310479_INSPECTIONS_20171231

NUH I H UAHULI NA
Department of Environmental Quai

Type of Visit: Compliance nspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine Q Complaint Q Follow-up O Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: O Departure Time: 3© County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: 4 Title:
Onsite Representative: (� ` ! Gin Integrator:
Certified Operator: Certification Number: I / . _o �.)
Back-up Operator:
Phone:
Certification Number:
Location of Farm: Latitude: Longitude:
Design C►urrent Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Fop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design C►►urrent
Dry Cow
Farrow to Feeder
Farrow to Finish
D.. P,oultr, C•.a aci F.o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
1pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes No [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
[ o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
t:I'No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 214120I5 Continued

Facility Number: - Date of Inspection: o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ED-R—o —1❑ 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): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
�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
P " _..
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[�_Xo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
� o
[] NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground 0 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?
[3 Yes
E;,Nb
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[Too
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[]'No ❑ NA
❑ NE
o17.res determination?
for
oes the facility lack adequate acreage land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
C] Yes
[ o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[] No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps 0 Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes dNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facilit Number: - Date of Inspection:
f
;4. 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
❑'11q'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
[3' -o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No [7fNA
❑ 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
ZNo
❑ 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
ENo
❑ 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
[3"�o
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
[;y90
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ jNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
u 'Vo
❑ NA
❑ NE
Comments (refer to'question ft Explain any`YES'answers and/or any additional recommendations or any other comments
Use drawings of'facility,to better`exolain'sltuations (use'additional pages as necessary):
l 7 — ec-
PSCK�
j"'� &'Cp�-c
r
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
0
/� 5 0, 1 C' , L L'� f--- OL 0 5-f V
P I C - 'o (� C T( r i+-err! C ! r S
�20 "( l Phone: [ ( P -7P6
' /
Date: Iro /
2k2015

Type of Visit: Q-Cbm//pliance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
t:.J Reason for Visit: 'Routine O Complaint (:) Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit:` Arrival Time: Departure Time: 193 O County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
5 kt'llAe J
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
C•urrenf
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle C►apacity
Pop.
Wean to Finish
iry Cow
can to Feeder
Non -La er
iry Calf
Ceder to Finish
I Z 4 0
airy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
I) , P,ouitr,
Ca aeit
P,o ,
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 D NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes FNo
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
H
Page 1 of 3 21412015 Continued

il
1facili umber: 7 Date of Ins ection: j r
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [a Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ­3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes CI -No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes / No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑i 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 Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E�No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [] 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
E(No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[:fNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Do
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ef�'_Ijo ❑ 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 21412015 Continued

Facili Number: - Date of Ins ection: 9
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes []-'No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q'1 oo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? [] Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No &NA ❑ NE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E3� No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes E3No ❑ NA ❑ NE
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
_
❑ NA
❑ NE
FNo
❑ NA
❑ NE
[�No
❑ NA
❑ NE
❑ Yes
❑ Yes
[] Yes
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 necessa-
ry)-'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
L. I
Phone: (� 7 / ) 8 K
Date: !0
//
121412015

91
Type of Visit ,j2rf6mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 94ioutine 0 Complaint 0 Follow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: . GG parture Time: County: Regiont
oop
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: q Title: Phone No:
Onsite Representative:1§integrator: z22Z,46 _
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = e = = Longitude: = ° [= 1 [= `l
Design
Current
s
Design Cure,nt
Wet Poultry
Cattle
Design Current
Swine
Capy
Population
Capacity Popu�la�tion
Capacity Population
❑ Wean to Finish
[] Layer
❑Dairy Cow
❑ Wean to Feeder
Layer
❑Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dg Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cow,
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes J'Iffo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ,Q,'No
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes , No
2
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ 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?
[I Yes ]'No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes -3—No ❑ NA ❑ NE
❑ Yes 'P"o ❑ NA ❑ NE -
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes M<o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes allo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes �NO [I NA ❑ NE
maintenance or improvement? '
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ YesL;3 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
,Z"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes [;JNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes PNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes C;-"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes �
El NA
[I NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J:K
❑ NA
❑ NE
Comments (refer to question#): Explain any YES answers and/6r any recommendations or any
Use drawings of facility to'be'tter explain situations: (use add�ttanal pages as necessary); _
- - �f:' ='fit• £ oi: $?
othenc�omments
�'§�y `a l* 4
i.;- sS_Bi Swfd��AY. nT.'i i;, 4MFk�.
P rre ewe -r
Reviewer/Ins ector Name
P
��' k`" Fw
t ,:i r g sis
Phone: 7
Reviewer/Inspector Signature:
Date: 311
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 ,[ *!1110 ❑ NA [IN E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes 2No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Jfo ❑ 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 .EfNo ❑ NA ❑ NE
23. If selected, did the facility fait to install and maintain rainbreakers on irrigation equipment? ❑ Yes P'Ro ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
PrNo
❑ NA
[IN I,
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ko
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q'N' o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�Vo
❑ 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
0 Yes
;:J'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
ONo
❑ 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
PrNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Uj
a,� v
i� 11?I/d
G, 77
7/ 2-//0
Page 3 of 3 12128104

1
jType of Visit 121'Cpmpilance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance I
Ji Reason for Visit O/Routine O Complaint 0 Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: L
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: r eparture Time: County:
r
l Owner Email:
Onsite Representative: / /////� 4'� r
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Pho a No•
Integrator:
Operator Certi ication Number:
Back-up Certification Number:
Latitude: = c = 6 = Longitude: =
De1111111 sign Current
Design Current
Design Current
Swine Capacity PopulationrEEIN
oultry C►apacity Population
Cattle Capacity Population
❑ Wean to Finish
airy Cow
❑ Wean to Feeder
a aye
EE
airy Calf
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean .
Dry Poultry
❑ La ers
on -Layers
❑ D Cow
❑ Non-Dai
❑ Beef Stocker
❑ Beef Feeder
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Other
10 urkey Poults
❑ Other
Number of Structures:
Dischar� & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
,❑,(No
❑ Yes No
,XJ
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes Z-No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P-fl o ❑ 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 'p-No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ; No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes fTNo ❑ 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 XNo ❑ 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 '[ to ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes12'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[]Yes 4!! No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes �No
❑ NA
❑ NE
�0
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (referto question #) Explain any YE9answers and/or any, 'recommendationsjor any other comments ',;.N
Use drawing' s. of facilit to' better explain situations use'additional a es as necessar b x'
LGt, S I►'1,w�� .Sli l w� +? Ct pp✓+ (;cJac,i j.
' 2Ve�r'JI
Arm - (e,6a rel- S 100k Day.
Reviewer/Inspector Name �''' �''�.; ,
Phone-
Reviewer/inspector Signature:
Date:
Page 2 of 3 1V28/04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes -1No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Otherlssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes VfNo ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
El Yes
[0No
[I NA
El NE
❑ Yes
[4 No
❑ NA
❑ NE
Cl Yes
P No
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes (' No ❑ NA ❑ NE
❑ Yes [Z No ❑ NA ❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
[71 No
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
[7No
❑ NA
❑ NE
Additional Comments and/or Drawings:
N
r
T
Page 3 of 3 12128104

Type of Visit ArCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Vis1:1101outine O Complaint 0 Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: - Li` Arrival Time: . G Departure Time: County:
Farm Name: G - Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = 6 = I{ Longitude: = o = 1 = If
i Design!i
(Current
Design Current
Current
DesignMM
Swine
Capacity
liftiOR
Wet Poultry Capacity Population
❑ La er
Cattle anneity Population
❑ Dairy Cow
❑ an to Finish
❑ an to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ La ers
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑Non -La ers
El Pullets
❑ Turkeys
❑Beef Feeder
❑ Beef Brood Cow
❑ Boars
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
2fNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
X No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
XNo
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ,O No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ErNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes P'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes Pl�o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes VrNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes YJ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes [3/No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
?No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑4o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[;Ko
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
(;lo
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
CYO s s ��^ /1 acv e
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: e Date: " (�
Pape 2 of 3 12/28/0 Continued

Facility Humber: 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 ❑ n Desig Other
❑Maps El
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23,
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ 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
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional and/or Drawings:
-Comments
& f
LI&IQ
1 g CU
1, el,
12128104

ivision of Water Quality
° Division of Soil and Water ConservationI//
`O Other. Agency r'
i�aci tty Number
�
Type of Visit compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: ]��
�`�C Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: j^
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude: = o
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
[--]Layer
1; ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: = ° = d = it
Design. Current
Cattle Capacity Population
❑ Dai Cow
❑ DairyCalf
❑ DairyHeifei
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State`? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P.Pdo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
2rNo
❑ NA
❑ NE
❑ Yes
&o
❑ NA
❑ NE
12/28/04 Continued

Facility Number: :3wl Date of Inspection
Was'Pe Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in): n
Observed Freeboard (in): Z' !
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 ❑ No ❑ 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 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 l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other, comments.
Use drawings of facility to better explain situations., (use additional pages as necessary):;,
bolcwv�l 1�
Reviewer/Inspector Name Phone: ii C
Reviewer/Inspector Signature: Date:
Page 2 of 3 12IT8104 Continued

Facility Nwmber:31— f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ETNo ❑ NA ❑ NE
the appropiiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [YNo ❑ 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
�!j 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
ZI No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
ZfNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
P NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[-_]Yes
A� 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
�J 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
P No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
r -
7/0
a• 7z
lis/G6
12128104

Type of Visit ('Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit P-Routine Q Complaint Q Follow up Q Referral O Emergency O Other ❑ Denied Access
Date of Visit: ,� *"6 Arrival Time: i 30 Departure Time: County: !/�- Region:Farm Name:rf Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title: Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: � o =, =„ Longitude: [� ° = 0 "
Design Current Design Current Design
Current
Swine C►►opacity Population Wet Poultry t►apacity Population Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
) 2U v
❑ DairyCalf
❑ DairyHeifer
Feeder to Finish
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑Non -La ers
❑ Beef Feeder
PGilts
Boars
❑ Pullets
❑Beef Brood Cow
❑ Turkeys
Other
❑ TurkeyPo Its
❑ Other
❑ Other
or
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
J2 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
0 Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ONo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
;2'No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: Date of Inspection 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
StI
ure 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 0'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 42! 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 �Mo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes FNo
ElNA ❑ 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? 1p
Waste Application
t0. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ,6No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) e9eCX41Yt M. &I&SgeA 4 LQ�& CP)
13. Soil type(s) /r1
,��
14, Do the receiving crops differ from those designated in the CAWMP? El Yes f- No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J;�'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes ET No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ETNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ["No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name - - -tl --- - Phone: q lC Z 6-7 •���
Reviewer/Inspector Signature: Date: 3 0(
Page 2 of 1272810-4 Continued

Faciliixy Number: Date of Inspection ZeTI
77 Required Records & Documents
19. Did the facility fail to have 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 E!TNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [I Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [:Ko ❑ 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
2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
O 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
2rNA
❑ 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
,2"NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,E No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZNo
❑ 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? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
,2jNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
9No
❑ NA
❑ NE
Additional Comments and/or Drawings:
lean �C�(y�QAGt N� p2(1t�v wy pl I',�S
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wab4a t
Vr
o'F 0,46T o� a�
P
Page 3 of 3 12128104

IType of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit..O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: y/ y/�.�1 Arrival Time:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Departure Time: County:
A-;g Z Owner Email:
Facility Contact: Title:
Onsite Representative: 22&-zS zatzt'LAs&�
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone:
Phone No.
Integrator: e-
Operator Certification Nu
Back-up Certifieation Number:
Region:
Latitude: = o = 1 066 Longitude: = o = 6 =
fid
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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 Stale (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — (f'j Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ 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): 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes L2'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 .E No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 NO ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 2rNo ❑ 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 Rio ❑ 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?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) �L'i^/'!?GtO�� rw/ ,
13.
Soil type(s) DIAL
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
•ETNo
❑ 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
,❑Mo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Z'No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑Yes
❑ NA
❑ NE
. _. .... .may v.. � e .... _-��...• u:i1'.�•..
Reviewer/Inspector Name �' ;; '":''.� Phone: G Gp
Reviewer/Inspector Signature: Date: y y V,,S'J
12128104 Continued

Facility Number:_ -3-- Z Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0-No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 12 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes O-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
O'lQo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
-lM
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
.ONE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
D-No
❑ NA
[IN E
27.
Did the facility tail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E]�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
I"No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
4�_'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
,21No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office ofemergency situations as required by
❑ Yes
PrfVo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�INo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
2KNo
❑ NA
❑ NE
9d'ilitional Comments;'a'bd/or Drawings:
4cla Ccn Q
• Gay.—�S �fE/x rvt j aot�
lZ
12128104

.i
�?'- €n9 t-s•xk�a�iE_.s
Type of Visit ,$Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Z'P-ermitted O'6e�r}tified © Conditionally Certified 0 Registered
Farm Name:.....1.'.LQf.N..s........ 16KaYu. ..d y.._................................................
ro
^.7 1 Time:
Not Operational O Below Threshold
Date Last Operated or Above Threshold: .........................
County: )
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
MailingAddress:.....................................................................................................................
FacilityContact: .................................................................................
Title:................................................................ Phone No:.....
Onsite Representative:....
(.!!1.4_Y,C(..5.....
k��rlx......................................
Integrator:...,,.M.Ltr-'0h. ,L..
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
AL
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? [:]Yes ;3-No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...............1..................................................... .................................... ................................... ................................... .......
Freeboard (inches): , ? '7
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes Zf4o
❑ Yes 00
Structure 6
12112103 Continued

Facility Number: — 7 Date of Inspection
,5. -Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ET No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ,�?No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 0'No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes D.No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Flo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes E No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ENO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ` +'n ;r M\l t QA (1A) PSf_t1Q �ia !1 TC"1021.9:r.& ._.. .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 2'Ro
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 2No
b) Does the facility need a wettable acre determination? ❑ Yes $No
c) This facility is pended for a wettable acre determination? ❑ Yes 0 No
15. Does the receiving crop need improvement? ❑ Yes Flo
16. Is there a lack of adequate waste application equipment? ❑ Yes ,23'No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ,J31Ro
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes .,fNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RVo
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 ENO
Air Quality representative immediately.
Field Conv ❑ Final Notes
tease cw 4 _,r
.- 5�1� 04d l SIs S1-l�We�
f �
15
l
Cow
So me e -e o� �s �eede c>
r,�
PrC0/-C?/5 a ✓c
ReviewerAnspector Name
Reviewer/Inspector Signature:
Date:
12112103
Continued

Facility Number: Date of Inspection 6 0
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ONo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ,E! No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2No
❑ 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?
❑ Yes
Q'No
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ONo
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
o
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑'&o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
[] No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
OVo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ 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 V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

{7 • ft
Facility Number eiL Date of visit: W2n- Time:
rO Not Operational 0 Below Threshold
j3Permitted Certified © Conditionally Certified D Registered Date Last Operated or A/bove Threshold:
Farm Name 1,/;3 bA19 County: u <`��
Owner Name: Pn!!„�r Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: _f G��1
Certified Operator:
Location of Farm:
Phone No:
Integrators h �/
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0` 4 66 Longitude 0 1 "
Design Current Design Current Design Current
Swine Ca aci .. Po ulation Poultry Capacity Population Cattle Capacity Po tifation
❑ Wean to Feeder
Feeder to Finish
%
7—
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I I
10 DairyI
❑ Non -Layer L 1 ❑ Non-Dai
❑ Other
Total Design Capacity
k sk,Total SSLW.=- I
14um6ec ofiLagoons
©'
❑ Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area t''
Holding., onds,/ S'oiid'Trag§
- — -- __
❑ No Liquid Waste Management
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 gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ZI No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes I,No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes E9 No
Waste C-01ection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Freeboard (inches):
05103101 Continued

Facility Number: — 4n Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (lie/ trees, severe erosion,
❑ Yes
,§No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
9 No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
91 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
E No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
B No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
JgNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
®,No
12. Crop type 6' /n X4, t/#A z�uC [_!r+g7e Gilulc�l ( t Df1Pa
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VLNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
® No
b) Does the facility need a wettable acre determination?
❑ Yes
CR No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crap need improvement?
❑ Yes
No
16. is there a lack of adequate waste application equipment?
❑ Yes
[�j No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
P.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
SNo
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Lil No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[Z[No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
UNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
E�,No
24. Does facility require a follow-up visit by same agency?
❑ Yes
KIo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
R No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�Coinmenfs refer to`" uestion # Ex lain an AYES answers and/arean recommendations or.an othev ifiments
Use drawings€oUacility to better,explain situations. (use additional.pagesaas necessary) �❑ Field Copy El Final Notes
K i- , � _ _ .. , _ ... � _ _ . �b. �;.. .. . Flu. .,. :n. •; .��
L��► , ejoe,14y are jA r�►��
y
AL
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 1/'
Continued

r
t ,
Facility Number: ' l — 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 V 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 ;KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes IN No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes A'[No
32. Do the flush tanks lack a submerged till pipe or a permanent/temporary cover? ❑ Yes M No
Additional Comments and/orDrawings:
5/00

t k0'Division of Water Quality
s
0 Division of Soil and Water Conservation
3j�,�
0 Uthet�Agency'
(Type of Visit kMompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Lute of Visit:
13 Permitted 0 Certified 0 Conditionally Certified 13 Registered
Farm Name: ..6 �� ......... .................... en.n.`.......�Aw I........
4 r ,r f -4 �/f a Dt /t
Owner Name: ti r' ""� 1 C it
................................................ G!...................... .......................
Time: Z = is Printed on: 7/21/2000
0 Not O erational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County: T.
v . f )..`....1...I..............................
Phone No:
FacilityContact: ...............................................................................Ifitle:................................................................ Phone No:...................................................
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Representative:......! ' 1_Dl� f......l�e ►i t'} GOf . Integrator: .. U/...�......................................................
Certified Operator:................................................................................................................ Operator Certification Ntt tber:..........................................
Location of Farm:
,:j Swlne ❑ Poultry ❑ Cattle ❑ Horse Latitude a 6 « Longitude e 6 64
! ` Design Current
Curr
Design err
' nt Desigo GiEerit
Y Sw�ae Capacity,Po ulation
Poultry
Ca acii Population Cattle capacity, population
Wean to Feeder
❑ Layer
❑ Dairy
eeder to Finish
❑Non -Layer
❑Non -Dairy
Farrow to Wean
-' Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Capacity
Gilts
Total SSLW
14 niber of LagooM ❑ Subsurface Drains Present ❑ Lag"n Area I0 Spray Field Area
_ loiiltt, Potads'/ So1ld,Tri� s ` ❑ No Liquid Waste Management System
s S
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. II'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: ...............................
.... .................................... .................... ............... ................... ................. ....... .... ..................
Freeboard (inches):
5100
❑ Yes 'PINo
❑ Yes 1 '
/// ❑ Yes No
h
❑ Yes /0No
❑ Yes :6No
❑ Yes P No
❑ Yes P(No
Structure 6
Continued on back

Facility umber: 7 Date of Inspection Printed on: 7/21/2000
5..Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, [] Yes P(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes _;3'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 PNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
X0No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 'd No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ;ZNo
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes (RNo
12. Crop type _ ge?r'"l u* a ► � t t� %> k_1 1 F G C
et dSv► *,-al 6 "OLze
13. Do the receiving_ crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes �IV0
b) Does the facility need a wettable acre determination? ❑ Yes ;3"No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes �fNo
16. is there a lack of adequate waste application equipment? ❑ Yes No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
00 WUP, checklists, design, maps, etc.) ❑ Yes o
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 040
20. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes jz No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes VNO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes �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)dNo
YiQlatGigns:or d feiencie ry re note d>tring thjs:vasit; Yoo wiij tec lye ijo cut' VT
• corres• oricience: about. this :visit:. • . • . • . • . • . • . • . • ..... • . • ......... ...... .
Comments (refer to, question #): Explain any YES answers and/or any recommendations oir any other comMents `�It !, It � li
Use,dirawiui offacili tobetterex lain situations: use'additionalpages:'asaecessa
! 1 �e s-le 4o 4ekke 6o-f1, G�OtS �DT S� a
Dvel'AI i) 4T e- -6�6e ! rT y a�-\a( recproLs alre, Vey Vve
Reviewer/Inspector Name S d Ptnr� 1 LL e,1 t, i x "e
Reviewer/Inspector Signature: Date: Iffltl hot 5100

I Facility Number: ` Date of Inspection ( � Qf� Printed on: I0/26/2000
Odor Issues
W-
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 �No
28. Is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt, ❑ Yes ❑NO
roads, building structure, and/or public property) /
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ,j 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
5100

'
I II Y 1 1 1 _, e. 'Ij
;I' 'Dtvnston of Water Quality
iil-P? , 4p i L 1 f,
( 1 ; Via, t 1 , F'
y
Dtvtsioti of Soil and Water Conservation
ftim
Agency,, Is _ I ; r �
. M�Fry�.. �151 .�h �:' 3 .'�M � u. .13:_ �. .i"`.� ..r., .. .. .w.� 1 fit.: -:.. � ..' }. .`II � ... rl. � �7'C ' I ..
t
N
I, � xt'� ���� � r �s-,. �, '�✓
... �. 7r �'i+.T{'l.•fs C Iklt�`�"'nr.l f� V�� E�F'�.
Type of visit RCompliance Inspection p Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Elate of Visit: �- J-{!V Time: G d Printed on: 7/21/2000
:�
CO Nut erational Q Below Threshold
Permitted © Certified ❑ Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..........
Farm Name. 6vt-.�...lL-.... } County: .... .�1�'`r��..i':1......................................................
................... .................. ...............................
OwnerName: ................................................... ........................................................................ Phone No:........
FacilityContact............................................................................... Title:................................................................ Phone No:..............
;`'Tailing Address: ....................................................... ...........
Onsite Representative: ..S...l..%^.'i''..:................................... .... Integrator: ! �'.......................................................
CertifiedOperator : ................................................... ...................... ............... ........................ Operator Certification Nuumber:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �' �
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I d JE] Dairy
19 Feeder to Finish JE1 Non -Layer I 1 1[:] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons I ❑ Subsurface Drains Present JJEJ Lag,,"n Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impactti
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyancc man-madc''
h. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. II' discharge is observed. what is the estimated [low in gal/thin?
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
SEMC[Urc I Structure 2 Structure 1 Structure 4 Structure 5
Identifier: ........................................................................................................................................
....................................
Freehoard (inches):
5100
❑ Yes ErNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 100
❑ Yes N No
❑ Yes VNo
Structure 6
Continued on back

Facilit�Number: 3 t — 1-]q Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, 0 Yes WNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure'plan? ❑ Yes j'�(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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes too
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes kNo
`haste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes t�'No
11. Is there evidence of over ap lication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 9No
12, Crop type 9-1,,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design'?
21 _ Did the facility foil 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 reviewlinspection 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?
El-i'Vo violafigns oi- dericiencips -Were noted• during {. is;visit; • Voit Will-tebgKle do rurthcr • ; ;
cor'res' ondence.aboU thtis vt I . ' .... •
❑ Yes Z No
❑ Yes Pj No
❑ Yes ONo
❑ Yes ER No
❑ Yes IZNo
❑ Yes allo
ElYes J�Q
❑ Yes YNo
,'Yes ❑*No
❑ Yes COO
❑ Yes �<No
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):
❑ Yes R'No
❑ Yes VNo
❑ Yes XNo
❑ Yes j 'No
P\he
}'12—( Gdl�r-L\y
9r
ReviewerAnspector Name jszt. t; y4_ Ask_
Reviewer/Inspector Signature: Date:
5100

ils�ty Number: 3 — Date of Inspection FacPrinted 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 hPlow [ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any deed animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4No
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 ONo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0 No
32. Do the flush tanks lack a submerged fill pipe or a permanent temporary cover? ❑ Yes [XNo
5100

Division of Sail and Water Conservation Operation
Q Division of Soil and Water Conservation ,Compliance Inspection ,t :n
4 �I
,.Division of Water Quality - Compharice Inspection n, R= s f i
13
Otlxer Agency, -,,Operation Rev1ew, eA,
12, Routine 0 Complaint
0 Follow-up of DWQ inspection
0 Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection Z®-
Time of Inspection
24 hr. (hh:mm)
Permitted 14 Certified [3 Conditionally Certified 13 Registered 0 Not Operational Date Last Operated:
f� Farm Name:........it!T1s.......
w in. . ..........................
County:.......... j ........................ ...................
Owner Name: Aff.1,:5.......11C(ft1UL1
..................
Phone No: .....:1.I.Q..Y...z. .0..-..3! .. .Sa.......................
tl
Facility Contact: .......... ..................c.................................................
:.......
.....da.J.f!).f..�............v........�...1......... Phone No 11
�...................................................
Mailing Address:.... Q.......
ITitle
....aACL..... 1 .... CA ...................................
.... p ny-C .....t*.f..��.
, ` r
1...r,.....,...............
Onsite Representative : ....................
....'.................................... .......... :...................................
. ,f !
Integrator:..'I'V.-F1.'I'V.-O-V ............................................................
Certified Operator:........ ... Q,t J' .......rlcj� ...
Operator Certification Number: �. .�Q ...............
Location of Farm:
A6
..................................................I.............. .. .. w
Latitude 0 1 '1 Longitude , 111 66
Design Current.
Swine "` Capacity Population
❑ Wean to Feeder
W Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design. Current .= Design Current
Poultry r -i.Ca acit • Population Cattle -Ca acity Population
❑ Layer "' ❑ Dairy
❑ Non -Layer 1 10 Non -Dairy
. ❑ Other
Total Design Capacity
5 ,k r 1E
Total SSLW
Numbetd Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑ Spray
Field Area
0 `,
Holding Ponds / Solid Traps System
Y'
No Liquid Waste Management S s
0
❑ 9 g
Dischartxes & Stream Imparts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ElSpray Field [IOther
a. It' discharge is observed, was the conveyance man-made'?
b, if discharge is observed, did it reach Water of the Stale? (If yes, notify DWQ)
c. €I' discharge is observed, what is the estimated flow in gal/min?
d. Dues discharge bypass a lagoon system'? (Il'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
❑ Yes kN"'o
❑ Yes 41"No
[]Yes <No
❑ Yes 0 No
❑ Yes T i°
❑ Yes �ZNo
❑ Yes )j�No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure.6
Identifier:
Freeboard(inches): ............... .1................................................................................................................... .................................... I..........................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

F!wRity Number: Date of Inspection
O{ door Issues
of 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 ONo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? []Yes 41No
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 KNo
31. Do the animals feed storage bins fail to have appropriate cover? [:]Yes To
X. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omtn en `an ,or swings .
r
3/23/99

facility Number:3/ Date of Inspection I
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? ❑ Yes `( No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
'y`C Yes El No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes 'qNo
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/improvement?
❑ Yes ;(No
11. Is there evidence of over ❑ Excessive Ponding ❑\PAN
El Yes tVNo
,application?
12. Crop type G I'ISC,l1Z� S G,_Cfv1-) _
_
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes '<No
14, a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
[QYes ❑ No
15. Does the receiving crop need improvement?
❑ Yes `RNo
16. Is there a lack of adequate waste application equipment?
❑ Yes A No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Wl�o
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
13'No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
VYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[ANo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application) ❑ Yes M No
23. Did Reviewef/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes � No
24. Does facility require a follow-up visit by same agency? ❑ Yes Pam' No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
16.06ati0isodifc6ndes -mere nQc�ghis:vish.Y-w`fl teeeiye, do fu�tl iit
cor'res orideince: a�otit: this :visit
.. .. .. .. e, r)r,i8ry."
„ ":. ... E..E....i I .. },.�.di E .-. �:.
Comments (refer to gt>estio #) Explatrr any YES answers and/or any recommenifations oriany other comments;°`
Use drawings of facility to -better explain situations: (use ad(fltional:pages`as necessary) 4 i
Ttjo(� aq bo-r� Off_gs OA ivif" dQKa_.i.,.. A . Pxvee� �,v e, Wkt nc.crt!�.j
nply liwo.. o>ti . Be M%A, .)SG (_,,O� ill S,Pfc as te�vieed_ b}f .so+`/ ana-�ts►s ,
¢i
-k 4- r-WtS -�y eel* elova
Reviewer/Inspector Name
.1,� EE . 3 1-7, r - i 1
Reviewer/Inspector Signature:
Date: 1-/ 7 -a .
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
Routine. 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection r T y� 24 hr. (hh:mm)
0 Registered P,Certified © Applied for Permit © Permitted 113 Not Operational 1 Date Last Operated:
Farm Name: ............
QY[.............n,z................ ............................................. Count
Owner Name: 1a.5........ .i�,,n,ato... .. ...... Phone No: .... ��1iR...`��.3Lr..................
Facility Contact:...................................:.......................................... Title:..................... Phone No:
..............................................................................................
s.
Mailing Address': ..........i.......�d.f.o�A.....R�.......... ........................... I ........ ............. ....., ........................................ .. g.-Saz.......
Onsite Representative:...........i yni7rtlY........................................................
............... ....... Integrator:.....A.Vcf .................................................
.............................. . ..............
Certified Operator;............................................................................................................... Operator Certification Number:.........................................
Location of Farm:
51......:.�4.�.-i.,;,.,t..(?:.�`..tt!^.�. .5.....
Latitude �•,' �" Longitude �• ����
Number of Lagoons 1 Holding .Ponds ❑Subsurface Drains Present ❑Lagoon Area ❑Spray Fielrl Area
". ❑ No Liquid Waste Management System
t
General
1'. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
[P No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
M No
c. If discharge is observed, what'is the estimated flow in gal/min?
�L_
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
1] No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
M 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
[p Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97 Continued on back

Facility Number: 31 — E
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (L.iLo(itts,lioldittg fonds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):........ �.:6...........................................................................................................
10. is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
Structure 5
12. Do any of the structures need maintettance/imlirovement'T
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type...........�&r.t,.Uof............... S��Vs�.��..G� . ....... c.:5r-V.0........ ............................ .................................
.......,
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.viola'dons or deficiencies were -noted -during this:visit.-.You.will receive no further
correspondence a4oiit this'.visit:-
❑ Yes tD No
❑ Yes h No
Strut€ure 6
Yes { No
El Yes No
U Yes ❑ No
❑ Yes P No
❑ Yes (3 No
...........................................
❑ Yes
IN No
❑ Yes
No
❑ Yes
No
❑ Yes
19 No
❑ Yes
allo
❑ Yeti
93 No
PYes
❑ No
❑ Yes No
❑ Yes No
❑ Yes No
Comments {irefer Ea question #): Explain arty YES answers and/or any recornmendations or, any other cor invents j'
K.
Use �drarvings of facility to better explain situations (use.additional pages as necessary).
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PK� j lWAV\� `NA (S d— c%.t"ClK 4r eaG� , V o �'OM 4e tt6eld t, T-9,,. �fa� "Card',,
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: �,,_ �, ���,,,, Date: y

WRoutine O Cam laint O Follow-up of DWQ ins ection O Follow-u of DSNVC review O Other
Date of Inspection a
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered [I Applied for Permit (ex:L25 for 1 hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last. Operated : .................................. .................................................... ......... ».......................... .........................
Farm Name: »................................................... ...................
..._....
LandOwner ........................... Phone No:..(.. ........................
FacilityConctact:................................................................................. Title:................................................ Phone No:..........................................................
MailingAddress: ......75.o....... . rksi......Q..x.r,,.a.S........ .......................... ... �.... ..............................�-
Onsite Representative:.. a.x r' S,.......f ............................................... Integrator:......: =1- :....
»»..............
.......................
fi Certied Operator:..... � riS....................... kz-n— .... .............................. Operator Certification Number: ......�.%.--3................
Location of Farm:
S?r.....e. �.s.......�. irLR........ a......., .....1.."I T....,t ....x a. x4., ..�rxa�a ............... ...........RWLII�.R.d......h.o .r.........o. .t� x ..- 4
Ss...., ....... :�. I,.....�.�..i.�..3.3................................................................................................................................................................ �
Latitude Longitude ®• ®` 0,,
General
1, Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
2. Is any discharge observed from any part of the operation? ❑ Yes ®,No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ®.No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ®.No
c. If discharge is observed, what is the estimated flow in gallmin? T^
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 KNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes tK No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes KNo
4/30/97 maintenance/improvement? Continued on back

Facility Number: ..'!}......
—.�.�.,�
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes RNo
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (j,agoous and/or }folding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
3...:.Is..... .... ........... ................ ...........................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes RNo
❑ Yes RNo
❑ Yes ERNo
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Aaste APolicatin
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type . In. 1' ..'............ .................. s.ar� n 5 1...�,,�, i.h...............................................
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 the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes 9 No
❑ Yes B No
0-Yes ❑ No
❑ Yes RNo
❑ Yes 0 No
❑ Yes 0 No
❑ Yes -0 No
&Yes ❑ No
❑ Yes allo
❑ Yes ® No
❑ Yes Callo
❑ Yes H No
❑ Yes ®,No
&Yes ❑ No
Comments,(refer fo'question'#)Explatn any YES answers'andlor any recommendat►ons:br eny,other comments.1
Use'drav✓iri s of facili to better'ex lain: sitiiations: use additional a cs as necess h
P g u.> �y
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Reviewer/Inspector Name �, . a is " 3�� ' -
Reviewer/InspectorSigneture: Date: 3 i _
.1W%
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No.3� -
DWISION OF ENVIRONMENTAL MANAGEMENT
�.• ANIMAL' FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE:_ , 1995
Time: /� 5�
Farm Name/Owner: l rl o rri I Kgi�,n ems
Mailing Address:
County: •� ti
Integrator: _j( n-� L4 Phone: Z � _? ail
On Site Representative: e-* A rrr-� Phone:
Physical Address/Location: SR- 2- YAA Le .vv—
—�-r� �R- _��] �"3 �-vow• dN. l-�d.E � "
Type of Operation: Swine Poultry Cattle
Design Capacity: 13dU Number of Animals on Site: 13 o 0 .
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: s S ° Q_� '--22Longitude: 7 �'_" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard: 2- Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes or Was any erosion observed? • Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or
IV
Crop(s) being utilized: ) G p-car-5 _-
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings? eS r No
100 Feet from Wells? e 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 or&9 ' If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or/No)
Additional Comments:
Inspector Name
cc: Facility Assessment Unit
Use Attachments if Needed.