820066_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qua

f�'` t
Got AA
i
Q�
Type of Visit: VC Hance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:
�Q
Departure Time: County:
Farm Name: r [�0�-Ylr �G�
Owner Email:
Owner Name: l t Phone:
Mailing Address:
Physical Address:
Facility Contact: %&,�t x CV-bj �cX Title: Phone:
Onsite Representative: t q Integrator: r4
Certified Operator: l,I�LS _- Certification Number -
Back -up Operator:
Certification Number:
Location of Farm: Latitude: Longitude:
Region:
Design Current
Design
Current
Design Current
Swttse
Capacity 'Pop:
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
` "
Dairy Heifer
Farrow to Wean
,O
Design
Current
Dry Cow
Farrow to Feeder
D . P■oal
Ca aci
P.o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. is any discharge observed from any part of the operation?
❑Yes
�o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[4NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑-llq-A-
❑ 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
❑ Na
D<A
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
0 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
El Yes
rN
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412014 Continued

Facility Number: - Date of Inspection: S
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No E3#A ❑ 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 EjLNu _ ❑ 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 EgNT' ❑ 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 [}'ITo ' ❑ 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
[Jo ❑ 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?
. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
L_l "'o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[] PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s): ALE,ti tr tf'`t
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EEF—? to ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
� ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes
[J� ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
NA
❑ NE
Reuuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�o
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
��o
❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E3<o
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[:]Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
E6
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facili Number: IDate of Inspection:
24_ Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
ED-Mo ❑ NA ❑ NE
[3-Na— ❑ NA ❑ NE
[-]Yes
N
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes u 1Vo- ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes [g Ko ❑ NA ❑ NE
❑ Yes [3>e 7 ❑ NA ❑ NE
❑ Yes
C3<o
❑ NA
❑ NE
❑ Yes
[]I —No
❑ NA
❑ NE
[:]Yes
la/o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
c
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: j,`) �) --k,,5 i
Date:
21412011

F_
bjM3 altll+a, juj
Itype of visit: %duompuance inspection U uperatton xeview u structure r.vaivauon U iecnmcat Assistance
Reason for Visit: 0 Routine 0 Complaint Q Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: _ r� Arrival Time: ; � Departure Time: CountyRegion: rl
Farm Name: ARE Fby/H` _ Owner Email:
Owner Name: ��j� J� Phone:
Mailing Address: V
Physical Address: Inc Wt Ai/f/Ir P17/p
Facility Contact: yon �n! � � i(1�S Title: Oml7 r Phone:
.9 s ❑
Onsite Representative: �/+� � ( Integrator: N
Certified Operator: Cr!l I r ro j dr _ _ Certification Number: -,-JQ�LzM
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
M. � Design Current
Desimal
Current
Design Current
SRane �Capaty�Pop.
`:>.
Wet Poultry
NONgn
Capacity
..
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dairy Cow
Dairy Calf
Wean to Feeder Non -La er
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
.Curren#
Dry Cow
Farrow to Feeder
D , l;ouE
Ca aci
IPo
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Irttnacts
1. Is any discharge observed from any part of the operation?
❑ Yes
E-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
[RNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
allo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 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
® 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): 9__
Observed Freeboard (in): a
5_ Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
U 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
15a No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
® No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Sallo
❑ 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
12 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers. setbacks, or compliance alternatives that need
❑ Yes
to No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
ED'NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn. etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus [] Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ 1rom those designated in the CAWMP?
❑ Yes
V,�j No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
5� NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
P NE
acres determination'?
17. Does the facility lack adequate acreage for land application'?
❑ Yes
Kj No
❑ NA
❑ NE
18. Is there a lack of'properly operating waste application equipment?
g 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
E`NE
the appropriate box.
❑WUP ❑Checklists ❑Desi�,n ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility 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
t' NA ❑ NE
Page 2 of 3 21412011 Continued

Fttcili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ® NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[] No
❑ NA
&-NE
❑ Yes
❑ No
U NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Yes S No ❑ NA ❑ NE
❑ Yes Eg No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA aNE
❑ Yes ® No
[:]Yes No
[:]Yes ® No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations'or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
'F=oflop/v f lAiron -e-or lea4i hr&v t , �76b6�yvt7,r`OW sc)ret�ne & o,
116, t0jM1 f,9nf Y&riots �fndt1e 14 nn1 ' pC l� i -th is wP2�
b P�, ��
LojoY164 `iO e d owr, OSS001 as f acs-i bye_
Reviewer/Inspector Name: _3'Q04 L: An et' -
Reviewer/Inspector Signature: }�
Page 3 of 3
Phone: 91,0_q,33-3 300(0ffi
Date: �'f 1 I�,)o la
21412011

WV -
`� " `Division of Water Quality
Facility Number ga - ©Division of Sail and Water Conservation
aQ Other Age�ey
Fype of visit: &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for visit. 0 Routine 0 Complaint 0 Follow-up O Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: AW
Arrival Time: '�(xjF�j Departure Time: ; County: , Region:
Farm Name: A R R 5tmS �� Owner Email:
Owner Name: Runn phi 11 [as Phone:
Mailing Address:
Physical Address: 1 S$"© t4ow'ad_ �J_ At(V lei I
c r
Facility Contact: Title:
Onsite Representative: -' Ryon rh j + I t pS
I_ nn,A, ._.._.__ ...
Certified Operator: Chc lel __1_. t an.ielf
Back-up Operator:
Location of Farm:
Latitude:
Phone: � 4q-;) 5-05—
integrator: ' f B
Certification Number: aa.'n 0
Certification Number:
Longitude:
DestgnCurrent$
Design Current
Design Current
Swine
Cap ity` Pop:
Wet Poultry
Capacrty .: Pop
= Cattle Capacity Pop.
:.;
Wean to FinishI
Wean to FeederI
Feeder to Finish
Farrow to Wean
1 7
ILayer
INon-Layer
,,I -;M�
I
- *�" "'
Design: 'Current
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
D . foul
Layers
Non -Layers
Pullets
Ca net P,o
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure N Application Field [] Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3, Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
r'Yes ❑ No ❑ NA ❑ NE
® Yes ❑ No
[:]Yes ® No
[:]Yes ® No
[:]Yes C�j No
[:]Yes Epo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility tittmber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate`?
0 Yes
r.;;�No
❑ NA
[j NE
a. If yes, is waste ]eve[ into the structural freeboard?
❑ Yes
[:]No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):�
Observed freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
® 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
EgNo
❑ NA
❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
rff Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Eg 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
[51 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
'R No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application`? If ves, check the appropriate box below. [-]Yes C'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 f❑ Evidence of Wind Drift[] Application Outside of Approved Area
12. Crop Type(s): &iy-b I &m LJ a Ti0 Sr Std // 6/Q /l)
13. Soil Type(s): /yj
14, Do the receiving crop from those designated in the CAWMP?
❑ Yes
D No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement'?
❑ Yes
allo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
[a No
❑ NA
❑ NE
acres determination?
ui7 )
17. Does the facility lack adequate acreage f'or land application?
❑ Yes
154 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CR-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
tS No
❑ NA
❑ NE
the appropriate box.
O WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes W 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?
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ® No
❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
CRNA ❑ NE
Page 2 of 3 21412011 Continued

Fa ility Number: 'S jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C5;�No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ER -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 ofan actively certified operator in charge? ❑ Yes ®-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification'? ❑ Yes ❑ No CR NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[5j 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
f;,ZJ�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
kni 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
j5j�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
RNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
M No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
YYes
[:]No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or -any otper ommeiit`S.
Use drawings of facility to better explain situations.(use'additional pages as necessary). _
Ri-rMfsee coax - df�smt �d1>° Cf
, ���el, P�oge -� x YVM' '3odYv�,
5 e 0�CrGi�-lei1yaCk�l�l'
lxicl�
OSid S[4 1 i �Cll�°1 Q'1 �O Gam, 14 a (lnc� mOr� 4�
-7, Ple e_ bI oh )050 o�� �o c1a G aaP 1 aye co�v9-
rckSid� 4f �a � 3, 60� !�al� C� b � � �-
9 ►m )a�+ �� -fi e are �� hOi o��))
Somme �Ic�s w e 4- , Y
npar�,p. F,-eld.s /�
ch,ck, eta s �1' 40 � 'Froo� �`` #owv -CA,1&76- L(f Ila
d Ss�l l s
A� 4f fovm 4- /1 YV0 f� Uri
rT 3
io clhec� &I r}`S I
39 ,'FD110*" . l3"5} . �Yl
rabbi 0l `1 b� Al� s�ury i
a� � 9
Rertrds h �shOAO
obi lS� Cn , OkAlr toyABM CwE 4N1(nll \ j
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
Unn„ Schn
-b u�Pi h r eta ldyW'7S,th �y
9
Phone: 9'1!o-Y` ,33��D c1e
Date: 1 IQ 9) a o ra,
Z14120l I

Facility No. Farm Name 4p� _Date .7 3 I
Permit COC OIC_ NPDES (Rainbreaker PLAT Annual Cert Daily Pipe )
FB Dro s 1 .3
Lagoon Name, S forspill wa 1 v
3
4
5
6
7
Design Freeboard / Last Recorded in
Observed freeboard
Sludge Survey Date
Sludge Depth
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume ifs 0.45
Date out of compliance/ POA?
�:�i:LTti,'.'11L�,�� c�i� T.lS:i.: �sl;>•r>�rr►F�, fl��
Rin Size
r - ..
s.I
Actual-------
-------
Design r .
' '�---�---
Soil Test Date a) ), a1306, Crop Yield �✓ Transfer Sheets ✓
pH Fields Wettable Acres T I AUGE
al
Lime Needed 0-I 7 �I'J3 RAWUP a or incinerator
Lime Applied Zf �^. Weekly Freeboard Mortality Records
Cu-I j01
� n-I *r a' I in Inspections ✓ Check Lists
Needs S (S-1<25) A1p 120 min Insp. Storm Water
Needs P it) in Weather Cndes
1 1 1-.�.�•,
MOW
, , r ,i7i:�
���r
Puffield
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
i
6
?
�1Q-
6
D, r-
��
3
-�
C8 fig
y 9 � R) v I y�P>
eiVP461�!E NUMBERS and affiliations
Date East WUP FRO as 3 FRO or Farm Records
Date last WUP at farm AU Lagoon # I' 31bkK6$
App. Hardware Top Dike q8
a` Stop Pump 4-).$
Start Pump Rfp
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213 Ib/ac
-ff
KO)n;er
`
a
3
sa,3
sa• y
�¢�d�sa,
4S
3
i;7i? f
t. 7
-7"
l/

Itype of visit: N-4Leomptiance inspection V Operation xeview a structure Evattiation V teennicai Assistance
Reason for Visit: Q(Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: � Region:
Farm Name: Owner Email:
Owner Name: y Phi I l i o Phone:
Mailing Address:
Physical Address: 15$ 0 fl{iyw� Rd Mq V I I1'e-
_
Facility Contact:YLLt pj f ���dj Title: 0Phone:
Onsite Representative: �Q� �) Hip( Integrator: W 13
Certified Operator: n h aa5x
P �-+,G/I (2 s Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
=
IF
Design Curren# I}esgnCgrrent
�,
"Fop '
Design Current
Swine
Capacity WetP, ultiry' Capacity p.
Cattle Capacity Pap.
�. �. s:
Layer Dairy Cow
Wean to Finish
Wean to Feeder
Non -La er
airy Calf
Feeder to Finish
¢ -
Da Heifer
Farrow to Wean
SILI Q
'�D @P:,oult Ca aci 1?u
Layers
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
='
Turkey Poults
Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes Q No ❑ NA ❑ NE
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 � No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes Jallo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

IFacility Nhmber: - W Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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): 19
Observed Freeboard (in): S30
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
❑ Yes jRrNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
W No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7_ Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
allo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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): acool A►t IL f�aV '. smao a-yl� &f1 Rj- CA"A0, W A Y
!
-
13. Soil Type(s): 1`tI r is
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N 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
RNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�KNo
❑ 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
75? No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[�JNo
❑ 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.
[?SYes
[] No
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall [:]Stocking Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
®No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
fNA
❑ NE
Page 2 of 3
21412011 Continued

lFacility Number. - Date of Ins ection.
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes gNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes g 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 2 NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 1�3 No ❑ NA ❑ NE
❑ Yes &I No ❑ NA ❑ NE
❑ Yes [R No ❑ NA ❑ NE
❑ Yes ER No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
P No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
[B No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
KNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Me- 14 ;01) I ._ J,T7/ac t
CEO jo Dfc�. b�c���
Nge Cj'P� tar h o- of 1 Qyo�
ci 11�r s�r�l�� and f,�,-Fa�lra� �d o cro f y
eof h j 1w ler c i* o-, c ror rile f -�►
�oa� wi �� fA�� l ilk G�owlriasod �iro►° r�r Lcrz 71�1��vve
Reviewer/Inspector Name: ��119rl (hhn 1>a1_
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
l/ 011

Cam'
m
Facility No. a— EE �Fann Name
_ Date '% �`
Permit i /COc NPD R ' r T
Design fr
Observed - - . r . •
_�■■�■��
���----
Sludge Survey Date
Sludge Depth (ft)
Liquid Trt. Zone (ft)
Design Flow
Actual Flow
Design Width
Soil Test Date 4 Wettable Acres RAIN GAUGE
pH Fields 7WUP Dead box or incinerator
Lime Needed / Weekly Freeboard Mortality Records
Lime Applied I-F AC_ 1 in Inspections +
Cu-I Zn-I 120 min Insp. 0
Needs P 0=-20 ai-41. Weather Codes 1 3
Crop Yield , Nt".Transfer Sheets
- - - -
Elgin Ifjffl
01 j
-
..,, _
rrnnrnr�>>sn_rr��
•
�rx�r lr
��
WEMAIRi
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
a
-
P •
�s
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-I 3000= 108 lblac; Zn-I 3000= 213 Iblac
App. Hardware

D f Pis _"f +049 j Q�t MOO
type of visit 0TCompliance Inspection U Operation Review U Structure Evaluation Q Technical Assistance
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
j�j �ll� Q' p jp�pq�.� j County: SLht S Region:�L
Date of Visit: L`�``���J Arrival Time: Departure Time:
Farm Name: 14QW&A_ �ikMJ Owner Email:
Owner Name: R)AnI -e 6 QA B I �„� Phone:
,'Nailing Address:
Physical Address:
Facility Contact: I I Il PC Title:f Phone No:
Onsite Representative: 1119T Integrator:
Certified Operator: n N�..... N n ii Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o =,
❑ « Longitude: = ° 0 I = u
Design Current
Design Current
Design gurrent
ine
Capacity Population
Wet Poultry Capacity Population
❑ Layer
Cattle Capacity Population
REJWean to Finish
❑ Da Cow
to Feeder
❑ Non -La er
❑ Da Calf
POWean
Feeder to Finish
-
❑ DairyHeifer
ER Farrow to Wean 158 $
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑Non-Dai
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turke i'oults
❑ Other
Number of Structures:
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ''No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
91No
❑NA
❑NE
❑ Yes
W No
❑ NA
❑ NE
Pine 1 of 3 12128104 Continued

Facility Number: Wk— (p Date of Inspection
Waste Collection & Treatm �t
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'? ❑ Yes %Na ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? El Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes IR 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 N 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? 9Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes �RNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes C'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5'No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C,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 q❑ Evidence fofl Wind Drift ElApplication Outside of Area
12. Croptype(s) (200)761
1�11/7�1� Ti(ity es171L7t { �?�'1✓QI1P f �Orn�r1/hft��S'mY�y��
13. Soil type(s) Akv y tt
11,o Is &*
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
W No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
RNo
❑ 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 tack adequate acreage for land application?
❑ Yes
CRNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
El Yes
W'No
❑ NA
El NE
Reviewer/Inspector Name .,�_C E 'i' I� Phone: �+. —
Reviewer/Inspector Signature: 4eAn1(Z_ Date: Ig c)()J o
1%'

Facility Number: Date of Inspection I 10 i 19 Ito
Required Records & Docunkin-s
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 CA WMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
2 t. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31 _ Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over. application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
3y. lowl't, -Nt"Wo, �U�7
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
❑ No
N NA
❑ NE
❑ Yes
W No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
aNA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
IN No
❑ NA
❑ NE
❑ Yes
N No
❑ NA
❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes CK No ❑ NA ❑ NE
❑ Yes 19 No ❑ NA ❑ NE
�Smal% +' + A
71 refs w{r2� sealed Chd +'Llt f �i'i� 61 bLIC slcje- of t gaols 14 iv PI,eAse In e)
Or`S `�hiS Svnmf^�S 9raw` PIti°aje cipa, `��D.rit Ott G'� �Q�OI�-i��
,S�Udyef"tVe ryas rnrf�lac '{ aDaq alcLJ,it C1YxIkaw 'r-a' a010 (ea(ewo'/C
�D� CDYId( , � a� I aj�` ea- 0n�-
i y, C !/ blh SIodg e.S'vrYP
lOw� d `� `t'hA �' o � S5 W %
f s is -Pi elh gr21 l r w h Cr wh i �► �'r ► m-1� �,_!tom
Mop
�1e�e�elz
�t'JS � Ofe &l gfa%
It�l�
i�l �►�1"Ih1�^
s Vol
of ©)C�r� dltin� 6�'00 al)�aw) e6ji e
�97 rnd�- c J
C0&jf7j�j n �, �Y
Page 3 of 3 12128104

Facility No. Farm Name Date
Permit COC OIC� NPDES (Rainbreaker
Pop.
_Type
Design
Current
rorwe-
12M
==I�rAl1
M19.IW 5
PLAT Annual Cert )
Lagoon -a y-a
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatment Volume
Calibration Date
11)j)IL41Q
2
3
4
5
6
7
8
Design Flow
Actual Flow
Design Width
Aq0
Actual Width
3!«l0�
Soq Test Date
pHrields
Lime Needed Q�i dco(-56
Lime Applied
Cu-1 ✓Zn-I ✓
Needs P
Crnn Yield
Wettable Acres
WUP _
Weekly Freeboard
1 in Inspections _
120 min Insp.
Weather Codes _
Transfer Sheets
RAIN GAUGE
Dead box or incinerator
Mortality Records
.0 Day
0
l J
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
-
$
3
Verify PHONE NUMBERS and affiliations
Date last WUP FRO Pe ---(a, 3-14 Date last WUP at farm
FRO or Farm Records
Lagoon #
Top Dike
Stop Pump
Start Pump
Conversion- Cu-1 3000= 108 Iblac; Zn-I 3000= 213 Iblac
Tr6
App. Hardware �►+r

OM5 -UVS )11(010
a.
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: rn Region:
Farm Name:Owner Email:
Owner Name: S01iil 12 6 �6pvaA_ Phone:
Mailing Address:
Physical Address: ++ j,�
Facility Contact: ��! I 1 Title: elm ' raya,e Phone No: Qqq_.) Syf (
P`
Onsite Representative:1 I l Integrator: r t— oj'h LL
Certified Operator: R— . Operator Certification Number: APLA 1433D
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: F7o = a" Longitude: = c= t
Design
Current
Design Current
Design Curren#
Swine Capacity
Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑ Dai Heifer
Farrow to Wean
1
Dry Poul#r�
❑ DEZ Cow
❑ Farrow to Feeder
❑ La ers
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ N Pullets Nets ers
❑
El Beef Feeder
ElBeef Brood Co
❑ Boars
El Turkeys
Qther
❑ Turkey Puults
❑ Other
Number of Structures:
❑ Other
Discharp.es & Stream Impacts
1. Is any discharge observed from any part of the operation?
[]Yes
jjallo
❑ 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 ofthe State? (Ifyes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�U
3No
❑ NA
❑ NE
other than from a discharge'?
12128104
Continued

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 I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 9 a
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion.. seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes P No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes $ 'No ❑ NA ❑ NE
❑ Yes 19No ❑ 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? M Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1�;JNo ❑ 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 IRNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1�_mLNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes JRNo ❑ 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) Q)/'dj I bawaa 44a v . ,Sr lI Groin Os
13. Soil type(s) >VD Is
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EdNo
❑ 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 ?
P Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
WNo
❑ 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):
i
Reviewer/Inspector Name _ cS C [ �,✓� � Phone: — c'3
Reviewer/Inspector Signature: Date: q
12128104 Continued

Facility Number: g Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes W No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes JR 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 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes C'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No UNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? Styes ,No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
El No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
tkNA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�O No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
RNo
❑ 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
ONo
❑ 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
RNo
❑ 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
eNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
[:]Yes
K'No
❑ NA
❑ NE
ayr t-#~calta{;m wer in aooy . Oreschff `t'-next eek b+s�o-d he
r lam- Lyl E �1J
m d Ole frl wos r Pose mal I or-x �e
N - hVVQ% i
e�tv�i�e �ca9301
[qjo) �5 � Jo-7O_ t
5� ud *(dp Ote- 1n 1 b�- a1� r doe, nod- ho�PQ eno -
w$ ����� Ia?aj
om
Of� � I _/�/ "�
�-Q C Ov'B^ Ot7�[ Q1 a { l 3 Mf C L broh }„as- }1ebl'(t�A 0- 010k�2 . C o ►�'k ,
as now 64wve �M 4r"_ (s.
n 40K*d o,,e`sP4d_-o P , S b�c�s ha�e not e-} A
�(d ��y � ,, Imo- %' y � , M4ol4�1�1��1�'1+QU tn.�,10 nlr�f��P�O•'rPSir����11:�'4?tC� w
r I/I a1AA

• Facility No.Farm Name HOO&&IA Date
Permit COC OIC_ NPDES (Rainbreaker
Pop.
Type
Design
Current
FB
Props
PLAT Annual Cert )
Lagoon
1
2
3
4
5
6
7
Spillway
Design freeboard
Observed freeboard in
Sludge Survey Date
Sludge Depth ft
Liquid Trt. Zone ft
Ratio Sludge to Treatmenj Volume
114191[i/m
Soil Test Date Wettable Acres RAI AUGE
pH Fields WUP ad b
.LQpor incinerator
Lime Needed Weekly Freeboard rtality Records
Lime Applied 1 in Inspections
Cu-I ✓Zn-I ,_,- 120 min Insp.
Needs P ather Codes
r'rnn Yialri / Transfer . . _ s
MEMo.-
n.�nrl�
• - -ter-
��
, -. '
---
MM
Pull/Field
Soil
Crop
Acres
PAN
Window
Max Rate
Max Amt
SG
f
Ga l'
q iqak_
�TTr 'o
- ' L
Whfjjt
IN
feff -Apr
-7
J
—IS 1bsfvl�Q�
Verify PHONE NUMBERS and affiliations
Date last WUP FRO �-)--1-/p�
Date last WUP at farm
��
1lL 4 -q- V3 yR7y��
l-
FRO or Farm Records I#�
-#3
Lagoon # ag,00
_�a,3p
3).r{a
Top Dike
80
4s,.)o
q0o
q1
Stop Pump (00
Start Pump, o ��
Conversion- Cu-I 3000= 108 Ib/ac; Zn-I 3000= 213
Ib/ac I
��r
Iq
14
hAblfff k
�(/�J I�-frf-py
App. Hardware
'���- yl,i � S�

plmS J'
QZ'Division of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit aCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit .Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: ® Arrival Time: :3QrZ� Departure Time: r]• County: S Region:
Farm Name: iywcc F-orn,5 3- Owner Email:
Owner Name: KOf n It 2 01" Phone: }
Mailing Address: 40a 44)wa!Gl-
Physical Address: ]�
Facility Contact: RyflA�`' 1 1 1 S Title: Q�P�' Phone No: 9
.1111
Onsite Representative: _Ry i l S Integrator: MLgh7►_Wipw 1 Certified Operator: Form I, t? L�y-r� _ _ Operator Certification Number: AkA 12330
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: ❑ o = 4 = Longitude: I=] ° 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
[I Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
e. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: a]
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 ofthe State
other than from a discharge?
❑ Yes ERNo ❑ NA ❑ NE
❑ Yes
J0 No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes &No ❑ NA ❑ NE
❑ Yes 257No ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number:-Q Date of inspection a l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes allo ❑ 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): i q Q
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JRNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed 2TYes ❑ 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? E Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [-]Yes JRNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No []NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JR No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. KFYes ❑ 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
t.Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. CroP type(s) (t)a t~tr1 ! B p/m d,1 /2 14411 v )'. (:&ry fy)A' -t '
13. Soil type(s) AV'6
IS
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
IRNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[5iNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
RNo
❑ NA
❑ NE
17. Does the facility tack adequate acreage for land application?
❑ Yes
12" No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
RNo
❑ NA
❑ NE
Comments (refer.to question #):.Explain any YES answers and/or any recommendations or an_ y other comments.
Use drawings'of facility to better explain situations. (use additional pages as necessary): , „
Reviewer/Inspector Name ! Phone: y 10 4W-3331
Reviewer/Inspector Signature: Date:
n ­ 7 ,.r a U r7nQin,r 0--f:.....4

Facility Number: Date of Inspection 11DIA116T
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes JRNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes IgNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. gYes ❑ No ❑ NA ❑ NE
NWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking OCrop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes MNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No aNA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
5;'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ERNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
RNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ERNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E�lNo
❑ 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
N�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
DINo
❑ 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
M No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[WNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Cyr,,qe 1 slVe Sarver `60� Q00(a �oaC, . �le�e`y,A-# Oewsl&e�fe
S vrv,e b6-e aid dfy ear, sl&due- ma'�•r&,f Play, ad- s lvje PM will f v"7/
� lei+-,544 e Pm iv*n P a'1.
b� ���ded� 9 y
PI-egf cl-e4,j -rah o4 of I a ocl 3, Keep ritrO brr>a s�G�` Pl�(4n�lcll.
&hjrl'-h/o J aoo)s have_ cov&p
rvos da - ' mid-&fobe r, Crvfw dow iended ir) Se ,,,6o- for bPim �
1sp s 4 odd ad s e(a rV rt�% 3 o c�ay� � harr,��rl - Ha7 �s� j �l�
S o beryls near read `f� e 4, pla nn m��9 `} o 4 �-& seed _ f-
a y '� y i
,� a '�, be y
Q-Y See. * r,,
caIily wa/Le-�
� rsfrrm7 rettrds irAdofbwk lea11,P-4
plege �e�ecQrds a, no w crops,
Page 3 of 3 12,128104

Facility No."-�6`4 Farm Name
Permit / COC .ar
Date
OIC NPDES (Rainbreaker
FB Drops
.3 nsi
PLAT Annual Cert )
Lagoon
Spillway
-------
1esign freeboard
iftserved freeboard (in)
Slu . • - - Date Perm Liquid
CXMFMM
.
3ludge -Depth
!C 11ADJ40+flr;3MIr 1
V30
Nj
Calibr4i& Date
•
WTR - I ID'esign
—�—
---
Width
Soil Test Date g 16
pH Fields
Lime Needed Z. I
Lime Applied
Cu f Zn
Needs P
Crop Yield
Wettable Acres
WUP
Weekly Freeboard
Rainfall >1"
1 in Inspections ✓
120 min Inspections
J Weather Codes
Transfer Sheets
RAIN GAUGE
Waste Analysis Date
ITTM
sell
Date of last WUP I-HU `1 . Date of last WUP at farm App.
Hardware W- Max HateU,J�t'`Max Amt uJ—
PulllField
Soil
Crop
RYE
PAN
Window
60
Dx,
App
U �
ry
Verify phone numbers and affiliations
T19 0(8 '+z-50
S'��4 � =�H� Sa• Cp ��a''1 �Q 7 � �Ot`'1

Type of Visit `@ Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit 1) Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Accesses� nn��
Date of Visit: �� Z(p o7 Arrival Time: � a Departure Time: County: Region:
�t�C;
Farm Name: Owner Email:
Owner Name:
I n
Mailing Address:
Physical Address:
0
Phone:
� n
Facility Contact: fLACP d Lq6jQA __ Title: 0 "inu- Phone No:
Onsite Representative: Qw-Uj 4,L 0, Integrator: _ _ _
Certified Operator: VM/W_ " Operator Certification Number: ` F,330
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = 0 0 4 0 u Longitude: 0 e= I = "
Swine
Design
Current Design
W..et Potiltry
Currenf Design Current
Fit Cattle
,,
Capacity
Population Capacity
Population, Capacity Population
❑ Wean to Finish
M ❑
��>: DairyHeifer
Dry Poultiy
a' D Cow
Non -Dairy
Layers
❑ Beef Stocker
❑ Non -Layers
= ❑ Beef Feeder
❑ Pullets
❑ Beef Brood Cow
Turkeys
O#her ❑ TurkeyPoults.�3`
a �,
s_ a
�._
❑ Other
2 .:.
;. .
❑ Other
I 3
F`�` Number of Structures:
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean
7
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
❑ Boars
❑ La er
❑ Non -La er
El
Dairy Cow
Dairy Calf
Discharges &Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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 ®No ❑ NA ❑ NE
❑ Yes
12
❑ No
P NA
❑ NE
❑ Yes
❑ No
ONA
❑ NE
R NA
❑ NE
❑ Yes
❑ No
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
❑ No
1� NA
❑ NE
/28/04 Continued

Facility Number:
Date of Inspection 1l� jZlpJt�
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?
Structu r
l Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 4a
5. Are there any immediate threats to the integrity of any of the structures observed?
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes] No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes )A No ❑ NA ❑ NE
❑ Yes 0 No , ❑ NA ❑ NE
If any of questions 4-5 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;KNo ❑ 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 ❑ 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 El Evidence of Wind Drift ❑ Application Outside of Area
i..�-� 12. Crop type(s) A G r d 5 �Lk3` S
13. Soil type(s) V\ uS1
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes IX No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes PgNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes CRNo ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application'? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes , No ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Revi ewer/[ nspector Name VJL-J)LANTb-Phone: (/ ''1! 3 3300
Reviewer/Inspector Signature: Date: MY _ �G „VCQJ 7
12128104 Continued

Facility Number: — Date of Inspection b
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ill No ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes to 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 9 No El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No RNA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1 No
El
El,RLNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
PO No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No 4NA ❑ NE
Other Issues
28_ Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes - ❑ 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 normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
P) 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
R 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
N No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
allo
❑ NA
❑ NE
a, riQe vA 6 Z au -7 St
r a►'n �C,o -� d'
6 yLc� -
,r per e.r_s - 0y. b..",
Page 3 of 3 12128104

Facility No. lc
Farm Name
P_
Owner I�S}hh
Operato�
Back-up , /
COC V
Time In
I
Time Out Date { 1
Integrator m­4
Site Rep : 14
No. M32
No.
Circle: �nera or NPDES
Design
Current
Design
Current
Wean — Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed — Finish
Gilts / Boars
ow —
lSd7
Others
Gorp
EBOARD: D sign
ge Survey ��
Yield 7/
Rain Gauge '✓
Observed
Calibration/GPM ' r.
3,� J
Waste Transfers
Soil Test _ Wettable Acres
Weekly Freeboard v Daily Rainfall /
Spray/Freeboard Drop / a Ra
a•
Weather Codes 1 min Inspections
Waste Analysis:
Date Nitrogen (N)
4 A
Rain Breaker --�
PLAT ----
1-in Inspections
Date Nitrogen (N)
Pull/Field
Soil
Crop
Pan
Window
Han
.44
w u

a � Division of Water Qasiity I
1Facilil3� Number dT Y O Division of Soil and at Conservation
Other Agency I
Type of Visit I$ Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit* Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 06Arrival Timer Departure Time: County Region:
Farm Name: �i�n-�_ .�J Owner Email:
Owner Name: t �C]t IYIt rh�Wdc Phone:
Mailing Address:
Phvsical Address: o l V'70 Py
Facility Contact:C�YVd?.�lJ�](1tLCy Title: ty Phone No: E VC]� ' M Ci
M �l , 5h'7 (p ag - h�
Onsite Representative: "ev�`ko `" ACVJ� Integrator: �J��i CI_i&M _
Certified Operator -at `V��' Operator Certification Number: r
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: ❑ o ❑ = Longitude: ❑ c ❑ 6 ❑ fl
Design Current
:.;,-,. Design
Current Design
Current
Swine
Capacity Population
Wet Paaltry 4: C,bapacity
Poptilatian Cattle Capacity Population
-.
❑ Wean to Finish
❑ La er
�. .x
❑ Dair
a Cow
❑ Wean to Feeder
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
❑Dairy Heifer
crow to Wean
/501 141Ww
Dry Poultry��
j ❑ Dry Cow
i "
"���
El Farrow to Feeder
�,: Non -Dairy
❑ Farrow to Finish
❑ La ers
11
' ❑ Beef Stocker
Gilts
❑ Non -La ers
f
,a= ❑ Beef Feeder
POBoars
❑Pullets
❑ Beef Brood Cow
:: .< y. ..
Other
❑ Other
y
❑ Turkeys
❑ Turkey Poultst
El Other
s„
-"
Number of Structures:
"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
*A
❑ 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)?
'1
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
-LR)NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
NjllVo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
5+No
❑ NA
❑ NE
other than from a discharge'?
Page 1 of 3
12128104
Continued

Facility Number: —
Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: _ Z_
Spillway?:
Designed Freeboard (in): �� J
•r t
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes_�o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 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? **_19 Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes _N 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 ElNA ❑NE
maintenance or improvement?P!PNo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable r Crop Window
El Evidence of Wind Drift ❑+Applicatioon_j` Outside of Area
12. Crop types) 'Im �� 4-6 . M Q r of s '. Cgof n - W ► w_+-: — cX w_ CzAJ .0
13. Soil type(s)
A ► t,
—
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations or any oth- comments.
Use drawings of facility to beer exp
ttlain situations. (use additional pages as necessary):
Reviewer/Inspector Name�- 2 J`j �T��� Phone: �( 0 3 '3
ReviewertInspector Signature: Date: O V ZC� iP
Page 2 of 3 12128104 Continued

Facility Number: 6 1 -0(06 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes )KLNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. El 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
IlNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
AJ�A
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
)KNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
®iNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No 'RNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30_
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
10 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 Pen -nit? (iel discharge, freeboard problems, over application)
32_
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�9 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
*o
❑ NA
❑ NE
Additional Comments and/or Drawings:
�2 A ass cx-r, 4-CF 6� (_n
r r
C� x ce l6-,, � �a-4, l
Page 3 of 3 12128104

Facility No. Time In Time Out r Date Cie
Farm Name c Integrator _ Jy
Owner )2 Site Rep
Operator f,' No. Ici Zj
Back-up No. _
COC Circle: enerai r NPDES
W_t
FREEBOARD: , Design p Observed
(
Sludge Survey ►+ 3L —Z I � A Calibration/GPM
Crop Yield Waste Transfers
Rain Gauge'
Soil Test w�
Weekly Freeboard
Spray/Freeboard Drop
Weather Codes
Rain Breaker i1 / �
PLAT
Daily Rainfall
120 min Inspections
Design
Current
Design
Current
Wean —Feed
Farrow — Feed
Wean — Finish
Farrow — Finish
Feed —Finish
Gilts 1 Boars
a —
S �
Others
3�3
Wettable Acres t�
1-in Inspections
Waste Analysis:
Date Nitrogen (N) Date Nitrogen (N)

e
Division of Water Quality
3, Fa'ciilty.Nttinbe `J Q Division Of Soil.and Wafer Cotiservahon' R �,
O Other Agency'
gency
Type of Visit 0 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 49 Routine Q Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
Bate of Visit: Arrival Time: T3p Departure'fime: County: s���3en Region: 6co_
Farm Name:owa�� �� S� / Owner Email: S3'7�r
Owner Name: �O�l�J_G _� I.O�✓a _ Phone: 5270—/Zf!7.O
Mailing Address: I �.?v� /t%t,�ar� /_t.r7_a� , faairy-v.j C AIL ,293f9_
Physical Address:
Facility Contact: _Ro-o-ei 'e lyotva— _'Title: _
Onsite Representative: �/�o�il•t f"Iawet.!rf
Certified Operator: 1Pv.,n,L _awcsr�
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator: Mom/ /I/ F14Fer_ s
Operator Certification Number: _f `%,-3d
Back-up Certification Number:
Latitude: E�0 =` �" Longitude: ❑o ❑; 0,g
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
❑ Non -Laver
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
arrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Dry Poultry
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkcv Poults
❑ Other
Discharkes & Stream Int acts
1. Is any discharge observed from any part of -the operation'?
Dischar<,e originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Call'
❑
Dairy Heifer
❑
Dry Cott
❑
Non-Dai
❑
Beef stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the dischar-c reach waters of the State? Myes. notify DWQ)
C. What is the estimated volume that reached waters of the State (gallons)`.'
d. Does d1scharg,e bypass the waste management system'' (If yes. notify DVVQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes Lt' No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
ONE
❑Yes
El No
❑ Yes
D,�I/No
❑ NA
ElNE
El Yes
Eg No
❑ NA
❑ NE
12128104 Continued

r
Date of Inspection �/ O
Facility Number: —
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
20<o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 - Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: 3
Spillway?: — cs 12-
Designed Freeboard (in):
Observed Freeboard (in): 3 7 &
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[ZNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
D'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
[rNo
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U CVO ❑ 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 allo ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,.,/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes DIN ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [/rNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre deten-nination
, ❑ Yes
❑ No
❑ NA
0�4E
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑
El NA
DINE18.
Is there a lack of properly operating waste application equipment?
[-IYeso
`No
❑ NA
❑ NE
:Comments (refer to gnestipn ft Explain any YES answers andlor any recommendations or any other. comments. .
JUse drawings of facility to better explain situations. fuse additional pages. as necessary):
I �Egse r.tie-� ; er q„�1 5�/ay Tor wfeds &J AeCC&_4sU� a'Cf 'Va �.,.eY,:` �,a�e ot�►r
/ p-OWL
/,1 �'
lCoo*CPA`s/' 3�
Reviewer/Inspector Name /Y� ]� Phone:
Reviewer/Inspector Signature: Date: 2_-Z, -o S
12128104 Continued

S . . i
Facility Number: jg.,a —G Date of Inspection
Re(Luired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Li. <o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑-No ❑ NA ❑ NE
the appropirate box. `,� ��
El,,�" ` ❑ C ,e510'sts ElDe? n ElNuK ❑ er
21. Does record keeping need improvement? If yes, check the appropriUe bo below. 6c;{ es ❑ No ❑ NA ❑ NE
0 as pp ❑ ❑ G �'s 1 ❑ !9rest-�4ri'd1 s T `�sf El
rite Application is �s rite Transfers `� n
ainfall ❑ fiteelri� L-r I1'op Yield 20 Minute Inspections onthly and V Rain Inspections D-weather Code
22. Did the facility fail to install and maintain a rain gauge? 0 Yes 9-1 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ERKA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA [J n
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes El No [—INA�E
26. Did the facility fail to have an actively certified operator in charge? El Yes 2No [�D �NAA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes [-INot�-tva ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
to
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
(01<es
❑ 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
El9
- o
❑ 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
L` <0
❑ 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
M' .
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑Yes
Li14o
❑ NA
❑ NE
Additr a k, no meats
4a recO * ivasf /e
rfsy rl C wren /o�oe�St tQ��I-w�,
recap ''I ` I
CrnP Y" 4/ recarc�s a�J Monih/Y a,,c{ i' r,-,, iRsPecli.ms
1"la� � Qv% L� cr�rp✓Pd / 1 -F.- f /
tC Gae7b;ntp� ..rC�RQ J q+l�
weal kL I Cp�� C pl ✓w� rl I �.2 C7 / /
r,4" ; un 5_
H CO `JO lej f
°T dK7d 6a� P; � S WC/"G :r� �� Q 1F�✓S t g �/7��� R/1ol P'1 /, rIo /V a!� �j
h el rr„a ..
12128104

(Type of Visit ® Compliance Inspection O Operation Review O Lagoon Evaluation I
jI Reason for Visit • Routine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: 9 - � Tune:
O Not Operational O Below Threshold
E211�ermitted G<ertified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: _
Farm Name: �G i^.., 6 _ _ _ ___ County: - `5&? M dCa.S 243 » - Ff O
Owner Name: _-,..__ R its c.0 lar& P�ho�neNo: q/0-
Mailing Address: �P . .. '�� ��n �� z.._..._,..... � Ar.�yG 6"Z& A/C_
Facility Contact: . uuafil... Title. _ Phone No:
Onsite Representative: „ . %1 o n a'"integrator•. 1qkw& r4 at
Certified Operator: J& 4n O'e ._ .. H9 654 &Ca� ..._ _ Operator Certification Number: 14 7,--?z2
Location of Farm:
M4�ine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �` Du Longitude
Desgp Current _ Dest 'Current
Swine CAMMadw Popiiaiion p3'camcitv -Population. Cattle -Po oa
Wean to Feeder Layer Dairy
Feeder to Finish 10 Non -Layer I 4on-DairyL
ow to Wean ] p
Farrow to Feeder Other _
Farrow to Finish ToW DesigiiCapacity -
Gilts
Boars Total SSLW
Discharges & Stream lrupacts
I. Is any discharge observed from any part of the operation? ❑ Yes 240-
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes L7<o
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes BI
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 9'1qo­
2. Is there evidence of past discharge from any part of the operation? ❑ Yes i f4o-
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes *0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �ioJ
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): (p .29
12112103 Condhaed

Facility Number: R..7— Date of Inspection F-7'53 0
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 94110'
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ®H<00,
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes E�W
8. Does any part of the waste management system other than waste structures require maintenaneelimprovement? ❑ Yes 8-d'Qo
9. Do any strutures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes lip
elevation markings?
_Waste Application
10. Are there any buffers that need maintenancehmprovement? ❑ Yes ago,
1 I . Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes E}Ko
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes GWO
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes MITo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes Rio
Air Quality representative immediately.
❑ Final Notes
t4
1, file
�
)tus/i
GVkj rn
fie
ev..n
/.9
MM.vny, /"fP_
1�pwGi c•,! �/��5
10
cI�
r /
ev� 3.ti['e
P
L.rr�d i4!
ry�ia� T
�✓
f�
r
Reviewer/inspector Name
Reviewer/Irsspector Signature:
Date:
R-�
12112103 Continued

Facility Number: 8� EGG Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? 21'�es ❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, ch ts, de a , maeS' etc.) �es ❑ No
23. Does record keeping need im✓provement? If yes, check the appropriate box below. ❑ Yes ❑ No
�7�;_n
Application ❑ Feebeard iaakysis. ❑
24. Isot in cdmphadiee wrth Jcable setback c�iteri rn a at the time of design? ❑ Yes 2-NO
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes U-No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) [:]Yes MNo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes S-No
28. Does facility require a follow-up visit by same agency? S-Tes ❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes 9-90
NPDES Permitted Fae hies
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes B-Ko—
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? if yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocldng Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facilitv Number
Date of Visit —7 `03 Time: A; 30
o1 (a
Not Operational 0 Below Threshold
❑ Permitted ©`` ICertified O Conditionally Certified © Registered Date Last Operated or Above Threshold: rt-1
Farm Name: 0warel Farms y
��ii Count
Owner Name: rl r1 ! e Ro UKrA Phone No:
Mailing Address: 1� ' ` (�af[i Rd, ! r G
Facility Contact:
Title:
Onsite Representative:
Certified Operator: Pori e)
Location of Farm:
Phone No:
Integrator: _rp � y
Operator Certification Number: 33 Q
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' K Longitude 0 �� U
Design Current
Swine Canacity Pnnutstinn
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
150 7
1.5 Q
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons -
Holding Ponds l Solid Traps
.Design Current
Pouhry 'Capacity Population Cattle
❑ Layer PE01
Dairy
❑ Non -Laver Non -Dairy
❑ Other
- Total Design Capacity
Total SSLW L
❑ Subsurface Drains Present ❑ Lagoon Area
❑_No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Snrav 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 obsen•ed. what is the estimated fioty in ealimin?
d. Does discharge bypass a lagoon system" (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
)esign° -, .:-Current .:_'-
e achy=_ Po nlatmn •'.:
❑ 5 rav Field Area
❑ Yes K�No
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure Y Structure 5
Identifier:
❑ Yes ❑ No
❑ Yes &No
❑ Yes 5No
❑ Yes Dl N-o
Structure 6
Freeboard (inches): �9 `� ;)3
05103101 Continued

Facility Number: R — 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 anv of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes LNo
❑ Yes LTNo
❑ Yes [24,
❑ Yes ErNo
❑ Yes 2No
❑ Yes VNo
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
0 No
12.
Crop type Cocos f
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
RrNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
52rNo
b) Does the facility need a wettable acre determination?
❑ Yes
ZNo
c) This facility is pended for a wettable acre determination?
❑ Yes
9No
15.
Does the receiving crop need improvement?
❑ Yes
Q�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ON,
Required Records &_ Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
ElE Yes
�,/
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
VNo
19.
Does record keeping need improvement? (iel irrigation. freeboard, waste analysis & soil sample reports)
❑ Yes
KrNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gdNO
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ErNo
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
2No
(ie/ discharge, freeboard problems, over application)
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
9No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Rf No
25.
Were any additional problems noted which cause noncompliance of the Certified AVl'MP?
❑ Yes
53"No
F117o violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers and/or. anv.reconsmendaOons ar:aav other comments =-
Use drawings of facdity to better explain s6atr6 (ase additional pages°as oiecessarv) `
_ ❑ Field Com' ❑ Final Notes
Reviewer/Inspector Name i! i e- h i
p
Reviewer/InspectorSignature: Date:
05103101 f Continued

V
Type of Visit (J� Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit % Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of visit-. [
Permitted to Certified 0 Conditionally Certified [3 Registered
Farm Name: P e L w9_
Owner Name:nn e- N a Wc� x51
Mailing Address:
Z�Z Time: : 00
Not erational 0 Below- Threshold
Date Last Operated or Above Threshold:
Count- Sr) %I2-G)
Phone No:
Facility Contact: _ Tonni e ke(,Ja CQ Title: t `n-tr Phone To:
Onsite Representative: — , — I ioc.,,Q Integrator: m Lt' g,ky _
Certified Operator: Pon I /4CU lc.,-ck Operator Certification Number:
Location of Farm:
CI(Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a �" Longitude 0
Design Current % " Design Current
aw-ine Uapactty .Po ulation ,
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder [�
❑ Farrow to Finish
❑ Gilts
Pouth-v Ca achy Pa ulat4a Cattle
�- ❑ Layer ❑ Dairy
x,- ❑ Non -Laver ❑ Non-Dai
-; ❑ Other
Total Design Capacity
Total SSLW
- Current-
v : iPenulat inn
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Sotid Traps ❑ Na Li uid R`aste Nlana ement System
Discharges R Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed. was the conveyance man-made' ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If ves. 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 DV4'Q) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑Yes JXNo
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 Cl Yes qNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: - 3
Freeboard (inches):
0510310.1 Continued

•
Facility Number: %2 -- &, (�.
Date of Inspection l i 7 ea
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 en-vironmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes I5 No
❑ Yes [,M No
❑ Yes No
❑ Yes [ No
❑ Yes 0 No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12.
Croptype
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?
EN Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Reauired Records &: Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
M No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
M No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M 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 09 No
24. Does facility require a follow-up visit by same agency? ❑ Yes [4 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P9 No
13 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
_.
Comments (refer to question i€) :Explatn'sny YE5 aus<rets an-diorarty;m recomendatwus or any_other comments.
:Use drawings of faciilitVAG' eater ezplatti sritnattons:,[use addrtwnal pages as necessary) Field Conv ❑ Final Notes
l' NO C`Lrl L'* (`eile-0..! rrr-j de,Dtr LAjC)' `L'
/❑
I f CVPI v.%9 6e-
M;-. <,e_ "om 4c,, z� �c i Q Lam= {Lfe ep lht t `r+l
Z.rf✓1 PL-C.! C rk -
1
iti�ebtet� CVrc- 01t-rry%;AA%'cr% �5 inej I•Jo! �etY c!�
�4 �J�rn`}Sc't�� CL,,
t
P- c -4-+-rf- +- hc,t,i P_ P cnrn C_Vvt: "S n e-e- Av- fez m
/��CS�
S/ fl[kcj [; trrcxa t� CL�e711.
RerdewerlInspector Name
Rerdewer/Inspector Signature:
Date: (�
O5103101 Continued

Facilit- Number: RIP —(s+(r Date of Inspccti„n 7 cz
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt.
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s). inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes [ No
❑ Yes No
❑ Yes M No
❑ Yes � No
❑ Yes No
❑ Yes ❑ No
Additional Commentsandlor Dravvia�s _
r f j �] /
— OCLS �c n jEs cV �c > 1T G Az — ,N 44t-r u d 4o, � ee r.
�1 ii ii
C�t�d� Ccl iaS"C insPer�,�n
0510310I

of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: o Time: & 3 ff
Q Not O rations[ O Below Threshold
® Permitted ® Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
FarmName: ...... ...... .l.?'�sd✓:.... ...... s........�.................................................. County: .......... Sty•�-y-d�..........�............�......y ............_....
Owner Name• .... Phone No:��/�)
Facility Contact: z ,C��� Title:......... .................... Phone No: ,,
Mailing Address:..... %,�.22 ..wR...1x�f�:� ! /.lt �Y _ ..MM........... ..
Onsite Representative: ...... °`!_ ... fl �r.......... Integrator: • (� u� ...�����✓..........
......................................
Certified Operator: p"J^��� Operator Certification Number•
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a ° 66 Longitude • A «
:= .Design;=' Current ` Design Current Destgii Curtest
ir,T:
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Poultry ;,'.Ciipacity Po ulafion Cattle :tagFaci , ;Population.;_
❑ Layer PO
airy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Naimberof Lagoons "' Subsurface Drains Present Lagoon Area ❑ Spray Fietd Area
1Hold�rig Ponds I SolzdTraps ❑ No Liquid Waste Management System
Diseharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Wo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. if discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes JR No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J�JNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Structure �� Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
'/ i.
Identifier: Y-S .2.............................'............................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Number: C'Z 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
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?
OrYes
[:]No
8. Does any part of the waste management system other than waste structures require maintenancetimprovement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
B No
IL Is there evidence of over application? ❑ Excessive Ponding [I PAN ❑ Hydraulic Overload
❑ Yes
®'No
12. Crop type ,5 i ems, .q. .�t�iP.4,� ; c�i ��
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
P No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
PYes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
Ec No
16. Is there a lack of adequate waste application equipment?
XYes
Flo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irfigatiolcfreeboar ante 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 reviewtinspection 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 ANo
,g Yes ❑ No
❑ Yes RNo
❑ Yes $ No
❑ Yes t�rNo
❑ Yes ® No
A504 )if Yes
�. i�-AQrpt1QIIs.or agf cJ'6nd0$ •i TrO I0 ' . . 1C�ij5,V1S�. Y04k 3t'}i�'IC lye i�0 ul b�
cori-esaarideizce: abut � this Visit:......... ............. ...... .
❑ Yes ® No
Reviewer/Inspector Name
' w 'xtiwx "'"%" µ _
Reviewer/Inspector Signature.• Date: /O 3l ®/ van

Facility Number: J?Z Date of Inspection /O -7 a
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below efflyes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of property within 24 hours? ❑ Yes n-1 No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RNo
roads, building structure, and/or public property)
24. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes M No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �2 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes allo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? Yes ❑ No
Additionalomments'an or° rawa
- _ -_ - -
5100

® Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit ®Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit .0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
I Date or Vi..sit: /� �1�� Fiore: �_ UZ l Printed ou: 7/21/2000
z -
-ot O erational O Below Threshold
© Permitted ® Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold : .........................
Farm Name: ...... n' ...-... Count}•- ............ -:,a sc :�'.............. •......--................
r7
OwnerVarner-...........7�o.:%rig, �rii�:c� Phone N. ........................................................... ............... .................--..---........-----..................-................
FacilityContact: ......./.�qr.�':ac.......-- ..��•��....... Citle:................................................................ Phone No:...............-.........................-.........
Mailing address: ����. ...................
1 : ..r. ........-:: ..�...-�,....11---...----..�f _ �,� ......- � ? .: f .............
OnsiteRepresentative: ................................................ .......,-../.-.-..--........-......----...................
Certified Operator:-.-.. .11A," .....- c f�` �J�.-
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse latitude • °
Design Current
Swine Capacity PoD>ulation
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
U
❑ Farrow to Finish
❑ Gilts
❑ Boars
Integrator:._. ................... .............-
Operator Certification Number-...........................................
Longitude
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ La},cr ❑ Dairy
❑ Nun -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lad Mn Area I0 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impact~
I. Is any discharge observed from any part of the operation:o ❑ Yes kNo.
Dischargc originate d at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If disch.trrc is observed- was the con1,cvancc rstast-madc" ❑Yes No
b- if discharge is nhser�ed. did it reach Water of the State? (]fyes, notify DWQ) El Yes ,�No
c. If discharge i, ubscrved- what is the csfinimcd lloNk in galhrin?
d. Does discharge bypas, a lagoon .v,tent:' (if ves, notit-v DWQ) ❑ Yes No
2. Is there evidence of past discharge from any part of the operation' ❑ Yes 91 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ZINa
Waste Collection & Ire-minent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Strtte IUry 1 Su-m:(mo 2 Structure Structure 4 Structure 5 Structure 6
Identifies: ��
Freeboard (inches):
5100 Continued on back

Facility Number:? Date of Inspection
Printed on: 10126/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes g 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 El No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes UNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes I No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes RNo
11 _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes Q No
12- Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes f No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes grNo
b) Does the facility need a wettable acre determination? ❑ Yes P'No
c) This facility is pended for a wettable acre determination? ❑ Yes EgTio
15. Does the receiving crop need improvement? ❑ Yes No
16. Is there a lack of adequate waste application equipment'? ❑ Yes'KNo
Required Records & Documents
17. Fail to have Certificate of Coverage & GeneraI Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JE� No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes kNo
22. Fait 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 .R No
yiolAlWis or• di'fei6.0&9. mere noted-diwihi2 4his;visit.--:Y:ou will..eeeive do it ;
Torres orideijCe: abouk this :v..... .
Comments (refer:to question #): Explain any YES answers and/or any recommendations or any other comments. 2 < =
Use drawings of facility to better explain situations. (use additional pages as necessary)- T'
A.
/-��%�L%�C�' 1���/'L/_J� '�(�G�i_'} C.�'�.C'S /s%G3' Gil•-mac'.✓.=G/�-C��
V
Reviewer/Inspector Name
Reviewer/Inspector Signature- ,_ � Date: 5100

0
© Division of Soil d Water:Con anservation -- Operation Renew =-
13 Division of Soil and:Wateit C66servatt6n Compliance Lsp'ecUon=
i
z
Division of Water _,slily Catipllance Inspecttoa 1v-
-�Otber en
g A c t eratton Revrew
r Y p
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Bate of Inspection -9-
Time of Inspection 1 24 hr. (hh:mm)
Permitted 0 Certified 0 Conditionally Certified [3 Registered Q Not Opera
tional Date Last Operated:
Farm Name: �wQr� �county: ...............�dY�...-............................
Owner,\`ame:.....1.�h.�1.!.I....................7�41 �?-.r.........---...... .. ---. . -................................................
Phone Na:...... _fV o -� d
FacilityContact: ............. ©- .t..e.�......................�......l....... Title: ........... ........................%Phone No:................ "- ..................
Mailing Address. ..1..6.Z2............. .C4, �d ........ ...!A.......Vf:.1..4.a.;.....N............................ ............,���..
OnsitcRepresentative:..............194 .n e..�........................................................... Integrator: ......... ..............y..�.�...........F......................................
Certified Operator:..�,tN.A..l..e.......4 ......� 45 ,,,,.... Operator Certification Number :..........................................
L?......... .........
Location of Farm:
t......--1--- ....---- I.....................................................................................................................................................................................................................................................
0 E
Latitude 4 � Longitude ���.c L�• �c �cc
Desi n Current -Desi g gn Current Design ;Current
Swine - -'-Ca acity Po ulation'` Poultry Ca'acity.;Population :Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer n-Dairy
Farrow to Wean
Farrow to Feeder ❑Other
ElFarrow to Finish w= Total Design Capacity %ZOO
❑ Gilts, P '
❑Boars - Total SSLW
--Number of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
�m
Eoldiiie,,Ponds / S61id
TrapsT❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 1�,No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. li' discharge is observed, was the convevance man-made? ❑ Yes gNo
h. If discharge is observed, did it reach Watcr of the State? (If yes, notify DWQ) ❑ Yes XNo
c. If discharge is observed. what is the estimated flow in gal/ruin?
d. Dues discharge hypass a lagoon system? (If yes, notify' DWQ) ❑ Yes Af 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 FfNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: f p
Freeboard (inches): ......... .......... �� i..........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Cl Yes ;&,No
seepage, etc.)
3/23/99 Continued on back

j
Facility Number: b Datc of Inspection
& Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes PQNo
(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 j4No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type 49(- Q h W r 4+er q0A
13. Do the receiving crops differ with those designat d in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination'?
c) This facility is pended for a wettable acre determination?
15_ Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
i S. 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? (iel 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 faci lity require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.: iio'violaEioris:oi- deficiencies •were noted• dtWirtg 4his'visit' • Y:oi1 wiil-receive Rio further
co rrespondeirce. about. this visit. . • . • . • . • - . - .
Vo,
/I&W� 9aod. 4- wellc��(fKe_va'- 1S. I 1
con. Gt'eSicl�,. X cz� iee,, a6•l tt,L ed 10e,-
SfW
❑ Yes 9 No
❑ Yes Rio
❑ Yes No
❑ Yes No
❑ Yes 10 No
❑ Yes No
❑ Yes ❑ No
❑ Yes No
❑ Yes to No
❑ Yes IQ No
❑ Yes [&No
❑ Yes [K No
❑ Yes K No
❑ Yes ;Q No
❑ Yes KNo
❑ Yes N_No
❑ Yes 20 No
L
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
/z'9� 17 9
3/23/99

I 'y
Facility Number: OZ — I)atc 0I'Ittspection�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation? 1<
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes qNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes PkNo
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 ANo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) ❑ Yes qNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes kNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes KNo
MditionaUConiurfents and/or,swings
a ;r
JL
r
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
[ff Division of Water Quality
15&Routine O Complaint O Follow-up of DWQ inspection O Follow-ff of DSWC review O Other
.� ■ - � rrar�..r �
Date of Inspection- 9
r- Facility Number
Time of Inspection % 1,30 24 hr. (hh:mm)
Registered 0 Certified Applied for Permit © Permitted E3 Not Operational Date Last Operated :.............
Farm Name: ...... J4cz).lt.r ......./ A"" 5 County: J.
.............
...------...�.................................................•-•. 1 ........ ..
Owner Name: _... ®r' r!.�.1�...................L..!pr.A... Phone No:......... 59.�..�.. �.�.�b....................................
......
Facility Contact: ... a+-v n..4'e.........1 WQrc[... Title: 0..W n �.r .... .... Phone No : ..............................................
..... ........... ......... ...... ..... .... .... r
Mailing Address:......1..��......`1Y 1S `�4l'Gr 'U............................. ...A.c.� ..!11 (. ... /.....i..,r.................. .2.,��,,.�.?..10,
...
Onsite Representative:...Ao^ i..C.........�eJ�tr�........................................ Integrator: .................... A_6r..........................................
Certified Operator; .................................... ..................................................... Operator Certification Number .........................................
Location of Farm:
Latitude �• �� 0" Longitude 0• �' 0"
{ spaDesig�n1,i urrent
x Deslgn Ciirreiit<. Des>gn
4iirreiit r
Swuie y Capacity
Pout s°Ca acit Po Mahan Cattle ';C aci Po Mahan
try p
, . R wv xPopalahon
> P y•A _
aA . P..
❑ Layer - ❑ Dairy
FE11
❑ Non -Layer : ❑ Non -Dairy
}
�a.
.�; ❑Other `�
T6ta! Design Capacity
'.`
t,i ✓ ink t - e
ro5'
LN
:^ v s .Tata! SSLW
#Nurrtber of Lagoons !Holding Paii -, .,
❑Subsurface Drains Present
❑Lagoon Area
Spray Field Area
❑ No Liquid Waste Management System
Wean to Feeder
General
Feederto Finish
Farrow to Wean
Farrow to Feeder
Z Q
❑ Farrow to Finish
❑ Gilts
❑ Boars
1. Are there any buffers that need maintenance/improvement? El Yes #No
2. Is any discharge observed from any part of the operation? El Yes 0,No
Discharge originated at: ❑Lagoon [I Spray Field ❑Other
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
b. if discharge is obsen-ed, did it reach Surface Water? (If yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed, what is the estimated Flaw in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify- El Yes ❑ No
3. Is there evidence of past discharge from any part of the operation? ❑Yes � No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑Yes ONo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑Yes O No
mai ntenancelimprovemen t?
6_ Is facility not in compliance with any applicable setback criteria in effect at the time of design? El Yes [�No
7. Did the facility fail to have a certified operator in responsible charge? ❑Yes No
7125197

Facility Number: z —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lagoorts.Holdigg Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(ft):...........s.1.................. .........Z.!lJ....----.................... ---...�.J...................................... ......---...---
.......................................................
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes No
12. Do any of the structures need maintenancelimprovement? ❑ Yes No
(If any of questions 9-12 was answered yes, and the situation Poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes R1110
Waste Application
14. Is there physical evidence of over application? ❑ Yes )kNo
(If in excess of WMP, or runoff a ermg waters of the State, notify DWQ)
Z
15. Crop type
r! `�fr �i h r fTNh1CC l
- ............................................... .......................................................
16. Do the receiving crops differ wi those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes /KNo
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes (9,No
18. Does the receiving crop need improvement? ❑ Yes No
19. Is there a lack of available waste application equipment? ❑ Yes No
20. Does facility require a follow-up visit by same agency? ❑ Yes No
21. Did Reviewer/inspector fail to discuss reviewrnspection with on -site representative? ❑ Yes WNo
22. Does record keeping need improvement? ❑ Yes ONo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the'Animal Waste Management Plan readily available? ❑ Yes kNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes O No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
No.violations°or defteiencies.were noted -during this.visit..You:will receive no further
corresponde & about this:visit: ;
G&6A zz_w k aq-�l e", . 1
COJ cojer yrL S cLCou�U
60oA recaiS,
�ee p o f �e ? Wyk
�tid welt � K-1Q,w��.
i-1poK.5
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:

I.
,❑ Division of Soil and Water Conservation ❑ Other Agency �' x
❑ Division of Water Quality n.,
0 Routine O Contrtlaint O Folimv-un of DWO insuection O Follow-utt of DSWC review O Other
Date of Inspection /2- -i
Facility Number � L 6
Time of Inspection E== 24 hr. (hh:mm)
0 Registered 0 Certified E3 Applied for Permit 0 Permitted 10 Not Opera Date Last Operated:
/ ........Sq�., �,rU ..J
Faint Name. (��!' "'/ "'
..
.. ................ .............................................................. County.
Owner Name:........ a!✓.�t�:......,t��fPFiCiF ... Phone No: (,�/...... .26..r�........
- .....
Facility Contact: ...................,¢,�Q`Title .......... Phone No:..................................................
..... .......................
Mailing Address: ........ IG.2,3 ....l��> �� .. ... l� ..1� /!�.�.... 00 .....
..................... ....................
......
f/....d�.. ..... P! �,...
Onsite Representative: .......... a''^�N7 a....ILrJ.... .............. ................ Integrator: .......
.. .P�-...........
Certified Operator:......... ................. I .................... ... Operator Certification Number,.................
Location of Farm:
Latitude ' 6 46 Longitude • 6 "
Current
Design Current - tDeS[gtt "Cnrrentra
Syvtne sett P ulatton
aPr
« Pout# �y P act Po" ulatton ' 'Cattle C ctP alation
P, 9
,.;Ca
❑ Wean to Feeder
.Ca" r.E9 _ty`,
❑ Layer ❑ Dairy
©, ❑ Feeder to Finish
KK6 ❑Non -Layer �. ❑Non -Dairy
Farrow to Wean
x
❑ Other x x;
❑Farrow to Feeder
Po
❑ Farrow to Finish
Total Design Capacity
[IGilts
a e _,
❑ Boars
r gTotal SSL�V
�Numbet` Of Lagoons /'Holdtitg Ponds ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
;� z
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes X] No
2. is any discharge observed from any part of the operation? ❑ Yes R No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If` discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surlacr, Water? (If yes, notify DVvQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in -al/min?
A. Does discharge bypass a laboon system? (If yes. notify DWQ) ❑ Yes (`No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes KNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? [:]Yes f No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ANo
mainte nance/i mprovemen t?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes W-No
T Did the facility fail to have a certified operator in responsible charge? ❑ Yes Al No
7/25/97 Continued on back

ram.
Facility Number: gZ —156
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lat!oons.Ilolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
❑ Yes X No
❑ Yes 1W No
Structure 5 Structure ti
Identifier:
i /
.................. �...... r.
Freeboard (ft): .... .................................................
. Al .. ... ..L�.......................................................
I...........
10.
Is seepage observed from any of the structures?
❑ Yes R No
11.
is erosion, or any other threats to the integrity of any of the structures observed?
JQ Yes ❑ No
12.
Do any of the structures need maintenance/improvement?
M 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?
0 Yes ,® No
Waste :Application
14.
Is there physical evidence of over application?
❑ Yes JNNo
(If in excess of WLLMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...... . 1� ........................
15.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes IN No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
,M No
18.
Does the receiving crop need improvement?
❑ Yes
® No
19.
is there a lack of available waste application equipment?
❑ Yes
JM No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
51Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
❑ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
0 No.vio'lations:or deficiencies were notedduring this- visit. .You.will receive:nti fu:rtlier
•. • correspondence atiout this:visit •:: ,
f� � . x
CorttQeents<(refer to question #1 `Iugpla�n°anyYES answers atid/or atiyFt�econxmtandatrons or any oilier commeu#.s�#
Use gs flf [aciltty tb better expiati stivahoas h(use additional pages as necessary) f'
",,...r.� fl� 9ss _ F'�ixs�r9ii
I/. J/i4� � �9y `1�� ,4,c,����.s�•� biZ �,�y- r �rydrv,�� .�/�vr�i� �i,�,� d,.. ��
�z.
�•vd Vi�l�/s� �.G���Y�I�J i��s �d� ,/¢4,y�✓f /Q�j u/L.� QiC+R�'i^'� �ar.C+C�i /
I,of'u 10V
jfa tssi,� ,l 77Z�.e
a /s 'WS4 R��G' i e-f'o..-1 .
fi �u*, r/
7/25/97
Reviewer/Inspector fame
, ¢0` S
Re«ewer/Inspector Signature: �~ Date: /ZO �7

Site Requires Immediate Attention: M 0
Facility No.
DIVISION OF ENVMON IMENTAL MANAGEMEN7
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: c� � u u5�_ , 1995
Time: ll7
Farm Nan=/Owoer:.' Wo L-' �'Lv �A 0 (a <J
Marling Address: k to {_Z N o W + LDI P'A L�
County: Avq S Do
Integrator: _ u fug �\ `1 F kco S Phone- k- `d 0v - $`I— Z L 1 �
On Site Representative: �RG N N ' 1 kb w o'(L D Phone: cAt 3` 5(1_7~Z"t 5
Physical Address/Location: 1D Z. Z �kuw 4" Ll o A 5 1�_Vr) }� o
Type of Operation: Swine Poultry Cattle
Design Capacity: MOD S 11 Number of Animals on Sitc:
DELL Certification Number: ACE DEM Certification Number: ACNEW______,_
Latitude: Longitude:
Circle Yes or No
Does the Animal Waste Lagoon have icient freeboard of l Foot + 25 year 24 hour storm event
G�r_(approximately i Foot + 7 inches) No Actual Freeboard: _fit. (c, Inches
Was any seepage observed from the lagoon(s)? Yes or(@ Was any erosion observed? Yes or To y ti
Is adequate land available for spray? 8pr No Is the cover crop adequate? Ye or No
Crop(s) being utilized: _ -T O N C-e-p-5 Q- o 1,J , w" At � R � �_ --
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings . Yes r No
100 Feet from Wells? (i�eiir No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-rnadc devices? Yes o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments.- n 1�,5 1-�Ac4v\ Lk
�O ok
Inspector Name
Si
u-o,ns ,
�AIA A.,2
A A
rr- Facility Assessment Unit Use Attachment_. if Needed,