310033_INSPECTIONS_20171231

OH I H CAROLIN ~
Department of Environmental Qual

ivision of Water Resources
Facility Number - © 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: -- Departure Time: County: Oit) Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: orl A AV 4,-e S
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er I :F�
Non -La er
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
.Other
Other
Poults
Design Current
Design Current
Cattle Capacity Pop.
Dairy Cow
DairyCalf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operati0 ? Yes ❑ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ZZpiication 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)
[r Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? fu
> � 0 9 O
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Yes ❑ N
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes E No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: --3,3 jDate of Inspection:_ / Itr
Waste Collection &Treatment ❑ ❑ ❑
A. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes No NA NE
a. If yes, is waste level into the structural freeboard? ❑ Yes E3<o ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 6��c�O
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f'
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes El"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 E5No ❑ 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? dyes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑'No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes El -No ❑ NA ❑ NE
maintenance or improvement.
11. Is there evidence of incorrect land plication? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
Excessive Ponding ydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? Ores Q-1O ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA VNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA jNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ETINE
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 6NE
❑ 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 ❑ No ❑ NA [E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ff` l
Page 2 of 3 21412015 Continued

Facili Numbet: - 33 jDate of Inspection: / fr
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑'NEE
'25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 0 Yes ❑ No ❑ NA ❑'NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes ❑ No ❑ NA NE
❑ Yes ❑ No E17NA ❑ NE
❑ Yes 0 No (DNA dNE
❑ Yes No ❑ NA ❑ NE
es ❑ No [] NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �J
1;10
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? es rNNo
34. Does the facility require a follow-up visit by the same agency? Yes ❑ No
❑ NA �NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to,questr©n #) Explain any,YESianswers and/or; any'additional,recoinmendations or" any;other comments
Use drawings of;facility, to,better explain, situations (use additional pagesas necessaiT). 2 7.-
/i f Z -�Q �� L✓ T..l'rfrc� n, Cn •'"y�Q/f.„Z
RQ OWI\ C O t j t�Q�G. fl �� �CA^-z.r—., IrJ Q _ tom/
7�G l S /ir' C T r�rlrNs
5ils e e C 4 ec[ Gin,l.r. sT � i.-0 5c— :_0_$ {.A.— d J, 5 C" P`Y r r 'f � %�i t •► /rn a El.lti
1�L L J/ '-
f'IvK �j , �'n �Ol�`r G 1✓.T r{O a � �� / r•1 k
u 540 A, r
i{ j i r
-F.rze board (0
v.�ARW bete ,r. <c�6"4.
7 Lvas /,ca lieidgr l`1 5e r (71ile- 14'"5 hrs, ,
i a �• �: �-' �� e 1 ct (4" 0 -' {.ror as d -we - 1► y c+G_a,. 6c a &"- p�cI
rd-0 a r"e a 1d, +1 C 4—�I; r
3p• �Rr leLi' +o r.n f•`1�y �►h�K+- d r�Ckw3 pc�n ln�� �r,C �kJd4kn[-A: onir7
tt �
Reviewer/Inspector Name: WI • t3 C! Ta h '� �^ Phone: r7 77 . 730 y
Reviewer/]nspector Signature: ^— Date: 3 l
Page 3 of 3 21412015

r
Division of Water Resources
Vacility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Q Compliance Inspection 0 Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: O Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / f b Arrival Time: Departure Time: County: �" Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 0 ', !'—e. s -K.,
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Design Current
Dry Poultry Canacitv Pon -
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operatio Yes ❑ No ❑ NA ❑ NE
Discharge originated at: ❑ Structure Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
EYes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
(u (5''900
2, f
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Ffyes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
0 NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection: '2. / f,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 01yes �'No No 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: G ► n��•5� �Yr) kit
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Flf7No ❑ 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 FINE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or env' onmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes EfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E:fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is re evidence of incorrect la pplication? if yes, check the appropriate box below. �s ❑ No ❑ NA ❑ NE
Excessive Ponding Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Y s- No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑'1GE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA VNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes [] No ❑ NA 54'
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
[]Rainfall [] Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fait to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA NE
❑ Weather Code
❑ Sludge Survey
❑ NA NE
❑ NA NE
Page 2 of 3 21412015 Continued

FaciliNumber: 3 I - 3 jDate of Inspection: 9 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No [] NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
❑ No ❑ NA
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No O 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 an odor or air quality concern?
�e �-N ❑ NA ❑ NE
pose
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
Yes
❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
PNE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes �No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes TDrN(o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 'O No
❑ NA
❑ NE
Comments ("refer to question.4):-E i lain any YES answers` and/or any additional recomineudations or any other comments ;;
.
. :
Use drawings of facility: to. better explain. `situations.(nse additional pages as•necessary).`
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P' s Sr L SC_Lirrq ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: Ito -77 1 73 0c%
Date: ely
21412015

Faci1
Type of Visit: Q Copipliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: l , Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: %vrrt]�1� �" integrator:
Phone:
Certified Operator: Certification Number: 1-1 -3 olS�
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
All
Design@urrent
Design Cu----
�: Design Current`"
�- Swine '' Capacity Pop 'a .
::
.. Wet P.oultry--bCapacity' Pop:
-
Cattle - Cpac� Popil
'Az Wean to Finish
Layer
Dai Cow
MA Wean to Feeder
I INon-Layer
I
Dairy Calf
Feeder to Finish 2,dD
���, ��fv
Dairy Heifer .�
a Farrow to Wean
Design
Dry Cow
Farrow to Feeder
iA
D , Poul Ca aci_ Pzo , Non -Dairy
Farrow to Finish
La ers
Beef Stocker
a Gilts
Non -La ers
Beef Feeder
4 Boars I
Pullets
Beef Brood Cow
'":
Z
jj
Turke s
.
s
Turkey Puults
x•Other,.`_
x=
g�
:• � .�� x;:
-9:3*1 10ther
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No 0 NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:]Yes [:]No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes E�No [DNA ❑ NE
❑ Yes g"No
0❑NA ❑ NE
❑Yes ❑ NA ❑ NE
I I Page I of 3 21412014 Continued

Facility- Number: - Date of Inspection: a,
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes I� ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 lStructure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: [N iCm�il
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): lag p(,�
�of
5. Are there any immediate threats to the integrity oo`f7any the structures observed?
❑ Yes
E4 No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en ronmental 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
j(No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
0 Yes
WNo
❑ NA
❑ NE
maintenance or improvement?
Waste A��lication
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
RfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
2Yes
❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Yo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
ENE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
PNE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
E
❑ 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 Sury
/❑
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
ZE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
❑ No
❑ NA
Page 2 of 3
21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ZN
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 D NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA Ej/NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] 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 ENE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [] Yes ❑ No ❑ NA 0 NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 2�NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No 0 NA VNE
� r
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ 's ❑ No ❑ NA
34. Does the facility require a follow-up visit by the same agency? Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any,YES answers and/or any additional recommendations orany other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
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or
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f F�r C- LP S -10 1 �( Z�/ 46CrM kK L-a7M ZAaY\_1T
- S
A� W rA-� Svl�E5
�64a YnAL / N AI (� . Zvi I11�n1�r1�1 dAY/JF, r /1 {��()
r �? 36/ LAYS, L r " ' I� "r �' Y Y L V C ✓ �1 , V J...J� 1' y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:`f /017643 e
Date: 9la. I I S
2/ 12015

�,.
. � tie
FaCilrty Number ' "/�► ' �r �� Division ofvSo%and:Water�Canservahon
` ��� s - `' y Other Agency��• �r� � � � �� �H
Type of Visit: Co fiance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 7 j5 Arrival Time: Departure Time: ® County: D OPUDA Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: '5-oN FAO r4x L(f 0.. Integrator:
Certified Operator: Certification Number: 3 as
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
...rti � ,p."%" `: ,��'� .k'a� ,�
' Design Current; ` * _ : Design;.jCurrent . � �` "' �.Design �CurTCdt"
�+'.,�' r �.��' � � .��,�-,� r. ,�� < - ,• <° t i �'.��
S vwe ;� Capacity P0p Wet�Poultiry ;Capacityr • Pap. ' Cattle. »-aCapac�ty ;Pop pd,
Wean to Finish La er airyCow
I FWean to Feeder Nan La er DairyCalf
'". '. Dai Heifer
Feeder to Finish 2bD
Farrow to Wean ~»,�Destgn Current D Cow
s r ` .s. �,.���r-'`.cam,+ �,�` �.- .
Farrow to Feeder D «Foul.:Ca acx �Po .`,,. Non -Dairy
Farrow to Finish La ers" Beef Stocker
Gilts Non -La ers Beef Feeder '
Boars 1pullets Beef Brood Cow
_'" ."'^` �* a+j` .r,:.:.�`,.r,y�,w�.,.,•. Turkeys
Turkey Poults
Other OtherF.
-
Discharges. and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Vj No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ o
❑ NA
❑ 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
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: u,msvbgj) U Gw�—T'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes fo /No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir nmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? Yes ❑ c ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Nc ❑ 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 VNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[l No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Zycs
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[;a"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
[3 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
oNA
❑ NE
20. Does the facility fail to have al] components of the CAWMP readily available? If yes, check
❑ Yes
VNo
❑ 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
XNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

LFaciHty Number: - Date of Inspection:,
115
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA ❑ NE
a25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of fast survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[] ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑Yes
I ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
2No ❑ NA 0 NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [o ❑ NA ❑ NE
Ves NNo ❑NA ❑NE
es ❑ No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments..
Use.:drawings of facility to better explain situations (use additional pages as necessary).
5r, ) (�EL[�� �ov(t - S W Aft- , IJ 4 C.�i r4 � �
Sq.) r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
1-0 C'R G-c-Ic oi3
q00
"?C PLA+- T Af
Phone l�
Date: j ,)
21412015

Type of Visit: ig Co pliance Inspection O Op ration Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint {Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ja j i Arrival Time: Departure Time: j 2 County: 4Z f Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: zmtj,? WE STO � Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: { I ,3
Certification Number:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
❑ Yes E2/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes YN
o E] NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facil'ty Nuth'ber: jDate of Inspection: Iy
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA 0 NE
Structure 1 Structure 2` l Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA cop
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): i10
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 MNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health orIYes7yo
'ronmthreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑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 Z/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
�No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does
Yes
❑ No
❑ NA
❑ NE
the receiving crop and/or land application site need improvement?
[/Yes
❑ o
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E(No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ 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
❑ Yes dNo
[:]Yes E/No
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑NA ❑NE
[DNA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: I -Lb t
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ YesYNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes 0 No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ZNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes e No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
No
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
L
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAMP?
❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:)Yes
F:J'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
dNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional -recommendations or any other,comments. "
I]se :drawings: of facility to better explain situations (use additional pages as necessai-y).
jy� raorn T,���E�i Jv �, P6 R6CN(TeoL,Oj I _r5 &P
LACE
3'c W
� � �-C-_� 7� i 3 Co a i I d UE Wa J 6n/ �F �G�
V
RC56 Ufl-Cf, A, 6 Ve-' Pkm NP-TTUdS.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phonk6� 0) "? 7 b- i 3 9p
Date: Z 1
2/ 1201

Flo
Facility Wdin&i �� ��D►vision of 5oi1"and;Water Conservation
w 0 Otther Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: {(Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 4 $ Departure Time: � County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 0 rJ ATH QA
Certified Operator:
Back-up Operator:
Location of Farm:
Design Cum
��;. Sw�ine� r �, Capacity�,Pop
Wean to Finish
`< Wean to Feeder
Feeder to Finish ji up
Farrow to Wean Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone:
Integrator:
Certification Number: 14 S
Certification Number:
Latitude: Longitude:
Poults
Discharizes and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Cy ow
Cy alf
Hy eifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes Z1110 ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
Yes J N ❑ NA ❑ NE
❑ Yes II No ❑ NA ❑ NE
Page I of 3
21412014 Continued

11-AcilityNumber: jDate of Inspection: 1► 1
L. aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1 LIP Glow -7
Spillway?:
Designed Freeboard (in):
YNWo ❑ NA ❑ NE
o ❑ NA ❑ NE
Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 2/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir nmental 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 E?rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes No
❑ NA
❑ NE
maintenance or improvement?
11YlstExie evidence of incorrect land application? If yes, check the appropriate box below.
Yes❑No
❑NA
❑NE
cessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
N ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
Ou❑ tside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
es ❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes ❑
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Noo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes /No
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes WNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes EfNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Sludge Survey
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectioWl�c
22. Did the facility fail to install and maintain a rain gauge?
El Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes FZINo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

FA
flity Number: - Date of Ins ection: 1
24k 4)id the facility fail to calibrate waste application equipment as required by the permit? [] Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesgNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes dN 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 No ❑ NA ❑ NE
permit? (i,e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes �o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ es �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? Ues ❑ No ❑ NA ❑ NE
Comments (refer to question #):,Explain any YES •answers andLor,any additional:recom endations or any other comments u .
Use drawings of facility to better explain situations (use: additional: � ..
pages as necessary):
w�.-tW Mo Lk U1ER_Cs" �N DDVJ I Td "DOE d Sao
C-XC.CSsVe �00V-TOCr� o� �SE�s, Sor�„E <«uo(f e�T sl�rn
Fu -THC,6L —'R-mccFtcL.D5 9AP F'ack�-sGN 6aAss wm-I Na
6Cn,v, VjDR . rho si NS of Srv►�+-� C 'tJ av��-XG 0, �Ea�
A GR.ofj a inn SS-T \155 Z 7" 6 `i 300E 2,015.
�vv To 13 F :�:550 � - ►�' � GbY'� P �� RAC SSca E,�.
wo,/ TO
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhoneN 4 Is r 3
Date: A lin
2 4/ OI4

`. Division of Water Quality
4� FacilityNumber - 0 Division of Soil and WaterConservation
IV/
0 Other Agency
Type of Visit: Q CC pliance 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 0 Denied Access
Date of Visit: Iz V 3 Arrival Time: t $' Departure Time: County: DL-PtZj Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: S�nala pr Kswe1& Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
X Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Pullets
Poults
Longitude:
Design. Current
Cattle Capacity Pop.
Dairy Cow
Calf
—Dairy
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
[:]No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
0 NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
e No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
[;�No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

[Facility Number: - 3 Date of Inspection: i2
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes dNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Identifier: LA&P A to ("mPJ Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes [/] No ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2No
❑ 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?
P Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
&No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
W No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
QlNo
❑ NA
[] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[`Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
2fNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[Z/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
WNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes U �[o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 'ONo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

V
Facility Number: jDate of Inspection: Lj
j
. Did the facility fait to calibrate waste application equipment as required by the permit? _]Yes [/] No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F3/No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes [2/No ❑ NA ❑ NE
❑ Yes E;14 ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
[:]Yes 6No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [� o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes VNNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? 2/yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facitity to better explain situations [use additional naves as necessarv).
N
t\4 ATA r MANC .
16'►) 4AVC
ACjtoNaw_-j.J
6gji tM?E
�r�EA-► 00A fICLOS. D&&* Lly
S� �G zolq
?LA >-I-N G9 .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
STANp QC -AK_.
U_
00 (VSDC9 LE OF Xo
Phone:
Date: 19-j/0 A
214 011

r
i
40 Division of Water Quality
Facility Number 0 Division ofSoiland Water Conservation
pOther Agen
Type of Visit: Q Compliance Inspection 0 Operation Review 0 Structure valuation Q Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral Emergency 0 Other 0 Denied Access
Arrival Time: Departure Time:® County: Region:
Owner Email:
Date of Visit:
Farm Name:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
I�—
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Phone:
Integrator:
Certification Number:
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
La er
Non -La er
Design,
. Current" =
Dry Poul try
Capacity
Pop.
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and -Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cattle
Design Current
Capacity Pop.... j
Dairy_Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes 0 ❑ NA [3 NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
21412011 Continued

Facili Number: Date of inspection:
Waste Collection & Treatment
4. 10 storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ' ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? �s ❑ 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 F6 WNo
❑ 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 rest, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �Ko
NN0[] NA ❑NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VN9
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0
❑ NA
❑ NE
acres determination?
'
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ Zo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[] No
❑ NA
21
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
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 ❑ No ❑ NA Efj NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [:]No ❑ NA NE
Page 2 of 3 21412011 Continued

FaciliNumber: jDate of Inspection:La
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA YE
25j {s the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [3 No ❑ NA
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ No ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No ❑ NA
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 fail to notify the Regional Office of emergency situations as required by the
❑ Yes 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 ,,❑ 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 N ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
No❑ NA ❑ NE
V
34. Does the facility require a follow-upvisit by the same agency?
❑ No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
F0 LA 6
p) E/rj HEJ�_ :?,C . w :LTjtftJC-~ PLC -AS F
G A [A = lJ►�
12-1`' g`r-71911-3, PoTI-F) OcJ Q
jSLr ENO uF
'7191-5 ,
1
ee ,
Reviewer/Inspector Name: /� �w [� (, , PhoneJ 110 E
Reviewer/Inspector Signature: Date: e7h 1
Page 3 of 3 21412 1I

(p Division of Water Quality
Acility ,Number❑ - ® 0 Division of SO andWater-Conseirvahon.,
0,Other Agency .
Type of Visit: O Co pliaoce Inspection U Operation Review Q Structure Evaluation (-) Technical Assistance
Reason for Visit: Eoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: i Arrival Time: Departure Time: j J County: DLe Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: JQN iMYALJ - 02TLLILIntegrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Swine
.
Latitude:
Longitude:
Design Current Design Current •. Design; , Current`` ,''-
Capacity Pop. Wet Poultry Capacity Pop Cattle Capacity Pop
Wean
Wean to Finish
Wean to Feeder
X Feeder to Finish } I 2.ao
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
Design ..Current
Dry Paultry C'anacit�r Pon_,,
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream_Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy_____
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes [/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
[—]Yes [] N
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: 11 754 Date of Inspection: t ZPt-
Waste Collection & Treatment
,4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6KON ! Ck's,6 37r
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 24
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes 1/1 ❑ 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 environmZo
threat, notify DWQ
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 allo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
[] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
66 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[dyes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[✓jNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�io
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�*o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[j/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 ENo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stacking [:]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 [] N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 .21417011 Continued

tacility Number: jDate of Inspection: It L
24. Did the facilityfail to calibrate waste application equipment as re required b the permit. Yes YNo
o NA NE
pPq Y P ❑ ❑ ❑
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 to provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 E o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes T No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional. recommendations or, any other comments
Use drawings of facilityto better .explain situations (use additional pages as necessar
y) ._. ,..
4rmc.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
JdAa
Phone: '% C _ b
Date:
Q/20 1

C� Division of Water Quality
Facility Number - 33 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Co pliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: t i I D Departure Time: 1 Zo County: flop (�-iJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: J oW igrTu a t j ivV-7�ic t Integrator:
Phone:
Certified Operator: Certification Number: 1-73 2 S
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
k Feeder to Finish 1l 1' -o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er
lets
Pouits
Design Current
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Djf Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 6 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
Ef No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: 3 % -2)1 Date of -Inspection: st 1-7
Waste Collection & Treatment
4. ,Is Storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: j,q �,,�� U4Cs�a►.1.1.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ',3 j 24
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 Ef No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [7 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/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [J/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
6Yes
❑ No
❑ 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?
❑ Yes
[Z"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FZ/No
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[/]
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[ZNo
❑ 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 EdNo ❑ 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 11]�T'40 [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FJ/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 131 - Date of inspection: i tty
24. Did the facility fail to calibrate waste application equipment as required by the permit? [:]yes IzNo ❑ NA ❑ NE
25.."Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes FdNo ❑ 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 dNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes _&No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
0 Yes E3"'No ❑ NA ❑ NE
❑ Yes EJ'No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
EYes �No ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Comments {refer to question ft Explain any YES answers and/or any additional recommendations or any other comments '!y
.�
Use drawings of facility to better explain situations (use additional pages as necessary). - ,w
k-ow S PoT MW l &COS i'o GE A00 R_SSED . SO'Du_ r=CA-0 k-TWEEP1 N a G
Wau-SES.
Reviewer/Inspector Name:
Reviewer/Inspector Signature;
Page 3 of 3
J O N" f4 941,!�1 _
Phone: ( %)D2 U -•-13W
Date: It
2/4/ 011

Facility N`umbet 33
I
.0 Division of Water Quality
`0 Division of Soil and Water Conservation'
0 Other Agency
h..
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: l Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ d �A`T�Ji► _ ! V x-�'^'``�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = e = d Longitude:
Design Current Design Current ' Design Current.,.-"'.
Swine Capacity Population Wet Poultry . Capacity Population.~ Cattle 'Capacity Population ;
.�,.
LJ Wean to Feeder
13 Feeder to Finish 0 ��
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Other
❑ Other
❑ La er
❑ on -Layer
:g Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
-
�Nuber�of Structures:
`tures•
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 L/I No ❑ NA ❑ NE
❑Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes N ❑NA ❑NE
❑ Yes S� zo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection ,►
,.� Waste Collection & Treatment
41,. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
!!
Identifier:Lr`'
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
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental treat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L1J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes C�l o ❑ NA [IN E
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
l2. Crop type(s)
l3. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? rYes
s
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 acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
No ❑ NA ❑ NE
El No [3 NA ❑NE
No ❑ NA ❑ NE
WN
o ❑NA ElNE
o El NA [3 NE
Comments ndlor apnayg�..erecommendationsor anyoher coy mmenWs
g(refer toquestton Eaplain.anyYES-answ;..e_ arwds � dand/or
ripsUe drawinsoffacility to'bette, ttuattons.(use " x
. v
l6 ) MtE b C-OTl2A t- S TZILL- W CE Eo S N o,. Oo Lwv►�n7r
.D� n1�
-
Reviewer/Inspector Name 6 L4,
= Phone:'91
Reviewer/Inspector Signature:
Date: 1 i
Page 2 of 3 1 12/28/04 ` Continued

Facility Number: — Date of Inspection l a
Required Records &_Documents
19. Did the facilityfail to have Certificate of Coverage & Permit readily available? g Y ❑ Yes E4 El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes lLJ 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
O/No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El Yes
❑ Yes
❑ Yes
�No
L No
[:3/No
0/b o
❑ NA
❑ NA
❑ NA
El NA
El NE
❑ NE
❑ NE
El NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
1[J No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes 940 ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O/No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0No
❑ 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
EJ/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
d o
[INA
[INE
33. Does facility require a follow-up visit by same agency?
ElYes
L No
❑ NA
❑ NE
Additional Comments and/or Drawings:.
J
Page 3 of 3 12128104

Facility;Numbet
3 33
V Division of WWater Qualtt} K �,
0 "Division of Soil and'Water Conservation ~
Type of Visit
Compliance Inspection
O Operation Review O Structure Evaluation
O Technical Assistance
Reason for Visit
O Routine O Complaint
O Follow up O Referral O Emergency
Other ❑ Denied Access
Date of Visit: I "f 1 G':ij Arrival Time: J iS' Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = d =" Longitude: 0 ° = g =
61
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
E]Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
o
El Yeso
JNo
El NA
[I NE
[I Yes
❑ NA
❑ NE
Page l of 3 12128104 Continued

I
Date of Inspection to 0
4 acility Number:
Waste Collection & Treatment
�f
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
LJ Yes
❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: rJ L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ENo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
ENo ❑ 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
environmentaltreat, notify DWQ
Do any of the structures need maintenance or improvement?
El7. Yes
,No El NA NE
8. Do any of the stuctures lack adequate markers as required by the perm
❑ Yes
Rit? 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
E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% or l0 Ibs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNNo
[INA
ElNE
15. Does the receiving crop and/or land application site need improvement?
Yes
El,
/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[3'/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
� o
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages"as necessary):,
y,) 1-7A Was re_v 4 4o 0Q6 ah 111mlo-i �.; .:. Zq Ars,Ak
Reviewer/Inspector Name----- :"o tnr--- l I tQ,�.t„� �d Ga:,,us Phone: Q�p �7qG -.73
Reviewer/Inspector Signature: Date:
LG/GO/VY LV"9918"GU

3
acility Number: 31 — 3 3 Date of Inspection t
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP M Checklists ❑ Design ❑Maps ❑Other
❑ Yes ❑ No ❑ NA Id NE
❑ Yes ❑ No ❑ NA Ld NE
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 ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
hlE
❑ Yes
❑ No
❑ NA
W_C�ElYes
ElNo
ElNA
❑ Yes
❑ No
❑ NA
r
❑ Yes
❑ No
❑ NA
❑ Yes
❑ No
[INA
;NE
❑ Yes ❑ No ❑ NA 6NE
❑ Yes ❑ No ❑ NA �NE
❑ Yes ❑ No NA MNE
El Yes No [INA [fE
❑ Yes ❑ No ❑ NA
❑ INJ
Yes [INo ❑ NA NE
12129104

-
Dtytsion of, ater;:(
r
' Fac�ltty�Num�ier�" � �j D�v�sion of Soil and
�0,
OtlteKAgency
^ ,x� =
Type of Visit ,CO pliance 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: 2L fi Arrival Time: j)L) Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: .. _ _ __ _ _ _ _ _ _ _ _ Phone:
Mailing Address:
Physical Address:
Facility Contact: ' I Title: Phone No:
Onsite Representative: Nr� ru �"ff Cf—rz- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= o =1 = u Longitude: = ° = g
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish IZ.eb
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
[Ell Ia er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: El
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ENo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2No
❑ NA
❑ NE
❑ Yes ONo ❑ NA ❑ NE
12128104 Continued

Facitity Number: 3 — Date of Inspection
L'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Q No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: I o (,gN Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Zj 2
5. Are there any immediate threats to the integrity of any of the structures observed?
Cl Yes
ZNo ❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
dNo ❑ 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 eat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElLd Yes
,�/No
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
M/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
L'J 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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
® Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
E(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
[I NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
&SOS<--n 4 n o A>D L-- A l' c'0l`Jr L�
k—c_6P 409M
LI a_T4
i�E Cq
�iV' �'
Sc�rr� C.o�'{ -Cl
c�,�
b+�I1�
Reviewer/Ins ector Name H Phone:
p �. a� Q°� i4L..
Reviewer/Inspector Signature ,. "to i Date: A6
12128104

w
Facility Number: — Date of Inspection
�5
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have rWUF
mponents of the CAWMP readily available? If yes, check DOC ❑ No El NA ❑ NE
the appropriate box. ❑ Checklists ❑ Desig
n ❑Maps El Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E3"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [J'No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �[]'No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? El Yes [I NA [I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes�Zo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
QN110 ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O 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?
ElYes
,��
LJJ 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
[I NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
7No
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
[I Yes
�❑ NA
❑ NE
12128104

t.
Factl>ty
Number
vision•of:Water: Qua1<ty =
vision of Soil and Water Conservation;
,k
Type of Visit Co Hance 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: 6 a8 Arrival Time: ® Departure Time: County: 11PUZ 1/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
❑ Wean to Finish
❑ Wean to Feeder
R Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feede:
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = f � „ Longitude: = ° = , ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field ❑Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Caw
❑ Non -Dairy
I
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? ([f yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ}
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
o
❑ NA
[I NE
❑ Yes
7No
❑ NA
❑ NE
Page 1 of 3 12/28/04 Continued

d 33
Fnaity Number: —j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: LA 6whl_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 139 Qi
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.)
WINo
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health: or
eat, notify DWQ
environmenta7No
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
L✓J No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[2/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Y "" ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ONo El NA [I NE
17. Does the facility lack adequate acreage for land application?
El Yes
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
70 ❑ NA ❑ NE
�5,� �.s�ws r✓E6b r�/�f� �o�ico�. 1C�Cp aDac�tbA�t� s�dot�tl� C����
l,l RE ® S7RiEI C YL >'111 ' 1,,1 BE r�,117� c c.E�, �2 Y. +'CE �L� c,�f 5 o t� J-C T AA0
1.16t. imp ALRE _-LV6PXXC l_ ov P.tVd $L/C 'rA:r 4f67 6jj7ALtf 0 &AALtr IV
Reviewer/Inspector Name Phone: C Q/ C —7 3
Reviewer/Inspector Signature: Date: /b o If
Page 2 of 3 12128104 Continued

r
f0 JFacility Number: 3 1 — 33 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LJ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ZfYes ❑ No El NA [I NE
LJ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ffNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
El NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
,ONo
LI o
❑ NA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
91yes
eJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E� o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
LJ 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?
El Yes
,,�
LJ 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
.�,,//
E o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
ElT Yes
�/
o
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
Yes
El�
,C
✓f�No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number ,
(0 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit C1f zRIInspection 0 Operation Review Q 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 Arrival Time: ® Departure Time: �� County: Z Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = L = Longitude: = ° = g = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
_____ �� ❑ Layer
_, ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =i:
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 dNo ❑ NA ❑ NE
El Yes
El No
El NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
❑ o
❑ Yes
o
❑ NA
❑ NE
El Yes
7No
❑ NA
❑ NE
12128104 Continued

� FacilityNumber: — Date of Inspection
Waste Collection & Treatment ,�,/
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L" No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA1"
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): eZ 23
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E1 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 eNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 lam'/o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes B No ❑ NA ❑ NE
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 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ja'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0/Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
<
1Vo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E�/No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
,1 NEFB �EkD W�Rcd�, r4�st 4� *�i s A+'dt.
15 J
s_x 3AYT t- rojs t,.Z,-�( Dtp.
�lFw ANAiL�S a3k-CDfD A0b SEnlb DWQ.
roe_-_ Slut L 7.oN 6S
Do N CAP ` TI 9 r EE9EUi
arL urccusl s�Nn (--P)' ra
1ZEUIL
Reviewer/Inspector Name 0%j>f,I 7rAQ�% (�L
Phone:
Reviewerhnspector Signature:
Date: ! b
12128104 Continued

f �
Facility Number: 3— Date of Inspection I[?!
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Z No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Doe record keeping need improvement? if yes, check the appropriateXseil
elow. Yes ❑ No ❑ NA ❑ NE
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis
alysis ❑ Waste Transfers Annual Certification
❑ Rainfall ❑ Stocking E Crop Yield ❑ 120 Minute Inspections and 1" Rain InspectionZN
Weather Code
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 [(No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0"
NNo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes O No ❑ NA ❑ NE
26, Did the facility fail to have an actively certified operator in charge? E Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA E�NE
Other Issues ��
29_ Were anv additional problems noted which cause non-compliance of the permit or CAWMP? El Yes Cf No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
M 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
CTNo
❑ 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
E <o
❑ 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
❑moo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
'ram"
❑ NA
❑ NE
Comments and/or Drawings:
12128104

t-.ivision of Water Quality
Facility Number 3 Q Division of Soil and Water Conservation /
r) Other Agency
Type of Visit Q Compliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ` Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone:
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o =] ' =] Longitude: = o =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Other
❑ Other ^ ;
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: E
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[-I Yes ❑No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
,,,Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > I0% or I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ EvidcQce of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
❑ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
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):
s CA -
ll7d t-'V In s f
Reviewer/Inspector Name c_j Phone: / cYd'--"j'
Reviewer/Inspector Signature: f e Date: 0j;;�`
Pace 2 of 12 S/04 Continued

Facility Number: ' Date of Inspection
17 7-
Ikequired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or Drawings:
AL
1� 6
Tf'Gt✓1S �' �GQI� % ('���` U� �OC�� �ifn � Sro"iO z
ewi6 cot
Page 3 of 3 12/2&04

.R
acifity Number
Division of Water"Quality 00.
0 Division of Soil and Water Conservation !.
Q Other Agency �
.. -:
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint J'Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
r
Date of Visit: // Arrival Time: /J ;� Departure Time: County: ��Z Region:
Farm Name: — - Owner Email:
Owner Name: �/��n/�yC//��7�/IrJ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ll% fsS
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other - - -
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ` = " Longitude: = o ❑ ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ TurkcX Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Daia Calf
❑ Dairy Heifei
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: W
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 XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
FzfNo
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
12128104 Continued

1 •-
Facility Number: _33 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? XYes ElNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes XNo ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !.t/ � 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [XNo ❑ 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
RI NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify
DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA
V(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 ❑ No ❑ NA
NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No ❑ NA
0 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, El Yes ❑ No ❑ NA
NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ❑ No ❑ NA
; NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ No ❑ NA
NE
Comments (refer to question #} Explain any YES answers and/o"r any recommendations or any other comments
E gy: P YM"�SF �•:�.3 ����� 9 aC. Y
LTses�drawtngssof facility to better egplatn sitpahons (use addehonal paggsfas�necessary,}.,���x§
o*. -
?, v5 - � -�� �m.`��is..i•�Sr.'1�.lL3ii'i'i,ys.i_'i,3iS'
..
44� L!RGao�.�5ow lPr 6 .�c[CTu' IIJN�2.z_,a_._ f �lr�o
.�o�'►f_,. �� Gi�.EF-�r� G>!iZ��� �PPGzcri�7za�s/�
m/¢C'lZv�S
L.S�2 /,/� e_ l�!`f �1� / OfLT !p �/J%��� n�Art'Ci4LL��`0
IeG'Po T 6t / �/O�w W%/`l�r �i%�.rQ zew ' �/ /l%FJ7ZF
Reviewer/Inspector Name Phone: 49
/a [
Review
erllnspector Signature:AAAI�Date: f
I212810 Continued

'4--
JPj Division of Water Quality � r
Fac>ltty Number 33 0 Division of Soil and Water Conservation �y
0 Other Agency.
f
ype of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
eason for Visit O Routine O Complaint O Follow up O Referral / Emergency O Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: L-._ S!_rOZ r Departure Time: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Region:
Owner Email:
Phone: 29C — !2e2fl0 C?_ae.L-
�1G - oe61tC
Phone No:
Integrator:; w' "
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = t 0 « Longitude: = ° ❑ 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
29 Feeder to Finish
1//,
149d
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
'
rDa--F—
j
Non -Da
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes to No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes 0 No
❑ NA
❑ NE
❑ Yes I;lNo
❑ NA
❑ NE
12128104
Continued

f
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑ NA ❑ NE
❑NA El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �fk
Spillway?: Aa &
Designed Freeboard (in):
Observed Freeboard (in): 22
Yes ❑ No
Yes ❑ No
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? 0Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �No ❑ NA El 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 WrYes ❑ 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? 40
11. Is there evidence of incorrect application? if yes, check the appropriate box below. [:]Yes [--]No ❑ NA /0 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 QEvidence of Winc,Drifl ❑ Applicgtion Outside of Area
l2. Crop type(s)
13. Soil type(s)
I 11�, 6-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
❑ No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[-] Yes
❑ No
❑ NA
VINE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
VNE
18. Is there a lack of properly operating waste application equipment?
-erac-011,6:0 c,9-�
/Q E�YXW AAo r��'9
❑ Yes ❑ No ❑ NA Yf NE
JA sue• /D. 5C.r,�,E"S
/ 2x
Reviewer/Inspector Name Phone•
Reviewer/Inspector Signature: Date: O 2
12128104 Continued

' Facility Number: j — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes /No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ;ZNo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
ZNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Vyes ❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
❑ NA
jZfNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes XNo
El NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes /////XNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes RTNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
E] 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 ZNo
❑ 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 %ZNo
❑ 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 'Ej No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
Yes ❑ No
❑ NA
❑ NE
A�dditional`Commetits aud/gr ravings : � 4 � P. � '
r
��Vin Lea®�JA;r Z Aw � T
71
/� -41R �cc 7 �tv/z l05 �Fr ,�oa,J, /4
rJ�c Aa
�dFR
f
12128104

Facility Number: —3 Date of Inspection
--/�%5Y� �55 SLfy liViS�s T. G1/nP/r,Q ��T <�✓rp L
C
g� A
-7;�A-1 &C..�v
� O�hzj A?r--Ak&z- i��,
S �9�� �GsPCz ov
.��vTF�,Qf}ry
416
4(1�rlp 7;Ine.
7/25/97

4i
0Division of Water Quality
Facility' Number Q Division of Soil and Water Conservation t
0Other Agency
Type of Visit VCompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit O Routine O Complaint m Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
r
Date of Visit: / Arrival Time: i� Departure Time: iM ,n County: 4 y GRegion: zh%-1 �
Farm Name: Owner Email:
Owner Name: Y / WA/I_1 , itJ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
� Onsite Representative: Z�� N/ TVIntegrator: �, ./.P�.al!/ C�u1i✓ ___�
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = is Longitude: = o = 1 ❑ [{
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
-- I ❑ Non -Layer - - - - -
Other
❑ Other _ ---
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & 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?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Da4y Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: I',
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 PTNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

4
Facility Number:, 3—
Date of Inspection
Waste Collection & Treatment --- • • -
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? oYes ❑ No
a. If yes, is waste level into the structural freeboard? Yes ❑ No
Structure l Structure 2 Strucfure3 Structure 4 Structure 5
Identifier: ' Of 4
Spillway?: ZVA
Designed Freeboard (in): _
Observed Freeboard (in): r�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONO
❑ NA ❑ NE
❑NA ONE
Structure 6
❑ NA ❑ NE
(ief large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes gNo ❑ 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? OYes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �Z'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require yes ❑ No ❑ NA ElNE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /ffNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding XHydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [--IPAN > 10% or ] 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ 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 [Z'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,A
�No
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
�' Y✓.4ov ,� � �/fi�ir�. � 5 �«�� ��a/u� s � �4-'f_Cf� lY.t! �oo..l s �'f�� .
/7/4 �/ri✓G C .� �ii Fp /f ��init c �i7`�od.� rLc�Eit/T
41V4 /'�I%D7'�cfa Wr9s7/ � I've"r idyF-O AJ
ReviewerlInspector Name Phone:
Reviewer/Inspector Signature: Date: d
12128104 Continued

,n
Facility Number: —J Date of Inspection /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA gNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA NE
the appropirate box. ❑ WUp [] Checklists ❑ Design ❑Maps [I Other to
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ;dNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA VNE
❑ NA VNE
❑ NA VNE
❑ NA ONE
❑ NA PKNE
❑ NA VNE
❑ Yes
❑ No
❑ NA
j YNE
❑ Yes
❑ No
❑ NA
XNE
❑ Yes
❑ No
❑ NA
'�gNE
❑ Yes
❑ No
❑ NA
gfNE
❑ Yes
ONo
❑ NA
OMME
wl "
ZYes
❑ No
❑ NA
❑ NE
Ada q' nal:Comments and/or Drawings:' " A
~- Q,)G 471V , 1T P �EQ L z�'Ife_ /� Fd c�.✓��9-zN �7-
1
/7�p /1�,� �z�,C� ��✓� / �OsT-c'� � �v��,J
41- �on/,�l ��ZoiJ D y.1-r /`tfr LT 1�iQi4
446
Lj�� 'ao Nof A,4plog_ ��7 4�z-�e 'e�o'�C'v ���F
wlw �' - _WzV"')a_ n
�2xf r✓�,f�C76� //fF �� � ��/ i�u.�r✓t�� ��� �/?C�,xrp �.Pr�[�
tlnlio S'ODpm.
l\,r70570pi _ R 03 O -75 12128104

Facility Number:' 3 Date of Inspection
-- le
r
6/645 Tear-; 0 iqr ir+_
,90
7/25/97

Type of Visit iO Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral / Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Ll Departure Time: County:
Region:
1 rK I/!5 (/ Owner Email: _____
qi o 2�lr��1�n'I
Phone: 29&�4��--�F��
Facility Contact: Title:
Onsite Representative: I ���o�✓
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =O =' F7't Longitude: =O =' = N
Design . Current Design Current
Capacity Population Wet PoultryCapacity Population
❑ Layer
❑ Non -La et
❑ Wean to Finish
❑ Wean to Feeder
QU Feeder to Finish
I//, 2M
119 70
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other.
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:.
b. Did the discharge reach waters of the State? (If ves, 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 9 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes 0 No
❑ NA
❑ NE
❑ Yes �INo
❑ NA
❑ NE
12128104
Continued

'!FacilitV Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
1A
Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?: Ae _ NQ
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
/Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
RfNo ❑ 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
VYes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Applicatinn -
• 10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
/ZNE
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window Evidence of
W� in riff ❑ Applic tion Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
❑ No
❑ NA
NI?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
ONE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
ZNE
AA2&)r—'/4 r,4 '0
8
_ _.10- �. Z2,4,
Reviewer/Inspector Name' �,r£'''1' a' Mom'` % Phone: 7%04- t�y`
Reviewer/Inspector Signature: Date: D Z
I2/28/0 Continued

`Facility Number: — Date of Inspection ! '
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes /No
❑ Yes 'ONO
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA )NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility. fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes /NO
V(Yes ❑ No
❑Yes El No
❑ Yes X1,
o
ElYes 7rNo
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA /NE
❑NA El NE
❑ NA ❑ NE
❑ NA ONE
❑ Yes )2fNo ElNA ❑ NE
❑ Yes L/J No ❑ NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
Yes ❑ No Cl NA ❑ NE
/417
c�?PQl,[C�iQ�
/4
400
oe
,� /"„,4fi% �N �.viv�n'tG�� ��,gc�T•9!1 y �(J /�,� / �/�/%1�5� /,i��' ' ��L
12128104

,. Facility Number: --5 Date of Inspection
--%b %! 1)
L.4 F 1qoefDuw
•'r D�/� �2 / uLL-EEO �%���C� [C�7f� Di G Ol+� / JIL7`� �` ``�..
3 �Azj "6eFwk,6a- � � `� 4!!--)E-
t�60 za7'
��o�s you y
Own
Douaco,
Y
7/25/97

Type of Visit QrCompliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: / ? Arrival Time: , Departure "Time: WrOCountv:
Farm Name: _ ,-29,j Owner Email:
Owner Name: {�-.,C� / 15_ _ Phone: _
?Mailing Address:
Physical Address:
Region:
Facility Contact: W Title. _ Phone No:
Onsite Representative: 0A_ _ _ _[ Integrator: `W`7—
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: 0 e 0 = Longitude: = ° = 4 = iI
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other -
❑ Other
Design Current Design Current
Capacity Population Wet Poultry. Capacity Population.
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ TUrke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current I
Cattle Capacity Population
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifer
❑ DEY Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Nuntibecof Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes FfNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA ❑ NE
❑ Yes P No
❑ NA ❑ NE
❑ Yes '10 No
❑ NA ❑ NE
12128104
Continued

Facility Number: — Date of Inspection L
Waste Collection & Treatment -
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
VYes ❑ No
❑ NA ❑ NE
a. If yes.. is waste level into the structural freeboard?
Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: A% �t4>�
Structure 5
Structure 6
Spillway?: Q1c� - - - Al -- —
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes �ZNo
❑ NA ❑ NE
(le/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes gNo
❑ 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?
f--' Yes []No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes gNo
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
yes ❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ONo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below-
RYes ❑ No
❑ NA ❑ NE
❑ Excessive Ponding Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Y1No
❑ 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
IT 'Does the facility lack adequate acreage for land application?
❑ Yes
,INo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
75 �Rr1 5 �F/�D.Q x�ZG� S L �f CF Ui✓ /_/�C c�..r �j�'�'e
Q� fVI2 5/057r 1-11
41VO ✓Iln��c'Ea �f��9sT/ �� /v 6 1
Reviewer/Inspector Name%
Phone: /
Reviewerllnspector Signature: Date: O
12128104 Continued

Facility Number:l.:3/ Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
gNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
NE
the appropirate box. (l WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
10
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
41E
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
ONE
23.
If selected, did the facility fail to install and maintain rair►breakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
VNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
VNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
ONE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[PKNE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
PIN
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
PNE
//XNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[I No
[I NA
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
❑ NANE
. 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
XNE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
2rNo
❑ NA
E
33.
Does facility require a follow-up visit by same agency?
Yes
❑ No
❑ NA
❑ NE
DNS1 NT
f ,ter
�j r°,�2,✓ 1� 11E ,o Ar
fffjJJ ��
,. / fi�ur�D I. ����•,�; c��.�R/3 f0/1 5,��/� . �4/�a P �Ai✓ Fiaq %y I ��«
0O 12128104

• � µ 4
Facility Number:' -� hate of litspLc•tion I1C%
7/25/97

,t
R
Division of Water Quality z
�� FaCill{�7 Nu�ibeC � Q: Dtvislon of So11 and :Water Conservation r� � F >.�^ f '� : 'y t��" R4
�.Y.Jre`! �� .a..ki;�t,�..r•: s'..�. �o� .c. �'� .:-P r-a 1{.. •i. ,-5... '� -:J; # .5 7;�� - . ,.,� k .x:,.t s. z� ��'F.y.�'��' J+r:
Type of Visit JZ Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit O Routine O Complaint QrFollowup O Referral O Emergency O Other ❑ Denied Access
Date of Visit: // Arrival Time: Departure Thee:1�2�'County:
Farm Dame:
Owner Email:
Owner Name: OAn4e,J_V Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish I_
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Region:
Ce
Phone No:
Integrator: wQ��
Operator Certification Number: _
Back-up Certification Number:
Latitude: = 0 0 ` ❑ > Longitude: ❑ o ❑ , =
Design Current
Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry. Poultry
❑ Layers
❑ Non -La ers
❑ Puitets
❑ Turkeys
❑ TurkeyPoults
❑ Other
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifeo
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:DO
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 ;gNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONa
❑ NA
❑ NE
❑ Yes
Z No
❑ NA
❑ NE
12128104 Continued

} FacSiity Number:
Date of Inspection !/
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
,Oyes ❑ No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes [;I No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA VI NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA C(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 ❑ No ❑ NA NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Totai Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑ No
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No
16. Did the facility -fail to secure and/or operate per the irrigation design or wettable acre determination', El Yes ❑ No
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA
NE
❑ NA
NE
❑ NA
VNE
❑ NA
NE
❑NA]NE
gL) L1A�aan/'�I �5 ow Peer V.--
4Oo �!� ooa 5E0 �c lza��5 Tls GrJP,xT7-/_C,0V /CiGPo.'e r �/lj/4aG� p e p
LSP �i42`G �ifi � 1 .-P02T 0- A&C, Q /�i7r ��i4u !t
' C-�nJ �Pv2 r G�.�Ffr�I /Uo�J_ - ��r�Y �✓�(� /� �0�2� ,��ONU; zG f/D�rJ
Reviewer/inspector Name Phone /t7 C
Reviewer/Inspector Signature: Date: /
1212810 Continued

Fadlii* dumber 31 33
I
6Division of Water Quality
'Q Division of Soil and Water Conservation
O Other Agency'
Type of Visit d Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ;Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 other ❑ Denied Access
Date of Visit:� Arrival Time: Departure Time: County: UQ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �+ f, Title:
[-
Onsite Representative: �Ky>
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator: Ty'W . Ay
Operator Certification Number:
Back-up Certification Number:
Latitude: = c ❑ ` = " Longitude: [—] ° ='
❑ "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish I, Lo-o Ibreo-O
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[--]Boars
Other
❑ Other
❑ Layer
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑
Daia Cow
❑
Daia Calf
❑
Daia Heifer
❑
Dry Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Coyd
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
El Yes El No
❑NA
El NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes
❑ NA
❑ NE
❑ Yes RNo
❑ NA
❑ NE
12128104 Continued

Fs ility Number: 31 — 3 3 Date of Inspection oS
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?��Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
PI'No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LR Q000 LA 6-01 3 Z
Spillway?:
Designed Freeboard (in): lGi I Q
Observed Freeboard (in): a.5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
,�/
LJ 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?
ental threat,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or enviwyes
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
21'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
dNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[/�
Ix
❑ NA
ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Q)EPA'yox 04 6Q
13. Soil type(s) �� A plow
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Ye [21No ElNA ElNE
15. Does the receiving crop and/or land application site need improvement? Yes ❑ No [I NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, ❑ Yes E]"No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes d o El ElNE
18. is there a lack of properly operating waste application equipment? ElYes LI No ❑ NA ❑ NE
[Au,to OW& AT ��i�' da 7j►(o.Q vPpn1 v o� z-1z1�S AY i8`' E6+ua is to-3�rrY
•{'a '5eQo Pop. r �.
�•� SoM�c 4�)SA L1-ap, n1L NE�r?r�r� A►.fD GotsTQot_ a� �C !E s FSck ANr Nti Nwo5v t41�OJJ2
t5.)
2-Q 06rt, Tu Ftoc �A�-3rr.1 S3 AK�(L
p -, • �L r r= Phone: 110) AT -3500 x
Reviewer/Ins ector Name u�. a
Reviewer/Inspector Signature: Date: 212143 v
12/2R/A4 rnntinuod

f�ility Number: 31 — S3 Date of Inspection a:S
IV
RecLuired Records &Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. L] Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers M Annual Certification
❑ Rainfall 93/Stocking [Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? Xes L71No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? RYes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑/ o ❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
U Yes
LZNo
LJ NA
U NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L34C
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
d No
[]NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B N
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
I� No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Z No -
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
�No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
7ff�
❑ NA
❑ NE
Additional Comments and/or Drawings:
'Pj') C"'T
GJ 'TPC
op OPTS
LQ.zP lj�t_D R,rV
12128104

M.
(Type of Visit 19Compliance Inspection O Operation Review Q Lagoon Evaluation [
Reason for Visit b� Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access I
Facility Number 1� Date of Visit: Time:
Not Operational 0 Below Threshold
0 Permitted 13 Certified M Conditionally Certified 0 Registered Date Last Operated or AboveThreshold:
Farm Name: y ►'l ✓h'1s �. County: 4 H
Owner Name:
Mailing Address:
Phone No:
Facility Contact: 46,117,111
//� Title: Phone No:
Onsite Representative: AAA A/ / fe,,P 46,11 ,1 + / _ Integrator: 6�&*/7 t/
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude e ° u
Design Current
awlile
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer 10 Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ® ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ray Field Area .
Holding Ponds / Solid Traps 10 No Liquid Waste Management S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [--]No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: A Z
Freeboard (inches): 6P Z 3
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: — 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 markines?
Waste Application
10, Are there any buffers that need maiiitenanceiimprovement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
,Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13, Do the receh.,ing crops differ with those designated in the Certified Animal Waste Management Plan (CAXI"vIP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the faciiin, need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reollired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
=: I8.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DNVQ of emergency situations as required by General Permit?
(ie! discharge. freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review•/inspection with on -site representative?
❑ Yes
❑ 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
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
..«. alp:. � .I=r..' •'8 _ .i&i :'a'•4-f�S �-'-.Q%%';' ry § '
Comments°(refer to qu�an #Y Exp]a—M any YES soswers!andlorsay recomimendi&ns or airy o ei Comm fs �<
Use drawings of facilityto better ezplarn srtuatrons (use adsirtronal pages as necessary} . ❑ field Copy ❑ Final Notes
e-T..r+..._wai.:ii:,'�..x..v:.,.�#r"''�.«.:-.�/�+=
rk44 �b ma ht 'kot 7�t� iHHe` �il�DGh !�4>/�$ �r�t� �/�{s�l e4t`fe
Ind AA"( `i ) % G �e,4A"7 �,r yoo.t Le eels �ow•t lag f y ^'- � Ile�� -A
x rood )n4 Pupj p lh e�&K a, .4+
5 f &UTA d' Aa/'drt A0A GdO/
Reviewer/Inspector Name.
Reviewer/Inspector Signature: Date: /
05103101 Continued

Facility Number: 31 — Date of Inspection Zi
O or Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. 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 ❑ No
❑ Yes [:]No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
O5103101

Type of Visit O Compliance Inspection' O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 33 Date of Visit: 4/25ROOZ Tane: 2pe►
Q Not O erational Q Below Threshold
Permitted IMCertified E3Conditionally Certified [3Registered Date Last Operated or Above Threshold: .............
Farm Name: W.eSt.QjX.FAnW. ay........................................................ .. County: P.top n.........
..jRQ.........
OwnerName: 1?a�t�y...................................... Wk&X0A ....................................................... Phone No: .........................................
Mailing Address:P.Q..Bax.297...................................................................................•....... KenansAleAC................................................... 2M3.4196.............
Facility Contact:.............................................................................. Title: ...... Phone No:
Onsite Representative: Geno-Keel dy............................................................................ Integrator: Bxu 7a.'x.uLlGatQluaa,.Xne..................................
Certified Operator: Danny.1................................. W.C.Stea.................. .............. 6............ Operator Certification Number: .17125.............................
Location of Farm:
East of Kenansville. On East side of SR 1959 approx. 2.5 miles East of Hwy. 50.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 " 57 25 " Longitude 77 " 53 15
DischarPes & Stream Impacts
I . Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 0 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: ......... ........ I ................. ................ .2.................
Freeboard (inches): ...............32............... ............... 3.0...............

Fy,ci ity dumber: 31-33
Date of Inspection 4/25/2002
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 maintenancefimprovement?
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 Coastal Bermuda (Hay) Small Grain Overseed
❑ Yes No
❑ Yes No
❑ Yes N No
N Yes ❑ No
❑ Yes N No
❑ Yes N No
Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19_ Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24_ Does facility require a follow-up visit by same agency?
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes N No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
---------------
[a No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
Has a large amount of old hay bails stored around the edge of field #2. This hay needs to be used or removed.
1 Ponding was observed on both of the primary spray fields. Work needs to be done on these fields to prevent this problem from
reoccurring.
Rest of records and farm looks good.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

Continued
l' acility Number: Date of Inspection 4/25/2002
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [] Yes 9 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, (] Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ) No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? [] Yes Z No

4
Type of VioR A Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit xt Routine O Complaint. O Follow up Q Emergency Notification O Other 0 Denied Access
Facility Number 3 Date of Visit: — Time: 9130
Q Not Operational Q selow Threshold
Permitted [j Certiified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold.
Up— Acl_� n
County:.....p+-.���..
Farm Name: ......................................................................................
OwnerName : ................................................... ........................................................................ Phone No:....................
Facility Contact:
Title:
Phone No:
MailingAddress: ...................................................................................................... ............ ...........-----------..................................---.......................... ........................_
Onsite Representative: ` ...........L .................... Integrator:..... 30<_ ..........................................w
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 it Longitude • 4 �u
Swine Ca cti .. Po elation . Poultry -. -Capacci Population 'Cattle C�� Po
Carrent
elation
Wean to Feeder 10 Layer I Dairy
Feeder to Finish I❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish TOW Design Capacity
Gilts
Boars Total SSLW-
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
old�ng Ponds /Solid Traps;
13❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes b(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation?
❑ Yes J�kNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
[-]Yes )`No
Structure 4 Structure 2 Structure 3 - Structure 4 Structure 5
Structure 6
Identifier:...................................................................
Freeboard (inches): e;� 3a
5/00
Continued on buck

E
Wa�ciliMlsiumber:-3\ - 53 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
)J'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
ONo
(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?
KYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
XYes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
ONo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
WNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN K44ydraulic Overload
WYes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
Dpo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
OKYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
_Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
HNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
J<No
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ANo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
hi No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ArNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
CN No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
,XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
vi atit}njs ;o ff drrf 601:16 wqre We errih1s'vis.
it.
Yoir w3i�
coriesoinideace: about: this visit '
p� �I�k--� ''k� l.`T•� -��-% c�'� c�\lam
�yr
a4,
VET-r�,e ta..'ri I.-e� t..► c�. ,.._ ._.
Al
Reviewer/Inspector Name Q
Reviewer/Inspector Signature: rA
_ Date: ._ goo

i
•%'scatty Number: -3 Date of Inspection
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 O(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
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 XNo
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 9No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ( No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional _tional Comments, an or. rawings;
-*3r? S
� +� �e�s- �► �e. � �� -�- w��w.��-. �p-�� ��� ice+-,
. � � �.� ►�� �`�� �... �+���, �-� � � � lac 1�,`
�CR-Uf 1-14 �
- l
1
'
■ -Ni~S
i--,
I` : t... a
1W
5/00

{ r; �Divlsion of Water aQuahty
..:.F Q.Dtvision of Soil a nd,-Water_Conservatton'. s �_
r:
Other Agency
Type of Visit WCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit:
Permitted © Certified 13 Conditionally Certified [3 Registered
Farm Name: e S�e "t Fq -v, � s l... ai C
................ ................---... ...............................
er OwnName: 'es c
,��a..n......... w
Facility Contact:
Flailing Address:
Title:
l� QO Tune: �S Pt-inted on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
7-� r
County- ..�J.IT .t..:I......................................................
PhoneNo:... ........................
Phone No:
Onsite Representative: ?��{ ►j �'j`�...."v.�l �. n,/.L?�Q.. f` % Integrator...-P.'�'d (• �}.1..`T._ ��?!'o�i► ?1,.
Certified Operator :....................................... Operator Certification Humber:......_.._.......
Location of Farm:
A,
�ffSwine []Poultry [:]Cattle []Horse Latitude �� �� �-° Longitude �r �° cc
Design Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I I 1 1[] Dairy
Feeder to Finish g—QQ Q ❑ Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag—n Area ❑ Spray Fietd Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If' discharge is observed, was the conveyance nian-nude"?
b. If discharge is observed, did it reach Water of the State:' (if yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/rain`'
& Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure ; Structure 4 Structure 5
Identifier: �/ - W Z ........................................................................................
Freehoard (inches): "3 3 37
5100
❑ Yes ,KNo
❑ Yes �$ No
❑ Yes �9 No
4 /a
❑ Yes ;KNo
❑ Yes jZ No
❑ Yes A No
❑ Yes BNo
Structure 6
Continued on back

Facility Number: 3 — 3 3 Date of lyspection IQ 2B Printed on: 7/21/2000
I
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
J4.No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
[9 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
0 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
11. Is there evidence of over application? ❑ Excessive Ponding]] [IPAN ❑ Hydraulic Overload
ElYes
E§No
12. Crop type 6C/'r►tiU,4 eL_I`'1A y 6,^e.I',,
13. Do the receiving crops differ with those designated/in the Certified Animal Waste Management Plan (CAWMP)?
ElYes
`UNo
14. a) Does the facility lack adequate acreage for land application?
ElYes
Jig No
b) Does the facility need a wettable acre determination?
❑ Yes
eEgNo
c) This facility is pended for a wettable acre determination?
❑ Yes
la No
15. Does the receiving crop need improvement?
-9Yes
❑ No .
16. Is there a lack of adequate waste application equipment?
❑ Yes
J•No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
J9 No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
JF[No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
19.No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
;ffNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
PgNo
Oc/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes )R No
24. Does facility require a follow-up visit by same agency?
[:]Yes
Er No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
'R No
deFcienges -were noted- dirritig this:visit.' - Yoit will •i•ebOVE; Rio rurther -
correspondence. abotit. this visit. .. . . .. I . I .. -.......... I . .
Com_ ments (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):
A.
ill t/10Q]el eisr i-aA gAe a re ors. fie e'd
�,�) �'-/ _!o 5y
1.&i r4e a fpcc;<S le be. eo, _ ete4/ oh-Ii e%d, gje , v_ ,;, Grp d� -Doh�t+/
rupto
15. Wow �o �i►�tivlq�G /2i`Lb6►"n2vdct 1/>!���q�io�
fp ej&b1,X(eje•nvdq.
►'9. T�a�� S� lI sit w�Pl�s � �avc gylgl�z�d �oJ' l/ ��cldt ,'��oft� . Use
ro��'1 da-�ed �,✓�s•{� Ana I s;.r orl
Reviewer/Inspector Name
Reviewer/Inspector Signature: a Date.

Fafiiity Number: j — 33 Date of Inspection !a 40 Printed on: 7/21/2000
Odor i-sues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor 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 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
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 A No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes A6No
Additional omments an orDrawings:
.w
P7. Growc, heezds +l2WeST C®"OpiJZ ar(' Cje,�cr'gf J���'✓"er ' -7� C2 �f �' 2
l�✓G�0.6j'�i
eS��.�l! rh ��?a 4�,en � l�
ol�t �b �s 9 �o� 64 j
w
5100

Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation O Other
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O• Other ❑ Denied Access
Facility Number 31 33
Date of Visit 2/18�2Q110 Printed on: 323/2000
O Not Operational 0 Below Threshold
Permitted M Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .............
FarmName: W..cstum.:>.kr. ..................................................................................... County: Ruplin ............................................... W..iRO.........
Owner Name:]?aAtn3..................................... �3!05101........................................................ Phone No: 11k-?.9f Ql> 4.Qx.R2!).........................................
Facility Contact: .............................................................................. Title: ..... Phone No:
MailingAddress: P.,O..&X 2Q2.......................................................................................... K.caansXillc,.11C._................................................. 283.49........-----
Onsite Representative: ........................................................................................................... Integrator: Br.gwWj.of.CJafrolinUI r..................................
Certified. Operator: jDamy..L ............................... West= ............................................. Operator Certification Number:.17325 ............................
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle Latitude 34 57 6 Longitude F 53 15 K
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? 0 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 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:...................................................................... .................................... ................................... ......................................................................
Freeboard(inches):...............26..............................22..............................................................................................................................................................

Facil' , ,i ktuber: 31-33 Date of Inspection 2/18/2000 Printed on: 3/23/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
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 ARWication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21 _ Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did 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?
4N&V' iniaiiini rir:defirciericies'were:rioted:�nring'ttiis'visit:V-66�vffreceivei2o#'urNieir:':
..........................................................
�nrracririnitiuiria ahri�it tRie.vaciiF._..'.'.'.'. . . . . . . . . . . . . . . . . .
Freeboard Check. No one on site.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
qV
Reviewer/Inspector Name

n Division of Soil and Water Conservation -Operation Review
_ _ _
© Division of Soil and Water Conservation -Compliance Inspection, _M ,
Sm Division of Water Quality'- Compliance'Inspection
C:.. - - ©,Other Agency- Operation Review.
IRoutine O Complaint 0 Follow -tip of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3f Date of Inspection i2!
9 Lr' Time of Inspection 24 hr. (hh:mm)
14 Permitted 11 Certified ©rConditionally Certified [3 Registered Not O erational Date Last Operated:
Fann Name: �D�l!...........`!..�..tk........ Y�:o. ................................................... County: ........ D.t.ZJ& ......................
Owner Name: --...-- �G�m-1.................. itks.11t`. ....----........... I'houe No:
FacilityContact: ................. Title:...................................--..--..--................... Phone No:...................................................
Mailing Address
Onsite Representative:.......... pptl11!1a1.......... W..Q 11......................... Integrator: WC� .................... ..............................
.... h ..... .............
Certified Operator: ............................................... . .. ...................................................... ...... Operator Certification Number:..........................................
Location of Farm:
Q,n......�&- .R...... .........S.1 ...... .. .. .....7i!�i..5..-..... QT.......t2. A�
t.............................................................................................................................................. ......... ............i
Latitude �' �' �:� Longitude
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
2 Gd
6 400
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current ' Design Current
Poultry Capacity Population' Cattle Capacity Population
❑ Layer JE1 Dairy
❑ Non -Layer JE1 Non -Dairy
❑ Other
Total Design Capacity Z_06
Total SSLW
Number of Lagoons Z ❑ Subsurface Drains Present 11171 Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`'
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharee is observed. what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system?
2_ Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Vol bo7i
Freeboard (inches): ............. Z`t Z Z
❑ Yes 15 No
❑ Yes
15@ No
❑ Yes
91 No
?iA
❑ Yes
(} No
❑ Yes
No
❑ Yes
{P No
❑ Yes J0 No
Structure 5 Structure 6
1/6/99 Continued on back

Ffilitj,Number: 1 — 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [&No
�.; seepage, etc.)
6. A� there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an
1 immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? 14 Yes El No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? M Yes JJ No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
1% No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes]
No
11, Is there evidence of over application? ❑ Ponding ❑ Nitrogen
❑ Yes
No
12. Crop type Sft_R.....�rGlan..... - ... .......... I........................................................................................................
.. rrnvG.tz........... ........... f
.....
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
BNo
14. Does the facility lack wettable acreage for land application? (footprint)
(� Yes
❑ No
15. Does the receiving crop need improvement'?
Yes
❑ No
16. Is there a lack of adequate waste application equipment`?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
® No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
21 No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[E No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
PNo
0 No.violations -or. deficiencies .were noted during.ttiis-visit:. Y•ou vall.re-ceive nar further. .
• eorrespgrideitce: about: this Visit.'....... ...................:...... .
Comments (refer to question#): Explain any YES answers and/or any _recommendations or_any outer comments _
Use &awings_of facility to better explain situations. (use additional .pages as necessary)
OVOLS OVI a pf-- ,n \1 0 F! 1111)" , SS Dwi. shout er �I Lj cw� 3 riSe.�-ac . K04M-
_ -
(a,r�oan DW'.L . S �,.pu1 d sae A;1 pJ rtV-U)4 0"1'3 `E4, at}ct ,, cpo^tn
t aW
ages o� [o. oot-s DWz, °{ Dwl 5+kM3 6e MS43,
S-A. cswr, 5S1�,OA ,e mmovt� iv.- C- 6'1. t-AIVItr Ae �O p+ tc+hc� c S kYt}t^� �j er,nv�C. ���{ p.
iq. OCOA g1tinJ�t} PG or�aw�� i,��-i ornl S�.o�W low- VA •4•0 k cull) 5P I
Reviewer/Inspector Name ' . ��r�. l►Anh
Reviewer/Inspector Signature: _ � ` ► Date: s f -2-S jQ9 1 I/6/99

t:i
"e Division of Soil and Water Conservation [Other Agency §t Y
Division of Water Quality
43 Routine O Complaint O Follow-up of DWO inspection O Follow-up of DSWC review O Other
Date of Inspection jjj,�-JqX
Facility Number
Time of Inspection '��{ 1,� 24 hr. (hh:mm)
© Registered ;9 Certified © Applied for Permit Permitted 113 Not Operational Date Last Operated: ,,
...
Farm Name: ..... ... "s6..... .�rAr1 _.: i.t..�.t1.4...................... . County: ........
� tY�........................................................
Owner Name :....................... ina .......... iL5J�� t!ti.._...................................... Phone No: ..... ���tr � .- f$8 .......................
ii
Facility Contact: ...................................................................... ....... Title: ............ ................................................... Phone No:...................................................
.
Mailing Address: .................E..;Q�.......�.).0.....rZ��:].
�,........................................................ ........... �+.5 �!. �.�.� �... �?�:...........---........---... .. � �..
Onsite Representative: ............. :/.e'w% i..................-----.......---------.... Integrator:......... &D'Wk".S ..........................................................
Certified Operators .................................
Location of Farm:
.... Operator Certification Number; .........................................
.............. 1`iSrl.t...�.,.5..r7aL .....Sri.��1 .... a ..... kip, .... .1-4. .................................................................................................. �
................ ... ....... .... ........................ .. _.....................................
Latitude 6 0" Longitude • ' "
General
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 13No
2. Is any discharge observed from any part of the operation? ❑ Yes ip No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes U No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 1P No
c. If discharge is observed, what is the estimated flow in gal/min? to
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ( No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97

-r Pa4lity Number: 3
Y8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ®No
Structures (LagoonsMoldine Ponds, Flush Pits, , etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ;9 No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
............... ............. ...........................................................................................................................................................................
Freeboard(ft): ...........:Z : .............. ............ z-, L...........................................................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15, Crop type ..................1 ,Y.ml�t.r a.. .................... ST?^.....yclr.................... .............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0-No.violatio`ns•o' deficiencies.we're-ntited-during this. visit.-You.rviII reeeive•no•ftirther
eorrespbndehibie A out €his:visit.,
❑ Yes DINo
❑ Yes UNo
.% Yes ❑ No
❑ Yes R No
❑ Yes (,3 No
................................
❑ Yes ® No
❑ Yes M No
Yes ❑ No
❑ Yes
IoNo
❑ Yes
No
❑ Yes
No
M Yes
❑ No
❑ Yes No
❑ Yes P3 No
❑ Yes 19 No
11- Gr",oy, MN'ta- O-rouv� tr.-L1.t� Z�c.
ir+ �c.�oan -WI Skcf)J) lot.
`f- rt,O_ cOeti. ls1� w
_k_1 � OA_�tod
kILL (Wald <�W� �c
ri�oc-J a►—
i cmy. � (. be� ON eJtey-
OcV L_ WOAl
ioe r%,Wej 6%j
,
z"'k.[ i'I�v1.U` �
�
(
� � � :^� l �
I- a l h
s�'14U� (� itl� MGitiO tJ� 4 V` J
*Ex, talK afa, ." 1<cA, �Ou_
wo�lc� S1ro�l� be reveg-eet C
l� �MA;, skodla bk irnQ�r�ed, ge�ftvt�a S%t}�ti be. ctA �e�r , er
Wed-, 4- volo.kter mrzses ghovft) he feNnovee1.
k hurNbW s %W u� 5 t� be a sus w 1 - `�,
`We�
►�2y bG5�S1t recalS sL�a�fd �e mn��xet� 1� �Q�
4c1�r•?tt tfir rfch
. LJS ���v(j ee
4 h , l t kR iI WIA11
...1.- L V712-IS
[ Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
0

fFE�❑DSWC Animal Feedlot Operation Review ��
®DWQ Animal Feedlot Operation Site Inspection
® Routine 0 Complaint 0 Follow-up of D%V 2inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection Z: 24 hr. (hh:mm)
Registered © Certified 13 Applied for Permit ® Permitted JE3 Not Operational I Date Last Operated:.....
Farm Name: .....fl�!2.S.6..'-n....... .p► .r....3.....'..tzG.>................ County: .... .Y...V.P. uerl................................. 7
OwnerName: ................ � ..... .. .. ........................................... Phone No: C.�.1..Q.).... all .......O.0................
Facility Contact:....................................................... Title:................................................................ Phone No:. q..f.It: ..2..R..�O..-.n.9 3a
1lailiugAddress: .........�o...... �...tt..74.........Z.q. L.. wa..c�.r�.S.V..x...f..�..�.. /i-C ... . ... ,.�.r3...` .
}�................................................
Onsite Representative:.....4�..4 4n..v.-....w.��.tirt...�R.�n.d..... Intel;rator:..--apt.9 .....................................
Certified Operator, .................... f ................................................... Operator Certification Number,.................. .
Location of Farm.
......s..1.0,C ...... �i... i.... ...... �..tr-�i t.x o�. s ,.r..l-f�3 ..... .ci..t..1�...�. x.�rx `�-?�!r......
�^ L T...
.. .�t--0-�`..---.refit.t lka.-.�.7. �.�...tt.f ..,-.......---- ............................... ......---.---.--.......... ........ .............. ........................... ..................
. .
Latitude ` 1 .4 Longitude • �` �"
Design Current
Swine Capacity Population
❑ Wean to Feeder
El Feeder to Finish
❑ Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity.. Population
❑ Layer I I fDairy
❑ Non -Layer El Non -Dairy
❑ Other
Total Design Capacity..
Total SSLW
Number of Lagoons / Holding Ponds 10 Subsurface Drains Present ❑ Lagoon Area 10 Sprav Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement'? ❑ Yes ® No
2. is any discharge observed from any part of the operation`? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes ® No '
b. if discharge is obsen--ed. did it reach Surface Water? (If yes. notify DWQ) ❑ Yes E$ No
c. If discharge is observed, what is the estimated flow in mUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes KNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes Q No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes EQ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
m ai ntenan celi mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes JRJ No
7/25197
Continued on back

"e y
Facility Number: — 3�
ly,
4 8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
l9 No
Structures (Lagoons,11olding Ponds, Flush Pits, etch
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
JR1 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ...2.'� .............. .S ................:
Freeboard(ft):..............................................................................................................................................................................................
......
10. Is seepage observed from any of the structures?
❑ Yes
0 No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(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?
❑ Yes
1$No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
QNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .................... x�n q.�.�.�ca.�.........................................._..................................................................................
16. Do the receiving crops differ with those designated in tTle Animal Waste Management Plan (AWMP)?
❑ Yes
KNo
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
18 No
18. Does the receiving crop need improvement?
B Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
IN No
20. Does facility require a follow-up visit by same agency?
❑ Yes
®'No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
j$No
22. Does record keeping need improvement?
CK Yes
❑ No
For Certified or Permitted_ Facilities QnI
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
JR No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
l$No
® No'violitions-or deficiencie's' w' ere -noted during this:visit. You:wiH i eceive' nolurther
correspondence ai out this -visit.,:..:::
Ctittimen s {refer to qtt on } {�Expla t arty YES answers and/or ahy�recom endatrons o m y lther cciimtne0figv
f fac:hty to better�explatn srtuatons (use addrttonal pages as,pece ary)��
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Lo�a
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.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: t

Site Reoui:.res i ., t1 ate Arendon:
Faciii� � No. 1-
DIVISION OF ENVIROMMINTAL MANAGE?VIENT
." �NTi/LkL FEEDLOT OPERATIONS SITE VISIT: ! ON RECORD
DATE: ?e
. Time:
Farm Na_Le'Ow;.er: WZ4 411
Mailing Address:$nv 2 `7g� ff.e, ? 3q 9
Count•;:7� [ s rL
Intearator rD�Nw_���n� a+ Pone:
On Site Represemarive: n n� �5 "" _ Phone: �9(o - U�BI/
Physical Address/Location: r � � 5oe 1 9.
Type of Operation: Swine Poultry Ca -,;le
Design C'apacit.: Number of Animals on Site: 6260
DEM Cerdficat on Number: ACE DEVI Ce_%w=1Cw_,on Nu be:: ACNE
La 'rude- °. � �L" Long=tude: Eltva`an: FPe.
Circle Yes or No
Does the Animc-d waste Lagoon have sufficient eeboard of l Foo_ = 2_� ve` ?^ kour storrl ev—_ t
(approxi_uarely 1 Foot - 7 inches) Yes or No Actual Free�o e: _Ft. Inchzs
Wa; ai.y seeoagz oose=,red ;Tom the lagoon(s)? Yes o= 1 °as a".: e osion obs:.: -r•ed? moo- No
• Is acecua.z lane avai}able for spray? covec.:�s or No(l
Does tide faci ir: meer SCS minimum setback, 200 Fee: c Dwe:lings? CDo_ No
100 Feet front e�ts? or No
Is the animal waste stockp' ed within 100 Fee: of USGS Blue Line S cam? Yes oi�
Is animal waste land applied or spray irrigated within 25 Fee: of a L.SGS flap blue Line? Yes
Is aTI1r�^_l waste �iSCincrgeL irit0 Waters Of the Site b�' man-e �Cz_�i_, illy 11i.� 5'`$iZ.i, Or Oii:
similar man-made devices? Yes or o If Yes, Please Lxul r..
Does the facilit-v maintain adequateAvaste management records (volumes Of im--inure, land app13ea.
sDrav irrigated on specific acreage with cove. crop)' r No
Additional Co=-ne:1ts:
Intl 5
Insaec;or �arn� �i •�t,�u
cc: Faciliiy Asscfss icnt Unit t. Se A[i3cll,—i if n,s I INifer1Cd.

Site Requires It.unediate Attention:
Facility No. 7
DIVISION OF ENVIRONIMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD.'
• DATE: , I995
Time:
Far. Name/Owner: � A rl ✓1 S4
Mailing Address:. Po Jgf�i1 _ li -7_ ►GF� Vt le _ Zir ?49
•
County: � t
inter. ator. oX C�P�� Phone:
On Site Representative: n �e5 4-cm
Da.n $! _ i 290 -o93a
Physical AddressfLocation: _ / vUr
Type of Operation: S wine X Poultry Carrie
Desists Cauacity: '&_o Sf6,O Number of Animals on Site: S,o
DEM Certification Number. ACE DEM. C=—cadon Number: ACNEW
Latitude: N * �_33 " Longitude: —T-7" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot _ 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) n or No Actual Freeboard: 4 Ft_ Inches
Was any seepage observed from the lagoon(s)? Yes o<9 Was any erosion_ observed? 420r No
Is adequate land available for sprav
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria?. 200 Fe4t frorn Dwe'_linas? epor No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line S t£eam. ? Yes o�
No Is the cover crop adequate? (9 or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS TVlGp Blue Line? Yes oo
Is animal waste discharged into waters of the state by man-made ditch, f ushing system, or other
similar man-made devices? Yes 019 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)?s or No
Additional Cpmments:.CZo� �r�4 • �,. ,� d b Ss wu 5 _w� �!
h .
Insacctor Name ature
cc: Facility Assessment Unit
Use .attachments if Needed.

l
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: _ 3 , 1995
Time: 1
Farm Name/Owner: ,2'a C' "_)+ M
County:
Integrator: (!6 4,2 4 xPn O _ Phone:
On Site Representative: i -e_ �( Phone: �y � ' �A3a
Physical Address/Location: ' .57,a7 %C
-50
Type of Operation Swine ✓ Poultry Cattle /1--c N 'S kS
Design Capacity Number of Animals on Site: -1 l 2va
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3`/ ° 6 W " Longitude: 7 ° ,/_` L" Elevation: Feet
32> , G `17 Circle Wor §oLl 3,t
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) ZQ or No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o� Was any erosio observed? es ' r No
Is adequate land available pray?Cq or No Is the cover crop adequate? (E�br No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellingsz9s or No
100 Feet from Wells? ne or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o N
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or&i
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or To If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? (9 or No�'r
Addition Comments: -46X• W-O() "- L` <44- ,'s D 0 -
Ins ctor Name
Signature
cc: Facility Assessment Unit Use Attachments if Needed.

f�
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report
3[ - 3
fz /?_0
Z Names of Inspectors
_ Freeboard, Feet
S - Top Width, Feet
3'. Downstream Slope, xH:1V 3
Yes No
Seepage? Yes No
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Yes / No '
(ramg�cSS r
Follow -Up Inspection Needed?
Yes No If Yes, Depth of Overtopping, Feet
Yes �No
r
Engineering Study Needed? Yes /0' No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes /No
Other Comments

Lagoon Dike Inspection Report
Name ofFarm/Facility _Yk (D '101?0*4 3(- 3 3
Location of Farm/Facility �S`7
Owner's Name, Address
D
?_ /
and Telephone Number
C-
t�dF
Date of Inspection
U
Names of Inspectors
EZ c_
Structural Height, Feet
Freeboard, Feet
2Y
Lagoon Surface Are Acres
g a,
s �.�
Tap Width, Feet
t
�
Upstream Slope,xH:IV
�
Downstream Slope, xH:IV
Embankment SIiding?
Yes No
(Check One, Describe if Yes)
Seepage?
Yes Vo
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? -
Yes �— No
b (Y J — W f: CL, VIA PA K-1Al 400
Yes �No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes `No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
Yes ­-14o