770020_INSPECTIONS_20171231

Type of Visit: 0 Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance I
Reason for Visit: AD Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access 11
Date of Visit: Arrival Time: Departure Time: County: ' egion: i�
Farm Name: I M „N24AS .lry _ Owner Email:
Owner Name: L_ Amr.. Q-& s Phone:
Mailing Address:
Physical Address:
FacilityContact: rWt k''dct S Title: Phone:
Onsite Representative: Lf
Certified Operator:
v
��wjyy Integrator: �
Certification Number: [ r�
6 2
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop. Wet Pointry
Wean to Finish I Layer
Design Current Design Current
Capacity Pop. Cattle Capacity Pop.
Dairy Cow
I Dairy Calf
Dairy Heifer
Design Current Cow
. Non -Dairy
Beef Stocker
Beef Feeder
Wean to Feeder
I
INon-Layer
Feeder to Finish
[Layers
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Laver
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
Wither
Other
I.Q.1i
Discharges and Stream ImDacts
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 [�ZNA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) [:)Yes [:]No 1 ''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 No ❑ NA [] NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ffi No ❑ NA ❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Conhinued

Facili Number: e717- Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes K) No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No jo 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
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
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 r% No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
LAC-
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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste TrINo
fers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ® No ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ja No ❑ NA ❑ NE
Page 2 of 3 21417015 Continued

FltciliAmber: jDate 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
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 satne agency?
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes F No ❑ NA ❑ NE
❑ Yes V@ No ❑ NA ❑ NE
❑ Yes [P No ❑ NA ❑ NE
❑ Yes [�j No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes [ No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Phone: 3'3
Date: -T // g
11412115

Type of Visit: ® Compliance Inspection V Uperation Review V Structure Evaluation V 'Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ! / Q Departure Time: County: �CLNcd Region:
Farm Name: � i �Am&ojn5 fin�tn Owner Email:
Owner Name: W 1 Phone:
Mailing Address:
Physical Address: j
Facility Contact: Wij01yN-v\pin S Title: Phone:
L4
Onsite Representative:
Certified Operator: _ N
Back-up Operator:
Location of Farm:
Latitude:
Integrator' Sf"r IiA�Ld
Certification Number: 17 6 Z .3
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
We# Poultry
Capacity
Pop.
Cattle
Capacity Pop.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Cow
Farrow to Wean
Design Current
Farrow to Feeder
D , Pouf
Ca aci
P,a
Non-Dal
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
- - - -
Turkeys
Other
TurkeyPoults
Other
Other
DischarEes and Stream Imuacts
1. is any discharge observed from any part of the operation? ❑ Yes CgNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? [:]Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
❑ No
'M NA
❑ NE
❑ Yes
1� No
❑ NA
❑ NE/
❑ Yes
P No
❑ NA
❑ NE
Page I of 3 2/4/101 S Ce

1?acili umber: - Date of Inspection: cj -7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes W No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No N 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 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 E;-a 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? ep
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? P@
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Felt W1ti0lol CA GO,,.. � Tlarlk -1 5m - caV`Qnr,
i r �
CaC
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P 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
C] NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
T
❑ 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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ERNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Tracilit' dumber: - Date of Inspection: 17
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes W 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 1P No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes y No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [ 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
�a 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
[P No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
[W No
❑ NA
❑ NE
Conuuetits°(refe�to question#} ExpIa►n any YES: answers and/or any addrtional recomi iendations or any other commeniN.
�;, ., .. >
Use drawings;offacility to .better expiate situations use additional pagesas
IW0�47 M0J,6
Po-fe cd( �Olv Cq ! o) 6,?_q ,-L1aq t
7, Reseto,f s ma t r -J-Yee s -f o i
�Jllh4 Ammon,!;rcdo
qta-qR,5-o3�1
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone: 9 �0.-y133 -33�a
Date: `# f '7
21412015

Type of Visit: 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: p 'Z? /,b I Arrival Time: Departure Time: qr+, County: L` %7tp=vW Region:
Farm Name: t %(%/ „� /� ph S �Q.yil'a► Owner Email:
Owner Name: �✓!l► r-L 0"rs Phone:
Mailing -Address:
Physical Address:
Facility Contact: �/l% / n(�y /�w A- OHS Title: Phone:
Onsite Representative: Integrator: 1.5�1MAT1110-4.4"
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
gn Carren t
W-Ac3. a'
Pop.
Design
Current
Design Current
Ca
gp city,
Wetl'oiiltry
Capacity
Pbp�
Cattle Capacity Pop.
_
r_.
.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
2
Non -Layer
Dairy Calf
Feeder to Finish
Da'y Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
D . Pko.ult :
Ca aci
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other "_,,
Turkey Poults
Other
Other
Discharges and Stream Impacts
1- Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No NA . ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes EP No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes � No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Nu ber: - Date of Inspection :1 c 71
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
2 rlr
Observed Freeboard (in): J
Structure 3 Structure 4 Structure 5
® No ❑ NA 0 NE
TT❑No ®NA ONE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes M No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) TO
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? T
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T
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
1�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
&_Puja
12. Crop Type(s).
13. Soil Type(s): C Q
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CPNo
❑ 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
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[V 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 Eg 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 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA [] NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: '7 - Date of Ins ection: /v
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 No ❑ NA ❑ NE
the appropriate box(es) below. 1P
❑ 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?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [] No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No [] NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application) Ep
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 1P 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 9� 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 (re er�Btoquestlon #} �Eaplain any:YES answers gnd/�oranyadti�tional recommendations arany otlzercomments.-11
f..�,.:9
Use drawings,offacilltyAtol�etter.exvlain situations (use additio"nal�aaaes;:asnecessarvl: - s
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
p' all lA14//JS Phone: gID133, n
6 Date: -7 E 4 '
214.12015

Type of Visit: W Compliance Inspection V operation Review V Structure Evaluation V Technical Assistance
Reason for Visit: 0 Routine 0 Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: '---�'-`-i"'-- Arrival Time: O : r Departure Time: q,.. County: i *1&Jo Region: (LAZ
Farm Name: �W ii,,. vh Owner Email:
Owner Name: ;., Phone:
Mailing Address:
Physical Address:
Facility Contact: ln) t1' A= "a„ , S Title: Phone:
Onsite Representative: Lf Integrator:
t4 I
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
op.
mc-a'I'lacit-VIER.—
Wean to Finish
Wet Poultry
Layer
Non -La er
Capacity
Pop.
t
Cattle Capacity Pap.
DairyCow
DairyCalf
Dairy Heifer
We to Feeder
2p
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D , P,oul
Design
Ca aci
Current
P.o
Cow
Non-D
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Q#her
Other
Turke s
Turkey Poults
Other
i
!M
Discharges and Stream Imnacts
1. Is any discharge observed from any part of the operation?
[:]Yes
M No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�] No
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
® No
❑ NA
❑ NE
of the State other than from a discharge?
T
Page I of 3 21412014 Continued

acili Number: -24C,> Date of Inspection: (o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[3 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
[4 NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): k
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
1� No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
TT''
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
® No
❑ NA
❑ NE
maintenance or improvement?
T
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!# No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Win r
ft ❑ Application Outside of Approved Area
12. Crop Type(s): `—i I -ariy, JC4 �
t
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EP 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 �D 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 iP No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3
21412014 Continued

)H'acili umber: 2 rZ -2 1IDate of inspection: WA
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
Qg No
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
qNo
❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
® No
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
(j No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes ® No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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 EpNo ❑ NA
❑ NE
Comments refer to ueshgn E latu;an YES�answers and/or an� _addittooalrF nimendations or... any other -comments
_y y
User better eyplain-srtvattons (nse. adciibonai gages_askdecess Y)•= :' ,•
.
Reviewer/Inspector Name: f " t'i )t
Phone:
Reviewer/Inspector Signature: `-
Date:
Page 3 of 3
21412014

R 3 , I
Type of Visit: a Compliance Inspections 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ® Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: $ ; Departure Time: County:
Farm Name:,k�:�,�,�;s�fl.•�++-. Owner Email:
Owner Name: j,J��'1Gf ,n G,,,o;,,f Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
K
a
Latitude:
Region: r-(2V
Integrator: Mtµyy�y✓�
Certification Number: 1,76 1
Certification Number:
Longitude:
MA
Design Current Design Current
Swme Capacity, ^� Fop. Wet Poultry Capacity Pop
.t
Design Current
C*attle Capacity Pap.
Wean to Finishy
La er
Dai Cow
Wean to Feeder
Z-
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
D . P,oult . Ca aci to P.
airy Heifer
Cow
Non -Da'
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
113eefBroodCow
Turkeys
MR
"§�
Other, Turke Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ®No ❑ NA ❑ NE
❑ Yes
❑ No
® NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [] Yes ❑ No [4 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 0 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: Date of Inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes c] No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 3 fi
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [P 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?
I I _ Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptabl�e Crop Window �s ❑�E~vidence of Wind Drift ❑�Ap�pliic�ationn Outside of Approved Area
12. Crop Type(s): emsfU'- s- `Padt4jro): -ik
13. Soil Type(s):�,Q Y „
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes M 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
W No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jo No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[:]Yes
[$1 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 {0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El waste Tra`nns'fers
❑ 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 ® No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

f
Facility Number: "j - `?-U Date of inspection:
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 7� No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
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 duality 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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
® NA ❑ NE
❑ Yes ® No ❑ NA ❑ NE
❑ Yes N] No ❑ NA ❑ NE
❑Yes ®No ❑NA ❑NE
❑Yes WNo [DNA ❑NE
[:]Yes No
[:]Yes ® No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (referto question ft Explain any YES answers and/or any additional recommendations or ao. other camimenti: «�
Use drawings: of facility to better explam..situationsi se.additronalpages as.pecessary) .Y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 11 p'- `f 3_3--3 3CY0
Date: =,—(, jV
2/412011

r
Type of Visit: ® Compliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit: • Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
n
Date of Visit: Arrival Timer Departure Time: /l; County: %C /Region:
Farm Name: t3 ►1S Owner Email:
Owner Name: Ply! Ohs Phone: '
Mailing Address:
Physical Address: 4 _
Facility Contact: Wi+ l" l` Y� ✓--,D v5 Title:
Onsite Representative:
Certified Operator:
Back-up Operator -
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design
Design Current :m, - Design Current
Swine
CapacEty
_ _ P.:.op.
Wet Poultry
Gapactty Pop Cattle Capacity Pap.
Wean to Finish
Layer 5. Dairy Cow
Wean to Feeder
Z(jp
(3
Non -La er
Dairy Calf
Feeder to Finish
airyHeifer
Farrow to Wean
-r
~� .
Design Current;I Dry Cow
Farrow to Feeder
ci P Non -Dairy
Farrow to Finish
ILa
ersI
Beef Stocker
Gilts
INon-La
ers
_a Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s"
Otheri
ZMTurk
e Poults�
Other
Other.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
CR No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
M NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:]No
NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
® No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[] Yes]
No
❑ NA
❑ NE
of the State other than from a discharge?
TT
Page 1 of 3 21412011 Continued

Facility Number: - Date of Ins action:
Waste CoAlection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate? ❑ Yes [)5 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): i-to
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 R 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
T Do any of the structures need maintenance or improvement? ❑ Yes [P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EpNo ❑ 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?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of A eptable Crop Window ❑ Evidence of ind Drift. ❑ Application Outside of Approvf d Area
12. Crop T e s :� 11 li)161VI +yr{) 55�
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
Q�No
❑ NA
❑ NE
❑ Yes
E� No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
❑ Yes
T No
❑ NA
❑ NE
❑ Yes
T No
❑ NA
❑ NE
❑Yes
®No
❑NA
❑NE
❑Yes
IrNo
❑NA
❑NE
❑WUP El 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 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
21412011 Continued

Facili Number: 9 7 - 2..0 10ate_of Inspection:
24' Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes �o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes a No
Other Issues
2$. 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? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question : Explain any YES answers and/or any additional recommendations or any other:commentsft
Usedrawmas"of facility to better explain situations fuse additional=vai! as necessary).
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
❑ Yes ® No ❑ NA ❑ NE
❑ Yes R No ❑ NA ❑ NE
❑ Yes J ] No ❑ NA ❑ NE
❑ Yes �C] No ❑ NA ❑ NE
Phone:
Date: ��
21412011

Type of Visit ® Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ® Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: i Arrival Time: Departure Time: ; County: t`TC Iii0tiD
Farm Name: r« L-0 Y Owner Email:
Owner Name: inn r!, �Phone:
Mailing Address:
Physical Address:
Facility Contact: W)K avtS Title:
Onsite Representative:
t�
Certified Operator:
Back-up Operator:
Region:
Phone No:
Integrator: n �a1-tGt.>t� LLC
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 4 0 « Longitude: = 0 = 0 =
ig
Design MUM
opulation
PRO=
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
n to Finish
F
❑La er
❑Dai Cow
n to Feeder
�G❑
Non -La er
❑Dai Calfer
❑ DairyHeifer
to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry-
❑ Dry Cow
❑Non -Dairy
❑ La ers
❑ Farrow to Finish
❑ Beef Stocker
s
Gilts
❑ Beef Feeder
Pullets
POO
Boars
I[] Beef Brood Co
❑ Turkeys
Other
❑ Other
Number of Structures:
❑Turke Pouets
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 r No ❑ NA ❑ NE
❑ Yes
❑ No
[� NA
❑ NE
❑ Yes
❑ No
Q0 NA
❑ NE
❑ Yes
❑ No
P NA
❑ NE
❑ Yes
& No
❑ NA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection l i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes oNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No EP NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
x
Observed Freeboard (in): 3 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
q9 No
❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
Lp
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
',JZI 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?
1
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
q No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
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
tp 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
1EP No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use draKjngs of facility to better explain situations. (use additional pages as necessary):
w
s
Reviewer/Inspector Name �J �! Phone: rf 4O
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes P;No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No %NA El NE
the appropriate box.
ElWUP El Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
rut No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[�NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
®_No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
53 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
IN No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
1�9.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
EA 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
Page 3 of 3 12128104

Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation V Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral Q Emergency 0 Other ❑ Denied Access
+ Date of Visit: P J Arrival 'Time: Departure Time: County: Region: Afe
i
I Farm Name: r•. rx"�'Tr e lt- Owner Email:
Owner Name: Phone,
Mailing Address:
Physical Address:
Facility Contact: 0("Ko4 'hp r+ I —Title:
N
Onsite Representative:
Certified Operator: u
Back-up Operator:
Phone No:
Integrator' U.' LSI� CL l�
Operator Certification Number: 17('.3 'A 3 _
Back-up Certification Number:
Location of Farm: Latitude: = n ET
= " Longitude: = ° = 4 =
Design Current Design C►►anent
Design C►urrent
Swine Capacity Population Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish ❑ La er
❑ DairyCow
Wean to Feeder �UQ ❑ Non -Layer
❑ DairyCalf
Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
GiitsLa ers
❑ Beef Feeder
PBoars ❑Pullets
❑Beef Brood Co
❑ Turkeys
Other ❑ Turkey Poults
Fri —Other ❑ Other
Number of Structures:
Lf
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑ 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? (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 N No ❑ NA ❑ NE
❑ Yes
❑ No
�INA
❑ NE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes\JU No
❑ NA
❑ NE
❑ Yes
F�No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

.wl Facility Number: I7— ZQ Date of Inspection �!
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No IWNA
❑ NE
Stru ture 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?
El Yes
No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
MNo ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ yes
Wo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12, - Crop type(s) �+ r IaS J�+• �,t 2,r
�
f'
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
l� No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments {refer to question.#) Eplatn any. YES answers and/or any.recammendatEons or anyother comments
w
Use drawn s of facili to better ex lain situations use additional a es as�ecessa il Y
T
Reviewer/Inspector Name r Phone
x
Reviewer/Inspector Signature: Date:
Page 2 of 3 I2/2004 Continued

Facility Number: 7 —W Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 41 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [1 Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
§a No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
[rr�NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EPNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ENo
❑ NA
❑ NE
26_
Did the facility fail to have an actively certified operator in charge?
❑ Yes
T No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E�4NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Wo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
FhNo
❑ 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
Wo
❑ 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
E5iNo
❑ 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
V No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
W No
❑ NA
❑ NE
Page 3 of 3 12128104

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
��7
Date otfVissi�it: l vaTime: [�f,�a Departure Time: + County: /"V'j0 Region:
Farm Name: h) l hd a �A vil Mon s l �.r fin Owner Email:
Owner Name: w r•O[L -AyY*XrU +'ts Phone:
Mailing Address:
Physical Address:
Facility Contact: 0+Male., 7.,,`'t' en5_ - Title: Phone No:
Onsite Representative: �+ Integrator: �Nlu.'qA ` &Zuwh
Certified Operator: N Operator Certification Number: rlloc�3
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = 0 0 r = « Longitude: = ° 0
Design
Swine Capacity
Current
Population
WDesign Gurrent
Wet Poultry Capty Population Cattle
Design Current
Capacity Population
❑ can to Finish
❑ La er
❑Dairy
Cow
can to Feeder
X>
10 Non -Layer I
airy Calf
❑ Feeder to Finish
Dry Poultry E]Dry
El
Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Cow
Non-Dairy
❑ Layers
El Farrow to Finish
❑
Beef Stocker
❑ Non -Layers
❑ Gilts
Beef Feeder
❑El
Pullets
❑ Boars
❑
Beef Brood Co
❑ Turke s
,�-::. -
Other
-
-
Number of Structures: FT I
ElTurkey Poults
❑ Other
❑ 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?
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 pan of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes [�LNo ❑ NA ❑ NE
❑ Yes
❑ No
rQ 7" NA
ElNE
❑ Yes
❑ No
NA
❑ NE
NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
12128104 Continued

; / Ioq
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ll
Structure 3 Structure 4
❑ Yes Wo
❑ Yes ❑ No
Structure 5
El NA El NE
jQNA El NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Oa No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ 'Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of��+Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) C.Fa i.0TJ S,S_A,, /�`���_M .. ,r+Ca,,.
13.
Soil type(s) �11�1�[,p�1[,
1a —�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
MNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
Q,No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
W, o
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
�No
El NA
El NE
18.
is there a lack of properly operating waste application equipment?
❑ Yes
IP
No
❑ NA
❑ NE
Comments (refer to qp on'�#} Eap gy YESNnswe siandlor any recommendations or.any other comments.
13semrawings of�fatility�to better„explam sttuahons. (use addtt,onal pages as necessary)
AL
Reviewerfinspector Name Phone: 10 33 3 3G0
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 f n Continued

• �S
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 �9 No ❑ NA ❑ NE
the appropiate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21 _ Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 9 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 P4 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
F 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
M 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
E] No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
PQ,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
RNo
❑ NA ❑ NE

e
Facility Number �7
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit S 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: � Arrival Time: Departure Time: /0711W County:
Farm Name: ill! t v.,00s t�IM, Owner Email:
Owner Name: _ W t\L Amilr 70 S Phone:
Mailing Address:
Physical Address:
Facility Contact: 1N tY L44 4i'-Aw10✓6 Title: Phone No:
Onsite Representative: Integrator: XD�j
N
Certified Operator: Operator Certification Number: i76a3
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
Back-up Certification Number:
Latitude: F__] o ❑' 0 « Longitude: = o ❑' ❑ '
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
+-� 7-00 I I ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design C
Cattle Capacity iP4
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Humber of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
J
E
❑ Yes �1 No ❑ NA ❑ NE
❑ Yes
❑ No
[ANA
❑ NE
❑ Yes
❑ No
R�NA
❑ NE
P..NA
❑ NE
❑ Yes
❑ No
❑ Yes
N No
❑ NA
❑ NE
❑ Yes
f5No
❑ NA
❑ NE
12128104 Continued

r. . %
Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No D9 NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1
Spillway?:
Designed Freeboard (in):
ss+��
Observed Freeboard (in): vt y
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
9 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
V] 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
[P 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 l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWNW?
❑ Yes
[P 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
(A No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'!
❑ Yes
1No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[�kNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary): n
A4 5"1
w
Reviewer/Inspector Name 7 Phon ja lf
Reviewer/Inspector Signature: Date: /
liUfS46'.NCN

.. .
Facility Number: r1— Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �No El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes R] No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [P No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
® No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
J0 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
M No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
fig No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C} No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Q No
❑ NA
❑ NE
and report the mortality rates that were higher than nonnal?
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
b�'No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[A No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
JBNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

0
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: dZ Arrival Time: Departure Time: County: 1 Region: F-90
Farm Name: ►'tp m0+�yrarr, Owner Email:
4 n1
Owner Name: W1A A, e-W #1.-S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: p� Phone No:
Onsite Representative: Integrator:
1 Certified Operator: l Operator Certification Number: 174-23
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = o = ` = Longitude: = o = I = u
Swine
Design Current
Capacity Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
Dairy ow
Wean to Feeder
4.
❑ Non -Layer
Dairy alf
_T
4�
Dairy eifer
❑ Farrow to Wean
D . Paul
KBeef
❑ Farrow to Feeder
❑ Layers
i
❑ Farrow to Finish
cker
❑ Gilts
❑ Non -La ers
der
❑ Boars
❑ Pullets
ood Cowl I
❑ Turkeys
-
Other
Other
❑ TurkeyPoults
❑ Other
Number. of 5truetures:
m
� ��
❑ Feeder to Finish
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b_ Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2_ Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes
❑ No
[;0 NA
❑ NE
❑ Yes
❑ No
f� NA
❑ NE
N NA
❑ NE
❑ Yes
❑ No
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
® No
❑ NA
❑ NE
12128104 Continued

Facility Number: q Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 5.No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
%NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d'9 "
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes �No
❑ NA
El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
ElNA
❑ 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? ` ]fes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? v❑ Yes MNo ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of�Acceptable
fCrop Window ' `❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) & r"twh �SS i)& , tuS7FUstP� .S!►'1QM C!v'[L Ir, Gy-es
13.
Soil type(s) Ca OY- is C ,
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[P 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
[5 No
❑ NA
❑ NE
Comments (refer to question #): Explain -any Y,ES; answers and/or any recommendations or�any other3comments r
Use drawings of facility to better explain situations: use. additional pages as necessary):
Ned 4v smea/ 4-k-& 0 7'� -7;" <,
prl [,ypr batiA Con AIW [er4e,_IS-14j
Cr000d
Reviewer/Inspector Name Phone: 7 J -� DO
Reviewer/Inspector Signature: Date:
Paee 2 of 1W29/0 Continued

Facility Number: Date of Inspection 1 1
Required Records & Documents j T
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 ❑ Desig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [)No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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
F5 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[P No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
1� No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
IN No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[P 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? (iel 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
C] No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 12128104

E "
9L
a�Dirio
noIFacilify amber -] zQ On of Soil and Water ConservafiQAgency
- -
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: / — % — Ob Arrival Time: Q' 00 Departure Time: County: ApldfW466NCY Region: `4?X
Farm Name: iAJ i'�� / ";U S Owner Email:
Owner Name: 11AM, . At44V VS __ ___ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Ali A! t., / 92&S
Certified Operator:
Back-up Operator:
Phone No:
Integrator: /emu_✓�LI u, (�;rd snJ A/
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o =, [=" Longitude: ❑ ° = I = u
I
esign Current Design Current}� �'i Design I� Current
Swine pacity Population WefPoultr}' [~opacity Populahon�CattEe Cap�acty Population
❑ Wean to Finish ❑ La er ❑ Dairy Cow
Wean to Feeder I1 10 Non-Layet ❑ Dairy Calf
Feeder to Finish kv 4'10i. A,:. ❑ Dairy Heifer
❑ Farrow to Wean rUry Poa ry El Dry Cow
❑ Farrow to Feeder""� `" - �� El Non -Dairy
❑ Farrow to Finish El Layers El Beef Stocket
Non -Layers
❑ Gilts ElBeef Feeder
❑ Boars El Beef Brood CoNg
Turkeys
s
Other
. 1
❑ Other fF Number of Structures:
J,
❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes RNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field El Other
a. Was the conveyance man-made`? El Yes � No El NA El NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes � No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)`? 71
d. Does discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes [9 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes [g No El NA El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State ❑ Yes [)I No ❑ NA ❑ NE
other than from a discharge?
Continued
Continued

Facility Number:—Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a, If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: E' S
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes 15�No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tbreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes CRNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
R 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
Pd No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
]A No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
5rNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12, Croptype(s) &rXAuc4�snn 1`''�c:- �/+l4tft/l1hE•i✓ C G
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[gNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
PrNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'
❑ Yes
[SrNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�ZNo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
UrNo
❑ NA ❑ NE
Reviewer/Ins ector Name �'`• ' "' s Phone: �9/I�4%$(
P l- V �... ,t
Reviewer/Inspector Signature: Date:
12128104 Continued

A
Facility Number: —7 — ZQ Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes [9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes El No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
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
�2 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
qNo
❑ 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
OrNo
❑ 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
gNo
❑ 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 Reviewerf nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
CFNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
1228104

4. - •
Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ® Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility• Number Datc of Visit: Time: 0 •' b
Not O erational 0 Below Threshold
® Permitted ® Certified Q Conditionally- Certified 0 Re„istered Date Last Operated or Above Threshold:
Farm Name: _ W t n d d ,A � M as n S 1—G,r rn County : �
Owner Name: iAt i nd c_ A. -an ri, s n cx< Phone No: ra8_z —M
Mailing Address: I bu h.^ ate, c & --- "nit t Ar, C . .183 45-
Facility Contact: l4 i Act G A t,n--Z-ns _ Title: Phone ?%o:
Onsite Representative: k��^n �. Z.rw9r� C _ integrator:
Certified Operator: �A� ► nCx jj' a Mem C Operator Certification Number: ! j&_13
Location of Farm:
® Swine ❑ Poultry ❑ Cattle 0 Horse Latitude �� �� �� Longitude
Design Current
Swine ('anoAtw-Pnnnlatinn
®
Wean to Feeder
i
❑
Feeder to Finish
❑
Farrow to W=
❑
Farrow- to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Design Current Design Current
Poultry Ca a' Population Cattle Ca acitv Population
❑ Laver ❑ Dairy
❑ Non -Laver ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
I Number of Lagoons I I JU Subsurface Drains Present iILJ L.aaKoon Area_ALJ Spras Field Area I
Bolding Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Imuacts
1. Is anv discharge observed from any part of the operation?
Discharge originated at_ ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is obsen ed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (if ves, notif}' DWQ)
c. if discharge is observed, what is the estimated flow in eallmin?
d. Does discharge bypass a lagoon system? (If yes, notif}, 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 8- Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structur-e I Structure 2 Structure 3 Structure 4 Structure 5
Identifier_
Freeboard (inches): :3 a
05103101
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �[� No
❑ Yes No
❑ Yes 0 No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [3� 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 14No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes Ea No
8. Does any part of the waste management system other than waste structures require maintenmce/improvement? ❑ Yes PqNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [5a'No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes JpNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes W-No
12. Crop type P�` m u r� . -k— . %^ , V Y 'cGl n (9 - S .
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 P No
16. Is there a lack of adequate waste application equipment? ❑ Yes 5No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 9,No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes P No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes PNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes W No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ELNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes W No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes FANo
24. Does facility require a follow-up visit by same agency? ❑ Yes W No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes W No
10 No violations or deficiencies were noted during this visit. You will receive no farther correspondence about this visit
amsmeiFs qm�t Exp nn aad/a a>.
❑ Field Copy ❑ Final Notes
Q'0c-���
Reviewer/Inspector Name
Reviewerllnspector Signature: . n Date: b
O"3101 Com*wed

Facility Number: -:�- — %3 Date of Inspection 3 8 0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor 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 [lush tanks lack a submerged fill pipe or a permanentltemporaty cover?
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes © No
❑ Yes © No
❑ Yes ❑ No
❑ Yes ❑ No
O5103101

Date of Visit: —1 S' Time: : 575
IQ Facility Number Z.0
Not Operational 0 Below Threshold
0 Permitted Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: W N du __A mmoms , .FQ1rm County: R1CVVK&1)o td
Owner Name: 1 tsl d tMm o t i s Phone No -
Mailing Address: 15 A4 wtJ P l o ce_ H 0.►yt I e-+ . tjC Z 93 ` _5
Facility Contact: W 1 a a u A► 4 k4o/J,S Title: N Phone No: l �— S 92--3 $Z 1
Onsite Representative: Integrator: cam+ n2l cs
Certified Operator: 0 I N d wAfdnl S Operator Certification Number:
Location of Farm:
NC_ 9,0y 1-17 No1r9,,. 4-,r> -S llao(v (FdOAj a"I!& r
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 9 4 " Longitude + ° K
Design Current _ L Resign Current Design Current
Swine Ca aci P,o elation l'�uultry C achy . 1?o elation Cattle°Ca achy P,o elation
❑ Wean to Feeder % DO 7 pQ ❑ Layer ❑ Da'
❑ Feeder to Finish
❑ Non -Layer ❑Non Da
_,-_ ........
❑ Farrow to Wean
❑ ::
Other
El Farrow to Feeder
r,.
El Farrow to Finish
r Total Design Capacity
ElGilts
'-
'���Total SS1G
❑ Boars
Numher of Lagoons QIF Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
Bolding Ponds=l Sotid Traps No Liquid Waste Management System
Discharims & Strearn impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lapoon ❑ 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 Xc Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes E N,
❑ Yes E No
❑ Yes
� / ( (No
MIA
❑ Yes [TNo
❑ Yes L--R No
El Yes 1p<
❑ Yes 0-510
Structure 6
Continued

Facility Numher: ' 7 — Z Q Date of Inspection —
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aunlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
r
12. Crop typeIF
-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Reauired Records & Documents
IT Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewerfinspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. W� any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes 0.1 o
❑ Yes ENO
❑ Yes ON.
❑ Yes [9<
❑ Yes 2TNo
❑Yes BN%o
El Yes [R No
❑ Yes
[3
❑ Yes
❑ Yes
,L?-No
2—No
❑ Yes
Leo
❑ Yes
c No
❑ Yes
Lw
<0
❑ Yes
fo
❑ Yes
0-5.
❑ Yes
3'No
❑ Yes
[1��
❑ Yes
D, o
❑ Yes ,LB No
❑ Yes L7 Now
El Yes ❑_11
[I yes o
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
rCommenis (efer to i{uesttan #) �`Ezpiatn any�YES�w4i: `_ 16r an} reco'mmendatro s arr then mments. -
Use diawm of faetli bettere Lun
to situa Copy El Final Notes
gsA ty bans. (useaddittonal pages as necar}}�
929 A _, � � we
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: —/ ^Q
05103101 Continued

f %
Type of Visit 10 Compliance inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up Q Emergency Notification 0 Other ❑ Denied Access
Fxcilin Number Date of Visit: ! 0 Time:
3
not Operational 0 Below Threshold
13Permitted ©Certified 0 Conditionally Certified 0 Reogistered Date Last Operated or Above Threshold-
Farm Name: e% S I Count}: _ _ 2 " rl,, nn e' rQ Wit'
IL
Owner Name:
Mailinc, Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative: integrator: �,r►�!`r+., (I c
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑Poultry El Cattle El Horse Latitude Longitude �• �• ��
Design Current
Swine Canacity Ponulation
Wean to Feeder
a
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry• Ca acitv Population Cattle Capacity Population
❑ Laver ❑ Dairy
❑ Non -Laver I I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons i I 1U Subsurface Drains Present - HL! Lagoon area 1L Spray Field Area _
Holding Ponds /Solid Traps ❑ No Liquid W aste Management Svstem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes ®No
Discharge originated at: ❑ Lagoon ❑ Svrav Field ❑ Other
a. If discharge is obsen-ed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Vi'ater of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in eal/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 1 Structure 2 Structure 3 Structure 4 Structure ; Structure 6
Identifier:
Freeboard (incbes):
05103101 Continued

Facility Number: — 10
Date of inspection o �,
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
I& 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 ReviewerlInspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
-�s.� .. `-wiw3r�.:
Commet(refer to queshoa#) Explainany YES anyswers and/or any recomnnendapons ar any other comments � ` .,
1s tY"
Userdrawut 01 facdr to bettor explain situations. (useladtiitionalipages ats necessary): El Field Copy ❑ Final Notes
u° y
Reviewer/Inspector NameAs '
Reviewer/inspector Signature: Date: 960to
05103101 <7- Continued

10/07/03 16:34 FAX [phone] MCBRAYER CDJ Im 001
ilo - o'-i en
IccOm �-Jacx&,� kmfycf\-S

10/07/03 16:34 FAX [phone]
MCBRAYER CDJ
lih 002
Date of Visit: 1$- Time: : $� 5
Facility number Z
Not rational 0 Below Threshold
M Permitted MICertifled 0 Conditionally Certified E3 Registered Date Last Operated or Above Threshold:
Farm Name: W;w a,.� A rAmot is FgtM County: RtC k KA o6l A
Owner Name: 00*0814 tM INN O•N5 Phone No:
MailingAddress: 157* AIA)'JPJ P I C Le— - Ham 1 e.f . NC Z93*-S
Facility contact: 1 W 4 u A m Mo A► 5 Title: Dower _ Phone No: g i O— 5 Sz —3 Sz I
Onsite Representative: Integrator: Carrot I eS
Certified Operator: g I rq a,, Operator Certification Number:
Location of Farm:
MC Hal 17 7 Nov g,. 4-a S x l & o (o (Fo 0W O / ' N 1-ect I'll �" "/<
9
Ellslrwine ❑ Poultry ❑ Cattle ❑ horse Latitude 0.0` Du Longitude
Design . Gnrrenf _ ===
Design Current ' Design Gtirretst
Swine Ca 'aci y Po nlation : '
Poultry Ca itci Po olatiot; Cattle Ca a ' . • Po - ulatirin
❑ Wean to Feeder �LOO 200
❑ Layer - ❑ Daity
❑ Feeder to Finish
❑ Non-LayerLUNon-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Capacity
Gilts
Boars
TOtHt: SSLW
": Number of L°agoons
❑ Subsurface Drains Present Lagoon Area ❑ spray Field Area
Holding Ponds /: Solid; traps t „-
t �S
No Liquid Waste Management System
Discharges ! Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaVrnin?
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?
Jyast Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure i Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (inches):
05103101
Structure 5
❑ Yes [a No
❑ Yes (Y No
❑ Yes dNo
/A
❑ Yes No
❑ Yes 13<o
❑ Yes lNo
❑ Yes ❑ K
Structure 5
Continued

10/07/03 16:35 FAX [phone] MCSRAYER CDJ
IA 003
Facility Number: -7 W- a Q Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ yes 0W0_
seepage, etc.)
6. Arc 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 ❑ Yes G<
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement? ❑ Yes [11No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ®Wo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes o
Waste Application
10. Are there any buffers that need
Cl
maintenance/improvement?
Yes
ErNo
11. is there evidence of over application?❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
Elyes
LKNo
12. Crop type R ti t__- i Ca /
a 5 fJ A �)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
LTlV0
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
[3' .
b) Does the facility need a wettable acre determination?
❑ yes
0iqo'
c) This facility is pended for a wettable acre determination?
❑ Yes
L4^1Qo
15. Does the receiving crop need improvement?
❑ Yes
[jNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ yes o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes E o
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes Biro",
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Q•1Vo
21. Did the facility fail to have a actively certified operator in charge? ❑ yes+
22. Fail to notify regional DWQ of emergency situations as required by General Permit? ��
(ie/ discharge, freeboard problems, over application) El Yes M o
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes oo
�
24. Does facility require a follow-up visit by same agency? ElYes 014
25. Wye any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [ (o
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
�' F�.iliS4'� Yeµ_
. A'1^"-ice t�44i::4.m s3ore�ihYS h'E.!' "�i Y;=v Ff �aw85''a"S'�?kn6'",�I1 f'..i ` 5 %aT'� $:Fw '�' +5 - a` _. �: "y'•'
Mum
4aC4tmi<IIeata{t el'e��o Qt n sp aitt any T S•atts�vet^s an l r a iy recomi"datitsn9:
�`• �I � �1({1 L '•�r�"r! � � ny i t�rR s�b"�31F " ,# 4 "-
se
ti ' i'faCJiliig io 6 e p"dain`siiti IIs. ( $ddlti0tla) ]isgesra$ eie�ssa } ,
Q w,,y . N ield CoUv ❑ Final Notes
Y ppJJ��
�...pi�4Yi..5(x�'-.�+"'ra`A��T,P1�14-
r a r 2x�-�.,, , ..y
ClV..•.V�S'.+YJ..1 r.�.faA.i'�("�[, iz.k'N RY''Gl,':-ftfR�i.Y;..wlwn'/s'..wx.nrovMrasy.V.,w�a.�. ry�
Reviewer/Inspector Name
Reviewer/inspector Signature: Date:
05103101 Continued

IType of Visit # Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit i Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
1 acilih NumberDate of Visit: /D Oz Time•
1`'ot O erational Below Threshold
Permitted 0 Certified 0 Conditionally Certified ❑ Registered Date Last Operated or Above Thres Id:
Farm Name: �✓ .� County: 'Ble ZA�d
Owner Name: /firy.+%f Phone No: /D) s_ Fo — /ZZ /
Mailing Address: _ ��y�i✓.✓ iJxe.� ,� 471
Facility Contact: "++e:*A Title: .Phone No:
Onsite Representative: Integrator:R�
Certified Operator: is.a.✓J _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 ` " Longitude '
'.Des[gn', Ceirrent - Design ~Ct[rrent ; Desegn Current
w _:_
SK _ Poultn w
Ca acit� P6 tilat�n a C iirtty :Po etlation = _Cattle Cs auto - Po tilatton '1
Wean to Feeder Zflfl Layer S-=
�= ❑ � = Dairy
❑ Feeder to Finish ❑Non -La er - Non -Dairy'
❑ Farrow to Wean _
[] Farrow to Feeder ❑other a
❑ Farrow to Finish _ Tatar Destgn C�i�acit}''
❑ Gilts t
❑ Boars - __ .. Total SSLW- r
e x
Number of Lagoons
❑ Subsurface Drains Present ❑ Lagoon Area ❑ S ray Field Area
Holdtng Ponds'I SoLd'Traps = ❑ No Liquid Waste Management System
1. Is a gesy di & tream Impacts o
1. Is any discharge observed from any part of the operation: fiM111 es o
Discharge originated at: ❑ Lagoon ❑ Sprav Field Other
a. If discharge is observed. was the conveyance man-made? ❑ Yes NNo
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ) ❑ Yes [XNo
c. if discharge is observed. what is the estimated flow in gal/min? w�'
d_ Does discharge bypass a lagoon system? (If yes. notify DWQ)00 es El No
2. Is there evidence of past discharge from any part of the operation? A`,xes Wo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes TkNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes W No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101
Continued

Facility Number: 77 —
Date of Inspection 0
5. Are there anv immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc-)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. 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
I2. Crop type
❑ Yes XNo
❑ Yes XNo
PW O—V . es>CNo
❑ Yes JRNo
❑ Yes Wo
❑ Yes ONO
❑ Yes ;WNo
I3. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
1ANo
9No
b) Does the facility need a wettable acre determination?
❑ Yes
&No
c) This facility is pended for a wettable acre determination?
❑Yes
W7No
15. Does the receiving crop need improvement?
'esN0
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
gNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checfl lists, design, map fete) f
❑ Yes
�No
19.
� l
Does record keeping need improvement? (ie/ irrigation, freeboard, waste an� alysis oil 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
PINo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application)
❑ Yes
)o No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
VNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cammesits;(refer tb'question-#) 11 x- Isin any,YES atisvvers aad/or_an} recam tidations er any.othtrooaiaeents. = _
p _
Gse dr�awtngs'of fa4ty to better tzpLain sitnatiotis.:{am additional "pages as aecessary) — -
ie FinalNotes
_;_;
lvfi
w
�js C/+c�iK Gvv s �.� ems►/..�/.�.�
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date: �� Q
051031OI Continued
r� � � �� p�,�o '� Gp•�.6�/��,.Jl- �✓a /,�,�.[od,Ejr�G.�vCc�.u�Ec�.

Facility Number: y7 — ?d 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 XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �<No
28. is there any evidence of wind drift during land application.? (i.e. residue on neighboring vegetation. asphalt. ❑ Yes >j 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 PCNo
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 xNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary coveO Yes El No
Additional Commentsand/or
05103101

Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: �/ Time; i
` 0 Not Operational 0 Below Threshold
Permitted Q Certified 0 Conditionally Certified © Registered Date Last Operated or Above Threshold:
�!C �rsa
Farm Name: ... �.(.Lt.�.�P�.... .... ��f .�rr� .......................... County:a74 .............._......_.....__......_..----- ...........�.........-
Owner Name: .... .._ .......................... Phone No:'S�S'z W—�Z"
Facility Contact: ........... �;J7 L�2 �..... Title:. ..................................._... .......... ... one No: .... _ _....
Mailing Address: I JI�....Il�t /t/..ce................................. ......... ......r� -• lcjr... .. �G. _....�....._.__
Onsite Representative: Integrator:.......... r �..... .... W
Certified Operator: ......./Vi ............................ 47js -- Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ` " Longitude e 6 I�u
Design Current-: Design - Curreat Uestgn C�rrat
SWme .. Ca ci -Po nlahon-, �a'3' - - • Ca ca Po rrlatiorr Catde :pao tion
ean to Feeder Y240 ❑ Layer ❑ Dairy _
❑ Feeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
El Farrow to Feeder ❑ Other
Farrow to Finish Total DES Cg 2�
Gilts
Boars Total SvSI,W-'
3 _ - Subsurface Drains Preseut In Lagoon Area 10 Spray Field
,Nntnber:of Lagoons
Holding Ponds,l Sohd;Trsps No Liquid Waste Management System
Disc. & Stream Impacks
1. Is any discharge observed from any part of the operation? XYes. ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field CdOther
a. If discharge is observed, was the conveyance man-made? ❑ Yes KNo
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 ANo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 9No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
fiFo
Waste Collection & Treatment v
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ANo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...........................
Freeboard (inches): 35
5100 Continued on back

f 1
Facility Number: — ,2a Date of Inspection /
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes to(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 gNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes )(No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ONO
11. Is there evidence f over application? ❑ Excess ve Ponding ❑ PAN ❑ Hydraulic Overl�/�p� ❑ Yes No
I / / I7 A / �./ /
12. Crop type a. " ) — 4dE
13. Do the receiving crops differ wA those desi ted in the Certified Animal Waste
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Plan (CAWMP)? ❑ Yes No
❑ Yes o
❑ Yes o
❑ Yes o
❑ 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.)
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?
E3 YIQI >�iQlis At d�f�ieit�tiles ire P9te� d�rri�g 4his.vl��t* Yoh wii� ><ee�ive �o fpftb
::-coriespari�eace:abautithis visit:�.•..:-:-.•.:...::-...•.•.•:::.:.:.:.:.......::... .
J . Pt'+ everfl,
D O-C kr- g .
❑ Yes P(No
❑ Yes No
❑ Yes I
❑ Yes 4 No
❑ Yes KNo
❑ Yes I(No
❑ Yes �No
❑ Yes KNo
❑ Yes $ No
❑ Yes ONO
Jed k fke- _C" car- d"'I '7 "k'
422., d 4.- / ,,, , ,
wcis sa.�,� (e w Le .- ne �i`P �� 'V'
Reviewer/Ins actor Name
p e) s y �' _ e`_. fix£. .F
Reviewer/Inspector Signature: Date: `4—70 5/00

'f
Facility Number: 7 7— 2!J Date of Ittspection Z O/
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below k
es ❑ No
liquid level of lagoon or storage pond with no agitation? "
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes o
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property) \\
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes KNo
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 APO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Rzo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ElYes❑1 No
5100

s:
0 Division of Soil and Water Conservation Operation Reveew
n- 0 Division of Soil and Water Conservation •Complianci n _ection
4. 5
_ -®'Division of Water Q(iahty Complitanee Inspection
M_Other Agency Qperaiton Revrew _ _ c ` 4�ls f{.
® Routine 0 Complaint 0 Follow --up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number % Z o Date of Inspection �a
Time of Inspection p: o 0 24 hr. (hh:in
Permitted 0 Certified 0 Conditionally Certified [3 Registered JE3 Not O erational Date Last Operated:
Farm Name: ...........1�- ...... -----''r.2........................................ County:........../�.L.G' '~-PcJ ...
Owner Name: ............. ✓........'".!?!a•.!f.................................................... Phone No:..__C9/O�._..1...: �2...............................
Facility Contact: Title: ........................................................... Phone No: ...................................................
Mailing Address: .iT� y....................... , .....! ............ .... ..............
Onsite Representative Integrator. �.iY.Ae4111� vd f ff
.......................................................................................................... ........ ..../ .......... '2. ri....
Certified Operator: ••.....-r�c,%�✓.- Operator Certification Number:
Location of Farm:
i
5,.....1.6..d ................................................................................................................................................................................
Latitude a =' Longitude 0 =1 =11
Design Current,"---- — Design _ Current Design. Current
Swine °` Capacity Population - Poultry = Ca acit Pb ulation Cattle _ .
ly p y Capacity Po uiahon
j$ Wean to Feeder .Z O6 ❑ Layer ❑ Dairy -
❑ Feeder to Finish ❑ Non -Layer ❑Non -Dairy -
❑ Farrow to Wean _
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Deslgn:Capacity
❑ Gilts, _ -
- ❑ Boars r„ ,TotaI:SSLW
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes X1 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes E] No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes RINo
c. If dischargc is observed, what is the estimated flow in gal/ruin?
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 [a No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 1K] No
Structure € Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .....2. I
..................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 5�'No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 7J — ZO Date of inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ANo
(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 JgNo
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 H No
Waste Anolication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑/Excessive Ponding ❑ PAN
❑ Yes
No
12,
Crop type � �V 6.�•�,• ��
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
(RNo
c) This facility is pended for a wettable acre determination?
(NYes
X No
15.
Does the receiving crop need improvement?
❑ Yes
M No
16. Is there a lack of adequate waste application equipment? ❑ Yes IR No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes A No
18- Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(te/ WUP(!&eck fists, esign, maps, etc.) Cl Yes UNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes JVNo
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
El— yiolaiicjris:oi d�ecier' faM, •were noted dour this:visit: • YoU will •eebeiye do further - . •
comes oride...abn� f this visit ... :::. ....:........ .
Coritments (refer to question,#} ^Explatn=any YFS_ ameiataos"oanswnJr: any oher comuments
-�
Use drawrngs of facility -to better explaui srtuatinons {use addtbonal pages as necessary) r ;I
Reviewer/inspector Name {� 3c L T - ' 3 a 4�1 W
Reviewer/Inspector Signature: / Date: y 1Lt�0 _
3/23199

` 3 1 -.6 . r. %4-^ti.';.",!^•(+ 'ff :n, ..�.;j,�i'i+.3'N rr,,rn'i•f•. yti�;`zLe.:i— —asl:: �.f"-K�-,. .:r`"•.{ .."'cr�:-- �,....-rVr^ - . ✓- ,. � r c•�=rr .,r�,r,•�.,, .
i 0 Division of Soil and Water.Cotnseirvatzon :Operation Renew z
- -
_ D Division of Soil and Water_ Conservation ;Complianceli�speetton T r r
®Division of Water Qahty ''CompEtance Inspection
z- [.Other Agency. Opetrahon Review'
w..---. ... . Wes- ._..
Q Routine Q Com taint Q Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number % % 2 0 Date of Inspection do
Time of Inspection p. o O 24 hr. (hh:mm)
0 Permitted ® Certified [3 Conditionally Certified 13RegisteredJE3 Not O erational Date Last Operated: p ..........................
Farm Name: ,W "!4........ rrw. !aC.... ems!¢I..... .--....... County: .......... GC.!C'�.-���.............. .......................
Owner Name: -•----•--• ,� ✓y�j,,,, ..... ^^7!eNt Phone No r g�G 2
-...................................................----------- .1 -..:%.....�...........................
Facility Contact: .. . ...f Title .............. Phone No: ...................................................
Tailing Address: /..`%...,��,�''�....T Cf. f.:�•...�Ef f.. .... i�r................................... I....., ....... I...... ....... I..................
................... ,...... r.....
Onsite Representative . Integrator: `' Ao�!
Certified Operator: ..............
!.+/-w..�.o--'1 Operator Certification Number:
Location of Farm:
�.................................1.....•-•-.---.............................................-..................................................................--.................................................--...................................... ............... sl/ ......�s.�................................................--.....................................-•-•--.-----.---..........................................................................................--.----.....-.-...... �
Latitude �•�6 •. Longitude • ° 46
Discharges & Stream Imeac
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 gj 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. Dices discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes P No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes E ] 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 Q No
Structure f Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............ z.�.. .......... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes gNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: -7 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ANo
(If any of questions 4-5 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 IgNo
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 .M No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
.9 No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
N No
12.
Crop type dd GyM K��I
13.
Do the receivingy crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
M No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
0 No
i
b) Does the facility need a wettable acre determination?
❑ Yes
allo
c) This facility is pended for a wettable acre determination?
Yes
Am15.
No
_ry
Does the receiving crop need improvement?
❑ Yes
K No
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WU -hccklists, esign, maps„etc.)" ;
19" Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to Have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24" Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: �4fl •yiolatioris:or• dimae.naes vvi�re noted dirrtng Obis:visit. • Y:oir will •reeeiye Rio further
correspondence: abaut. this visit.: "
❑ Yes JR No
❑ Yes 9 No
❑ Yes &"No
❑ Yes ; No j
❑ Yes ® No "
❑ Yes No
❑ Yes 9] No
❑ Yes ❑ No
U Yes Z No
❑ Yes 0 No
A6
mr
Reviewer/Inspector Name ;
Reviewer/Inspector Signature: g _:.
Date:
3/23/99

- _ W:0'Dtvision of Soil and Water Conservation = Operation Review
©:Division of Soil and Water Conservation - Com lhincc Ins ection
P. P
Divisi. 6nof Water
� _ - Quality -Compliance Inspection
- : C] Other, Agency - Operation -Review
0 Routine 0 Complaint 0 Follow -tip of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection Z 5r
Time of Inspection 3 D 24 hr. (hh:mm)
❑ Permitted ® Certified © Conditionally Certified E3 Registered JE3 Not Operational I Date bast Operated:
Farm Name: ......-.11"..l '� .. �T!"�.�''or�..�'f �`- . County:..... drl.. r!!(..........................................
Otivaner Name: .......... !.v�'✓t y.....C1'.�!!t./l�1? I .... ........................ Phone No: ..-sr....2
Facility Contact: ............
•/-�Title:.......... Phone No:
Mailing Address: -...1 ��..��x. ✓,`!....�1.���......���" ���f.l.Y .�. ���..............�...:........................................ ...............* ..........
Onsite Representative:..A./z.A f�... W!*`!r'�lJ� ........................................... . Integrator:......�r..!��e.tQ..... r.l�''�..f.� L.�......
Certified Operator: ......... 4!� "'"... r.,,,p.�!-.T.......................... .............. Operator Certification Number:..........................................
/ .....11`teM�
Location of Farm:
L.-......................... ........... .---------- •........ ........ ........................... .......... .....................---------------- ....................................... ............ ..................... ............. *r
Latitude `14 Longitude ' 9 "
Design Current
Swine Capacity Population
® Wean to Feeder
2-60
112,00
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps j No Liquid Waste Management System
Disci & Stream Impacts
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originaled aL ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance ratan -made?
h. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon sysicni?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
a. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure
Identifier: 4,
Freeboard (inches): .......... �. -
Structure 2 Structure 3 Structure 4
[:]Yes No
❑ Yes No
❑ Yes KNo
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes ;RNo
Structure 5 Structure 6
1/6/99 Continued on back

N
Facility Number: -7 26 Date of Inspection
Z/9
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El Yes
No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
C'No
8.
Does any pact of the waste management system other than waste structures require maintenance/improvement?
ElYes
IQ No
9.
Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
PdNo
Waste ApOication
10.
Are there any buffers that need mail ntcnance/improve ment?
❑ Yes
,� No
11.
Is there evidence over application? ❑ Ponding ❑ Nitrogen
❑Yes
.�[No
12.
//of
Crop type L7!Q.!"'*fJ.. �..!� ��R..................... .. �....... ......�..........
...........................
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
MNo
14.
Does the facility lack wettable acreage for land application'? (footprint)
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
A No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
JKNo
Required Records & Doculuents
13.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
1KNo
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, wastes analysis & soils ports) Ayes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes gNo
21. Did the facility fail to have a certified operator in responsible charge? ElYes 19No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes KNo
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes kNo
24. Does facility require a follow-up visit by same agency? ❑ Yes ;'No
❑: NA:V1Qla,tiOltS:OI: deiiciencies.were' noted. duriniz ttiis:visit:: You rvill.retceive no Mrt}ier.::
i s : - p--orresp6ddence: about: this Visit.; • ; • ; • : ; ;
Comments (refer to "question #}: Explain any YES answers and/or any:recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary) D r }
i Q. Coll �✓A�fJ� �✓, /� i� �� c s ,s./ �� ; 4
eo esls.r.� Ldr4 cv�rcfsi.� e F /e�,1�
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 11/6/99

Division of Soil and Water Conservation [3 Other Agency
Division of Watef Quality
JR'Routine O Complaint O Follow-up cif DWQ inspection O Follow-up of ()SWC review O Other
Date of Inspection MUZzZ
Facility Number
R Time of Inspection /ram 24 hr. (hh:mm)
13 Registered A.
Certified 13 Applied for Permit [3Permitted 10 Not Operational Date Last Operated:
..........W ;�!. f %rrc County: l..l..�ly!Qf� i ....... I.,— ....... .......................
Farm Name;�..P.....t.... .j �...:�...
1 1
Owner Name: ... /,,/J.!_hl............................................................... Phone No: 7./0�...............zI ................................
Facility Contact: IN ... --- I...... �.?......... Title:... A.UX.e,.j- ......... ............. ... Phone No: ....................................................
iK
........... ....
Mailing Address:...l.L..... /7 n...im..
L�.../S° �... lJ ............ ...... Z...�..�.. 3
Onsite Representative:..L.!... ..96 . Integrator:............ ......................................
Certified Operator: ...... W)....-_..........A.R.Anox_s ....................... Operator Certification Number:...J7 z.
Location of Farm:
Latitude Longitude
Designv ° Current �, :<<De
= N Capacity .Population-Poaitry ; :Caj
Wean to Feeder
co
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
urrent:� �g '"". �- Destgn =� Current .
pulation Cattle � CapaettyyrPopalation 7"
❑ Layer
R ❑ Dairy
❑ Non -Layer
- ❑ Non-Dairyr
I[] Other
Tatai Design Capacity' �1�077
W
,Total'SS
t`
Numbet of Lagtwns J Holdrng Ponds ❑'Subsurface Drains Present ❑ Lagoon Area ❑ 5prav F�etd Area
.
X� 5 Y 4 ❑ No Liquid Waste Management System f
,a+` �✓x..gkw ec,c.c.{sl
General
1. Are there any buffers that need maintenance improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: [ILagoon [ISpray 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 pal/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 ANo
❑ Yes 9No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
((No
❑ Yes
[No
/&o
❑ Yes
❑ Yes YNo
❑ Yes VNo
Continued' on back

}
Facility Numher: -- 0]
8. Are there lagoons or storage ponds on site which need to be properly closed"
Structures f Lagoon tiolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes KNo
❑ Yes xyNo
Structure 5 Structure 6
Identifier:
Freeboard(ft): ............. ••......................................... .....................................................................
10. Is seepage observed from any of the structures? ❑ Yes 010
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Appikation
14. Is there physical evidence of over application?
(If in excess of WMP or runoffent ring waters of the tale. notify DWQ)
15. Crop type 4. .............................
....� �1Ur..f.:Y.Y.1,.S—A........ .... .
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20, Does facility require a follow-up visit by same agency?
21. Did Reviewedlnspector 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.'
❑ Yes PNo
❑ Yes KNo
❑ Yes
9N4o
❑ Yes
j (No
❑ Yes
KNo
❑ Yes
EA No
❑ Yes
O'No
❑ Yes
Rd No
❑ Yes
iKNo
No.vitilationsor deficiencies were noted during this:visit..Yoin4ill receive no further
• : � ccirresporidenee about this:visit:•. � � : � . � . � � � � . � : �. � : � -. � ::.. . � � : � ...... .
❑ Yes L (No
❑ Yes ONo
❑ Yes ❑ No
Cotgment§ (i efer to question #) "'Expiain`any 1rES answers and/or any reconimeridatuins of any'oiher cviriments.� e
Use dt^awings of facthty to better.explain siEuations.`(ttseaddltional pages as necessan
Co 4 ie 4o Q e Cater ra ss o.� jam&. [� .
7/25/97
Reviewer/Inspector Name)
Reviewer/Inspector Signature:_
Date: N