310321_INSPECTIONS_20171231

NURTH UAHULINA
Department of Environmental Qual

Type of Visit: QCompliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance I
Reason for Visit: a Routine Q Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: © County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: P� �� j T,
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone:
Integrator:
Certification Number: ( �-75S`
Certification Number:
Latitude: Longitude:
Design
Swine C•apaciiy
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design
Cattle Capacity
Dairy Cow
C►urrent
Pop.
W n to Feeder
Non -Layer
Dairy Calf
eeder to Finish
Design Current
1) , Ploult , T Ca a_ci) P,o ,
Layers
aia Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Dischar es and Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes to Q 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 Q�o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ElYes RNo ❑ 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 21412015 Continued

ti
r
Eecility Number: - 3 2 Date of Inspection: G /�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �' O ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No —❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental _rest, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes rNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes ❑ 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 Ej 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 D 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
LJ 1"o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;2,No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E2<o ~
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
To
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EfNo
❑ 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
EErNo
❑ 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
fo
❑ 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
ff No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
-C_J No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - 3 L I Date of Inspection: 11-14f
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E 1 _o ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
[ _ "o ❑ 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
EfNo ❑ 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? ❑ 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 Na ❑ 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 I3 l<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes LLJ go ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA D NE
I
Reviewer/Inspector Signature:
Page 3 of 3
Date: 12- G 146
21412015

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: Z f" Arrival Time: Y Y Departure Time: 3 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �r r
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number: _ % I- 7 S t
Certification Number:
Longitude:
Deslgn
Swine Capacity
Finish
Current
Pop.
Wet Poultry
La er
Design Current Design Current
Capacity Pop. Cattle Capacity Pop.
Dai Cow
Feeder
Non -La er
Dai Calf
o Finish '2_4 iso
'Z 5 I
Dai Heifer
o Wean
o Feeder
U
Dr: P,oult ,
Design Current
Ca aci P,a ,
D Cow
Non -Dairy
o Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharses and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ETNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
0 No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

�+PClity Number: `31 - '3 Z Date of Inspection: 12
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: �.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
E3"ko
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ONo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Rio
❑ 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
❑' q o
❑ NA
0 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
I_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
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[jNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[7f No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[]No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ONo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E3 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
6No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
F:(No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Tic-ility Number: - Date of Inspection: it 2 JZIT-
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes To ~ ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [] Yes EJ-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No []' 'AA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes 1_d'""' ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes � 1`Q ❑ NA
❑ Yes �o ❑ NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date
f� z3 it
21412015

Type of Visit: (3f Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: ((� Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 $ Arrival Time: I / S Departure Time: ® County:.' c, �J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: rv1(r.S �Z� Cr
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number:, ��-
Certification Number:
Latitude: Longitude:
Design Current
Swine C++opacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
Layer Dai Cow
Design Current
Capacity Pop.
Wean to Feeder
Nan -La er
El
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current D Cow
Dr. Poultry CaA I aci. P,o , Non -Dairy
La ers Beef Stocker
Non -Layers Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
11111
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Imaacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes [:]No
❑ Yes [� `
❑ Yes [No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

FacilityNumber: Date of Inspection: 1% I
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: coC'0-6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lys
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
ZNo
❑ 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 environmen
1 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
El Yes
o
❑ 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
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 E3/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 0
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Mo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes WNo
❑ 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 o
VN
❑ 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 FjNo
❑ 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 a 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 ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes F2/No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Z Date of Inspection: it ItZliq
24. Did 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 ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
[—]Yes dNo ❑ NA ❑ NE
❑ Yes E�J/N(q ❑ NA ❑ NE
[:]Yes WNo ❑ NA ❑ NE
❑ Yes No
❑ Yes �o
❑ Yes Ej/NO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #):,Explain any YES answers, and/or any additional recommendations.or an other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
�L 013 S sA M tP� Sh�ev�� ?�k0 Z� l of fin— �s Eat
rEcoy,nmw- 9 )q rzM, vncv4f W-11V S.4tj Ado �&1(�O1Va1y\SST,
LEHSE fi� S-y.10f d 261S Oo NJT LISE
P�6c,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
C11R ZEW r Sock
Phone(��-
Dater I
214 OI4

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Gleason for Visit: 61toutine 0 Complaint 0 Follow-up O Referral O Emergency O Other Q Denied Access
Date of Visit: j- j Arrival Timer Departure Time: County: ilhA j Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address: 1
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
ffn!5A �013
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
er
Current Design Current
Pop. Cattle Capacity Pap.
Dai Cow
Dai Calf
Wean to Feeder
HLa
Non -La er
Feeder to ! .Wish
Duo Pioultry
Layers
Design
Ca aci
Dai Heifer
C►urrent Cow
P,o Non-DaLry
Beef Stocker
Beef Feeder
Beef Brood Cow
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
ulletsI
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
KrNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
R[No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

acili Number: - Date of Inspection: M11Y
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l 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 )E!rNo ❑ 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 grNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P-No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ElYes 7No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
)KNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
T No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
VTNo
❑ 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 7
No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr4sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I ° Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VfNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes PN
❑NA ❑NE
❑ Weather Code
El Sludge Survey
❑ NA ❑ NE
o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Pacitity 'Number: - 32Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Efy"No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes .,,ZNo ❑ 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 J�!j No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 0 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 Z No ❑ NA ❑ NE
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes X5 No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes 2�No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes �No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [—]Yes VNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, comments: .
Use drawings of facility to better explain situations (use additional pages as necessary).
As
d , j R�,rD ► -- A411 610 zn .31 9
61A.1900
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: pCc1�_3 i�aa_;
Date:
21412011

Type of Visit: Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance 1
Reason for Visit: XRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access I
Date of Visit: Arrival Time: Departure Time: County�Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: {Y,4lv6
Certified Operator: � Igm GS I , /Ill
Phone:
Phone:
Integrator:
��o�
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pap.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er I
EEI
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urrent
D . P,oulh. Ca aci P,o ,
La ers
Gilts
Won -Lavers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
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?
❑ Yes �No
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[] Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Faciliumber; - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 9 No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 0)
Spillway?:
Designed Freeboard (in):� _ s
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 j] No ❑ NA [] NE
waste management or closure plan? 7�
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 10
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PfNo ❑ 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 ❑ Appliicat`ioon Outside of Approved Area
12. Crop Type(s): SC ' (= 5cL c CP) 12,e Z(.i�f
13. Soil Type(s): _ IVa9...-
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [] Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists 4❑ Design Q Maps ❑ Lease Agreements
❑ Yesfiq No ❑ NA ❑ NE
N ❑ Yes o ❑ NA ❑ NE
❑ Yes'rNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
0 Waste Application ❑ Weekly Freeboard [] Waste Analysis Q Soil Analysis Q Waste Transfers
Q Rainfall [] Stocking Q Crop Yield 0120 Minute Inspections Q Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
Page 2 of 3
o
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued
❑ Yes'rNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
0 Waste Application ❑ Weekly Freeboard [] Waste Analysis Q Soil Analysis Q Waste Transfers
Q Rainfall [] Stocking Q Crop Yield 0120 Minute Inspections Q Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
Page 2 of 3
o
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
0 Waste Application ❑ Weekly Freeboard [] Waste Analysis Q Soil Analysis Q Waste Transfers
Q Rainfall [] Stocking Q Crop Yield 0120 Minute Inspections Q Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes N
Page 2 of 3
o
❑ NA ❑ NE
Q Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facili Number: 113ate of Inspection: VU /
24.-Did the -facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes kNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
VtNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 'EANo
❑ 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
❑ YesNo
V']
❑ 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 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.,
Use drawings of facility to better explain situations (use additional pages as necessary).
P -
1
0
D.3
).
�� jr5�fi
1.q
1-C�
19
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: CIO
Date: (�U
21412011

I)i'visiou of Water Quality
F�Cility Number � - * Division of Soil and Water Conservation
Other Agy
Type of Visit: WCompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: IM^�`I + I Arrival Time: Departure Time: County: U/1i Region:
Farm Name: ��(�;� �C 1/A/ C (41& Owner Email: `
Owner Name: Phone: `C—%9
Mailing Address: 1Sa J"rOC_y_- J %VC E Pt� V'C\ VcSc C`11 LL Nc, D3 ` x sy& S
Physical Address:
Facility Contact:
Title:
Onsite Representative: (,2Q_C� 1 !—�xlC�
)L
Certified Operator: G S __ V- %y �
Back-up Operator:
Phone:
Irate r��ator:
Certificati In Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
apacity Pop.
Finish
7Eeedertto
Design Current
Wet Poultry Capacity Pop.
La er
Design C*urrent
Dai Cow
Feeder
Non -La er
Dai Calf
Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I)i, P�ouI C•_a aci P,o ,
Layers
Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turke s
Turke Poults
Other
Beef Brood Cow
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ['k, ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 14 No ❑ NA ❑ NE
❑ Yes §&No ❑ NA ❑ NE
Page I of 3
l
21412011 Continued

Facility Number: -3 jDate of Inspection: /4
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 7❑� No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I QC
Spillway?:
Designed Freeboard (in): j? . S l q. S
Observed Freeboard (in): t-1 ! Ll 14
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 121 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [)(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window�j ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): SL—(Z 01 l Y E (- C P—) c5�f--, 6a5 C C.-, E ( P)
13. Soil Type(s):
L
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
VY
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
90 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
KNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
k No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
V No
❑ NA
❑ NE
the appropriate box.
�T
QWUP []Checklists []Design Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
XNo
❑ NA
FINE
Waste Application 0 Weekly Freeboard [D Waste Analysis Q Soil Analysis
Q Waste Transfers
E] Weather Code
0 Rainfall Q StockingE] Crop Yield Q 120 Minute Inspections E] Monthly and V Rainfall Inspections
[] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 1 - j Date of Inspection: /
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes No )ANA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes IX No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 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
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any; other comments «:
Use drawings of facility to better explain situations (use additional pages as necessary).,n
(v
yy
8 L l�Q.i7 j 1CW C�� o� 13 PAS
f �p coN`�'O� /N
C�-� f Flu � �!
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
21412011

Type of Visit `Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit -Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival _I�
Time: ®c— Departure Time: � County: a Al Region:
�
Farm Name: _S@cnes f� l JY Ei aM _ Owner Email: n n
Owner Name: _ .�A &X G � lC 11V Cj p
Phone: J) b ` aT - �d
Mailing Address: h Sd 'S-7oc)iAjC I c-p i?j—A E0SQ___ R ILL ivc Dgys9' 56S
Physical Address:
Facility Contact: / Title: �7 Phone No:
Onsite Representative: "��7A�y�— Integrator:
AtgM_CS P 1��N C G10
Certified Operator: i Opera%r Certification Number: f C93,45
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o= I 0 11 Longitude: = o= 4= u
Design Ourrent
Swine C**opacity Population
Wet Poultry
Design
Oapacity
Current
Population
Design
C►attle Cfft—)a c i t:yj
Current
Population
❑ Wean to Finish
JE1 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
Feeder to Finish I rQ L490
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Layers
❑ Dry Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Farrow to Finish
El Stocker
❑ Gilts
❑ Boars
Other
❑ Other
❑ Non-LayNetsets ers
❑Pull
Li Turkeys
❑ Turkey Poults
ID Other
ElBeef Feeder
El
I
I
❑Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 OkNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
❑NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
)dNo
❑ NA
❑ NE
12128104 Continued

Fadlity Npmber: Date of Inspection of 0
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X
No[INA [INE
a. if yes, is waste level into the structural freeboard? [IYes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: p
Designed Freeboard (in):
Observed Freeboard (in): Ly
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) r
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 rest, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA El is
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ N
(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 ❑ N
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ N
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P.No ❑ NA ❑ N
❑ 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
E
E
E
E
E
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes )0No
❑ 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 to
o
[I NA
El NE
18.
Is there a lack of properly operating waste application equipment?
[I Yes
❑ NA
❑ NE
'.Comments (refer to question Explain any. YES answers and/or any recommendations or any other comments �.:
Use drawings of facility tonhetter:explain situations. (use additional pages as necessary): ; A
Reviewer/inspector Name Phone: 920-49(p
Reviewer/Inspector Signature: Date: g%�%/�
Page 2 of 3
12128104 Continued

Facility number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A140
❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El X
NEl NA El NE
ElElthe appropriate box. WUP Checklists Design El Maps [I Other 21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis Q Waste Transfers ❑ >44ual Certification
0 Rainfall El Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
TkNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L)(! No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
❑ NA
❑ NE
Additional Comments and/or Drawings: s'
aOC_-�-
CA(1L6Q_gTK_W �)uao 1 l
Page 3 of 3 12128104

x. 4
Facility.Number 3� 1
1.Id
IType of Visit §kCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Z Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: v Arrival Time: ®�^ Departure Time: County: L�� Region:
Farm Name: ')Arr1r_-5 Crr_ �C�6 t��m Owner Email:
Owner Name: �m e5 1`. KIN 6 Phone: ►r''3 Cod 9
Mailing Address: 1� 1 ocr w ep Is E ice{ 1 LL , NC _'R 5 (D
Physical Address:
Facility Contact: Title: Phone No:
j(
Onsite Representative: �_ y\ o
Certified Operator: m (—� _ K-t IV 6
Back-up Operator:
Location of Farm:
Latitude: E__1 o
Design ',Current yDes�g
-Swine ,. ,Capacity Population:4VetPoultry� Capac
;_ ❑ Wean to Finish ❑ Layer
❑ Wean to Feeder F ❑ Non -Layer
Feeder to Finish a
El Farrow to Wean -Dry Poultryn
❑Farrow to Feeder I x.
❑ Farrow to Finish
❑ Gilts I
I'=
�- ❑ Boars
Other =
❑ Other
Integrator:
Operator Certification Number:
Back-up Certification Number:
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
« Longitude: E:j o =' =
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
0No
El NA
El NE
❑ Yes � No ❑ NA ❑ NE
12128104 Continued

11
Facility Number:"3 j --.0 1 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): q. - ,
Observed Freeboard (in): CJ�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [3NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ 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 0 No ❑ NA ❑ NE
maintenance/improvement?
l l .
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
A 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
e'of Wind Dri/
❑ Outside of Acceptable Crop❑ EvidencDrift Application OutsideofArea
12.
�Window'
[❑
c r
Crop type(s) J e, ]Ee SCL4_F_ oql
13.
Soil type(s) No" a,K_
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
�A(No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
to 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
ti.. � ., •v._ -..---.^^�-- ✓
°Comsients (refer•to q._.uestion-#): tip Wn,'any YES:answers and/or any recommendations or.''anyfother c©tnmentsg
'Use drawrngs of facility to betterexplain_ situations. (use additional pages as necessary)i
3II91oq �.� 3•�
Reviewer/Inspector Name S Phone: 3�
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
XNo
❑ NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No
❑ NA
El NE
the appropirate box. ❑ WUP 0 Checklists Design 0 Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
P(No
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ )Inual
Certification
[] Rainfall El Stocking FA Crop Yield El 120 Minute Inspections 0 Monthly and I"
Rain Inspections 0 Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
XNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
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
No
❑ NA
El
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
K
ElNA
ElNE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
kNo
El NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9,No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number
*0 Division of Water Quality
Q Diyision of Soil and Water Conservation
O Other Agency
Type of Visit
Compliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
y[.7lRoutine O Complaint
O hollow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: /y Region:
Farm Name:
Owner Email:
Owner Name: 1�� N� 1 Al Cal Phone:
Mailing Address:
Physical Address:
Facility Contact: r Title:
Onsite Representative:��-
Certified Operator: �iq f Y)�
Back-up Operator:
Location of Farm:
Swine...El Wean Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other.
❑ Other
Phone No:
Integrator:
Operator Certification Number: F ��
Back-up Certification Number:
Latitude: 0 0 = 4 = Longitude: = o = A = 4i
Design Current Design Current Design
Capacity Population ,.Wet Poultry Capacity Population. Cattle Capacity Pi
❑ Layer
dR ❑ Non -La er
I Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
El :key Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
rra�
DairyCalf
FDairyCow
DairyHeifer
D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
i
Number of Structures-',,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�eNo
❑ NA
❑ NE
❑ Yes
ANo
Cl NA
❑ NE
12128104 Continued

i
i
Facility N;m�ber: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes X] 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: -tT 1
Spillway?: Q
Designed Freeboard (in):
Observed Freeboard (in): L
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 X 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 gNo ❑ 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 O(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes 0No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or to 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
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
0� 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 orany other" comments:`
Use drawings of facility to better explain situations. (use additional pages as necessary):
C<2)7q31j4uC w0(0c14G ON of _OS►oN C)I/ 4rcl
LReviewer/Inspector
er/Inspector Name ( Phone: Signature: Date: Q
Page 2 of 3 12128104 Continued

e
Facility Dumber: — l Date of Inspection L
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WIJP ❑Checklists El Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
F;�_No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
%No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[NJ No
❑ NA
❑ 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
O(No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes , No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes A�No ❑ NA ❑ NE
Paige 3 of 3 12/28/04

`i Lad
_Division of Water Quality
lity Number 0 Division of Soil and Water Conservation
0 Other Agency
Fy
pe ofVisit Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ason for Visit d Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t 0 alto E Arrival Time: o Departure Time: County: CN-114AJ — Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: = o = 6 Longitude: = ° = I = u
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
© Feeder to Finish tab
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischames & 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 Stocket
❑ Beef Feeder
El 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 LT/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[2 No
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
12128104 Continued

r Facility Number: 31 -3ak
Date of Inspection :o o
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: LAC mug) 1 L A (7ob r.r Z
Spillway?:
Designed Freeboard (in): -
Observed Freeboard (in): (0 3 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 0No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalat, 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 L2 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 (<,.l No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 N ❑ NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s) of
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
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
D<. ❑ NA ❑ NE
ElNA ElNE
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: ( ck �g 6�
Reviewer/Inspector Signature: Date: 6 7�c. b-1
12128104 Continued

S
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
Facility Number: -j t -3 Za I 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 appropiate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
IZ
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
L7�ZNj
❑ NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
ElNA
❑ NE
2b.
Did the facility fail to have an actively certified operator in charge?
ElYes
L�' o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Elo<o ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
B<o ❑ 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
QNo ❑ 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! No ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[2<o ❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
dNo ❑ NA
❑ NE
Comments and/or Drawings:
12128104

Type of Visit20utine
Hance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival Time: �] �% Departure Time: County: Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c= g= ie Longitude: 00
0 g a
gl
■
Design Current Design C«urrent Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish I I IE] Layer ❑ Dairy Cow
❑ Wean to Feeder
I JEJ Non -Layer I
I
❑ Dairy Calf
® Feeder to Finish
❑ Dairy Heifer
❑ Narrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Cowl
El Turkeys
Other
❑ Turkey Poults
I ❑ Other
I umber of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes f /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
No
El Yes
�❑
L(No
❑ NA
❑ NE
❑ Yes B No ❑ NA ❑ NE
12128104 Continued

Facility umber: — Date of Inspection a ti
W^,?ste 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: LA 6 asN 1 LAL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ��J 3V
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes P o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaltthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E "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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LQ No ❑ NA Cl NE
maintenancelimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 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) i W E L P) S �d
13. Soil type(s) N a e Na A
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
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? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
MNo [I NA ❑NE
WNo ❑ NA ❑ NE
o ❑ NA ❑ NE
No ❑ NA El NE
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): .
rA4 aNp 1ZCC.ott.oS C,a�1C_ (,ra o,r% 1 •
Reviewer/Inspector Name N�A g p&LL, � — Phone: qj C — 7 3��
Reviewer/InspectorSignature: Date: At 10G
pnao 7 nr7 7111910d d'nnli#tnad

Facifily Number: Date of Inspection t� G
required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Zf No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9 No ❑ NA ❑ NE
the appropriate box. ❑ VPJp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0"No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ErNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L'1 No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes[!I'No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[��(NNo
[I NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
EK.
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[Z NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
B No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LiNo
❑ 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
E 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
EllT Yes
,�/
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
N
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
[I]
7
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation
Reason for Visit 9rRoutine O Complaint O Follow up O Referral O Emergency
Date of Visit: %d / Arrival Time: � Departure Time: nty:
Farm Name: �!� m FS Owner Email:
1
Owner Name: om Phone:
Mailing Address:
Physical Address:
O Technical Assistance
Q Other ❑ Denied Access
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: _d!�T�,6
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
Operator Certification Number:
Back-up Certification Number:
Region: -A490
Latitude: = o = I = Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
r I - ❑ Non -La ei j
Other
❑ Other
Dry Poultry
Non-L
Pullets
Poults
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
I
❑ Dairy Heifej
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
IN
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Eil
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 ;9 No ❑ NA ❑ NE
[]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
/No
❑ NA
❑ NE
12128104 Continued

t
! �r
Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure ? Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �/f �
Spillway?: L�O
Designed Freeboard (in): ZZX
Observed Freeboard (in): 35
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
0
ElNA
ElNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElYes No
X
❑ 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 > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evi a of 'nd Drift ❑ Application Outside of Area,, `
l2. Crop type(s) XJ�/t' M0f- f !�'�i/ } ��R!}z+s 1 SAU9�c iJ7 Zip ��✓F—�•5 p
13. Soil type(s)
/
Do the receiving crops differ from those designated in the CAWMP?
A14.
❑ Yes No
❑ NA
[I NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes XNo
❑ 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 ZNo
❑ NA
❑ NE
�) Z//��,7 ��L /'S f it��GI2T S/%uJ•� 0 21x'1G[Q�j��Ei 5/'ll`.f�O�i✓�.
tlr�
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: /O
12128104 Continued

r
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 No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
y Yes El No
❑ NA
El NE
El Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking Crop Yield r 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes VN o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
No
❑ Yes 0.No
El NA
El NE
24_
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes �No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes /15No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
gfNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
IL1 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an. on -site representative?
❑ Yes
["No
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
/A No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Ool�Cf�700,rJ,
rp (.eep �z �� cow 05 X"F__ Ay
A�1177 IPMIX 5 A40A)•
12128104

Type of Visit (' Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit O/Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
acility Number Date of Visit: t Time: da
Q Not Operational Q Below Threshold
Permitted Certified [3 Conditionally Certified © Registered Date Last Operated or AboveThreshold:
Farm Name: ..... rTES..... C:.......K-261....... f.................................. County: ........ (D1AO................. _... ...._...._.............
OwnerName:...... _ ...:........... .................. ........ ...... _................... ................. Phone No: ... ....._............. ............... ........................................
Mailing Address:.. _.. _.....
Facilitv Contact: .......r. rw. _.... _�n.W W... Title:.. ....._... ......_....W.. W .. �7Phone No: ..�...... . _ ...........
Onsite Representative: (9 m e..i _ JF ✓ k� G Integrator: f.,.
Certified Operator: ................................. . . ..... . . .....
lAwation of Farm:
Operator Certification Number: .... .................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 64 Longitude • 1 49
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes o
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)
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 it Z
❑ Yes ❑ No
❑ Yes Q No
❑ Yes Eff o
❑ Yes
Structure b
_........ •-...... .................I......... ..... -•-........
Freeboard (inches): 3
12112103 Continued

Facility Number: — Z Date of Inspection
4.
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes ❑ o
seepage, etc.) i
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes [( N
closure plan?
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes QNo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes Leo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑Yes o
elevation markings?
Waste Application �
10. Are there any buffers that need maintenancermprovement? El Yes 2rN
11, Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes L o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type E GE9460PA S 6
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes C640
14. a) Does the facility lack adequate acreage for land application? ❑.Yes ;;��
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑ Yes L�'No
15. Does the receiving crop need improvement? ❑ Yes Leo
16. Is there a lack of adequate waste application equipment? ❑ Yes ro
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes ffNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 0
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
�Gomtts'{rclerta�,qurst�on:#j aayYFS.:a�versaacl/or�ay,-�..-�.ori�yoffi�M� _ ,:��'`� „`
$Use dras f 13ityto`b ttesar�matiot�s. (tee sddib Pages �} ❑Fuld ❑ Fina!
,
.m py � ores
CA
Revieweranspector Name
ReviewerAW Spector Signature: Date: Ell 16

Facility Number: 3 -
Date of Inspection
gMuired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W1JP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iet discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
YPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes No
❑ Yes
❑ Yes JNo
❑ Yes 6/3
❑ Yes [2rNo
❑ Yes W'No
❑ Yes ago
❑ Yes [ N
El Yes [YNo
❑ Yes QNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112fl3

Type of Visit 0 Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit 10Routine 0 Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
Facility Plumber
Date of Visit: Time:
�
Not O erational Below Threshold
Permitted 0 Certified ©Conditionally Certified D Registered Date Last Operate or Above Threshold:
Farm Name: A � F S G" (Zm County: pLyN
Owner Name: \ACES 2{�'rf _ Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: �C�fnel7 Integrator: �5 e
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 ' OK Longitude �4
Wean to Feeder
JLJ Layer
IU
D
Feeder to Finish
s% ❑ Non -Layer
I❑
N
Farrow to Wean
Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Cap
Gilts
Boars
Total S
No Liauid Waste
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Laizoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in galimin?
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 I Structure 2 Structure 3 Structure 4 Structure 5
identifier: #-,;( 4Z _
Freeboard (inches): 32 Z
05103101
❑ Yes 0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes [Z No
Structure 6
Continued

Facility Number: 3 —321 Date of Inspection �Y/O A I
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
1. Is there evidence of over application? Q Excessive Ponding 0 PAN ❑ Hydraulic Overload
12. Crop type �� r E.'SCu E (,=-K�z� 1. J m
13. Do the receiving crops differ with those designated to the Certified Animal Waste Management Plan (CA"
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 or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes [6 No
❑ Yes &No
❑ Yes [INo
❑ Yes 0No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VrNo
❑ Yes ONo
❑ Yes ONo
❑ Yes R�No
❑ Yes J' No
❑ Yes JO No
❑ Yes ,TNo
❑ Yes 2No
❑ Yes 0No
❑ Yes OrNo
❑ Yes 1� No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
Comments(refer to question?#I) _Explatn"any YES answerssand/vr an recomm ©d'attonsor any ©ther,�co�nments;
s
., ;
Use drawings of facipty to better explain sstvahons .(use addihonal pages as„necessary) ' ❑ Field Copy ❑ Final Notes
/�//T � /CJFF/�' �� I%Y%LJbD � �,t✓
�O/11 PL�/�n1�� � St�.E�' TtON
d^j 312o f02.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
05103101 Continued

•
Facility Number: 5 / — Date of InspectionLl�C1 cI f iJ
Odor JnM
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fanblade(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 10 No
❑ Yes VNo
❑ Yes VNo
❑ Yes VNo
❑ Yes F No
❑ Yes 1�rNo
❑ Yes ❑ No
Additional Comments=and/or=Drawings:. A.
05103101

r
Type of Visit JDICompliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit Routine O Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I
Date of Visit:
Permitted [3 Certified © Conditionally Certified [3 Registered
Farm Name:
Owner Name:
Mailing Address:
Time: 1 �/
Date Last Operated or Above Threshold:
County D wEl,'nif
-
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: K k ' — Integrator: Pre `S
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude ' ° 0" Longitude ' 4
Design
Swine Ca achy
❑ Wean to Feeder
Current Design Current Design Current
P,o uli tion Poultry Ca achy P,o ulation Cattle Ca achy P,o ulatioa
❑ Layer I I i
❑ Feeder to Finish
❑ Non -Laver n-Dairy
❑ Other
Total Design Capacity
Total SSLW
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons 0
Holding Ponds /Solid Traps
❑ Spray Field Area
❑Subsurface Drains Present ❑ Lagoon Area
_— —
❑ No Liquid Waste Management System
Discharues & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: l 2-
Freeboard (inches): Zg 3q
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
gNo
,Yes
❑ No
❑ Yes ONO
Structure 6
Continued

Facility Number: 3 1 — 3 Z 1 Date of Inspection Z Z-
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes XNO
❑ YesXNo
,0Yes ❑ No
❑ Yes ONO
❑ Yes [2"No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Po//n��++ding El PAN ❑ Hydraulic Overload [I Yes JZNo
12. Crop type r� V G(ct Oi `1 , �$.M, 9 l7 Fes 1, V e 19Cks vtv) 104j�elf.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? Yes ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ZNo
Required Records &Documents
eNo
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
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)
OYes
❑ 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
�XNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
X'o
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
ElYes
ONO
24.
Does facility require a follow-up visit by same agency?
ElYes
0No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ YesXNo
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
11
Comments (refer to;questi©it #}: Ezpfain anyYES answers and/or any recommendattons;or any other "eomments:.
Use drawings of faciltty.to better explain situations. (use addidofiApages as necessary) - r [j Field Copy Final Notes
�❑
R ,, 1..10-4 e ofrq,: -In oVe s' 4 }%4P ceiv t-'eeOl ; ^t Ares A►ia(
lr 'Sell et . ' j F o A s 4 ,r-evr ^i twee ►n f; e 1d1 S n d 6 A ), 4e
V►C1y1I44'r crossiOtt -pE,✓1-� e� 4'lie T,rriGliaioh 1'.1e. ThiJ
;�-F�
In ff ¢ A rf 4D b e CA er 1 e\J � a I I v -� a �s �'� �a�-t `� � ate �e� ; �� �, yea
�-Ae s---eA^,\ . %o1n heeW -'0 Co;. h47
oiSs;_c4Ahee i,xp 10M-0)j4;,'t5 So:i, e 13Y1PIS In FS a"A
ReviiewertInspector Name Q1�✓ot �� t;'J
Reviewer/Inspector Signature: Date: ZD D
05103101 Continued

t
Facility Number: 3 / — Date of inspection 3 20 Q
O or Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
24. 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 i'No
[:]Yes -2rNo
❑ Yes 2rNo
❑ Yes f 'No
❑ Yes P!rNo
❑ Yes fNo
❑ Yes ❑ No
.Additional -Comments andlor.Drawiugs
re Lave 4 e-ee-S � Sll � v S J GYtA iro,- ve,5elo, II 51'Z�+"L�►�'�
t �I
A[oL;- aCldr�dHhce w;411
�
ech 5oodev';ne 5 Krae4;ces-
�r0+"'1 Cewn-1 114Ve
/i
V1 ou � i OL l re
y so 1 w��er Dff G�
,.-a1Per dD LvAtie n 4a4 i l5 i, s; � ned 6y y vg11 f l nd
-1AR4 rerkGvl/ Lva3 elcne wraker1j,
1 S. .S.-me c1-re As ee1ie S'4u, otC -Az 5-Gve.
impwaved . -rc,;-a.11;17 -/lie s)4e 6-F.'estvf Fends
r�. �ee. �4CUm2n�aT��Y-, G[+bed-� S�✓vl.yt••� OVCY' W-'%4ert\/4
!
ow #iewt� MeeveA laved in f` r,!A
lR - $ e s "re �o use a 1'v4s pia � I
da s O- qff h(A4i47n everOS 4,o G:'ijCV ��1 �?►'Irv%}e�1 Al4j%�j�G�
y
4e 11S. A)"Ot 4e, reed l c.v 1 eke u;'n"n eiff ` c-44i Oh.S
crv�
i iN -2-002 crt She S,ngll Cf�GS ►'� Fes+;ye l"t t,[orAr��C w%-��r`>�►J
noted �j'irs issv-e /40 ye�f
Other'-�-ha,� nneo et b0YP, ) -)he �ae�%���� Gfio�s� Anal
�Pj0e.S'01' ne'14by kef�.
05103101

�• .Drvisron of Water QFiahty -
j
_ x Divisioii of Soil_and Water_ CgnsPrvatior w�
r ip Other Agency_ --
Type of Visit Compliance inspection Q Operation Review O Lagoon Evaluation
Reason for Visit -013outine Q Complaint Q Follow up Q Emergency Notification O Other I] Denied Access
Facility Number
Date of Visit: [
3 ( Z D
Permitted [] Certified [3 Conditionally Certified © Registered
—' 1 of
Farm Name: 4'� 5'["10 h GCS !.. e�
Owner Name: .. l�l• }�w}'} ....u4t�p=
D1 Tune: �S Printed on: 7/21/2000
Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
'
County: ....... if ---- ..............................................................
Phone No:
FacilityContact: .............................................................................. Title: ...--........................................................... Phone No:
MailingAddress:................................1y....,..."''� ...........](�jC� .....................-...-..............-..............................--.-................--.......-...-.....c..l...-....-.-......-.................-..........................
t�Dna`! .
Onsite Representative: ! �9-ti a.jI-P Q r Integrator:,
Certified Operator: ............................ ...................... ....J .....-............ Operator Certification Number: .......................... .
Location of Farm:
ine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 « Longitude ' 4 44
Design Current Design Current Design . Current
x Swine . Ca Po ilatiiaiCa, Po Poultry Cattle
=' Wean to Feeder ❑Layer I ❑Dairy
r:
er to Finish 3 D ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder
❑ Other
='•3r Farrow to Finish Total Design Capacity
?f` Gilts
W
Boars Total SSLW
Subsurface Drains Present ❑Lag-m Ares JE3 Spray Field Area
t= Hotding� Ponds /itd Traps - No Liquid Waste Management System
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon ElSpray Field ❑ Other
a. If discharge is observed, was the convevance man-made?
b. If discharge is observed, did it reach Water of the State`? (If yes, notify DWQ)
c. If discharge is observed- what is the estimated flow in galhnin?
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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:........_.....r_...................................................... -......-..._-...-......................................................
Freeboard (inches): 31 j
5100
❑ Yes &No
❑ Yes No
❑ Yes�No
-)'1 I Cl
❑ Yeslff]No
❑ Yes IdNo
❑ Yes,/EfNo
❑ Yes/ No
Structure 6
Continued on back

Facility -Number: 31 —� Date of Inspection r7/ Printed on: 7/21/2000
r: Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes N0
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 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 ge f rh u 4_6n�"OIYY(Z 0 LJ"'1�2 f7nV,
13. Do the receiving crops differ with those designated in the Certified Animal W.
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?
,rYt,_<6V,bo-"Kg
Management Plan (CAWMP)?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel 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?
0;10 violafions;oi• ftrjcieu6e5 vtre itofea during this:visit; Yon -it eegive Rio further
coriesp6ideik e: about this visit.:
❑ Yes�No
❑ Yes '13No
❑ Yes TNo
❑ Yes No
El Yes /'IF-eNo
❑ Yes ZdNo
❑ Yes 0"No
❑ Yes FrNo
❑ Yes 'M
❑ Yes "❑ o
❑ Yes �o
❑ Yes &No
❑ Yes A!fNo
❑ Yes )ago
❑ Yes To
❑ Yes T1V❑-t10
❑ Yes o
❑ Yes 3<0
❑ Yes ,Ll No
❑ Yes�No
4ve we 11 kef4 • 1 here >'s av)- t J
�x c¢11 Q (�e,,114 -t �fi�� �(, Be- s V r P a L � se a L✓� s� ea �1��7 � y
yvri�v) 60 dA?s llDr,,,� !. 1
Reviewer/Inspector Name
Reviewer/Inspector Signature: 1t�� , Date: _5Z '5-O / 5/00

FacilitjiNumber: Date of inspection 25 O% Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 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 J2'go
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yeso
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑Yeso
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.) ❑ Ye�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 ❑ No
i,ona omments and/orDrawings:
AJ
J
5100

+"MV i6n of Water Quality
.0 Division of Soil and Watei Conservatton ' -
;.
x
Type of Visit . f Gompliance Inspection. Q Operation Review p Lagoon Evaluation
Reason for Visit ,QfRoutine 0 Complaint Q Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit-.
31 Z l
0 Permitted [3 Certified © Conditionally Certified E3 Registered
Farm Name: ......... i?1.' '`L' s .............................
Owner Name: ...........5.1...s3......................re ......
.......�........ .
Facility Contact: .............................................................................. Title:
s�Time: Q D Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County:....!..!.......................................................
PhoneNo:.......................................................................................
....................... Phone Nio:...................................................
1YailingAddress:....................................................................................................................................................................... ............
.............CC..,.,.J............... ll
Onsite Representative:G.•t�...l�....^�j�i i r�'Jr!. Integrator:,,%
...............
Certified Operator:....................................................... Operator Certification Number: ..
Location 'of Farm:
Rrswine ❑ Poultry ❑ Cattle ❑ Horse Latitude e 6 44 Longitude • 6 «
Design
Current Design Current Des" Curremt
Ca
Pop Motion Poultry Capacity Po elation Cattle. Ca . Po lion
r Wean to Feeder
❑ Layer ❑ Dairy
Feeder to Finish Z
❑ Non -Layer L I❑ Non -Dairy
Farrow to Wean
_`-
= Farrow to Feeder
❑Other
Farrow to Finish
Total Design Capacity
Gilts
Boars
Total-SSLW
Subsurface Drains Present La non
A...rea JE1 Spray Field Area -
-Hohdmg 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 man-made?
b. if discharge is observed. did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed. what is the estimated flow in gaUmin`?
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
Stru-tune l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .................................................. Z......................................
Freeboard (inches): q T
5/00
❑ Yes VNa
❑ Yes No
El Yes /�No
}1 /4
❑ Yes X No
❑ YesXNo
❑ Yes )xNo
❑ Yes NO
Structure 6
Continued on back

Facility Number: 3 —3z 1 Date of inspection % 10 Printed on: 7/21/2000
S` Are there any immediate threats to the integrity of any of the structures observe ? lie/ trees, severe erosion, ❑ yesI'PINo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes XNo
(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? Cl YesXNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? Cl Yes ❑'�Io
Waste Application /
10_ Are there any buffers that need maintenance/improvement? ❑ Yes�No
11. Is there evidence of over application? ❑/Excessive Ponding ❑ PAN ❑ Hydraulic Overload a_ `1 /+❑ Yes �No
12. Crop type Fist, re, TA'sI 'V f",r vlvp(Oi Te;*0 rC , FerP .Vok AL�� 1jrsift
I3. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP) 7 ❑ Yes)�No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes XNo
b) Does the facility need a wettable acre determination? ❑ Yes 10"No
c) This facility is pended for a wettable acre determination? ❑ Yes XNo
15. Does the receiving crop need improvement? ❑ Yes fi�'No
16. Is there a lack of adequate waste application equipment? ❑ Yes 1VfN0
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? C
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ,rNo
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes O'No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑Yes )ZI
23. Did Reviewer/] n spector fail to discuss review/inspection with on -site representative? ❑ Yes fi!rNo
24. Does facility require a follow-up visit by same agency? ❑ Yes 'Pilo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes )YNo
0: 10 yioiafiQris or defegenues •were noted ding this ...
visit: Yoh will reeeipe Rio i'ui-ther. :
correspondence: about: this visit:...... .
Be sv ce la Ilse A &Vg54e- R nci t s; s domed w��►'� 6p d� y9 �6'
cZ,pp�i CG►=jt0P1 a e_al44e���—Z'�
�S 1lP�if 1� 1 "�,e 40 �,�r/�S w��`c� ✓ej v%� 1. �ah pr r"a/'e 0-f, •ne rtcin2Z'
well kell .
Reviewer/Inspector Name '
Reviewer/Inspector Signature: Date:
5/00

Facility. Number: — 5n) Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 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'IgNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes '0 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 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 ONO
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
5100

a
x D>v4s�on of Soil and Water,
Ihvtsron of Water Quality"-
. DOther Agency -"Operation=]
e O Comolaint O Follow-up of DWO insoi
Facility Number
_ C..:
of DSWC review O Other
Date of Inspection
F Time of Inspection UJ, /VJ 24 hr. (hh:mm)
Permitted 0 Certified E3 Conditionally Certified Registered 113 Not Operational D21,) e Last Operated:
''�✓ v►�- County.- ............... }
Farm Name: .................. ... ................. IMW ............. F � _ •..-.-.-.-........... ...L�....4.�1'�......................
......
OwnerName �'! ......... in .. ......................... ...................... Phone No:.......................................................................................
Facility Contact: ...:. .....Title �� Phone No:
MailingAddress: .........................................................................................................
Onsite Representative:....
[ f..........................................
...........
CertifiedOperator :..... <.�......................:..........:[........... ...........................
Location of Farm:
........................................ ... .. .........................,
Integrator: ............... YS `L- ....
`e ...............
Operator Certification Number:
Latitude • ° 44 Longitude 0 4 «
Srvirte ,_
Design 'Current-
Canacity. Population
❑ Wean to Feeder
[Feeder to Finish
Zt{ p
❑ Farrow to Wean
!
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity 'Population Cattle Capacity°Po-ulation
❑ Layer I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total'Design Capacity:
-Total-SSLW
Number of Lagoons ❑ Subsurface Drains Present JE1 Lagoon Area JEJ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
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 gal/min? —
d. Does discharge bypass a lagoon system'? (If ycs, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E<No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes P(No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: -0�1 r f� 7—
Freeboard(inches): Lt 3 k s.................................................... .......................................................... ....................................................-.._.............................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
3/23/99 Continued on back

3
Printed on: 7/21/2000
Facility Number: — Uate of Inspcctio:t "ved?
5. Are there any immediate threats to the integrity of any of the structures oees, severe erosion,
❑ Yes
[3�4o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
allo
(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
r4-
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0.,No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
5[ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
WNo
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
0�'No
is facility is pended for a wettable acre determination?
❑ Yes
�o
5. the receiving crop need improvement?
:thsere
❑ Yes
�No
16. Is a lack of adequate waste application equipment?
❑ Yes
JRNo
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9�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
,kTNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JKNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
�o
Oe/ discharge, freeboard problems, over application)
El
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
RLNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
RTTo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
0: 1o.- iWhiioris:or- &flcienctes were noted during this visit: • Y:ou will•receive fio further;
correspondence. about. this .visit
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better e�xp_Un situations. (use additional pages as necessary):AL
j
}j��y • i�l� S t��c>�i .�g� �- G3��4�-iT7?jv�a.JC � � L.✓-r �j vV+�J-F t/wr'.
Lk.bb
qD°10 cow-�e^ C- t. `- _ .-��'�� J , r -Po%+ �_ al t
v �!V � `"(`� _
t� t AS A\A k O OLS 0,h6 we Vt JA/\AA^ Q_tA_.2(_ --f rk.�
Reviewer/Inspector Name ( re e.., W1 L
Reviewer/Inspector Signature: e�
Date:

1
Facility Number: Date o1' Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Es- ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yesio
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 f 4'No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes q<No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 6a No
3/23/99

Facility Number Date of Inspection , 11 V_
Time of Inspection l 24 hr. (hh:mm)
19 Permitted 0 Certified Q Conditionally Certified © Registered IIJ Not O eratiorna��l Date Last Operated:
Farm Name: U—A M tS E e k pl l Fa r rrt County:._ 1 q p �..........................................................
Owner Name:................�.'� G�� Phone No:
Facility Contact: ........................................... .. Title.............................. Phone No:........
'flailing Address: .............
Onsite Representative: cr&mGS a►r'r" �� Integrator:,,,
�!?!7..?t.. ............... ......... ......I ..
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
...................................................................
Latitude Longitude �• ��� ���
;S.wine;.
Wean to Feed
Design Current
Canacity Population
❑ er
Feeder to Finish
24-S O
Zi4 dO
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
�NuntiberWof Lagoons ❑ Subsurface Drains Present 11FILaeoonArea ILI Spray Field Area
.�Holdtng'ld & I Solid Traps ❑ No Liquid Waste Management System
m ..>
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes CgNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance loan -made`? ❑ Yes 9 No
h, 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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ) `b - 3 4 5-
Freeboard(inches): ......... ........... ..........Z 3.............................................................................I..... ..........................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes
0 No
na
❑ Yes
EffNo
❑ Yes
1Z No
❑ Yes
O No
❑ Yes A No
Structure 6
❑ Yes 0 No
Continued on back

Facility Number: —3 Z Date of Inspection
6; Ard there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes Q,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 E9 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? [:]Yes 29 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 15No
Waste Antilication
I0.
Are there any buffers that need maintenance/improvement?
❑ Yes
,KNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑pp PAN
Yes
❑
SNo
12.
`
Crop type Cie/*mvd4 GC,-'tU&Ii4SulC'/re,5Cue�f344,reIJr�t4[�
f
t�fR►'-.
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
9 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
9No
b) Does the facility need a wettable acre determination?
❑ Yes
® No
c) This facility is pended for a wettable acre determination?
❑ Yes
21No
15.
Does the receiving crop need improvement?
Styes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
$f No
Reguired 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
jffNo
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 DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
KNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
54 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
.9 No
0; Nd.vi9laodiis;or• deficiencies •*ere noted• during this;visit: - You :will -receive Rio; further
correspondence abaut. this .visit_ ... ..
Comments {refe_" question #): _-Explainany YES answers -and/or an recommendations nr-any oilier commenis:
Use drawings of facility to•hetter explatn:sttuationsx (use additional' pages as necessary) - -
�q . ,
fS, Fesc.Ve s*vr,r (d 7 �'lac�
s Io-�- � clover o
I lLt d t.
wo✓ -- +C' e. -4 tAn - e57r.V42 aVe✓ r,o,t4o bey' t,dc�
(Field �A cow~vi teetftudg-K.^oAoc,t.+- �e��-�-a
e _4,mU sl , Go�S�g1 � •'Yt,t1d5 �Vp�' L"��'�c .� Z .
ZT, �—FL,+U re '/ S ; i- M y Y? ¢ ¢ dC d '�v pj� f ►'tit rt e l SDrv��
4Y•CedS Strain jA Le,%�2rhdtJe �,ro�r+1 �q� vow •Ael- 1'Jo:.tse5 !
- �q /�-► S r-�e � � t =1, a A� Go s?� i -�-► ah at r1Ot •��Ji� nit � S L,� j� �.9 ✓z
Reviewer/Inspector Name r [ //�A
Reviewer/Inspector Signature: Dater
3123/99

Facility Number-._?-3z J Cate of lnsprction 1
[1'e#or Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes % No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes WrNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 24 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 5jENo
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 JKNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes IffNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
3/23/99

i It
� I 'RAI"" zg❑ Division of Soil and Water Conservation 0 Other Agency
x
. Division of Water Quality
KRoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
1 � I�Y91
Facility Number
Registered ItCertified AApplied for Permit 13 Permitted
FarmName:. ........................ ``'....................................................
Owner Name: ....... ....� ��........................... ......
Date of Inspection
Time of Inspection 24 hr. (hh:mm)
0 Not Opera onal Date Last Operated:
............
County: .... ..---.........111.�..............................................
Phone No: .... 1-``— � i ---RXL1
Facility Contact: ..................................................... ...... Title. Phone No:
Mailing Address: At U..... f �.� `�.. 4-g` �... �......V.0.I...A.... n . q
Onsite Representative: L.,+2v1.`'....... '................................ Integrator:.....................................................
Certified Operator:............................................................................................................... Operator Certification Number:.................................
I.o Von of arm•
.......... t~5�........... ..�.. �.......'^`� ....... .......................... �....
V.`C..................................................................................................................................................................... ....
Latitude • 4 16 Longitude 0• 4 46
(General
1. Are there any buffers that need maintenance/improvement? ❑ Yes t4 No
2. Is any discharge observed from any part of the operation? ❑ Yes CR No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 14 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes Q No
c. If discharge is observed, what is the estimated flow in gal/min? r'!�
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 19No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes CO No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes R No
maintenance/improvement?
fi. 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
Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes V4 No
Structures (LagoonsMolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes Vf No
Structure 1 Stricture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................... ...............................................................• I...... ..........•----•................... ............... .......................................
Freeboardft - d ........ S...............................................................................................................................................
10. is seepage observed from any of the structures? ❑ Yes 0 No
It. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 4No
12. Do any of the strictures 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?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP1, or ru f entering waters of the State, notify DWQ)
15. Crop type ... f . _ ?...... ....................................................................................................................................
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.Vlolatlons•or deFicienc'ies.were-nated-auring this,visit'._- Yo-U.4ill reeeive-n6llirther
Ofrespkldei O about this:visit.::::::
❑ Yes 0 No
❑ Yes NNo
❑ Yes 0 No
❑ Yes gNo
❑ Yes VNo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes IZ No
❑ Yes N(No
❑ Yes 20' No
❑ Yes j@ No
7/25/97

❑ DSWC Animal Feedlot Operation Review
Eff DWQ Animal Feedlot Operation Site Inspection
0- Routine O Co;n laint O F(illow-u of DWt ins ection Q Follow-u of DSWC review O Other
Date of Inspection
Facility Number 3
Time of Inspection 24 hr. (hh:mm)
D Registered M. Certified © Applied for Permit E3Permitted 113 Not Operational I Date Last Operated:
Farm Name: a .e�...E.:...... t County: D-ut.L.n...................................0. �..?.r ..-i7.
Owner Name: .....
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
�.�.. i....... u.0 .�-►.... .....'1.. ... .i.:...ty-1. �.. %i C! ...1.' .4.. ............... Mailing Address:...
Integrator: I " -S-Onsite Representative:.... .....D..-.-r.. i...... __1............................. ..................
Certified U erator�....................
p........................................................................................... Operator Certification Number, ... ��v..�.7...�............
....
Location of Farm:
Gtra...s..aS.lc...s..t.cl�k.....�....5....L.......,...a.�.�.x:o.SS.�.,n�a. Q.:..� .....................S�s�..�t..}.-�:,....a......t.�^.. .... ..�.�.t�.�.�.....
Latitude Longitude �• �` �`�
Design Current
Swine Capacity Population
Wean to Feeder
,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 I I ❑ Dairy
❑ Non -Layer I 1 10 Non -Dairy
❑ Other
Total Design Capacity 7�/
Total SSLW
Number of Lagoons /Holding Ponds 10 Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? 0 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 ER No
b. if dischan, is observed, dill it reach Surface Water? (If yes. notify DWQ) ❑ Yes 19 No
c. if discharge is observed, what is the estimated flow in .ilfmin?
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 El 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
maintenanceli 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 KNo
7/25/97 Continued on back

Facility Number:2 ti — y
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes I,No
Structures (Lagoons. Holding fonds, Flush Pits. etc.l
9. is storage capacity (freeboard plus storm storage) less than adequate?. ❑ Yes KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... :... _............. ........�.`......................................
Freeboard(ft): .................... ................................... .................................... .................................... ....................................
10, Is seepage observed from any of the structures? ❑ Yes E&No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes 9 No
12. Do any of the structures need maintenance/improvement? ER 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 CK No
Waste Application
14, Is there physical evidence of over application? ❑ Yes KNo
(1f in excess of WMP, or runoff entering waters of the State. notify DWQ)
15. Crop type "F rr�. ........... .......................... ........................................
!^'---.._..---.• .
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? XYes ❑ No
17. Does the facility have a lack of adequate acreage for land application? (Yes ❑ No
18.
Does the receiving crop need improvement?
KYes
❑ No
19.
Is there a lack of available waste application equipment.)
❑ Yes
allo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
K No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
C&No
22.
Does record keeping need improvement'?
❑ Yes
CKNo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
(RNo
24,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IgNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
J9 No
0 No.violitionsor deficiencies rvere-notedduring this-visit..You:will re-ceive'no ftirther,
correspondence about this:visit.
Comtnents'(refer:.to question #.): Exptain any ;:YES answers and/or any recotnmendattons or any other comments. ,
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iceviewerfinspecwr ratite
Reviewer/Inspector Signature: 17
�-A , �j „ n , IL 9 o
h Date:

•
•
Site Requires Immediate Attenti-
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: C3 �' , 1995
Time:
Farm Na
Mailing
County:
Integrator:
On Site Representative:
Physical Address/Location:
Type of Operation: Swine ' V Poultry
Phone:
Phone: ,
o All/ - 3
Cattle
Design Capacity: 26139W Number of Animals on Site:
DEM Certificapon u2mber: ACE DEM Certification Number: ACNEW
Latitude: 7 SJ ' Longitude:, ' �' �" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have4agoon(s)?
icient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches No Actual Freeboard:" Ft. � Inches
Was any seepage observed from Yes 9
as any erosion observed? Yes o No
Is adequate land available for s ray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: Ci� S� f
Does the facility meet SCS minimum setback criteria? 200'Feet from Dwellin `Yes No
100 Feet from Wells? Yeses, r_ No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes `r'� If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated bn specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name
Y
cc: Facility Assessment Unit
habMwasm.-
Use Attachments if Needed.