310830_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Type of Visit: U CCopliance Inspection U Operation Review U Structure Evaluation () Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: /�j, 6 County: j Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
r
Onsite Representative: 4A tic -
►)
Certified
Operator:
Title:
Phone:
Phone:
Integrator:
Certification Number: pf � 5'6 7
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
We -an to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Giits
Pullets
Latitude:
Pouits
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes Q No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page l of 3 21412015 Continued

Facili Number: IDate 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: J`✓1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA 0 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 ZNol ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding [] Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesZ�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
o
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2� o
❑ 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
o
JNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[] NA
❑ NE
the appropriate box.
❑ WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
&No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: b Date of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25: Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesVNo ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes /No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes []"'No
❑ Yes /No
❑ Yes
❑ Yes o
❑ Yes No
lUse
Comments'(refer.to question,ft Explain any YES answers and/orany"addition'al reeommendatinns orany othdrawings of facility to better,explain situations (use additionahpaes.as.necessary. }.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
0Z
Phonef/ 90 ))q(— -13
Date:
21412015

Type of Visit: 0 Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: L. County: DLfL'Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ui�i� S�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: atom
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current Design Current
Pop. Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Dairy Cow
C►urrent
Pop.
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Dry Cow
Non -Dairy
I 113eef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D P,nult C►_a aci P.o ,
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes [:]No
[:]Yes ❑ No
❑ NA ❑ NE
❑NA ❑NE
❑ Yes PNo
NA ❑ NE
Yes❑ NA ❑ NE
❑ Yes[DNA ❑ NE
Page 1 of 3 21412014 Continued

Faciiity Number: jDate of Inspection:
Wasie Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
ONo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Stru/ct�urre� 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): T
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
E/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 environment I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [�No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Eg No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
dNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No
0 NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes Ed o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes � o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes VNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Ot
21. Does record keeping need improvement? If yes, check the appropriate box below.
dYes ❑ No
[] NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectioWl�
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes [o
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. D;d the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? Yes o ❑ NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 2No
[:]Yes No
[:]Yes 2No
❑ Yes No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �o
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
it drawinas
96)
o:question,#):iExplaiganylYES answersand/orany additional rec
iciltvtobettereznlain situations (use additional paces as necess'ar,
Coe
Yu tzv e, �
(0ev °F °Z r.� �(C,4.0
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
LL_
❑ Yes E(No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
nmendations or any other comments = a .
., `:
Phone: /b Tb —13 V
Date: S ��
21412015

h
J
jType of Visit: Q C pliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: �J tArrival Time: Departure Time: I 2ra County: Region:
Farm Name: T� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: f (srn t,-i e 5� f Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
I JLaycr
Design Current
Capacity Pop.
I
Design
C*attle Capacity
Dairy Cow
Current
Pop.
can to Feeder
]Non -Layer
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
6Y99
-a.00
Dr, l;oult .
ILavers
Design Current
Ca aci Po ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layer
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPuults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[� No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Q a
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
F5__No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

lF,aeili Number: - $ Date of Inspection: / S" }'—
Waste Collection & Treatment /
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes L.� "'o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2 O
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [Io ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a [:]Yes ❑ No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental hreat, 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? ❑ YesF]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 f No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes i 'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes 2rNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [i]-'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes 21'No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [] No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[]] No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Oth
21. Does record keeping need improvement? If yes, check the appropriate box below.
[Waste
Fes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
Iudge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
El No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes
[D]"No
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

F."ili umber: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ej Ngo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the ropriate 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? Efyes ❑ No ❑ NA, ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No F rNA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[—]Yes NNo ❑ NA ❑ NE
❑ Yes
E2<o
❑ NA
❑ NE
❑ Yes
E_ i No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes l"
No ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Comments (refer to`question;#): Explain'anffES answers and/or any additional'recommendations or any other comments.
Use drawings of:facili : to`.b.etter. e`xplaln situations (use' additional. pages,as.necessary).
��. ,- U 7 41-4- dxrl ) M1
7 701 ! hh f n'
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z r\o 14dfe S"_greyf, f-(Us iCeA 41�
(�Gq��s• (yeTCoQ � (�l.�I-+ fPco��CS� cl
S O-7G �w c� c•� C
Reviewer/Inspector Name: __ 0(1L' I � FD -`,,e
Phone: f O 7 ?i 7-?Ocl
Reviewer/Inspector Signature:6L�LA Daterdo
`
Page 3 of 3 21412015

' Division of Water Quality
Facility Number �—v"_j
IN61—Vi7siongo;f Soil and Water ConservaQther Aency
Type of Visit: Co iance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: 17j= County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Fk.A L)KLI� a&&D Integrator:
Certification Number: Otb S (p
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity B. Wet Poultry Capacity Pop.
Finish La er
Design Current
Cattle Capacity Pop.
Dai Cow
Feeder
Finish
Wean
Feeder
F
Nan -La er
Dai Calf
Design C*urrent
Dr, F,oult . Ca aci P,o
Dai Heifer
D Cow
Non -Dairy
Finish
La ers
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Puults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA [] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes Wo [DNA ❑ NE
❑ Yes �No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: 31 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? (] Yes O/N o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 `
Identifier:
Spillway?:
Designed Freeboard (in): 2
Observed Freeboard (in): 00
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes Wro ❑ NA ❑ NE
Yes o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [] Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �VNo ❑ 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 0 Yes do ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes N
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 126o
N
❑ 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 '� Ld
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes YNo
❑ NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes &No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis D 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 O o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes To
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Fn Mity Number: IDate of Inspection: f
24. Did the facility fail to calibrate waste application equipment as required by the perm ?
❑Yes
No[] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
L�I No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes
No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[]Yes
LL! No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
[/No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
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
[� ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�//V6 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( To )' [ 6 _ !
Date:
11

�'• ��.. N, f.:'s ;-{ ':} - i 1 ;ai 4 �- :7 tS '.q 1.: Vs y 1: 1t5 1
I? � :. : • ti � 'Drv�sion of Water aah � z �� _: s �". , , ��a�
QDivicioti of Sod and Water Conservation
Factht Number,
DOkhcrAgcncy
Type of Visit mp Cliance 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: t I Arrival Time: ® Departure Time: County: I Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Phone No:
Onsite Representative: WO &ep Lk=L-_t" Integrator:
Certified Operator: Operator Certification Number: -.a�s�°�
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 6 =61 Longitude: = e = t
� a�J�4z
�1.�,� 'De`sign; Current' Deslgn-' Current s°Y INIj,
at ;i sa cva i :: :.5 §. Wetfobitr . plici. p;:"C'a'ttle �mne:': tt w.k9 w Capac�ty'iP,opulat�on { Ypt, Capacity Fopulat�on * _ .pacity...P.opnlation:�
-?�3�d•b.i.i ifl I#:a :,C,z r.� :t... .; %in.'. F:3t, •r:,a .s. ie .'�xl.;ltid�:io�•_- t.xra. :¢�e=:..�: r., ,.
i' ❑ Wean to Finish ❑ Layer 1. ❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer ❑ Dairy Calf
Feeder to Finish 2rOD ��tit+ �� airyHeifer
❑ Farrow to Wean sX are ; . ' ,, i ( ❑ D Cow
p�yr Poultry i
El Farrow to Feeder 'El Non -Dairy
❑ Farrow to Finish El Layers
❑ Beef Stocker
❑Gilts ElNon-Layers
El Pullets ElBeef Feeder y
4
❑ Boars _ ❑ Beef Brood Cow
❑ Turkeys
# 7. Y�.i kyY'`, � ' •? !. fit'$ ` I I�..�i � f''
Othert F i' `�'1 �ws , �c t .i� till ❑ Turkey Pou Its
❑ Other xy, A:.a x r:.,,. ❑ Other
:- ,ia. 4
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
Cl NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�o
❑ NA
[:1 NE
El Yes
YNo
❑ NA
❑ NE
12128104 Continued

Facili Number: 31 - S 6b Date of inspection: a
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 )I
Identifier: �*'
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
94
Structure 2 Structure 3
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [yNo ❑ 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 (3/No ❑ NA ❑ NE
maintenance or improvement? r
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E ] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required 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
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall InspectiFl_]
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NA ❑ NE
Page 2 of 3 21412011 Continued

Fac My Number: - Date of Inspection: ;L1 i I f 11
z4. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes dZ
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[] Yes
�No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
[] NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
d"�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
Vo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
d
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
FNo
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question ##): Explain any;YES answers and/or anyadditional.recommendations or any other. comments.
Use drawings of facility to better explain situations (use'additional pates as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
'JaN1J
Phone:
Date: S
2/4/2 Il

Type of Visit: 0 Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Y� Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
4 z7 Z
Date of Visit: Arrival Time: Departure Time:© County :y Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: &=E Sj �- Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
2 U6e?
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design
Cattle Capacity
Da i Cow
Current
Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Design Current
ltr. Ca acit P,o ,
Dry Cow
Farrow to Feeder
Non-Dairy
Farrow to Finish
[Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Diseharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes ZN
❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FacilityNu ber: - p Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes n No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): 3b
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�NoO
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment hreat, 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
dNo ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z2'1�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):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes To ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[i]'l o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
L7 1 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 appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes �o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis 0 Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ENo ❑ NA ❑ NE
f
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes []`No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [] Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [; io ❑ 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 �o ❑ 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
C2/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
2/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
Reviewer/Inspector Name: Phone:
Reviewer/Inspector Signature: C Date: g-7JIZ,
Page 3 of 3 21412011

Factlt ,N�umber,"�
� �
Type of Visit G7 Co pliance 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: L I l Arrival Time: Io b Departure Time: County: �Ut7 LI.J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: milt AN1C3% $'I'E�O
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = f = 1{ Longitude: = o = 1 =
it
,�.s .4 r rag a1 ' �:1 ai�;f
1114 , ili)eE n Current ` ,. l)e5� CilCrent:
,r=�,i 3 x iDesigni Current:... l;,
's Swtneh . i : s = g ,'. * ' ,. ;. =Wet Poul ':ca"tacit' ih ulation C tale rg�tl `.
Ca actPo, pulatson �.. Y C p y p w �C p c y Papulatton
� r� � a-k.�xe.tta E�.. P-. y � p, �t�x��...�4�RE.�aE��.r�,_r�r,.,..�s_a=.e�:reay:b • ���„� Idint
❑ Wean to Finish ❑ Layer I❑ Dairy Cow
❑ Wean to Feeder ❑ Non -Layer ❑ Dai Calf
Feeder to Finish 6 -f o b El Dairy Heifer
k m t
❑Farrow to Wean +' ❑ D Cow
❑ Farrow to Feeder
nry on>try i x ,4
� Non -Dairy
❑ Farrow to Finish j ❑ Beef Stocker
Ij
z ❑ Gilts ' ❑ Beef Feeder
❑ Boars ❑ Beef Brood Cow {
i UthCIJ 2 hR�a 4s� si0,Turkey
c 4 > } e' $
1r!
❑ Other � NUmberjof Structu1%70.
777 .a 5 .ek a �; :- = _. i 3 ,3T= ,1€'Ul' < P i : � 1 kkq;" r �.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation`?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 21 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
oElNANE
ElYes
WNo
❑ NA
❑ NE
❑ Yes 2 No ❑ NA ❑ N)✓
1
2/28/04 Continued

Facility Number: — 3a Date of Inspection 21
Waste Collection &'Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: CA c.or✓
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 35
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes iNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes V"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 QNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes El No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes O/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
WN
o ElNA ❑ NE
o El NA El NE
E;�No ❑ NA ❑ NE
7No
o ❑ NA ❑ NE
❑ NA ❑ NE
c e }
Comments (rkefer to question;v#) sExpla�n any YES answers and/ortanykr�ecommendations ort:any other Commentsr.' :
�.Use�d`rawmgs oT�incility tq,ti ter carpla�n situations ,(use ad$ditronal Pag s, as ne essa yh)":_
SL_U)D CG SVit-V
w
q
Reviewer/Inspector Name "� a °x§ ',lJu'iJ Phone:
, ,'L
ReviewerlInspector Signature: Date: ZIIt I
Page 2 of 3 1 12128104 ' Continuer/

Facility Number: 31 Date of Inspection l �)
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design [3 Maps El Other
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [�(No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E�No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections E.,/]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
NNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Elld Yes
,Id
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L7 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[3"No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
l-✓1No
[INA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El2 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
El 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
ElYes
20 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application) -
32. Did Reviewer/Inspectof fail to discuss review/inspection with an on -site representative?
El Yes
,_,/
❑ NA
[:INE
33. Does facility require a follow-up visit by same agency?
ElYes
,Off'N"o
I, 4
❑ NA
❑ NE
h'r.. L . 8
Additional Commeats.and/6r Drawin s ' t t ��
g. �.,�� ._ _-f_
Page 3 of 3 12128104
Page 3 of 3 12128104

%A M. %3a
Type of Visit 6C r
pliance Inspection 0 Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 2 ��1� Arrival Time: I 100b Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: _.. Phone No: _.
Onsite Representative: EmAiAZ(- 7t"
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 1 Longitude: = ° = ` =
Design
Swine Capacity
Current
Population
"WetPoultry
Design Current
Capacity Population
Design Current
Cattle C►apacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Calf
Feeder to Finish
❑ Farrow to Wean
(p4CO
(��?
Dry Poultry
❑ Layers
Non -Layers
❑ Pullets
❑Dai iLeifer
❑ D Cow
❑ Farrow to Feeder
El Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Beef Feeder
❑ Beef Brood Cow
❑ Boars
❑ Turkeys
❑ TurkeyPoults
❑Other
Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
�?NZo
El NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
L
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 3— 3 b Date of Inspection a l D
r
Nf aste 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 I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LIA&W
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2A
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmentaltheat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VNo ❑ 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
E3 No ❑ NA ❑ NE
maintenance 'or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
2No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
"'' o
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
Zo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[: lvo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L�I, N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L No
❑ NA
❑ NE
;C m�menAS (retfer�to�ques�t on; #) � En a�YES� ns e�rs�a�dl�� any recommendations orany other, comments. P
Use etitelexpla d[rawings.o.'ftfaWity to binisituations;(use additional pages,as'necessary):
� f ,iAki'e "fiz r
our SLUOGE SUR-VE
•
I
Reviewer/Inspector Name T b W!V r j� Phone: q + —
Reviewer/Inspector Signature: Date:
Page 2 of 3 112128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2�No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes � No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ 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 o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes o ❑ NA ❑ NE
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? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes �o ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes [;(No ❑ NA ❑ NE
❑ Yes 3 No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
2 No
❑ NA
❑ NE
U No
❑ NA
❑ NE
EJ No
❑ NA
❑ NE
o
ElNA
ElNE
Ll No
❑ NA
❑ NE
Additional Coirilmentsand/otsDrarvi'ngs3 ,. ? r
i
12129104

Type of Visit C mpllance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit aRoutine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: I y� ! Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
C Title: Phone No:
Onsite Representative:�1C4tJ�
Certified Operator:
Back-up Operator:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = 6 =16 Longitude: = o 0, =
Ld
Design
Current
Design Current
Design Current
Swine . C•apacity
Population
Wet Poultry
Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ Laver
❑Dai Cow
❑ Wean to Feeder
❑ Non -Layer
❑Dai Galf
Feeder to Finish
17 G
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑ Nan-ts ers
❑ Beef Feeder
❑ Boars
Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures: EJ
❑ Other
❑ Other
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
� o
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: — Date of Inspection $ G
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 I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: LA6yoij-
Spillway?:
Designed Freeboard (in):
pp
Observed Freeboard (in):p
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
0 No ❑ NA ❑ NE
through a waste management or closure plan?
eat, notify DWQ
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaZo
El7. Do any of the structures need maintenance or improvement? Yes
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
Rf 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
iNo ❑ 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
1
R No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EjNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
U/ 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
4No
❑ NA
❑ NE
Reviewer/inspector Name �p /,� ' -(mil Phone: jd 'TR —7
Reviewer/Inspector Signature: Date: 5
Page 2 of 3 12128104 Continued

.Facility Number: 31 — 0 Date of Inspection S
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[;fNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2(No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
YNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[!"No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
G3 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
YNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
B No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewedlnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
� o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
WNo
❑ NA
❑ NE
Additional Comments;and/or DritWings
a
Page 3 of 3 12/28/04

Division of Water Quality
Facility Number S3a O Division of Soil and Water Conservation
O Other Agency
Type of Visit I& Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit M Routine O Complaint Q Follow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: I ] I Ie J b$ Arrival Time: /o OU 7 Departure Time: County: 16&Dl.-1:1y Region:
Farm Dame:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: f7"wr 1N <37-E Eb�
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ o = = Longitude: = o = = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish (y4 b0 670
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
❑ Yes N No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
[]Yes
❑ No
❑ Yes
J4No
❑ NA
❑ NE
❑ Yes
M No
❑ NA
❑ NE
12128104 Continued

Facility wNumber: `s} —$3p Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6r�a
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �J
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes (A No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1P 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 M 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 IX] No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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
V] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
M 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
MNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
CgNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name t�rWNgRGRIMES SaNIuF RWtL Phone: 91st!
Reviewer/Inspector Signature: Date: I - 1(D-oS
12128104 Continued

Facility Number: 3 t -SRO Date of Inspection 1 1Co �8
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes M No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes C4 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JR No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�j No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
19 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
® No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[ANo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
MNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
US 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
[2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
UlNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
_MNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Division of Water Quality .
Facility Number 3t
0 Division of:Soil and Water Conservation
y Q Other Agency
Type of Visit VORoutine
mpliance Inspection Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit Q Complaint 0 Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 21'lo Departure Time: County:Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: �imrjyo- 0 Sete_fl
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o = = Longitude: = o =
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish O Lfv
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non-Layet
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouits
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge`?
❑ Yes [No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
(]No
El Yes
CJNo
[I NA
El NE
❑ Yes I3 No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 4 Date of Inspection o
Waste Collection & Treatment
[No
4.' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ( Ub
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes O No
❑ NA
❑ NE
through a waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ 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 ZrNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes CrNo ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[_1 Yes
I] 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
L'f No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2L/ o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
L✓J 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):
X i) Y(-Or) CsP -1 a( C4 L-16 (L4Tj4k)
Reviewer/Inspector Name Phone:�� L%
Reviewer/Inspector Signature: Date:
1 12128104 Continued

Facility Number: 31 — g3o Date of Inspection 4 to
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 2rNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑Yes
P No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
QYes
�o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[]No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[o
[I NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
WNo
❑ NA
ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Elb Yes
,�
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EfNo
❑ 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
Q 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
[K No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZNo
[I NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
LI No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Dw�sion of Water,Quality
S3 00 Division of Soil and Water Conservation
Vacility Number =
Q.;.Other Agency
Type of Visit (Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (/Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: o`� A OG Arrival Time: ® Departure Time: County: SUPIMO Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: I Phone No:
Onsite Representative: MABO kt _ LEA0 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c ❑ I ❑ Longitude: = ° ❑ i = "
Design 'Current Design's Current ;Design`s 2 Current, P
Swine Capacity Population' Wet Poultry Capacity Population Cattle Capacity zPopulation
❑ Wean to Finish I ❑ Layer W.
❑ Wean to Feeder ❑ Non -Layer J'
® Feeder to Finish (.qm
(oIDC� --- - 7t
❑ harrow to Wean
F Dry,'Poultry'
❑ Farrow to Feeder
„ ❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑N�o
[I NA
El NE
El Yes
L2 No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 Date of Inspection s i
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: [A6vy-h)
Spillway?:
Designed Freeboard (in): 19.7
Observed Freeboard (in): c
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 S/No ❑ NA ❑ NE
El Yes El No ❑NA El NE
Structure 5 Structure 6
❑ Yes MZNo
[I NA El NE
❑ Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes eNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes iNo ❑ 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 E(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes t 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 Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12.
Crop type(s) g C i4 l S 6-0
13.
Soil type(s) AUIR
14.
Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
2J/No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement? ❑ Yes
D<o ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
1a No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
❑ NA
El NE
18.
Is there a lack of properly operating waste application equipment? El Yes
�eNo
Z 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):
FAQ AND CAD
'
Reviewer/Inspector Name Phone:
Phone:
Reviewerlinspector Signature: Dater-`,! a (P
Page 2 of 3 12128104 Continued

FjLcility Number: 3 ( —8 Date of Inspection I z; -i Tat,
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WIJP ❑ Checklists ❑ Design ❑Maps ❑Other
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
CJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�>Nx
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z'o
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
2No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,�
L?'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LiJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31: Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ 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
ff N
El NA
[I NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 0 compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J6 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access,
Date of Visit: 3 �� �l7 Arrival Time: 1111 Departure Time: i County: �14064 " Region: zz.
Farm Name: S LZO �7 �Lja /�a. _______ ___ __ Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: rZ4 .5rffo
Phone No:
lntegrator:1'0 �0
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: =o =I ❑61 Longitude: ❑°=, ❑,,
Design
Current
Design Current Design
Current
Swine %apaci y
Population Wet Poultry
Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
7
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
;
❑ DairyCalf
Feeder to Finish
Slp�.
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
t
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
i
❑Beef Feeder
El Boars
El Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
i
❑ Other
10 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
VINo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
.d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
JzNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
X No
❑ 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 1 Structure 2 Structure 3 Structure 4
Identifier: _!!Z--
Spillway?: _ A10
Designed Freeboard (in):
Observed Freeboard (in): �r
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
0 Yes ,Z No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes JZ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
PTNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
,.,�{
YJ 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 Drill ❑ Application Outside of
Area
//❑
12. Crop type(s) /Qi�'r(.� lT ,�. '/1. 0,16asF�,�
13. Soil type(s) A L.j
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
fA No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
O No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑
Yes
UrNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
J3 No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�ZNo
[:1 NA ❑ NE
Zo) L,i NP /V460s 70 6f. yo2
S�Q� JQ 1110961.i W_5 r4a✓�
Reviewer/inspector Name �' L ".<�; (/� , �4 ��$x Phone: Y«'-:5YGU
Reviewer/]nspector Signature: Date: tt
1212814 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes PNo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes PrNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes C'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[�No
❑ NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
7No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
&No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C/1C
[:]No NA
;dNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
/Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
ElNE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency'?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
- A- FFjv Wks 64u_
N7z�}G 41r-;�X/L 71 i��i9 -iNF + �� F/t-. .�7Wae raW.4C eo�44 C f
Z 6&- sqA r-- 7D 9E F L5,
A% rr -' /��' Esc- �s7�r� ,, %•�ig�/�f p y
�1j,uJ
- 6-0 00 'sr 4�V
12,28/04

]Type of Visit fa Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit 7Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number I
Date of Visit: I
Qo Permitted )d Cerffied [3 Conditionally Certified [3 Registered
/Farm Name: ............................................................................... ....- ... ..........
Owner Name: Zyjj ...'�. H�4................�EAT. .. 6dQ�.............
�i Time:
Q Not Operational C Below Threshold
Date Last Operated or Above Threshold: .........................
County:....1Ci<+!.'...........................................................
Phone No:
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Facility Contact: ......................... ................ Title: ............
...... _....... Phone No:...................................................
Onsite Representative:. !! N.......... d rl.SlC....................................................... Integrator:... V N �s......................................................
Certified Operator:................................................................................................................ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 66 Longitude • 4 44
Discharges & Stream I_ImpaCts
1. Is any discharge observed from any part of the operation?
❑ Yes ZINO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made'?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/rain?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
Identifier: ...............I.....................................................................................................................
Freeboard (inches): d _
12112103
Structure 5
❑ Yes INO
❑ Yes U-1 No
❑ Yes
❑ No
❑ Yes
140
❑ Yes
Vx0
❑ Yes
W(No
Structure 6
Continued

Facility Number: 31-- p Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type OCKMOPA L N > Sr►n,k.. G 2.S�ta Q J64S(f=0 . .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes �o
❑ Yes 'No
❑ Yes X
❑ Yes
❑ Yes
❑ Yes 7No
o
❑ Yes
❑ Yes YNo
❑ Yes W, o
❑ Yes
❑ Yes
❑ Yes No
❑ Yes ZNo
❑ Yes 2/No
❑ Yes Zi�o
❑ Yes YNo
❑ Yes E� No
r; :.cC
; `td.'Id: i'Vc ii - .�:r?.";Rm .' e..LB §ii.'.:a:,•..�:€��1:23 § ', E:f" J t If 't't2!t a. 1 ,tl'.'.ta'-, 1-..:}-,.. - „tt1,�:P°""" �}:.#: �E: i1+G Y fltE,- " rl.: Sri°Cl! °N9:" Ei """I
•Comments;,(refer tow�guestAan:#) Explain�any YES;answers�and/ortany recommendations ortany,other,3comments t!E!:n g 3 ��, F"''7 €'a ! $, sp
F . t9 11 1'-4 tuL4:rif:..w;S.,;..«GWi:6i«iLtt..6l:.,_.:.i3.,k.iitN�L' �" ' ", 1;4i 1�3 f-
«! i! fit_ a rtP fii§k �'�v'. - Ia.�Y;i ': S 1 ,1 I E � i
^ `€fid { �'j
lUse drawin(gs pf faa�#tppty W,better(( explaF�nf s�tuationsl(use arldraonal3pages asf necessary) tie y ❑ Field COPY [I Final Notes
-. "3¢� f i # F•i ES tI is E lkl '�E. 1
... E ARE, t
t 1.. N S
i1PO�TE CQoP `leu°
GE ILT. 12) r3E I/riA St9 Ta,pA`�
�Et�12PS ".4' Fifm AKC �ixLIBwE
T
Url
Reviewer/Inspector Name ??a`a& w' 7' 1A rC:LI9 .,y ° ` �� - .rr•.I
, I1 ��t
Reviewer/Inspector Signature: Date: ,3 a
12112103 Continued

Facility Number: 51 .. 3
Date of Inspection
Required Records & Document~
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes [ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? /
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 7No
o
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
Yes
❑ Yes
❑ Yes
❑ Yes
34. Did the facility fail to calibrate waste application equipment? ❑ Yes
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Stocking Form ❑ Crop Yield Form [:]Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

a,
Type of Visit VCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine OComplaint 0 Follow up 0 Emergency !Notification 0 Other ❑ Denied Access
Facility Number Q I
Date of Visit:
Permitted © Certified [3 Conditionally Certified [3 Registered
ti
Farm Name: ^ a JA
Owner Name:p �f
Mailing Address:
Time /Z ee'
Date Last Operated or Above Threshold: _
County:
Phone No:
Facility Contact: Title: -p Phone No:
Onsite Representative: S4BVe LPIi►.�rl Integrator: 2?j,, ,in /s .0-/N
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �� u
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca aci Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non --Layer I I JQ_Non-Dairy
❑ Farrow to Wean
❑ Farrow to Feeder, ❑ Other
❑ Farrow to Finish g
Total Design"Capacity "I
❑ Gilts
❑ Boars Total SSLW
Discharges & Strgam Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): Z
05103101 Continued

12
Facility Number:
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? (If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
❑ Yes ❑ No
Cl Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�o
24. Does facility require a follow-up visit by same agency?
ElYes
/'�i
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commeints (refer to question i): E ptaln any�YES answers4iitn any recoitntne d dons or'any other comrnerits
Use drawings facility to better explain additional necessary)
of situutlons ,(qse pages,as ❑Field Copy ❑Final Notes
1 '04 : d h J Jr r vs ryJGC
.5p ✓ C1 +� � �-- G O-�' W a ,S^4 r 0-njZt 11 co d 14 i o, Ll Y7 G�
�l�e s�O'"J�7 � R-�"e ✓v, l,V a S n o �" C G ✓ ►r-eC-�. W ��h �- Q✓'r^ f ve d � `Lie
►'�a �'� OilC-7ad s�ayo�cd . I��. Q v�nn grr;vepj sliarpy
Q -fei Said, 1'�fr. 0V?"S'Z had Jul KC4L/r0e -�r�� 1'lgv��� 44e
�vn repayv� becq v�P hP had �'otina( altar �' ��� Gail a;� wed,
Reviewer/inspector NameL44
Reviewer/Inspector Signature: Date: 03
05103101 Continued

e
• Facility Number: 3) —9 Date of Inspection l 3
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?
29. 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 ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments and/br`Draivings: „ r
i►-r,J�ar4+� eVeh.� ��.n} -3'�,e 9tv•� �„JqJ /10� 'orop�rl7 rp-f��nq
f�Isa %�'� �vr�n sAid Gar,.Q�-�;a►1s We✓� �1�� AS W.r+-,d ✓
7 1_ y
C dY+^r p ! r Jl q '� t,.. �q J n i -r O C4Y} Ce Y yl i2� -� 1''1GI ✓4h e,-e �l�S r eD
e1'7 a ���, /Ya-ssl.re eja )h2 vh -4,o p,00� Gdvev-Age
�-�►'vihn s�i� 1� �.,>AS �uhnih.� fit" /✓30 ✓�s;
O5103101

T
Of wale. t uallty
tDir r s..,,..
Sn0 DW616n 6f�f 18nf� WSter COl]SerVBtlO,rdl
* N i O=Other A nc •LY ,..at 'i`°�4E :� 3. -�s� IVY'
` r
Type of Visit OCompliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit J2rRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number I 3 O
Date of visit: Time: 18 " ) 5
IQ Not O erational Q Below Threshold
© Permitted ❑ Certified [3 Conditionally Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: ,.g°, Neattj S"-iC ! ._ County: >
Owner Name: Z Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: —J7k, -n eor'e
Certified Operator:
Location of Farm:
^� Phone No:
Integrator: A ref1—., 01 S D'e
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Morse Latitude • 0" Longitude 0'
Swine, Ca achy Po ul%
❑ Wean to Feeder
❑ Feeder to Finish
U Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
;., Nunlberof 1Lagooas
Holding Pon*] SoHd Traps
'Design ''Currenf D'es�gn `Current
=Poultr'v S "!;caps EPo ulstion Gattic ", '.:' ' .`Ce`'actty °:Po" tilat on
i ❑ Laer i,.E ❑ Dairy1
❑ Non -La -Layer Non-Dai E '
❑ Other
Total Design ity Capac�
€ is
.TotAYSSLW; ,
t ,
■
Discharges & Stmarn Impacts
1. Is any discharge observed from any pan of the operation? ❑ Yes X1No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El 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 ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ZNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes.,ZNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard (inches); 3 7
05103101 Continued

• Facility Number:
Date of Inspection 2 Ga d
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes CR 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 ,ZNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ONO
Waste ADDlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes ONO
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes Z No
12.
Crop type -B e'r --..idot ila YO'L ' /I Grc1; n
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes 21 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ONO
b) Does the facility need a wettable acre determination?
❑ Yes '�?No
c) This facility is pended for a wettable acre determination?
❑ Yes ZNo
15.
Does the receiving crop need improvement?
❑ Yes E?rNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes "Eallo
Reguuiired 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/ WiJP, checklists, design, maps, etc.) ❑ Yes ONO
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ZrNo
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 ReviewerlInspector fail to discuss review/inspection with on -site representative? ❑ Yes ZNo
24. Does facility require a follow-up visit by same agency? ❑ Yes /Z No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes "ONO
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Coirinients` (refer to yuestton'#) Ezpiaiie any YES sasw ers'and/nr iiny �ecvmmendations:oir anv`other c6mments.' ` t',i
f' }9 3Y Sgx
l ) - i i
Use drawings of faeility,to bitter explain situataons:;Cuse additional pages as necessary)
„ opv ❑ Final N ;
s �[] Field C Notes
-T"h rs �'a r�^-1 ;s
�c t'-�y
Ala �'�-����cd i� �h �Ge1l� n-F
c�•-td r-�,'6y, .
tie r^eear� f mle w -
y dell kerl - The 6e,^^-kvd6i
efa is.
e
f g 5po o "X Ana( s tA; t'•, e 1l o u.te q reA
if we [ ke f 4.
ReviewerlInspector Name
Reviewer/Inspector Signature:
05103101
Date:
Continued

Facility number: 31 — Date of Inspection 2(c, Dir
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?
Additional Comments and/or Drawings:
05103101
❑ Yes ❑ No
❑ Yes JZNo
❑ Yes ONo
❑ Yes J/ No
❑ Yes JZNo
❑ Yes ONo
❑ Yes ❑ No

tDivision of Water Quahty
Q;Drvtsioi of Soil.ah&Water COnsei' atio
:�s c Q,�Other.Agenizy
,�^!l ,N�=;''>�:1 � ,�f�.qui, n � R•. �af� �. .F �r.� .�� d ,,5 - ��� _ .r ., r 1 1,, .E' � P
Type of Visit xcompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification Q Other © Denied Access
Dale of Visit: 151-?1101 1,1111ne: I /Dvq Printed on: 7/21/2000
Facility Number
Q Not Operational Q Below Threshold
© Permitted ❑ Certified [3] Conditionally Certified 13 Registered Date Last Operated or Above Threshold : .....................
Farm Name: 9°.....................................................ctii `.r.......................... County:.;pvi.1'l,
] �....................... I ...... I...............
OwnerName: 6.......H.441- !:—.......................................I......................... Phone No:......................................................................................
.Facility Contact:Phone No: ............................................ fitle:...................................................................................................................
MailingAddress: ..................................................................................................................... .....................................,............................................... ..........................
Onsite Representative: :T Yb. ti oan Integrator: �fQ� ^f �T Qr
Certified Operator: ................................................... ............................................................. Operator Certification Number: ..........................................
Location'of Farm:
'-
Swine ❑ Poultry ❑ Cattle ❑ Horse "a"•""`
I I
k I r I """K"" " I i- , , I
Design Current
Design Current Design Current
Ca d Pe dilation .
Poultry
Ca aci Po ulation Cattle . Ca ci : ° Po ulation
Wean to Feeder
❑ Layer
❑ Dairy
eeder to Finish
&qO
❑ Non -Layer
I
I[] Non -Dairy
Farrow to Wean
aY
Farrow to Feeder
❑ Other
'aa
Farrow to Finish
Total Design Capacity.
p,=
Gilts
yt
Boars
.................... .... ...W..... _.....,-.
_.-. _,._. .
Total SSLW
Numberiof Lagoons ,f ❑Subsurface Drains Present agoon Area ©spray Field Area
3 x � • l ri �.'ug,�`"Fr� v� ' -� , �t�t _ _ i r a, ti
Holding Ponds'/ Salid'Traps ,., ❑ No Liquid Waste Management System
Dischames & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &: Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
...............
Identifier: r......................................................................................................................................................
.....................
Freeboard (inches): 2 /
5100
❑ Yes )ZIRo
❑ Yes "ONO
❑ YesNo
❑ Yes1Z No
❑ YesNo
❑ Yes -NO
❑ Yes PNo
Structure 6
Continued an back

Facility Number: % =o Date of Inspection 3 D j Printed on: 7/21/2000
�. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 01No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes 9No
(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 ,eNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
0Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ YesXNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes 21Ro
12. Crop type ,�e/.►,,,q-��`-� , Sr�gLI Gr'a!n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes ffNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes AI'No
b) Does the facility need a wettable acre determination?
❑ YesA!fNo
c) This facility is pended for a wettable acre determination?
❑ Yes ,fNo
15, Does the receiving crop need improvement?
❑ Yes ZINO
16. Is there a lack of adequate waste application equipment?
❑ Yes XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? Cl Yes )2rNo
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,,ZNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ErNo
21, Did the facility fail to have a actively certified operator in charge? ❑ Yes ONO
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes OINo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? Cl Yes J2,&O
24, Does facility require a follow-up visit by same agency? ❑ Yes MO
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ,O(Yes ❑ No
�'VQ YiQia�igris;oT dgf t iencies vt re ed dpring � is.visjt' •Yoh will-t&oiye Rio further. ;
ro, iesaonn'de&ahout;this:visit.:...:.:.:.:.::..........•.•.•.•.............. .
g. tj4s4e wA1 Jegk",n� •f,oM UNLpin9 sl-141or► a4 IAjoo1, cave 4o 6at, w or
,7; rt�,✓ol �p� �✓1� 1►'l-��r� 1, clorc�t �t /e4k .5-iojo]Dcd.
Be Sore -gyp shJ) dowrl S s4e-1 Eve-, 4)./INC 1, r¢VCt7�
SO 0 t1 P p f `!f C f C- -k j M, SO4f, � 1'J Ar o m b y ;1,ks , t -n4o enrin S beZ ,
�3�k► sne
e �v �e t�e►fi Glo� %'y'�Lv�Qj/ . 1eo ��hor-{ems
I
y A
Reviewer/inspector Name . ''1 Q Lt/6{i.A : NO, OWN
Reviewer/inspector Signature: Date: Jr 3 5100

Facility Number: Date of luspection S e7 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or.public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes poi�o
❑ Yes
No
❑ Yes)eNo
i
❑ Yes 10No
❑ Yes_ZNo
❑ Yes �No
❑ Yes ❑ No
....:'i Additional'U'ornmentsand/or Drawings:
zs. Re s.rc �Jo o✓cfseeA aft bvf 8.5 acres 4,, +�ee� wt;�r� v►�
Of wavlg4e F/ • over 3u/f `1i�1� ��� � id�tq� g • J� sic /e�
1 S. t•!io* ��- '�-o : i''t-� rO�'e be /' we � p(,q o ✓l t`I,� /r'�'xi. � S Z -�i � .
6vef41)� f11e {aG. Ii 7 be,-r,.-v4 era fl -b reco.4S rr,e t.vell f<e,*,
w
5100

JS Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
(Type of Visit )WCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number 1 3 Date or visit:
Permitted [3 Certified (3 Conditionally Certified (3Registered
Farm Name: .................. Q.y......0/�.11.1�....s� .......................... ..............
Owner Name: ! D Wer't...4 `1
.....................................................................................
Tillie: 3= ZJ Printed on: 7/21/2000
Q Not O erational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County:..... .v�.1.1 .....................................................
Phone No:
FacilityContact:..............................................................................'Title:................................,............................... Phone No:
MailingAddress: ............................................................. ............................................................................................................................................. ..........................
t /+ /
Onsite Representative:....) .h.t ...,�)AA. '.e Integrator:.... raLJ!'►S C)l CA!�,(..t..�1.g............
...................................................... .... ............................
Certified Operator: ................................................... ............................................................. Operator Certification Number:............................ ..............
Location of Farm:
f
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • �� ��� Longitude �• �� �44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 6 qd9 00 10 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑,Subsurface Drains Present 1113 Lagmin Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste ;Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes ONo
Discharge originated at: ❑ Lagoon [ISpray Field ❑ Other
a. [I' discharge is observed, was the conveyance smut -made? ❑Yes No
h. If discharge is observed, slid it reach Writer of the State? (II'yes, notify DWQ) ❑Yes $No
c. ll'discharge is observed. what is the estimated Ilow in gal/inin'? n/'I
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ONO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 15 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge'? ❑ Yes jffNo
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes PNo
Structure I StFUCtUrc 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...... ,. f;...................... ...................................................................................................................................................................................
Freeboard (inches): ?
5100 Continued on back

Facility -Number: ) — ,3D Date of Inspection Printed on: 7/21/2000
1. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑Yes ONo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes $ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'? ❑ Yes 9 No
_Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes $ No
I. Is there evidence of over application? �❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ,M No
12. Crop type Gee—r''wei c} 1"7' j,j
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNo
14, a) Does the facility lack adequate acreage for land application'? ❑ Yes J3 No
b) Does the facility need a wettable acre determination'? ❑ Yes IffNo
c) This facility is pended for a wettable acre determination? ❑ Yes In No
15. Does the receiving crop need improvement? ❑ Yes �gNo
16. Is there a lack of adequate waste application equipment? ❑ Yes 'PNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
JdNo
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
,J No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit'?
(ic/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency'?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
;
N+06ia(ipris;or• &ficiehdC $ 4 re noted• 00-ring tbis'visitf Yoh +vial r, eceiYe Rio fueth r.: ;
Corr orideike' about: this visit
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
;
1,t)a✓ k �b re?, -%a v e non
pr�s�IIsshe h � �it�erme�e4adin -4-o� be✓rptuci�
�JNeI ejXb);sh Je.-AjL"dq, over�et��.l4
, a o-1se f6ev4�ee-r14ztk1d:PLj.
�°7 : j�dl
1464
oo ss;61 e .
•
1911 Ge r.v v at a s'f roty re card r . a n of kec� w �-} i,
No-ie: r,I ,tSs% V1a,, nee�A1f4& 6e CJrMe" based ow +rV,'j14)oh desZ..e_<
sacreg9ei
we".54C pi,,. r, lrfe►411 6ks S'S ncees, Ley► j?q4/oi, desr9l, has'�fr6 .
IReviewer/Inspector Name S�O ►'C wG1 rf� �� i J I
Reviewer/Inspector Signature: Date: 9 a 5100

Facilely Number: Date of Iktspertion Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or helow ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours'? ❑ Yes XNo
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes $ No`
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )�q 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 P No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes %No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0No
Additional Comments an or rawings:
•
5/00

Division of Sail and Water Conservation Operation Review
Q'Division of,Soil and Water'CnQseErvatinn; Conatpl�ance'Inspecteoi €
' F J;PDl QpWity° Coml7llance'Inspec40n l F r
v�..51an O� WatF.'r - € EE � 3 :, E� 1 1 r
Qther AgAe'ric O erat><mn € € r E € �': ER �f �i�'
r - >}•1 .io. € P Y^�.r� �.a,. >a
LQrRoutine Q Complaint Q Follow-up of•DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number _
Date of Inspection
Time of Inspection 24 hr. (hh:mm)
Permitted O'c"ertified Cj Conditionally Certified jQ Registered [] Not Operational Date Last Operated:
FarmName°. ... ............ .!...r r.... County: %J................................................................................................................... ......-
OwnerName: ................................................... ............................... . ....................................... Phone No:...........................................................,.,.........................
Facility Contact:.............................................................................. Title:.................. Phone No:
FlailingAddress: .......................................................................................................................................................................................................... .......................... .
Onsite Representative:.... . Integrator: 2QpL-1! ,�7� Cf►R-i..t+ t "'
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
A
.......................................................................................................................................................................................
Latitude 0 1 " Longitude • 6 «
Design .Current Design 'Current ;, Design Current
swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer EE:]N
y
❑ Feeder to Finish ❑Non -Layer Dairy
❑ Farrow to Wean
❑Farrow to Feeder ❑ Other
El Farrow to Finish ,�;�''@S1Il Gaj?aClty�'
k
^ € []Gilts
f r ir` .b E €
❑ Boars Total'SSLW
4..
�Number,of Lagoons �' ❑ Subsurface Drains Present ❑ Laguon Area ❑spray Field Area
Holdiiig.Ponds'/ Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes INO
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ElYes i�No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes �ZNO
c. II'discharge is observed. what is the estimated flow in gal/min?
d. Docs discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 2. Is there evidence of past discharge from any part of the operation? ElYes ;7JO
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [I Yes ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes INo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .............et.....c�........................................................................................................................................................................................
1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yeso
seepage, etc.)
3/23/99 Continued on back

Facility Number: �/-'S's,7 Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type C .
A.-� 6
vmsr•,
13. Do the receiving crops differ with th/e designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24, Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
.. Rio vii......0. deficiencies •wire noted ciirri . _ Ols'visit} • Y;OI} .Wiil•teceiye tRo, fucther
corresonc�ence. a�aut this visit«
❑ Yes ZNo
❑ Yes 2fNo
❑ Yes / No
❑ Yes j(No
❑ Yes P fq
❑ Yes I i
❑ Yes JP'No
❑ Yes ONO
❑ Yes ETNo
❑ Yes 2rNo
❑ Yes P'No
❑ Yes [?No
❑ Yes ZNo
❑ Yes �No
,Yes 'b
❑ Yes No
❑ Yes No
❑ Yes J�J No
❑ Yes PTO
❑ Yes 91,10
❑ Yes 9<0
,.,
YES answers an �otniiierits (defer to•questtori zplatn°anyl, d/or any reeoinmendaiions or3anyiother3cotriments'`'�` i Ft ( .
Jse;drawings of facility: tobetteeexplain situateoits' (useEaddrtional ,pages,as �, iE, ti E . ,'3 �v �4
19 PST ICF.O tr.a.� : �; T � E S i�p�: t_cap ,-A M A,- rTA r-J p s s� lc �.y Fa �6oAZV
C--f-+Jtk2- AAS M ,VDT t<Aolr'o Al 4^<GAS A77-t;.Aj r-,jo
-ram 4 s'e-ve•,-, PA;RL
ay 'T4 R A Pe rat + S Irr'/►,£
v3 i +tom 3 pS .�9iA �
w _ r „-
iJT.
Reviewer/Inspector Name 1 ° ' t'7 "'t! y � a T ��'l.y lej7� t `%ci
Reviewer/Inspector Signature: .1111"?, r J, fJ F,..Date: S,q
3/23/99

VFacility Number: I j=� 3 o Date of Inspection 7 �
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes 1/4o
liquid level of lagoon or storage pond with no agitation? �/
27. Are there any dead animals not disposed of properly within 24 hours? El Yes VNo
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes [/No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑Ycs — No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNO
'Additional omments"an or,- rawmgs:
AL
P� P Pi-�/ Qo�a�tYl�S� Gi�ss r-T EL>
3/23/99

[3 Division of Soil and Water Conservation ❑ Other Agency F4
Division of Water Quality
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 3
Facility Number G
Time of Inspection !Z 24 hr. (hh:mm)
13 Registered .Certi-friied U Apprlfied forPermitPermitted 13 Not Operational *Date Last Operated:
FarmName iS 9...... 1'.... ?i ..�............................ ........ County: ......... .l�.tiin........................... ...............................
Owner Name: ICA�t'}► .. Phone No:-
....``.....t..............n ��! .......................................
Facility Contact: .............................`l. �4:1n.......M=1 ........... Title:................................................................ Phone No:...L.rt.�a . °�(:.. ? 3..........
Mailing Address: ............ .2. 0L. KJ.A+iJl aa.•.......................................... {? 1��J�.... N ... � 4- ....
......... ....... ... ........................................................Mtn... ,...,........5:............................... ...,,.�
Onsite Representative: ................... 1�nn.... P�UjrR.................................................... Integrator:..............
Certified Operator................................................................................................................ Operator Certification Number ......................................
Location of Farm:
...........Ox...... r.j"k....... a i c ...Q..:.........`�?.....A5J0j,. 0 :...,..XA;.U.$.......5a.. ..... a.:....:Slz..I.0.1................ ............................................. I...................
............................................................... ......
Latitude 0 6 66 Longitude • 4 46
CWvvn ;' ;
It
an Pnuitry
❑ Wean to Feeder
Feeder to Finish
(6(408
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
d.
,`;`Design C
I A Cattle 0 Cal) Cit.v-POI
General
1. Are there any buffers that need maintenance/improvement? l] Yes PiNo
2. Is any discharge observed from any part of the operation? ❑ Yes [�_No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes QO No
c. If discharge is observed, what is the estimated flow in gallmin? N jx
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [� No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 1P No
7/25/97

Facility Number: �l -- $O
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
PbNo'
Structures (LaeoonsJlolding_Ponds, Flush fits, etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
rANo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(tt):............IL.................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
M No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
W No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
M No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
0 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ..................... L:( r.t,.k...........................`!O'.'.41.l1..q.iCAuIN...................................... ................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
1�9 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 review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
1P Yes
❑ 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
[] No.violatioitsor. dericiencies.were noted -during this:visit:- :You'will- recei:ve°ito•ft rth:ei
. ctirrespi)Wehce: A out •this'.visit. ; :. .: .
di (k W J) s(nQa b l' . 'M` 10 q- rCP_{DGU.
16- Cori` 'rivc, e oY4s 4o i o.l nvp, �xv m oL -iv\
5► l I �ur�o�� �� ,�As I,, ?Ulf w f r. C.
G Gdoyn. A "r, 80s iGr or, i t)1QK
WWI 04,M.5 O� Old.
careU 6� (ow antes Syr n;5 yull, w6-
7/25/97
Reviewer/Inspector Name
Reviewer/InspectorSignature: AAA— /�„ - /,{J Date:

r
3 ❑DSWC Animal_Feedlot 4peradon Remi w-,
, �.D�WQ An>�nal F edlot 0peratlon"Site' Inspection .. .<
0 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection uttd24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:.1.25 for 1 hr 15 min)) Spent on Review
2,Certified ❑ Permitted or Inspection includes travel and processink
❑l Not Operational Date Last Operated: ...... . ....................................................................................... . ....................................................
Farm Name:.... . ..... ..................... .................................. County: .....1.:�
....................... , .......................
LandOwner Name: ..10.4`f ................ . ........................................................ Phone No: ........�,51..... ...............................
p 4 r, � y�
Facility Conctact:.....Eas.j..........T.l.. �j..x? ....'...1............ Tstle:.. .tv. ................ Phone No:..........................................................
MailingAddress:........ .. .......... f. �3i....... r1� �................................H!�r....�..�1 V......................................... Z ..
OnsiteRepresentative: ..........1+!1, rL.t................................... Integrator:......]N n.+...................................................
Certified Operator:.....................................„HIa.,r.................................. Operator Certification Number:..,(! v Z t, ,Z........,
Location of Farm:
Latitude ®6F-0--7­1' 44 Longitude �• ©� ���
Type of Operation and Design Capacity
DesignCurrent Design,,Current Design Current
Swine Poultry Ca aci Po ulationa' CattleCa 'aci Po ulatlon Ca aci Po illation„
❑ Wean to FeederI❑ Layer ❑ Dai
Feeder to Finish OD ❑ Non -Layer N0n-DaiLy
m. El Farrow to Wean
z:
Farrow to Feeder,..' TotRlDesign Capacity v 4� O # #
Farrow to Finish' F S L'
a_� �. ,..� .......... ........ x ��° W', C7 000�k'fi
Tot S
;❑ Other „r{r�77
�.
larmber of Lagoons% Holding Ponds © Subsurface Drams Present
p2 �� Oagoon Area < ® Spray Field Area
r a 1"
�:_ .
Gengral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes
Mo
❑ Yes
UM
❑ Yes
Gg4o
❑ Yes
9-No
❑ Yes
Eg-Ko
❑ Yes
&M
❑ Yes
❑ Yes
Brj�o
Continued
on back

Facility Number:. 3.1.......—........ O
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes EKo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes mod""
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes GKo
StructuECs lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes & No
Freeboard (ft): Structure^1 - YStructure 2 Structure 3 Structure 4 Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes EKo
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes O No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
GI-Ko
(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
EIKO
Waste
Annlicati911
14.
Is there physical evidence of over application?
❑ Yes
D-No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ......... .s
16,
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[2, o
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[moo
18,
Does the receiving crop need improvement?
❑ Yes
RNo
19.
Is there a lack of available waste application equipment?
❑ Yes
RNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
&Ko
For
22.
Cgrtit3ed Facilities Only
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
B-1�0
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
®'No
24.
Does record keeping need improvement?
❑ Yes
M-1- o
Commei ii ,(refer to gaestionf#� Explain any YES answers and/or,any recommendations or any other comments:'
Use drawings of facility to better explainsitu'ations: (use addrtional.pages as necessary) '.
SrnoGL �je 5 ,.'� SPe-'4y P01i�irICr A-1,4z r
� �� p P 4345s,>.
Reviewer/Inspector Name AW"Ni I �
Reviewer/Inspector Signature:l.�.- Date: 8
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

zde saa f c - x .' a s r: a
Date of,Ahspecti' 'A"Time of InspeG#ion��
Faclll WI Number 3 1 �� A� r. � s �!.��
., Use 24 hr _time
Farm Status: E �» � �D....__....._...._................. ❑ Routine ` Complaint ❑Follow-u
. _
Farm Name:.... .....IL \A ..�..................................._.................. County:.. l..V�//Ao""� .......»............
Owner Name: ..,47.,»__. _ ... �............_.».... _.....» .... Phone No: ..... $ . �ZJ........
Mailing Address: . ��. 1..._.....-»..L` Z� ».» .. _..... _.». ........ �11�R: _ _ ».... _z®....»»
if
Onsite representative: ......... .._...... _........_ Integrator: it_...................._.....�..........
Certified. Operator Name: . ..... ........... .».............. _...... ......... ..._....... _..... .........
.... _...._.....
Location of Farm: -
Latitude 'D A Longitude
❑Not O erational Date Last Operated:
Type of Operation and Design Capacity
~� Fi r
,i e�Fr, `�'',Ria
Nurimber i?A.uFtrytVirmber. C,ai:tl.e.rx ,�£N'umber
.
Wean to Feeder a er Dairy
Feeder to Finish Non-[ aer Beef
Ell � jo
V.
Farrow to Finish _ 0 Other Type of Livestock s
a 1w, � p,.... .
Number of'Lagaons! HoldingPonds / y Subsurface Drains Present �'
�� ` � F � � ❑Lagoon Area � ❑Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Was there any adverse impacts to the waters of the State other than from a discharge?
S. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
R Yes ❑ No
❑ Yes. [SNo
c
❑ Yes ® No
❑ Yes ® No
❑ Yes
KNa,
❑ Yes
® No
❑ Yes
® No
® Yes
❑ No
Continued on back

6. is facility not in compliance with any applicable setback criteria? ❑ Yes ® M
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)? Yes No
• 8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (Lacoons and/or Holding Ponds)
9. Is structural freeboard less than adequate? ❑ Yes ENo
Freeboard (ft): Lagoon i Lagoon 2 Lagoon 3 Lagoon 4
_.... ... `L� ....__ ._ ...... ..— .......................................... _ _ ..... ...._ ......_
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWO)
13. Do any of the structures lack adquate markers to identify start and stop pumping levels?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .......!'K:.... ..... . .:........ . .... ........_... _..
16. Do the active crops differ with those' designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the cover crop need improvement?
19. Is there a lack of available irrigation equipment?
For Certified Facilities Only
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss reviewtinspection with owner or operator in charge?
❑ Yes UNo
❑ Yes No
❑ Yes No
0 Yes ❑ No
❑ Yes A]No_
❑ Yes ❑ No
❑ Yes ®No
❑ Yes ® No
❑ Yes No
® Yes ❑ No
❑ Yes ❑ Na
❑ Yes ❑ No
® Yes ❑ No
❑ Yes IN No
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"fir �-.k'C���*eu � •�'��xi,� : .� i �•� �?xx x __ s � �• �, �;x a � !tS �'}� i'x�w � ti.v;"�+' t t'; �T ��a "M ��''
Re.1/leWer�InSpBCtOr blame y: s xrn S a�z� ?m�axAp s » ;£.1 i 4 t�t a
RevlwerllnspectorSlgnature
+e, r
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96

N.C. DIVISION OF ENVIRONMENTAL MANAGEMENT
COMPLAINT/EMERGENCY REPORT FORM
WILMINGTON REGIONAL OFFICE
Received by: LJ 7 �1 1 L� „ ,` S 42tri , O �Date/Tim:
Energency: Complaint: County: IJ>�J 4 v,,�
Report �-Received
Fi:c>mr 1/J_
Agency: l�J�.aJ c) �, to Phone No.
1!5 E�FAiVT4
Address: Tse OJ�hane No.
complaint or Incident:
Time and Date Occurred: l? -i 0 '5 4 _
Location of Area Affected:
Surface Waters Involved: Groundwa ter Involved: Other:
Other Agencies/Sections Notified:
2nvestigation Details: i'R�• r�( ; ,5,yor� -�/� 4c"ofo�7'
Investigator: / Nate.
��
EPA Region IV (404)347-W2 Pesticides 733-3554 Emagenry Management 733-3867 N'We Resources 733-7291
Solid and Hazardous Waste 733-2178 Marine Fisheries 726-7021 Water Supply Branch 733-2321 U.S. Coast Guard MSO 343-M87
127 Cardinal Drive Extension, Wilmington, N.C. 28405-3845 • Telephone [phone] • Fax [phone]
An Equal Opportunity Affirmative Action Employer