770017_INSPECTIONS_20171231

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: *Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I I Arrival Time: Q 00 Departure Time: ©' County: Z�%t-Lt�o egion:
Farm Name: 11) r tl s�H s �w � �'I[' ����'�'1 Owner Email:
Owner Name: G? �f� E ry c Ld, &H Phone:
Mailing Address:
Physical Address:
Facility Contact: PC- L4-/ IL/14�1 Title:
Onsite Representative: Ca.1/1 D S
Certified Operator:
Back-up Operator:
Phone:
Integrator: /--,_ e""-?
Certification Number: I -I
Certification Number:
Location of Farm: Latitude: Longitude:
I
Design Currents
Design Current
Design Current
`Swore
Capacity --Pop
Wet Poultey
_
CapacetyPop
C•artle
Capacity Pop.
a er
DairyCow
Wean to Feeder
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: El 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 �o ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
j�3NA ❑ NE
1�NA ❑ NE
�NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 2/4/10I5 Continued

11�acilityNumber: - Date of inspection 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -3ZN
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees.. severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No DNA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
❑ Yes
y No
0 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): Gq4d A �y tit
s
S
13. Soil Type(s): O
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
T
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[P 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 ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tra sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
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?
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

V acility Number: - 7 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No [:].NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of 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 No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 19
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
32_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 10
No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [El Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations fuse additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l 1 r-
Date:
21412015

i ype of visit: Q Compliance Inspection V operation Review U Structure Evatuation U 7vectinical Assistance I
Reason for Visit: 4D Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: , Departure Time: jj�� County: &*oJ✓h Region:p_
Farm Name: ��i 5 af1S JGv i' i� - Owner Email:
Owner Name: P0 r j v) Phone:
Mailing Address:
Physical Address:
Facility Contact: Pam( oryah WTsO rl Title: Phone:
Onsite Representative: Integrator: 1116 • A, 'J/Lj
Certified Operator: �t Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Design Gurrei
Capacity Eop. ^
.
Wet Poultry
Design
Capacity
Cnrrent
Pop,
Design Cnrrent
Cattle Capacity Pap.
Wean to Finish
j
ILayer
Dairy Cow
Wean to Feeder
I
iNon-Layer
I
a' Calf
Feeder to Finish
Design Current
D . I;oul Ca aci P,o ,
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dry Cow
Non-Dai
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Other,
Other
-
Pullets
Turkeys
Turkey Pouets
Other
Beef Brood Cow
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: 7 "
a. Was the conveyance man-made? C] Yes ❑ No PNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No 9 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 QNo NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Y No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: IDate of Ins ectiom
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Vg No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No W 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 P 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 ip 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 rVbNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Cr/o'p' IWin ow ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): W
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes R No El NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes $a No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes N No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reouired Records & Documents
❑ Yes [PNo ❑ NA
❑ Yes 16No [DNA
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ER No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 15B No
❑ NA
❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

Faoility Nuwtber: - Date of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below. T
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
answers. and/or any addit
►,'(tise additional pages as
44k N�Ae _.� 0 W �'
(Cle'10 9)0-0440t�l
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 10 No
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes �j No
❑ Yes ® No
❑ Yes EANo
❑ Yes [TNo
❑ Yes No
ans aranytotliei=;
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Phone: 33
Date: �Z
21412015

Type of Visit: Q Compliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit�ORoutine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: I/oS/:(�J//.3 I Arrival Time: / Departure Time: � County: )? a Region: T
Farm Name: �dsoyl is Jl+���C�✓1,I�.� Owner Email:
Owner Name: [�,� 2�aAcv j Phone:
Mailing Address:
Physical Address:
Facility Contact:
—TG�k���C{�3 �LfSUY�Title•
Onsite Representative:����Sl1�L
Certified Operator: l (.CI,t ` 6rx� W" [Soo —a
Back-up Operator:
Location of Farm:
Phone:
Integrator: 0 LT tr�� e,
Certification Number: Irl 9P %
Certification Number:
Latitude: Longitude:
Design Current
Design Cu`rreut
Design Current
Swine
Capacity
Pop.
Wet=Ouftosx.apa_a ity Pop "''
Cattle Capacity Pop.
$-. .
sh
WegFede
Layer
airy Cow
Weder
Non -La er
airy Calf
Feeish"
Dai Heifer
Farean
Design Current
Cow
Farroweder
D , P■oul
Ca ctty Po .-
iry
Non -Da*
Farnish
La ers
Beef Stocker
Gil
Non-La ers
Beef Feeder
Bo
Pullets
Beef Brood Cow
Turke s
Ot
Turke Poults
Oth
" Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [24 ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No g-NA- ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) [:]Yes [:]No D.NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No Q_bL _ ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [&No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes � ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

lFacility Number: q7 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [g-<o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [1],� ❑ 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
03 1V o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�o
❑ NA
[] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
�o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
53No
❑ 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
QN-o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
OR'1Go
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. [—]Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wi d Drift ❑ Application Outside of Approved Area
12. Crop Type(s): CN6�S �ts3 {fi9"""�
-
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
G q'o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
K No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
g j No
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[L[4
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes G No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [—]Yes Q'17o ❑ NA D NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check appropriate box below. [v]�Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard aWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall O Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [j3/No ❑ NA [] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No 63"N" A ❑ NE
Page 2 of 3 21412011 Continued

WaciRx Number: rPT- Date of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2'Ko- ❑ NA ❑ NE
25_ Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Zl4ito ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes OAF ❑ NA ❑ NE
❑ Yes ❑ No [g-1q2C ❑ NE
[:]Yes Io ❑ NA ❑ NE
[:]Yes [2,Vo ❑ NA ❑ NE
❑ Yes [DIo ❑ NA ❑ NE
❑ Yes 2 go- ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [L1 M ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes IDo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes L?< ❑ NA ❑ NE
aents'(referyto. question #fj: Explain any YES answers and/or any additional recammendahons ar any'otfier
Cmmcam>neuts.'
Use -drawings of..facility to better explain situations (use additional pages as necessary).
"LI Ple14''c - 0",4e�-1 Cm'Sysr7 e' lalJ
`e�'X 6.0"-L 4A- 'e'nrv- 2tov— /0
a�/ea�
Reviewer/inspector Name:
Reviewer/Inspector
Page 3 of 3
Phone: %/D —03 3 -3339
Date:
21412 J,1

Type of Visit: 40 Compliance Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Rererral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: W s ,,\'s SLJ i n.e— Fav-r,\ Owner Email:
Owner Name: �M.t` Fj(yLZln �L l5 o r\ Phone:
Mailing Address:
Physical Address:
Facility Contact: YA," T n0L*^ W 1 l 5 O" Title:
li
Onsite Representative:
�t
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: N . G - + Ll+l -,./ l 5
Certification Number: I q 5—�6
Certification Number:
Longitude:
Desi Current-
Design Cueot* -sue
Design Current
Swine
Capacity`Pop r Wet Poultry
_
C•apacityPo� Cattle Capacity Pop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
�.�,tI jNon-Laycr
I
Dairy Calf
Feeder to Finish
W&D*
Dairy Heifer
Farrow to Wean"
Design Current
D Cow
Farrow to Feeder
""t r =D . .Poultry
Ca acityl o�
Non -Dairy
Farrow to Finish
` q" La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other__}�
? TurkeyPoults
_
Other
Other
.u�
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes EA No ❑ NA ❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
❑ No
03] NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ® NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes Pg No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - j Date of Inspection: 5 J
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1P No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EL NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �u
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes V 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 FM No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? TT
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes O 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 l
n r.� i .. A. ! tom,. i_ _ r . t I I a 1 \
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ® No
❑ Yes E4 No
❑ Yes [!0 No
[:]Yes [P No
❑WUP ❑Checklists ❑ Design [] Maps D Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes M No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes $ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [P No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ONE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

I+acili Number: jDate of Inspection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes N No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes KNo ❑ 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 5M 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 R] 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 V No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes og No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[%No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. ;
Use drawings of facility to better explain situations (use additional pages as necessary). #
j t of Z. Me� 5 - 0 hX d�o re. i r� 2-0 tZ,
lAd 4�00 ,-, CC4 Gy'd w a t IS ALO-d -to
QC��h-PS S�� r JOrI'l� PX�OSIOain has �-eet� o�c�r'r`>� � 4-9
CL^eA S •
• AL waS� 5 ate. �a S Co j �� c- s'
Reviewed]nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: y `�
21412011

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit * Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 27 f Arrival Time: D f Departure Time: r qw+ County: Region: 5120
Farm Name: L-Jt ls,.� 5 5W+.,, Fa,, Owner Email:
Owner Name: ecwj 5y''j0tV\ W-1 150;1\ Phone:
Mailing Address:
Physical Address:
Facility Contact: F"-"- �r'H a- 0' [So h Title: Phone No:
Onsite Representative: N Integrator: AG, I'IA.dV,t S
Certified Operator: Operator Certification Number: I7
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = 4 0 " Longitude: [� 0 0 s a
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
Design Current
CattleIM963paeltvAr
opulation
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
Non -Layer
❑Dai Calf
Feeder to Finish
Lj Farrow to Wean
❑ Farrow to Feeder
�i ,�
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Layers
-
❑ Farrow to Finish
❑ Gilts
El Beef Stocker
❑Non -La Non -Layers
❑ Pullets
❑ Turkeys
El Turkey Poults
❑ Beef Feeder
10 Beef Brood Co
❑ Boars
Other
Number of Structures:
❑ Other
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 Wo ❑ NA ❑ NE
❑ Yes ❑ No RNA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes ❑ No NA
❑ NE
❑ Yes tA No ❑ NA
❑ NE
❑ Yes th No ❑ NA
❑ NE
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
P No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
�bNA ❑ 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
Wo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[� No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
`
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
J�j No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
U 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
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
P No
❑ NA
❑ NE
T C011Lque 01- 6&e 014.61s Q1V_0L-t'j 1a500� .
WAFMWAA
12eviewerhnspector Name �' : IIIIIIEZv _ Phone: Qjn —to
Reviewer/inspector Signature: Date: /Q
Page 2 of 3 I2/26/04 Connnueu

Facilitv Number: — Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Wo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ElNA ElNE
ElEl❑ Design El El the appropriate box. WUP Checklists 1
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 D Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No P 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
1R NA
.❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P 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
s
Additional Comments and/or Drawings: y" `I
5 Lu e- 5 U-�
Page 3 of 3 I2128104

fir;--• " L:�',5'�IS'. .lY",�'�s ��lriL'r'...�?''2'e'y"zj,;�':.v;r�ri3'•^.f""vC-C"�"Yrr"T"r'. -.�s �. r.. ,.^r,.y.' ��. �i. i'.Iti .x-; .:•c;' .'f: _. .v=;s'+ c'. s"t.lF:-y' Y-��:-.,I1� �p'w'v-•
r•"'-7 w
1 type, of Visit p p ' s
yp � Compliance Inspection O Operation Review O Structure l=valuation• O Technical'Assistance
Reason for Visit @ Routine O Complaint O Follow up " O Referral O Emergency O Other ❑ Denied Access
Date of Visit: is 30 Arrival Time: U, 2 Departure Time: County: R:X M01'JD Region:
Farm Name: _�} ��ayl 4 Sw t iM 1-Lt•+r m Owner )Email:
Owner Name: `�+� B�r`'QvF �%t lka' Phone:
Mailing Address:
Physical Address: j
Facility Contact: Pa t' I Kati WL&A Title:
Onsite Representative: ti
Certified Operator:
Back-up Operator:
Phone No:
Integrator: Pa [we+4v ac x
l7Sd6
Operator Certification Number: .r
Back-up Certification Number:
Location of Farm: Latitude: = 0 { = 4f Longitude: = o =
Desigu'y -- Current
Design Current
Design Current
SwjWean
C+apacityopulation
Wet Poultry C•apa_city Population
Cattle Capacity Population
❑o Finish
❑ Layer
❑ Da Cow
Ell
❑ Non -Layer
❑ DairyCalf
❑ Da Heifer
-. Dry Poultry
❑ D Cow
-
❑ Non -Dairy
❑
❑ Beef Stocker
❑ Non-ts ers
Non -Layers
❑ Beef Feeder
❑ Pullets
❑-Beef-Brood Co
❑ Turke s
❑ TurkeyPoults
❑ Other
Number of Structures:
o Feeder
to Finish
❑ Farrow to Wean
- El Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other '
- ❑ Other
Discharges &Stream Impacts
1. Is any discharge observed from any part of the operation?
[I Yes
,�, �
hy']Vo
❑ NA
❑ NE
Discharge originated at: ❑Structure El Application Field El Other
a. Was the conveyance man-made?
El Yes
'
❑ NA
[I NE
Did the discharge reach waters of the State? (If yes, notify DWQ)
El Yes
,�,�lo
[a<o
❑ 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)
El Yes
El No
,,��,,,/�/
L�lNA
❑ NE
?. Is there evidence of a past discharge from any part of the operation?
El Yes
6�mo
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
2'<o
❑ NA
❑ NE
other than from a discharge?
12/28/04
Continued

a.n F` , �-.•+!'m "s, �1 w 4 !i ."ixs4.,�.�i•-.•;+, a4
y 1
L 'V
W
Facility, Number: i,7 -- i 7 Date of Inspection 114o
W1.1ste 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?
Stnicture l Stnicture 2 Structure 3 Structure 4
❑ Yes ✓L f No El NSA El NE
❑ Yes El No RNA ❑ NE
Structure 5 Structure 6
Identifier:
Spillway?:
r
Designed Freeboard (in): Jj
Obsen'ed freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LPNI'o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
5� o
❑ 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
21 o
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
5Io
❑ 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
,�
IICI No
❑ NA
❑ NE
maintenance or improvement?
Waste Ap2licalion
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
L{; o
❑ NA
❑ NE
maintenancelimprovement?
11, Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
Md"No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) 1 &-eyhLlJA VYA.c.. �Uf,�r.
htr GolaS
,
13. Soil types)
%da?CCo
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L1Vo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
194lo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination: ❑ Yes
L411�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
&�Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name
-M IrA Phone: 9/0- t 13 3 - 3300
Reviewer/Inspector e:
Date: t v 3 0 09
12129104
v
Continued

Facility Number: 7r — Date of Inspection ! D`1
1�
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes F!! o ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
RlI o
❑ NA
❑ NE
the appropiiate box. ❑ WDp ❑ Checklists ❑ Design ❑ Maps f= p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
9 Io
❑ 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
�❑
Eill'o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Q no
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Elo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
5214
❑ NA
❑ NE
f
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EKo
❑ NA
❑ NE
Other Issues ff
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ ,,�--,, Yes ll�tvo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
j] Yes
2110
❑ 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
O'ltlo
❑ 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
Pi o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
9-no
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
G-tdo
❑ NA
❑ NE
Additional Commed#s and/or Drawings:
ellr n, r irrR �,c.. � nor ss /r-� s arc cos ,
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit 9 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ^/�r Arrival Time- �� % Departure Time: � County: m�� Region:
Farm Name: (�ri B it,, F M Owner Email:
Owner Name:. L(/WIS . fail^ Phone:
Mailing Address:
Physical Address:
Facility Contact: i _y t �ltn Title:
Onsite Representative. H
P
Certified Operator:
Phone No:
Integrator: A1,U^P-1L40n.CLC_
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: 0 0 ='
❑ « Longitude: = ° =' = u
Design Cgren
Design Current
Design Current
Swine C•apacih Population
h
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
I
Dairy Cow
❑ Wean to Feeder
I IEJ Non -Layer
I
Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl I
❑ Turkeys
Ot c
❑ Other
10 Turkey Pouits
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
N No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
K& NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
�9 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
P NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�'No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
MNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes $No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
PNA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ONo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property 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
W No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
If No
❑ NA ElNE
(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
TO 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 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Drift cationjJOutjside of
❑�:'
Area
12. Crop type(s)
5CU-e-th_S4a1rt_,),_CCQS
Wind
j
prC,rvw.tOlA tu57 tr
13. Soil type(s) Clejacta,-M& u 'e—Uoj3a
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
JANo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
T 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
EP No
❑ NA ❑ NE
Use drawings of facility to better explsin situations.- ( se dd�teo a! pages;as neee ry} � ��er�ommeuts
s
Comments (refer to question # Ex Jaen anv YES u essa �
� ) P
i
7
Reviewer/inspector Name Phone: 9/D yco
Re-viewer/Inspector Signature: fffi&L Date: S h
12128104 Continued

.ti
Facility Number: 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 appropriate box. ❑ WUP ❑ Checklists ❑ Desi gn ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes P No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ;KNA ❑ 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
RNA
❑ 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
{,
I,�CI 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
19 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
In No
❑ NA
❑ NE
�� , Caa[ t 6 ra{ 1o" ` -to �-- U-� JQr c(n o.,o� colt
' j 1 cl' 011'-�Q4'
gevxe
44 VUja_1__
12128104

Division of V1'ate r Quality
(Facility Number `�' r O Division of Soil and Water Conservation
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason far Visit IbRoutine O Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S % Arrival Time: *I Departure "time: .'� County: 'R1&M0"d Region: FRO
1j Farm Name: WI SDA'S So1r1t. f�xrt'W Owner Email-
,JOwner Name: ?Qt., sr!idn W i son Phone: -!�0)
Mailing Address:
r�
Physical Address:
FacilitvContact: Pa.J BnjajA WI(SOK —Title:
Onsite Representative: t(
U
Certified Operator:
Back-up Operator:
/� Phone No:
Integrator: `)' bl_ry S
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =u Longitude: 00 =4 [= «
❑ Non -Layer ❑ DairyCalf
Feeder to Finish ❑ Dairy Heifer
❑ Farrow to Wean ❑ Da Cow
Dry Poult b
Farrow to Feeder ❑ Non -Dairy
❑ Farrow to Finish ❑ Beef Stocker
Gilts ❑ Beef Feeder
❑ Boars ❑ Beef Brood Cow
--
Other
❑ Other Number of Structures:
Design Current Design Current Design Current
Swine Capacity Population V4'et Poultry Capacity Population= Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑ DairyCow
❑ Wean to Feeder'
❑ Layers
❑ Non -Lavers
El Pullets
❑Turke s
❑Turke Pouets
❑Other
[]Yes
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
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? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
r No ❑ NA ❑ NE
❑ Yes ❑ Na P NA ❑ NE
❑ Yes ❑ No 99NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes �4No ❑ NA ❑ NE
12/28/04 Continued
Design Current Design Current Design Current
Swine Capacity Population V4'et Poultry Capacity Population= Cattle Capacity Population
❑ Wean to Finish ❑ Layer ❑ DairyCow
❑ Wean to Feeder'
❑ Layers
❑ Non -Lavers
El Pullets
❑Turke s
❑Turke Pouets
❑Other
[]Yes
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
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? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
r No ❑ NA ❑ NE
❑ Yes ❑ Na P NA ❑ NE
❑ Yes ❑ No 99NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes �4No ❑ NA ❑ NE
12/28/04 Continued
❑ Layers
❑ Non -Lavers
El Pullets
❑Turke s
❑Turke Pouets
❑Other
[]Yes
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
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? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
r No ❑ NA ❑ NE
❑ Yes ❑ Na P NA ❑ NE
❑ Yes ❑ No 99NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes �4No ❑ NA ❑ NE
12/28/04 Continued
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (Ifyes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation'?
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
r No ❑ NA ❑ NE
❑ Yes ❑ Na P NA ❑ NE
❑ Yes ❑ No 99NA ❑ NE
❑ Yes ❑ No P NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
❑ Yes �4No ❑ NA ❑ NE
12/28/04 Continued
12/28/04 Continued

L
r" L
Facility Number: Date of Inspection S 4 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No 1P 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 El NA El NE
through a waste management or closure plan?
It any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
P Yes
❑ No
❑ NA
❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
PNo
❑ 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
1b No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o No
❑ NA
❑ NE
maintenance/improvement?
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VJ--No
❑ 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 Soi
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area 1.
12. Crop type(s)
❑ NA ❑ NE
13,
�� r
Soil type(s) (/���'1 w —Ca `�1 L.l�
fg - WcA
p
r
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
PNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[,j� No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
P No
❑ NA
❑ NE
Comments {refer to question #): Explain any YES answers.and/or anv recommendationsvor any other comments
Use drawings of facility to better explain situahotis. (use additional pages as��necessary)�
A-zt-7 io�'e
7� Sub$ n-ka� ►mPraV�r''� ►'� s Oy1
t�C� �-� CS tNdost�e
areas arot,,.rid
a9�+, �
oh
Key up -t4
'�P.�
5wd 5e,
-�-,bt,
iwa-rk
QS�,Co1 ,5
01 Reviewer/inspector Name i r
1
Phone: 41O)g33-33W
Reviewer/Inspector Signature:?AkLt4��oDate:
4 /016
Page 2 of of I2128104 Continued

Facility Number: 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 PNo ❑ NA ❑ NE
the appropriate box. 0 WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IgNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
JpNo
ITP
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
eNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
b�`No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�5No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
JP No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
11�No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
QjPNo
❑ 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
JANo
❑ 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
EgNo
❑ 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
�allo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1Z No
❑ NA
❑ NE
g
Additional Comments and/or Drawin s•
Page 3 of 3 12128104

1
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: `r 2 Arrival Time: Departure Time: County: A 4 n� Region: JCW
Farm Name: W. 5orkS SW t'� Owner Email:
Owner Name: p-+( Pr cw��SOh Phone: 10 �'R— 3 r] 9
Mailing Address:
Physical Address: Facility Contact: Pa[ 6r46.4 01 S011 Title:
if
Onsite Representative:
Certified Operator:
Back-up Operator:
W
Phone No:
Integrator: A)& Ynu..,rVE..S _!
Operator Certification Number: r 75—a
Back-up Certification Number:
Location of Farm: Latitude: = o = ` =" Longitude: = ° = ` = "
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poul#ry
Capacity Population
1
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
❑ Non -Layer I
Feeder to Finish
❑ Dairy Heifer
❑ Dry Cow
LJ Farrow to Wean
Dry Poultry
❑ Farrow to Feeder
`' S
El Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other ❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[�No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
MNA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
IFNA
❑ 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
F�No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
° No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 7 —
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:
❑ Yes ®►No ❑ NA ❑ NE
❑ Yes ❑ No JNA [INE
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9311
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 10 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 El NA El 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? 1P Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes toNo ❑ 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 El NA El NE
maintenance/improvement?
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes F,No
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
(--]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area I
12. Crop type(s)
13. Soil type(s)
❑NA ❑NE
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
91No
❑ NA
❑ NE
15_ Does the receiving crop and/or land application site need improvement?
❑ Yes
10 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
Cl NA
❑ NE
W 0-f L or,
-rry 4,-P
&4-t areas Ern LaiWh �
1004-S
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 2 of
Phone:
Date:
1212'8104 Continued

y 4
Facility Number: — 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 ElNA ElNE
the appropriate box.
ElWUP ElChecklists El Design El Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E�No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ES 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
G!TNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ER No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�gNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[ANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
❑ Yes
fp No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EP 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
E] No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Additional Comments and/or Drawingi:
WaS t .-na (y 5 '_ S St, Lt ,t`1V4d "454 wQ&-
( Af ,- / TX w-e�) ,
Page 3 of 3 12128104

i
Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine Q Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: .3.Z Or Arrival Time: 09: 0Departure Time: I 09 ,�q..t County: X0'tom Region:
Farm Name: ��! %� S Su'� ^2 �'rtr M Owner Email: 1
Owner Name: r L•J Phone: ��o) bSdr 37q a J
Mailing Address:
Physical Address:
Facility Contact: 4'i't lseH Title:
It
Onsite Representative:
Lt
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 No:
Integrator: A& Plw,�►s
Operator Certification Number: l 7'56,6
Back-up Certification Number:
Latitude: � o [ = =gi Longitude: = o = A = ei
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: O
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'?
II
❑ Yes ❑ No ❑ NA ® NE
❑ Yes
❑ No
❑ NA
EM NE
❑ Yes
❑ No
❑ NA
(�} NE
❑ Yes
❑ No
❑ NA
(� NE
❑ Yes
❑ No
❑ NA
[P NE
❑ Yes
❑ No
❑ NA
P NE
12128104 Continued

f
Facility Number: — 1j Date of Inspection /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No
❑ NA
EP NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
19 NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ No
❑ NA
0 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
[p 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
VNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ❑ No
❑ NA
KI 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
61 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑ No
❑ NA
9' NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
(8 NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift El Application Outside of Area
12. Crop type(s) Ada l o�A e[n, Kj� �), LBrn . PO _
t W4`i Wr V (on
13_ Soil type(s) (�,P00-
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
jj5 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 iand application?
❑ Yes
❑ No
❑ NA
® NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
EDNE
Comments (refer to question #): Explain any YES"answers,and/or any recommendations° oranypothercommenis
Use drawings t4kcility to better explain situations. (use additional pages as necessary): �e s
A,
Reviewer/Inspector Name "/1�'Qv .' "` Phone: Q7
ReviewerlInspector Signature: Wia Date: Q
Paee 2 of 1212AA04 Continued

Facility Number: Date of Inspection
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA [P NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA Ep NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 10 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
IN 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
1P NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
[9 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
411 NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
IM NE
Additional Comments and/or Drawings:
1 [- l fi;&. , 0" 31Nt'/
Pa..•( br-"" haft -vim Ke.r 'Ps-
5
Wt n By-
Di�A4 B� �QS Aar+ a� T'o
&V I7of­ Gi GCYSS A0
/.,Cu 5afe s
it l lD
Page 3 of 3 12128104

i, a Division of Water Quality
!Facility Number '� —��'7 0 Division of Soil and Water Conservation
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit 0 Routine O Complaint 0 Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I Arrival Time: v� �� Departure Time: D ! t(OCounty:. �l Jmond Region: �/�
I
Farm Name: _ �'.sonl swine 144—M _ Owner Email:
r �/
Owner Name: Pam.! B EYQJI� Wi I Sbg {{ {{ j` _ Phone: 6ia — 37 �
Mailing Address: 3208-. & 6 SOn Alit l P&J " , F" I k-At _ )X �$ 3 3 e
Physical Address:
Facility Contact: paBtr.�tu^ W, �r1 Title:
L1
Onsite Representative:
14
Certified Operator:
Back-up Operator:
Phone No:
Integrator• lau-VrS
Operator Certification Number: 5b�
Back-up Certification Number:
Location of Farm: Latitude: o u Longitude: = o
Design Curreut
Design,,.,. , Current
Desi;grt Current
Swine
Capty^4Poplation
Wet Poultry
CapacttyPopulatian
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Da- Cow
❑ Dairy Calf
❑ Dairy Heifer
El D Cow
❑ Wean to Feeder
❑Non -La er
Feeder to Finish Q,$©p
,a�,
Dry Poultry .::
❑ Farrow to Wean
❑ Farrow to Feeder
t:a
`''
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Beef Feeder
ElNon-La ersEl
EGilts
Boars
Pullets
❑ Beef Brood Co
k .r
❑ Turkeys
Other
a `"
❑ Turkey Pouets
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man -trade?
❑ Yes
❑ No
51NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
0 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
® No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[A No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

i Fach* Number: 17— 11t Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes V] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No P NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
33`)
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 1P 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? [P 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 ZNo ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [51 No ❑ NA ❑ NE
maintenance/improvement?
IL _ Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
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
allo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
EA No
❑ NA
❑ NE
.Comments (refer to question #): Explain any YiES`answers and/or any recommendahons or any, o[her�comments.
8
Use drawings of facility to better explain situations. (use additional pages as necessaryp� wy l
7. &re. arms QfA v eta � Le r�dcL, s, i� Mr, t ldso., � S' • h
-i rocres of gri dcb sue; ( cam( sew 6crmudQ '4
T
Reviewer/Inspector Name 1M e Phone: /O) 5��3 �-F 0
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Faciif'iy Number: 'r"l — f Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 51 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �] No El NA El NE
the appropirate box. ElWUP El Checklists El Design [I Maps El Other f
21 _ Does record keeping need improvement? If yes, check the appropriate box below. 5D Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard CS Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
N 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
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Wo
W11rA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
® No
❑ NA
❑ 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
W 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
JK] 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
r
Addthonal Comments andlar Drawtngs. .t z. _ �a�.
aA%
585 C" .
W�Q S LA -C +0 CO C+ Was ke �, � e�"7 �0 "'3"'I S
naS6 1V \e 00\jf doD
12128104

Type of Visit Q Compliance Inspection O Operation Review • Lagoon Evaluation
Reason for Visit O Routine O Complaint 41 Follow up Q Emergency Notification. O Other ❑ Denied Access
Facility Number Date of visit: `� 1] 0 Time: s 0 O
O Not erational O Below Threshold
© Permitted [3 Certified 0 Conditionally Certified 13 Registered Date Last Operatedd or Above Threshold:
Faun Name:W!forCounty:
Owner Name: g.. V �tnr�.. W S �k Phone No: ,,...... 9 10 — & S Z
isiling ,address: 3 z 0 - _ Fit l e.r (o e ITT L 2 3
Facility Contact: Title: Phone No: �f0 — 1/82-2-
Onsite Representative: ._ _ _ . Integrator.
Certified Operator.
Location of Farm:
Operator Certification Number.
❑ Swine ❑ Poultry ❑ Cattle ❑ horse Latitude • K Longitude ' uu
Discharges & Stream ts
1. Is any discharge observed from any part of the operation?
❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Feld ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Freeboard (incises):
12/12f03 Continued

Facility Number: Date of Inspection I—L
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ 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 maintenancehimprovement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste ARRA ation
10. Are there any buffers that need maintenance!miprovement? ❑ Yes ❑ No
11. is there evidence of over application? If yes, check the appropriate boa below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor lssues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.

IType of Visit • Compliance Inspection O Operation Review Q Lagoon Evaluation I
for visit O Routine O Complaint O Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: f0 O Time:
O Not rational O Below Threshold
E3 Permitted 0 Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: . __ + Sar��S t� Ke, F4rvw County: Q +c-dxdl
Owner Name: . $ .. LA ']Phone No: _ _._ ! 0 — (VIEZ — 3_Y-4i 9
Mailing Address: _ ��_ Cal 111imn.—AlAliewe TJL _.
Facility Contact: _ _ _Title: Phone No: 2/0 6 S 2 —'� 8 L'L
Onsite Representative:
Integrator.
Certified Operator. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �' Du Longitude 0
Swine Capadty
_IDes,� _ �.Cnrrea�
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
—Number.oi'�igoons
Curirient
y�Pojp -Cattle. Aaft
oota
=,
Layer Dairy
Non -Layer = Non -Dairy
Total Desgn`.C*adr9
Tom SSLW
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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
u Idener: __
Freeboard (inches):
.12112103 Continued

Facility Number: Date of Inspection i o
5. 'Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ 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 maintenancerunprovement? ❑ Yes ❑ No
S. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes ❑ No
9. Do any stuuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehunprovement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for laud application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acne determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ 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 ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.

Type of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
�Faeilin 'umber I?ate of isi[ ( b Time: _K : 00
6 Not Operational O Below Threshold
® Permitted ® Certified © Conditionally Certified M Registered Date Last Operated or Above Threshold:
Farm Name: W LSo" C Ll ill l— rna Count-: Q, & M&"&
Owner Name: �Lc4 LI) i ( _C U-4 Phone No: ��a1__ �_r� — 4-C
Mailing Address: a S G 1�33g
Facility Contact: 12r-+4 r. U.� am Title: Q,Xn<_- Phone No:
Onsite Representative: ("A 4 4 ,_ 1.1 i �Q H Integrator:
Certified Operator: J.S eTh Operator Certification Number: i �S��f✓
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ i-lorse Latitude ' �` 0 " Longitude ' • K
Design Current Design Current Design Current
Swine Capacity Population Poultry Ca acity Population Cattle Capacity Population
❑ Wean to Feeder I I ❑ Laver I 1 10 Dairy
® Feeder to Finish qSt>b1 I JE1 Non -Laver I 1 10 Non -Dairy
❑ Farrow to W-ean
❑ Farrow -to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ goy Total SSLW
Number of Lagoons
Holding Ponds I Solid Traps
Discharges S Stream I_mnacts
1. is anv discharge observed from any part of the operation?
I❑ Subsurface Drains Present JI❑_Lawn area ]❑ Spray Field
❑ No Liquid Waste Management System
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obser ed, was the con evance man-made?
b. If discharge is observed, did it reach Water of the State? (If ves, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if ves, 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: I
Freeboard (inches): A3
05103101
❑ Yes [P No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
® No
❑ Yes
allo
❑ Yes
® No
Structure 6
Continued

Facility Number: Date of Inspection `c- t'- t u___
5. Are there any immediate threats to the integrity of any of the structures observed? (it/ 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? El Yes ®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes W No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes [ja No
9. Do any stucrures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 1�1 No
Waste Anniication
10. Are there any buffers that need maintenanceiimprovement? ❑ Yes [ &No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑Yes
15a No
12.
Crop type LAP cm dfr E144
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[0 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?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes]
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
W No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ Vl'Z iP, checklists. design. maps, etc.)
❑ Yes
W No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
[�] No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JR No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify- regional D1i'Q of emergency situations as required by General Permit?
❑ Yes
® No
(ie' discharge, freeboard problems, over application)
23_ Did Reviewer/Inspector fail to discuss reyiewlinspection with on -site representative?
❑ Yes
[ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
15a No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[P No
10 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
,---. -r .. .'-_:a.•.es; ..,-.0 ,gam•°�. . -. ... .-'-:: �`'.i r=""=-'-..�. '-:.' $ ""5�.�—.`�-�1dL-"Yi�:�2`c: -_. �'.�'•�r��.r- a._,e- Avg,. .,:+'"sr .�'�4...^i
Cotnmeats'{refer to quesEsonj: Eip]sin any YES aasweis n/orantyrccaaimendatioas or anv ather cammts..
r _
Use drawings of f tcHity to better explain situations.- (use adds ionil pages_as aecessary) G Field Copy ❑ Final Notes
k`�t reCQ�-.ko
s-
ReviewerlInspector Name
Reviewer/Inspector Signature: Date: O
05103101 Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
05103101
❑ Yes ❑ No
❑ Yes R No
❑ Yes F41 No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No

. a
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine Q Complaint C) Follow up O Emergency Notification O Other ❑ Denied Access
Facility- Number
Dale of Visit: Time:
I
not O erational Belor.• Threshold
® Permitted ® Certified 0 Conditionaliv Certified 13Registered Date Last Operate�d7 or Above Threshold
Farm Name: O WS I1 Counn: __ f i Cf,_V-% a A
Owner Name: Rr to c, w _ t-J i (.Cir-a - _-- Phone No: _ 0, - 4 $ 2 1 ('Ia=)
Mailing Address: i (go rzneA
Facility Contact: Q,v+ 4 �Sv� -Title: d a, i n e r- Phone No:
Onsite Representative: cJ13i^ti G_ � l;J � S U-\ _ . Integrator: L L C. �-
Certified Operator: � h ''-� t S o� Operator Certification Number: 1 7- 5 e !a
Location of Farm:
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° " Longitude a I
Design Current Design Current Design Current
Swine Capacity Population poultry Ca achy Po nlatioa Cattle Ca achy Po uladon
❑ Wean to Feeder ❑ Laver I ❑ Da'
® Feeder to Finish O c'} d ❑ Non -Laver ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder 10Other
❑ Farrow io Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons 0 ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges 8- Stream Imnacts
1. Is any discharge observed from any part of the operation? ❑ Yes ] No
Discharne originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convevance 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 Slow in eat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
?. 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 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure 5
Identifier.
Freeboard (inches): _ �2_3 i
05/03/01
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ER No
Structure 6
Continued

a
Facility Number: ( Date of Inspection 3
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public healtb or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type R e r,,,L L,ct-z- -4- Sw- - C-rr� r
❑ Yes
® No
❑ Yes
® No
❑ Yes
No
❑ Yes
KNo
❑ Yes
0 No
❑ Yes
[ANo
❑ Yes
W No
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[Y'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?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
Qj No
l6, is there a lack of adequate waste application equipment?
❑ Yes
O No
Required Records & Doeumen
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ VaT, checklists, design, maps, etc.)
❑ Yes
Y No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[71 No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
8 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Fallo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[ANo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[jO No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EANo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
,. .r n r
Comments (refer�to�q on #I): Ezplain any YES answer�sanorfany recommendations orany other comments.
Use drawings of ia-Ved ty to better explain situsttons .(use' addtttonal pages as.uecessary) ,;W �
.w ❑Field Coav ❑ Final Notes
01 ] C%43
�G •J t�,-boa �1, �+ tre co'-J[ a c �d 3.5
c� .
Reviewer/inspector Name
Reviewer/Inspector Signature: Date: D 10&
05103101 I Continued

d
Facility Number: — '� Date of Inspection O
Odor Issues
26, Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a pi rmanenthemporary cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes ® No
❑ Yes ❑ No
05103101

i♦'Division of Water Quality ,
il
F
--to LDtvtsioa of Soil and Water Conservation _
x '
v
d
A O over Agen�yy"� A�'
of Visit Q Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ®Routine O Complaint O Follow up Q Emergency Notification O Other 6ff � ❑ Denied Access
. F.:7�
Facility Number 77 17 Date of Visit: 12-6�Q9t Time: 11:01!
Not Operational O Below Threshold
® Permitted ® Certified 13 Conditionally Certified [3 Registered Date Last Operated or Above Threshold_
Farm Name:Wjh(ta's.Sw0cFauw............................................................. County: lUchmoad-------------------------------
Owner Name: BAAa - --- - - - --- - �lilsQn--- - - - - - - - - - - --- Phone No: --
Mailing Address. Jjj$0..J.o=.&R1Cj11g5-Ch -gild.... .......................................
FacilityContact: ...........................................................Title: ............................................... Phone No: ......................................
Onsite Representative:----------------------------------------------------- Integrator: n G.�suwFa�olsilufR,�.------------ ---•
Certified Operator: Paul.),.... ................ W.j hom...--------................ . Operator Certification Number: 1.73-,fi6 ............................
Location of Farm:
On west side of SR 1466 approx..4 miles north of intersection with SR 1471 at the Moore County line. AL
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 • 07 26 u Longitude 79 • 36 20 u
.. Design Y"Carrent T Design Current 4 Design Current
Canacitv -Population - Poultry. , Ca.,aci - Poo ula i6n Cattle, CaoAcity Population "
Wean to Feeder
® Feeder to Finish
8800
❑ Farrow to Wean
❑,Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
~❑ Other
Total Design Capacity 8,800
Total,ssLW 1,188,000
'•'i .. -r- is � ';`. W, 1 '. - ': •. �. i, ._fi .... .... .,__ `.�.
Number of Lagoons 1 Subsurface Drains Present irffLagoonArea ❑ Spray Field Ares
Holding Ponds /;Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ® No
2. is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ........... 24............
........................... ..................--• -------------------------- ..... ........................... _.._.._.._.._.._..
0510101 Cnminued

Facility Number: 77-17 Date of Inspection 124-2000
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste ADDlication
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
® No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12.
Crop type Coastal Bermuda (Graze) Small Grain Overseed Wheat
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?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
® No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
® No
Reguired
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19,
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit. You Aill receive no further correspondence about this visit.
� sue.
Comments (referto gnesbon #)Explaun ariy�Y,ES answers and/ortanyl�ommeadatiousior any other comments.
.-s-�xis4Y"- sue;
Use drawings oifaciiity to bciter explain sttU non. {nse addifioual pagesas essay), ❑ Field Copy ❑ Final Notes
�• .�=� ;-..:tip- _ � - -
Owner was not available at this time. No one around farm site. Will contact at later date to review records.
Reviewer/inspector Name John Hasty
Reviewer./Inspector Signature: Date:

19�1-16 3l0
--
` = 1&4t oii of Water QrdaUty
m = _ _
s_ Q vision iSf:Soil and=Water Conseiryat,on - -3
O:Other Agei*cy =
_ -
r
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other [IDenied Access
Facility Number Date. of Visit: = -Time: ' 3 Printed on: 10/26/2000
0 Not O erational Q Below Threshold
Permitted (3 Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold
Farm Name: / �Sd7!1, rf....... e&i Jv! ... tP. - - County: �.G � 04I.ffu.Gl!... ........ .......................
Owner Name:.......!' y.. a'.!!`.' .............. ...i!.'.... �1..1................................... Phone No:.........5 .1. .~..r7...<.. 1......................................
Facility Contact: T �,C�i -e..r ....... ...... Title �............. Phone No: �L
............... ................................................... ................................................................
Mailing Address:........ 1.111.p ...... .t� ....SrCt 1�� .....`.- .-.....&......._....... �l.�crHC� 7... �. L� ............... ...�2...
i' � r �+ ._.t.r
Onsite Representative: ............. Q w_K e........................................................... _... Integrator:...... .%1� ............47.... � rC`l/.G.......................
Certified Operator :................................................... ............ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ; " Longitude • �• �66
Design Current Design Current Design Current
Swine Capacity Population Poultry Capakity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer JEI Dairy
Feeder to Finish ❑ Non Layer in Non -Dairy
El Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity g g
El Gilts
y ❑ Boars Total SSLW
Number of Lagoons I ❑ Subsurface Drains Present I0 Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps 1 ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes P No
Discharge originated at: Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the convcyanrc luau -made? ❑Yesio
b. If discharge is observed, did it reach Water of the State'? (if yes, notify DWQ) El Yes /�\No
c. If discharLe is observed. what is the estirnated flow in gal/tnin?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes J�No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 9No
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: .................................... ......................... .......... . ........................................
Freeboard (inches): Z$
5100 Continued on back

I r
Facility Number: rf — e7 Date of Inspection /O—d/ Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application J�
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? ❑ Ex essive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes No
12. Crop type he'LLCC-6
r. t✓
13. Do the receiving crops differ witif those desialated in th9kertified Animal 4te Manag ent Plan (CAWMP}? ❑ Yes ;<No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Po
b) Does the facility need a wettable acre determination'? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes KNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes K.
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes &No
22. Fail to notify regional DWQ of emergency situations as required by General Permit? 'l
(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 RNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes X(No
: -yiolatiorisbr•defcienues were notea-d>�rr-ifiii ibis:visit:.. u will-reeei*4e ou fulrtb -:
conies oridence: abatif this :visit::: :
Comments (refer to: question #): Explain any YES answers and/or any recomrnendations`orany other coitiments
Use.draNnin -„of fitali to better ex lain situations. {use additional- a es.as necessary,)
%wcf j Mq�n>Fa1x
r,aK5 s.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5/00

y
Facility Number:- Date of Inspection �]�p� Printed on: 10/26/2000
Odor Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
f No
liquid level of lagoon or storage pond with no agitation?
/ K
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
kj(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
P"No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
, No
lAdditional'CommentsandforDt-awings:._ -- -- - -
5100

S
Facility Number - - Date of Inspection
_ _Y Time of Inspection I> 124 hr. (hh:mm)
Permitted [3 Certified [3 Conditionally Certified (] Registered JC1 Not O crational Date Last Op er ted:
FarmName:_.....i......................... County- ....................................
Owner Name ...... ��' a- Jv• l s��� Phone No :............. Jrrz.` .7 ...................................
..................................................................................................... 4�
Facilih, Contact': .................� Title: Phone No: ..............
TailingAddress:..............................................................................................
Onsite Representative:.............. .................
Certified Operator: ............................
Location of Farm:
................................................................II...cc................ ..........................
PIntegrator: ..................! ...J................. .....
Operator Certification Number:.....,,....
Latitude =0 ' =•1 Longitude =• 04
Design ,Current
Design' Cuecet t Design Current
Swine, - Ca acrty 'Po 'elation. oultry .
Capaci ` . Po elation Cattle .Ca ace , Po ulation
❑ Layer
Dairy
- ❑Nan -Layer
LO Non -Dairy
.
a F v
CI
` TotalDesign Capacity;;
Total SS:;_
_ Number of Lagoons'
' r ,�.� y
Lagoon
❑ Subsurface Drains Present ❑ L Area ❑ Spray Field Area
Holding Ponds l SoVdmTrapsu
❑ No
Liquid Waste IVlanagement S}'stem f
..__,..
❑ Wean to Feeder
Feeder to Finish
�
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharues & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance tnan-made? []Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (Ifye;, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/ruin'?
d. Does discharge b ass a lauoon s stem? If yes, notify DW ❑ Yes ❑ No
g )P" � ) ( )' Y Q)
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure a Structure 6
Identifier:
Frechoard(inches): .........f...7.................................................... ... .._.._........................... ............_........ ....... •...........................
5. Are there aXhreats to he in ny of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepa,e, etc.)
3/23/99 Coniinued on back

Q Routine Q Complaint Q Fotlaw-u of DWQ inspection Q Follow-up of DSWtiC review ther
Facility Number Date of Inspection U7,7?E�9 rZ~ov
Time of Inspection I J: d-O 124 hr. (hh:mm)
Permitted 13 Certified Q Conditionally Certified [3 Registered 113 Not O erational Date Last Operated
Q
Farm Name e �k J [ �I l f r Countv:............0 .!. .h. s7 .G.......... .......................
Owner Name:....... r UCvt� W rM�S - Phone No:.--.. � . .... S-2..- j. l........................
Facility Contact: ................©Gu Q f� ..... Title: ...... Phone No ...............................
Iailing Address: .... l..l �D .� Q..^...e.5..... / .�.�l.C��.. L.5. i�.s..(. �r.l.f..t`.GI )VC.......................
..............f ^ J ,;. .
Onsite Representative: . Integrator: far.. ,; ...,,••„..................................................................................... ........................................
Certified Operator: ................................................... ................................ Operator Certification Number:..........................................
Location of Farm:
.................................................... ........................................................................................................... ------- ___ ............. .................................-.......................
w
Latitude a 4 •4 Longitude 0 '
Design F Current Design CuireuY Desi "Eurrent -
Swine gn
-. ;
Ca`acrty:'Po-'iilation Poultry Ca""acity ;Po elation Cattle Capacity.,Po elation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish Non -Layer Q Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish -
Tota1 Design Capacity Sd�
_ ❑Gilts ."
❑ Boars Total77
SSLW T.
Numlie_11r of Lagoons' ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
v . a.
Htildrng Ponds /: SoVdtTraps ❑ No Liquid Waste Management System
Dischames & Stream I_mpacts
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 conveyance man-made'?
b. If discharge is observed, did it reach Water of the State'' (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure ? Structure 3 Structure 4 Structure; 5
Identifier: u + Mar��r
reeboard(inches): ....... ../......................... ......................................---.....---................................................ ......
❑ Yes JNNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Ayes ❑ No
Structure 6
5. Are there any immediate thre t ��r
f the structures observed? (ie/ trees, severe erosion, ❑ Yes [I No
seepage, etc.)
3/23/99 Continued on back

Q Routine Q Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review JMOther
Facility Number Date of Inspection
L�.��_.,..... Time of Inspection i zj 24 hr. (hh•mm)
Permitted [] Certified [] Conditionally Certified [3 Registered [3 Not O erational Date Last Opera ed:
Farm Name: _....L.e.{!. f. 6h_ Jr i1 f rtr�- County: !� ` GX at �7`.........................................
.....I ............ .. 1 ................................--•.----
Owner Name: ...... g.......4� W,.1..1 SB2"� Phone No: dQ � Z- .....................................
FacilityContact: ........................................:.......................... Title:................................................................ Phone No:.............................................
NIailing Address:
.................................................................................................................................................................... ..........................
Onsite Representative: Integrator: !fir a.............................................
Certified Operator:........,,,....... Operator Certification Number.,.,,,,,,
Location of Farm:
....................................................................................................................... T
Latitude �' �� ��� Longitude ='
DesignF ';Current _ Design .Current Design Gurrerit
Swine �- _ _
Ca ac>ty =Po ulation : _Poultry Ca acit -;-Pa ulation Cattle - Ca 'aci -Po uation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish d D ❑ Non -Layer JEI Non -Dairy
❑ Farrow to Wean ? `
-r
❑ Farrow to Feeder 7 ❑ Other
❑ Farrow to Finish
❑ Gilts Total Design Capac�tyn_
❑ Boars Total SSLW =; r;
1)ischart es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge ori-inated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water (if the State? (If ycs, notify DWQ)
c- If discharge is observed. what is the estimated flow in gal/ruin'!
d. Does discharge bypass a lagoon system? (If ycs, notify DNvQ)
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?
1%'aste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Identi[7cr:
i=rechoard (inches): .............................. ........................................................................................................... ...........................
5. Are there any imm ate threats to he in grity of any of the structures observed? Oe/ trees, severe erosion,
/��I]9 seepage, etc-)
❑ Yes ❑ No
[:]Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Wes ❑ No
Structure 6
❑ Yes ❑ No
Continued on back

Facility Number I)ate of Inspection
Time of Inspection ]J0 24 hr. (hh:mm}
Permitted P Certified (] Conditionally Certified 13Registered [3 Not Operational �Date Last Operated
Farm Name: vV i 5 �h�� Aj�/ - County:............R. - :......-...................
............
..................................... ........................................ ..........................
OwnerName. 16J... .. . ...... 1...................................................... Phone No:.---..............--...................................................................
Facility Contact: ................j .......lfIJ.L'fr�S�� ... Title:...... ... Phone No: .................................. I ........ ........
Mailing Address:.... ........... ..JLp.S.. .....C..............." .......... I�LVi.IV C ` ...... c..................---....... ....
Onsite Representative:......... .... Integrator ......... 7......
....GtN S.. itrnYZs
Certified Operator:..................................................W_1...5��......................... Operator Certification Number:..........................................
Location of Farm:
Latitude a 9 .4 Longitude ' 9 ':
Desi n
- g
Current `< ' W- .:_
= Desi -
gn " Current - '< Design- Cerrent z
Swine - Capacity
Population.;^-._PQWfry. : =.Ca acaty'.<Po elation Cattle ,. Ca acity 1'0 ulahon. fe„
❑ Wean to Feeder
_:
❑ Layer
❑ Dairy
Feeder to Finish
jV00
:-:
❑ Non -Layer
I
Non -Dairy
Farrow to Wean
-
❑ Farrow to Feeder
[] Other
❑ Farrow to Finish
- Total Dest Ca sett
:::
-
❑ Gilts-
"-
Boars
=
e Total SSLW
Number of;Lagoons, ©° ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
-
Holding Ponds %Solid Traps �^ ❑ No Liquid Waste Management System =-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Ix No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes JNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes KNo
c. If discharge is observed, what is the estimated flow in gallmin? Al
d- Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes W No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ANo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: uu�
Freeboard(inches) ......... 1.................... I............................. ................... I .............. .......................... ....... I.. ....... ............... .............
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes KNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: T2 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over applipation? - ❑ Excessive Ponding P PAN
12. Crop type
❑ Yes K No
Yes ❑ No
❑ Yes IxNo
❑ Yes lyNo
❑ Yes Vf No
❑ Yes [VINo
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
Z No
b) Does the facility need a wettable acre determination?
Cn �
El Yes
❑ No
c) This facility is pended for a wettable acre determination?
- - Cir
❑ Yes
❑ No
15- Does the receiving crop need improvement?
❑ Yes
jj�No
16. Is there a lack of adequate waste application equipment?4d'
ZA[ar;p w+
El Yes
/[)\ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ln4n1 A' � 9Yes
18- Does the facility fail to have all components of the Certified Animal Waste M nagemen Ian readily avAableV
(ie/ WUP, checklists, design, maps, etc.) Yes&No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) YeNo
-Z -
20. Is facility not in compliance with any applicable -setback criteria in effect at the time of design? - �f' El Yes V No
21. Dill the facility fail to have a actively certified operator in charge? % ❑ Yes I(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24. Does facility require a follow-up visit by same agency?
❑ Yes
19 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
0 No
0: 'N.O-vig4atidtis :ordeficiencies -were hb4ed• d - " ' ' ihis:visit: - Yob wiil-receive oo turthcr - . -
C . .. poiide... about this nisi • ... :..........:. ....
invents (refer to yuestton #) Explatn any YES,answers and/or any recommendatrons o nyother comments: - • ' `
rl, /1J.&J fr
• .-'" w �•' 1 Vim/ " /� �► � 41 L,,_n i v *'C!'y' +"'M"'.
tO
Reviewer/Inspector Name
Reviewer/Inspector Signature.
Date: V ��
3/23/99

❑ Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality `# �
reais'`asr»d% a`.>`. xr;y:rz& -+:
16 Routine O Comnlaint O ,Follow-un Of DWO inspection O Follow-up of DSWC review 0 Other
Facility Number Date of Inspection Zy-q
Time of Inspection � 24 hr. (hh:mm)
D Registered gCertified © Applied for Permit Permitted 113 Not O erational Date Last Operated: ..........................
Farm Name:....YyJ.1..�. Q.R. ..... 5wl.t�te.--....I'GI"+n................................... County:...... t.G�^..1.!:1,.4.,k�....... ............... .......................
Owner Name:..... Y� ..................... s..kl�......................................... Phone No: 0 _Z3
' 7q-1. ........
9 .- ..-•--.--�°--•---........C.......
Facility Contact: ....$.r..!�.al�....... .'.. SO► .................Title: Vhs.a.h.4r......:......................... Phone No:.....1. 47 .._....................
Mailing Address: AN.r_11n4f.Cbn.1
OnsiteRepresentative: .... l�1-�`'�ai�`--.-.th�!••�,Sb. .......................................... .._ Integrator: ............ 1\.J-..G PrU •---------•-----
Certified Operator....... . .I. �k :.........;..............1/ .t...�.v..'`_.....---.....------....__---:-_-_• Operator 'cation Number: ------------.............-------------
Location of Farm: r
0
"a
Latitude Longitude r—• ��"
sF a s a °DeStgn Current ? DeSt ` CElrreltt pv,.,:. s K e51 Curren M
gn D, �_
5wineng,: �; Capacity Populattoa S Panitry,,, : Capacity ,Population Cattle $ Capaeity;,.Populatton
: ,., v.
❑ Wean to Feeder ❑ Layerff
4kt [] Dairy
KEFFeeder to Finish Ofl ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ .,
Farrow to Feeder ❑ Other
Farrow to Finish h4 Total Design Capaciiy , Q [j
❑ Gilts w e
' T&i ss w x
[I Boars T
La oon Area Spray Field Area W
,�, .Numberof Lagoons / Holding Ponds � � ❑Subsurface Drains Present ❑ g ❑ P
�
T i.
❑ 10 Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, What is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. , Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes 'No
❑ Yes I
❑ Yes ❑ No .
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ YestNo
o
❑ Yes
❑ Yes DNO
❑ Yes No
Continued on back

Facility Number: 7 — I
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La2oons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes No
Yes ❑ No
Structure 6
Identifier:
Freeboard(ft):........ ......................... .............. ......................
10. Is seepage observed from any of the structures? [] Yes 0
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes K N 0
12. Do any of the structures need maintenance/improvement? XYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess o&Mrp.l
or runoff ente :n waters of the State. notif DWQ)
15. Crop type
.... .... .k.� .......f.7L�.......................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AW,MP)?
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"
[] No.vioiations or deficiencies were' noted- during' this visit..You4ill receive no further
cor'r6 6ndence shout this _visit:• : - - . :
Cotiimeitts:(refer':to question #) Explain any`.YES answers and/or any recommen¢ad6ns�or any other c
r
Use drawtngs of factltty to better;explain situati<ins;`(use additional pages as nceesssrv}
l i.
Needa.... �70rz,"�
1 1a6t� %re� owA, file r/ e ref ,e_",ed /7
41/2� 1410w r6011—
1: et Wt l L Al � S 1eS 1 r 6ai� Mark',( 1 kS t�[p�.
JKYes ❑ No
❑ Yes [KNO
..........
❑ Yes ff NO
❑ Yes WNo
❑ Yes 9No
❑ Yes 9No
❑ Yes KNo
❑ Yes 9No
❑ Yes Z No
❑ Yes D�_No
❑ Yes PO No
❑ YesNo
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: (A-s/_ ( I. fdl�& C/ Date: q—

Farm Status: L r4l 1 !��
Farm Name: o { _ L ea-� r County: Q� �► "n hr�
Owner Name: Phone No:
Mailing Address: 3 D 3 o ld L eaT�12,n er1p2�3 3
Onsite Representative: la CI CL Integrator: At tr• vL
Certified Operator. — Q I91n Operator Certification Number: 17 5-6 {a
Location of Farm:
Latitude �`Q• �,J" Longitude Q• 0' 04
Not O erational Date Last Operated:
Type of Operation and Design Capacity
%.'sW
Srrtgecc =w Nnmler`PbnItFYNuutberCsdle�y�"F3�Turimber�
Wean to Feeder
Feeder to Finish S$ 0 0 ❑ Nco-1 Aver ❑ Beefy
Farrow t0 We -an k j ., r» 'adEl s
Farrow to Feeder
❑ Other T Livestock Farrow to Finish
Type
..sr-
,Nambernf iiagoons r1 Holding Ponds' Subsurface Drains Present
* ❑ Lagoon Area - S ra Field Area
.....
aeral
1. Are there any buffers that need maintenance./improvement? ❑ Yes *0
2. Is any discharge observed from any part of the operation? ❑ Yes ANo
a. If discharge is observed, was the conveyance man-made? ❑ Yes allo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes KNo
c. If discharge is observed, what is the estimated flow in galfmin?
d. Does discharge bypass a lagoon system? (1f yes, notify DWQ) ❑ Yes R) No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
4. Was there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes qNo
S. Does any part of the waste management system (other than lagoons/holding ponds) require U3 Yes V +No
maintenancrJimpmvemCut?
Condnued on back

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to ban a certified operator in respoasiible charge {if inspection after I/1/97)?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La oohs and/or Holding Ponds
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3
1
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures obsented?-
12. Do any of the structures need maintenancerunprovement?
(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 adquate markers to identify start and stop pumping levels?
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 Berm �04L /Ctlrn / k 4 e
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilitin Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did ReviewerAhspector fail to discuss reviewrmspection with owner or operator in charge?
irnri�fi;te:(r�fir Yn r��rcYirm 3{l=c.�irnlain'a*ni•YFC aneQirrc anrilrir arw't
12 , Lajce>r, loos, k n eeJs w►ow; „g
13, S-kkr4-5++Or PkhP P%cwkers Ac4ed 40 bC inVfOt)1'eJ.
❑ Yes ,0 -
❑ Yes 'ANo
❑ Yes 04No
❑ Yes Wo
Lagoon 4
❑ Yes Q No
❑ Yes JANo
,Yes ❑ No
0 Yes ❑ No
❑ Yes (% No
❑ Yes Wo
❑ Yes MNo
❑ Yes PNo
❑ Yes MNo
❑ Yes JZ No
❑ Yes C.No
❑ Yes MNo
❑ Yes Q No
❑ Yes O.No
Reviewer/Inspector Name ` ' '� � FUN-`
Reviwer/Inspector Signature: Date:--is-`�7
cc. Division of Water Ouafity. FValer Ouofity Section. Facifitv Assmsment Unit 11/14/96

Routine Q Complaint Q Follow-up of DW2 inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection -D27
Time of Inspection ; 30 124 hr. (hh:mm)
Permitted [3 Certified © Conditionally Certified © Registered [] Not OperationalOperationaj Date Last Operated:
Farm Name: .....iN.1..L. ?'�..f ... �� E C,r7 .... County• �G1j rvt lSh`�. .......................
... .. ;.............. ..... .........
Owner Name:..... &yC''?.....* ......... � � �.................................... Phone No:..........�P. .. (r.. .. T. ......__............. ._
Facility Contact: . ....................................... Title: ..................`�
Mailing Address: .._Jllp.... E f ... %% •. �t�..,f!f r.......................
Onsite Representative: ........ (,�r,• r ea✓
....................................j...........................................
PCertified Operator: ..trl.l f 5
Location of Farm:
Phone No ................................
-./Lt°.................. ........ ... 33
Integrator: ...............
Pu ril;s
Operator Certification Number:
Latitude & 46 Longitude ' & "
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes Ai
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? (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
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ��
Freeboard (inches):
......................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes No
❑ Yes �No
❑ Yes
o
❑ Yes
No
❑ Yes
o
❑ Yes
o
t_
Structure 6
❑ Yes 2:19-0
3123/99 Continued on back

t.. 1
Facility Number:27— Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
raw s
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need main tenance/improvement?
11. Is there evidence of ver application? Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with se designated in the Oified Animal Waste M agement 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
IT. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20_ Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
PLN'O"*iolA'tioiis:ojr, dW7iciencies *ere pQteii•d(W* i' ig this;visit; � Yoer wiii-t4eetriye .. fug... •:. -
coriespaiideirce: a�atit: this visit:..::::::: ::....::....:....:..::..:. .
ra.r,x /"/KS J�[..OZ'kf y�- we//
�nQ. �J �%�" ! �S BCc� Q QQ� /Bvp�� �( �•S �rlk e .
❑ Yes XNo
❑ Yes P(No
❑ Yes P p
❑ Yes Wo
❑ Yes / \�'No
❑ Yes ,(�`No
❑ Yes D(No
❑ Yes gNo
❑ Yes PfNo
❑ Yes RIo
❑ Yes Gg�No
❑ Yes WNo
❑ Yes WNo
❑ Yes ONo
❑ Yes .9No
❑ Yes XNo
❑ Yes KO
❑ Yes XNo
❑ Yes KNo
❑ Yes KNo
❑ Yes PNo
fReviewer/Inspector Name ,"1� �z
Ip92 5-���wA� M r._ e
Reviewer/Inspector Signature Date: y'-�
AL

Facility Number: -7 —Z 7 Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes '❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ('J No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes 14 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 PqNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes J!(No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No