude: = U = , = u Longitude: = o = 4 = i1
Swine
❑ Wean to Finish
❑ Wean to Feeder
Design Current Design
Ca aci Po u!a o`n Wet Poultry Capacity
P ty -9P �
❑ Layer
{ ❑ Non -Layer
Current - Design Current
Population° Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
Feeder to Finish
Oz) /
Dairy heifer
❑ Farrow to Wean
+ Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
AF
❑ Layers
❑ Non -Dairy
❑ Farrow to FinishEl
Non-L a
❑Beef Stocker
ElGilts
ers
a
x ❑ Beef Feeder
El Boars
Elp Pullets
❑ Beef Brood Cow
Other:
❑ Turkeys
ti ; ❑Turke Poults
«_
❑ Other
r
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[4 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
CZ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
§4 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
J� No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
24 No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
W No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
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
[9 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ZI No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): C 17
Observed Freeboard (in): 3 G>
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[4 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
4 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
� No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E4 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
W No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
D.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, le arrt I AIgI A71
13. Soil type(s) g
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
MNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
a No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
IN No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
;9 No
❑ NA
❑ NE
Comments (refer to,question #): Explain any YES answers and/or'aay recommendations or any other comments. '.
Use drawings of facility, to better explain situations. (use additional pages as necessary):
o?/ xSw NY,&) 4DPI-4 b;,n'.1
se , —79 VP K a e e U_6 e ) 7- 13 Not
Reviewer/Inspector NamePhone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection f D
Y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2!�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. -Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rain Inspections I, Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
29 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5&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
[9No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27_ Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C9 No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
9 No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® 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
[9No
❑ 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
UQ No
El 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
A No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
® No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

—;
© Division of Soil and Water Conservation - Operation Review
Division of Soil and Water Conservation; = Compliance l:nspection
Division of Water Quality -Compliance Inspection
Other Agency - Operation,Review .�`
Routine Q Complaint O Follow-up of DIV2 inspection O Follow-up of DS«'C review Q Other �
r Faci143- Number � Date of inspection -
k _ -- -- - - -- Time of Inspection FZ=?A hr. (hh:mm)
n PermittedACertiffed E3 Conditionally Certified Q Registered 0 Not Operational Date Last Operated:
'�
Farm Name: ...��t��� ��...L,�.r��.�t~r.�.�`.�. County .............._............
/� �J Tr
Owner ;rame:...,gi[�d......4,lk,' ..t..e Phone N©: ��f
....................:.".....�...........
Facility Contact: w e I
f y, .................._ Title. �% /� Phone No ���-
Mailing Address: .... J1.70...... .� N .......!!1lFC ��..... G!.t......................./..V...�' ..... hO c° ...-/�-........�Z�36�......
Onsite Representative: t= Lr+-}ft-�i.....
........................... I ..................... ......... Integrasior................�..................................................
.................
Certified Operatom..'eukA f-i ,%...............W0cie..1 Q Operator Certification Number
Location of Farm:
♦I
------ ................. ................................................ ...... ...........I.- ..
Latitude Longitude
Design Current
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Dion -Dairy
Total Design Capacity
Total SSLW
i
Number of Lagoons 10 Subsurface Drains Present ❑Lagoon Area I0 Spray Field Area
Holding Ponds / Solid Traps C� ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes allo
h- If discharge is observed, did it reach Water of the State'? (if yes, notify DWQ) ❑ Yes �No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does dischargc bypass a lagoon system? (If ves, notify DWQ) ❑ Yes ONO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 311.,."...
Freeboard(inches):.............................................I......................................................... ..........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
3I23/99 seepage, etc.) Continued on back

Facility Number: 92— Dale of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures tack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding [IPAN
12. Crop type r 'eO
13. Do the receiving crops diffe with those designat d in the (,erli
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
►ram
❑ Yes Q No
❑ Yes PNo
❑ Yes KNo
❑ Yes #NO
❑ Yes 0 No
❑ Yes Wo
tied Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
❑ Yes
KNo
❑ Yes
eNo
❑ Yes
VNo
- -- — ❑Yes
[ No
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
-18. Does the facility fail to have all components of the Certified Animal Waste Management PIan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Rio "O. 1406ris o:r- rickni-_ a -"'re rtotec1 dt#ritrtg ihis.visjjt; rlxifte
. . correspondence. about. this .visit. ... . .
❑ Yes EkNo
❑ Yes No
❑ Yes No
[]Yes JKNo
❑ Yes allo
❑ Yes ONo
❑ Yes No
❑ Yes No
❑ Yes fig -No -
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other coriiments:
Use drawings fof facility to better explain situations. (use additional pages as necessary): - - • - _
/ a', /d'a/[S ���dO� ¢ ioelflea i'v� iN e�, A.
Ott+— C'0,90d c "7D
Retiiewer/Inspector Name hT SA4
Reviewer/Inspector Signature; J�ir'A.,,, Date:
3123/99

Division of Soil and Water Conservation ❑ Other Agency
.� Division of Water Quality
.. = .
_ -�--�--...�,-.-••,ram �,.���""..._M
10 Routine 0 Complaint O Follow-up of DWO inspection O Follow-up (if DSWC review O Other
Facility Number Date of Inspection
Time of Inspection ' O 24 hr. (hhartm)
13 Registered O Certified 13 Applied for Permit © Permitted 113 Not Operational I Date Last Operated:
Farm Name: ..... ,��T/j�.F.� ..f-.!r! ..... E/......... County:.... ..5r.1:- JA................... ............. I .........
Owner Name: ........ ..
............... ui- .....I�`x'.f `a .......................................... Phone No:... t ... ..`..�..2..! ............,
FacilityContact: .......... ............. Title :................................. ............................... Phone No: .................................. ..................
Mailing Address:......%f,70.....F.....Gi!/FE, ..... .. i ✓ .. G...... 6 ..................
Onsite Representative: 4� �'� lIJ�F/�... .. Integrator:.._.r_w,'y 9. .�st!4-1--f..........__
Certified Operator. ..... .,,r ...... ...... .................. Operator Certification Number.... �.� ...--•-•------ ----
Location of Farm:
..................................................................... ......
Latitude • 1 Gf Longitude ' 46
0
❑ Wean to Feeder
Feeder to Finish
12O-C)
12-00
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑Gilts
Boars
ifi,��,ECurrent n
ty`'yI'opulaiion
,, r
Design; Current: �.. '.Desig
d Ca acit �Po ulafion Cattle
P � Y PCppac
`❑ Non -Layers -L J❑ Non -Dairy]
. ❑Other . � �, � ,, •+ ,� � �'
TotaI Design Capacity-
. --
a
' 'Total SSLR' "
;-
❑ Subsurface Drains Present 110 Lagoon Area P Spray Field Area
TO No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
JKNo
2. Is any discharge observed from any part of the operation?
❑ Yes
PENo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
�KNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
tKNo
c. If discharge is observed, what is the estimated floc~• in gal/min?
d. Does discharge bypass a lagoon system'? (if yes, notifv DWQ)
❑ Yes
KNo
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
KNo
4. Were there any adverse impacts to the waters of the State other than from a discharge"?
❑ Yes
XNO
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
M-No
mai ntenance/impro ve me n O
G. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
XN 0
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
)U'No
7/25/97

Facility Number:�1I tog
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsXolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier
Freeboard (ft): Z y
........... y ��
....................................... .. I.............
10. Is seepage observed from any of the structures?
❑ Yes O No
❑ Yes FXLNo
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
........................................................................
❑ Yes KNo
❑ Yes R No
12. Do any of the structures need maintenance/improvement?
M-Yes'
❑ No
([f any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
O�No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
JRrNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .,Ss.d.-Cs�'...........................................................................................................................................
16. Do the receiving cro/ps differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
MNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
%No
18. Does the receiving crop need improvement?
❑ Yes
P[No
19. Is there a lack of available waste application equipment?
❑ Yes
V3 No
20. Does facility require a follow-up visit by same agency?
❑ Yes
[&No
21. - Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
WO
22. Does record keeping need improvement?
❑ Yes
IQNo
For Certified or. Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
PjrNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
1KNo
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
KNo
0-No.violitionsor. ddkieneies-were noted, during this:visit:: You:W'iU receive.nto fdrilier,.:
corresppndebce A oui this. visit:- :
7/25/97
Reviewer/inspector Name
Reviewer/Inspector Signature: Date:

Site Requires Immediate Attention: NO
Facility No. —V---ZRT
DJVLSION OF ENVIRONMENTAL MANAGEMF.,I 7
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1D k Lhk-, 1"5
Time: SO
Fame NarnNOwner: A UN L4vc-V-- -*
Mailing Address.
Comy: 'S Am4so �1
integrator. 'ta(LIQ�k 'FA1-rYAS r.�-Y1C.. phow :
On Site Representative: k Phone:
Physical AddresyUcabon: JK- li`#
,m'ss "m —(LL
'io W �W411L. Q.. yll
V'e-'AArn
"type of Operation: Swint -\,tL Poultry Cattle
S
Design Capacity: —1O Q Number of Animals on Site: -716o
DEIM Certification Number: ACE DEM Cutification Number. ACNEW
Latitude: ' �' Longitude: "
Circle Yea or No
Does the Animal Waste Lagoon have sufficient f wboard of i Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches)(Yes or No Actual Freeboard: _fit. Itches
Was any seepage observed from the I oon(s)? Yes 01Q9 Was any erosion observed? Yes or&)
Is adequate land available for spray or No Is the cover crop adequate?(�6or No
Crop(s) being utilized: _ n
Does the facility n;eet SCS rninimurn setback criteria?
200 Feet from Dwellin . Yes r No
100 Feet from Wells? es No
Is the Animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 49
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map BIue Litre? Yes or No
Is artiimal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or4D If Yes, Please Explain -
Does the facility maintain adequate waste management records (volurccs of manure, land applied.
spray irrigated on specific acreage with cover crop)) Yes or io
Additional Comments: NAB a-E4 U►2E .
Impector Narne _ Si
cc: Facility Assessment Unit Use Attachments if Needed.