670001_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: Q Cgrfipliance Inspection U Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: 6 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: ON.SWly) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ?A-ML TV, litL�S� q
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Integrator:
Certification Number: S I I 14
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
C►apacity Pop.
Wet Poultry
La er
Non -Layer
Design
Capacity
C►urrent
Pap.11,111,
Design Current
Cattle Capacity Pap.
DairyCow
DairyCalf
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr, P,oult ,
Layers
Design
C_a acit
Current
Pop.Non-Dairy
Dairy Heifer
Cow
eef Stocker
Gilts
ers
eef Feeder
1
Boars
1
1Non-La
Pullets
eef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
Page 1 of 3
9
21412015 Continued

Facility Number: - Date of Inspection:
Waste_ Collection & Treatment
4. •Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: `�""",/ S
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 2/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 environmen I threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes a ❑ 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 &N/o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 2fNo
❑ NA
❑ NE
maintenance or improvement?
/No
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes r
VNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
Zo
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 �rNo
❑ 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 YNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:]Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ l20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections 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?
❑ YesVNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

F cili Number: jDate of Inspection:
24; Did the facility fail to calibrate waste application equipment as required by the permit.
25r Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Y s
Yes
]M No ❑ NA ❑ NE
❑ 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: 6hA tA Ci7o
N
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
2No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[::]Yes
YNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ 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
❑ Yes
❑ Yes
FN
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
(Comments (refer to question! ft Explain,any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages.as necessary).
y
v f 1je Cd7 E�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
r, ,
Phon 1 rJ ( ,
Date: W�p 3
/4/2 15

Type of Visit: Q 7Routine
pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: a Arrival Time: ® Departure Time: County: 6/J-U1.,/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: MA n-148 LI �l-SAS Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 2 0 q f "f
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Dairy Cow
Design Current
Capacity Pop.
Wean to Feeder
I JNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean ?ZOZ)
Farrow to Feeder
Farrow to Finish
Dr. Poultry Ca aci P,o
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkcy Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes jNo
o ❑ NA ❑ NE
❑ Yeso ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0No
❑ 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: l_A666 ,NJ LW Irst_vrJL r 13 LACiy1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ 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
L,3Flo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
V(Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
WNo
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
Waste Auolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[] Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of 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?
❑ es
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
VYes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
ETNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
0 Yes
EZ�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
I o
❑ 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
ZNo
❑ 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
WNo
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - Date of Ins ection: 4
24. 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 TNo ❑ 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 �zNo ❑ 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 dNo
❑ Yes E?(No
❑ Yes [2No
❑ Yes G3"No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
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? ❑ Yes
[3/No
No
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any.other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
eC-D Wa !t-(< C� N-t-�pc.T1 A crt Na r+n T .
WN r'Q ALL- J NE I)C-� / woQ obcoS Tb 8F DO►�c AND A09 MEW S AC
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone(
Date: IS�
/4/10I4

Type of Visit: U CC Hance Inspection U Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: © Departure Time: County: 0AIR4 Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: F �1���-�T(_(� S Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Design
Wet Poultry Capacity
Layer
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean Oc#S
Farrow to Feeder
Farrow to Finish
Gilts
D . l;aul Ca aci_
Layers
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Non -Layers
I
113eef Feeder
Boars
Pullets
I
113eef Brood Cow
Other
Other IOther
Turke s
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? -
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes N
—]Yes
No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Fficili Number: - Date of Ins ection:
Waste Collection & Treatment
4.=Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E% No ❑ NA ❑ NE
a. If yes, is waste le into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L�7�1 V
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 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
, (not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[/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
—
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):
i
14. Do the receiving crops differ from those designated in the CAWMP?
❑ s
No
❑ 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
E/No
❑ NA
❑ NE
ReQuired Records &_ Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. dyes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ YesYNo
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes
❑ NA ❑ NE
Q Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faeility Number: - Date of Inspection: d
24.-Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes El"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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes tNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes dNo
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ❑ No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes [ 11
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes YNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary):
1 1 �,) rTSS 1(.69 L7-016 A09 W169 (4WWL_ ,
r/A�jo , d6AI 6WX)Ck Cf�LL ,l}!�/12, G��CI�I ��iN. 6IL� Cay►'t�(.E�E
C,At.�� 0MC, -OTS �A.<, .
L(VC-LS AIJ,0 fArdrALL
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone qt))
Date:
21412014

Type of Visit: UCo pliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q?5= Departure Time:® County: otJ� Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �� IUA�1gN Py r Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
1 '15._7s.9
Design Current Design Current
Design Current
Swine C*opacity Pop. Wet Poultry Capacity Pop. Cattle
Capacity Pop.
Wean to Finish La er DairyCow
Wean to Feeder
LNon-La er
DairyCalf
Feeder to Finish
Daia Heifer
Farrow to Wean
6c56
000 Design Current Dry Cow
Farrow to Feeder
Da. P.ou1 Ca aci P,o , Non -Dairy
Farrow to Finish
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Turkeys
Other
Turkey Poults
11 Other
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes g
❑ NA ❑ NE
YesNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

F'acili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure i Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2/3 Lt V
Structure 3 Structure 4 Structure 5
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?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
[:]Yes E] No ❑ 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 No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2fNo ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
ps [3No ❑NA ❑NE
Yes ❑ No ❑ NA ❑ NE
[:]Yes io
[:]Yes N�Zo
[:]Yes
❑ Yes
❑ Yes g No
[:]Other-
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes allo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes o ❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FELedity Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes No ❑ NA ❑ NE
25! Is the facility out of compliance with permit conditions related to sludge? If yes, check CeYes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ F lure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon LA
10
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 YNo
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes bd" o ❑ 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 L2No ❑ 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 2 Io ❑ 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 L.Q 1"o ❑ NA [3NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations ,or any other comments.
Use drawings of facility to better exulain situations fuse additional naaes as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phon ec?
Date:
421121011

(Type of Visit: (jCo Hance Inspection U Operation Review O Structure Evaluation () Technical Assistance I
Reason for Visit: 70utine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1. Arrival Time: I T 'So= Departure Time: County: AN Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
r
Onsite Representative: JOWfl j Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
C►apacity
Current
Pop.
Cattle
DairyCow
Design
Capacity
Cnrrent
Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oul_
Layers
Design
Ca acity
Current
P,o
Cow
Non -Dal
Beef Stocker
Gilts
Non -Layers
I Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
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 EZ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
[:]yes ❑ ❑ NA ❑ NE
❑ Yes VNo
NA ❑ NE
Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: G7 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes To
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3
Identifier: UUad Z ►ram 3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):L/^
❑ NA ❑ NE
DNA ❑NE
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 No ❑ NA ❑ NE
❑ Yes En/N o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �No. ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [21<o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [—]Yes do ❑ 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 YNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? I'es ❑ N ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [:]Yes VNoD ❑ 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 [J(No ❑ 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 ❑ Yes�Zo ❑ 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 [i]'Po ❑ 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 21412011 Continued

Facility Number: - Date of Inspection: t4
15 IL�.--
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C3 N ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Na ❑ 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 ❑ N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L NO ❑ NA ❑ NE
Other Issues
<o
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
❑ 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[3/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 j2 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 <o
[] NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes U Nc ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes e No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments'
Use drawings of facility to better explain situations (use additional pages as necessary).
a l� C-°A,rjJWt/E ljE6P Co A47,o L, ! PA[JC* , LrMf A6V4 W , FR OMT T M9 L MP10
MOSr p M&J=AA1.
ZG) leFEf WP al:cr 6/s-T4 A6(0"f,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: Ll .S
21412011

Type of Visit: GrCoMnliance Inspection O 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: 7 Z Arrival Time: ® Departure Time: g YS County: OMA a K/ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: `jW P'T1A a0 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design C►urrent
Wet Poultry C►apacity Pop.
Layer
Design Current
Cattle C*apacity Pop.
DairyCow
Da' Calf
Wean to Feeder
Non -La er
Feeder to Finish
Da' Heifer
Farrow to Wean
Farrow to Feeder
3cW 26D6
Design Current
D P,oult , Ca aci P,o
D Cow
Non-Da'UY
Farrow to Finish
Layers
Bcc f Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPouets
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 V3�
o❑ NA ❑ NE
Yes ❑ NA ❑ NE
❑ Yes 2 110 ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: (p'1 - Date of Inspection: 1 l
Waste Collection & Treatment
4. Is`siorage 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; LA & ou 1 L wO3
Spillway?:
Designed Freeboard (in): 7-10 �r
Observed Freeboard (in): 2.0 31
5. Are there any immediate threats to the integrity of any of the structures observed? E 'Yes
❑ 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 ❑ 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 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 l 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 LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes % No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of 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?
❑ es
❑ No
❑ 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
VNo
❑ 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
No
❑ 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 Ef 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 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 21412011 Continued

Facility Number: jDate of Inspection: 1 t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�lo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA 0 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 o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes &No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [—]Yes M 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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
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? ❑ Yes
9�40
❑NA
❑NE
l__I lv
❑ NA
❑ NE
k �J yNo
NA
❑ NE
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or. any. other comments z
Use drawings of facility to better explain situations (use additional pages as necessary).
! s,) -EAlp"tic &4166P CdNIYLo �—
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: ( / f: " 7�3 11,1
Date:
2/4/201

Division of Water Quality
facility -Number® (p 0 Division of 5ot1 and Water'Conservation
Q Other Agency
E
f Visit com fiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 11C/ata/1 j� I Arrival Time: ® Departure Time: County: '1A6r146k Region:
Farm Name: `�'� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Ca Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = c = ; =ig Longitude: = ° = i = «
- r Design Current. w �� Design Current
wine Capacity Poulariop .v, V1'et Poultry Capacity Populahon C
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
fff Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
'LJ N
ter
Other
❑ La ers
❑ Non-Laje--
❑ Pullets
❑ Turkeys
❑ Turkey_Poults
❑ Other
Cy_ ow
Cy alf
y Heifer
Cow
LJ Non-Dai
ry
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood
Discharizes & Stream Im acts
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 Vo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
El NE
❑ Yes o
,❑
El Yes
El NA
El NE
El Yes YN
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: i LA 6�V'
Spillway?:
Designed Freeboard (in): '
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ 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
t reat, notify DWQ
7. 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
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
o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
I�l El ❑ 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 > l 0% 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 [/ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yesr—]X❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes laX
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments "..
Use drawings of facility to better explain situations. (use:: additional pages as necessary)
26, PA fik, sLtJC�,C O)J 1A6 d- 3
26�� NE�C1 �Py w�fl PEG�a�S
Reviewer/inspector Name yQ (/�_ ": Phone: l C
Reviewer/Inspector Signature: 41 Date: ho
Page 2 of 3 12129104 Continued

Facilitg Number: — Date of Inspection . 6
Re uired 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 ❑ Maps ❑ Other
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
dNo
❑ 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 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
[TT
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
U No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
eyes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PVo
❑ NA
❑ NE
Other Issues
�
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElO Yes
No ❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L.yNo ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�/No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
��No ❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ElNA
fN
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes❑
NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12/2"4

6
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: '7 Z Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
i .nn
Onsite Representative: Uoly��� f'� /V7 Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: 0 0 = 6 = Longitude: = n = , = fl
Design
Current
Design Current Design Current
Swine Capacity
Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
® Farrow to Wean
OC&
a Dry Poultry
❑ DryCow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
[I Beef Brood Co
❑ Turke s
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ 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 I of 3
❑ Yes LSNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: — r 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?
❑ Yes E o ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: tr Cs 00\J I LAG6z^j Cry ,,v3 &ou
Spillway?:
Designed Freeboard (in): oZ ZO 3S $
Observed Freeboard (in): aZ % S q cl 1 S
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 ZNo ❑ 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 t 4at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesNo ❑ 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 [AlNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2/No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving craps differ from those designated in the CAWMP?
❑Yes
❑ NA
ElNE
Does the receiving crop and/or land application site need improvement?
❑ Yes
go
[I15. NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?Q Yes
rNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[J� o El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
lYJ No ❑ NA
❑ NE
4 '
r�. A .. � r' ��s' .i�� •r-�3="+��Vi ..
Comments (refer toquestt©n�#) Ezplam anyYES answers and/or any.r�ecommendahons,orany=other comments.,
Use drawings of a- f ity t©'6i f er:explatn s�tuattons {use,addttional`p ges as�ne ssec ary) s
51,006-C "Thf 't`6rt- GA&01W �l 6.� _ 1,I�E� P6 A
abr) FAI_ ce P l
Reviewer/Inspector Name V o(� Phone D -
Reviewer/Inspector Signature: Date: 2 O
Page 2 of 3 1 1 12128104 ` Continued

Facility Number: Date of Inspection 6
s
111auired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desi ❑ Ma s ❑Other
l p
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain
Inspections❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
O No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
rNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
E(yy es
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
9No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N
[INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
IlJ 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
3/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
E3 N ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional•ComnientS.in&.or Iii Wing 5' :: ,
12128104

Type of Visit compliance I;pcomplaint
ection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 30 16 6 1 Arrival Time: © Departure Time: County: eat4—d I Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
J
Onsite Representative: _LJ EK _- ►^!y6_P _ Integrator:
Certified Operator:
Phone No:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Latitude: [= o = { Longitude: = ° 0 , =
Design Current
Design
ItPoultry
Current
Design Current
Swiae
Capacity Population
Kcsapacity
Population
Cattle Capacity Population
❑ Wean to Finish
ID Layer I
I
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes 2No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o El NA
El NE
❑ Yes
El Yes
go ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection o 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E 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:( (46,0 1 to LwyL L> &tfd►v 3 k.+4C��I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): n. 36 ci ti r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes EiNo ❑ 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 thn t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesN El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ LT
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 ADDlieation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L/J No ❑ NA ❑ NE
maintenance/improvement? ��
11. 1s there evidence of incorrect application? 1f yes, check the appropriate box below. El Yes LI 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
0No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[2fo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
EJf,;-o
[INA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
El NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
,ET
0' o
❑ NA
❑ NE
REsPaNj9 to cfeE 6X % t-VJ 6?6- 2 &u C.0t42 E j R�VY> c.EvE L RA.['J�D ryt��2
F*IfZj, ua&.o-b&j "v614 6o rior vSSxBL.`y SHa,/ LA&.G-c DR.oAS. FIl.kk soARO P► w
Qua ��.,FA� c.�.�s �b gE 1�'q f� 7a DBE , A/o szG1�l5 �F diSCfVAK" lYl
tJACY0zi✓.S, �/ rt.� C,aNT L NuC- f'o -
Reviewer/Inspector Name 1 0 Phone: 9/0 719 —
Reviewer/Inspector Signature: Date: �'d
Page 2 of 3 12128104 Continued

{ .Facility Number: 6 'j — Date of Inspection G 3o a
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps p ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional;Comments:and/.or Drawings
•
Page 3 of 3 12128104

6n H I
Type of Visit 6 C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 7Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p$ Arrival Time: g.3o Departure Time: County: ONSL4-) Region:
Farm Name: Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: kftll?WOOD 5,6(jr LJ609
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = s = tl Longitude: = ° =, = «
Design Current Design Current
Design Current
Swine
C►►opacity Population Wet Poultry C++opacity Population Cattle
Capacity Population
❑ Wean to Finish
❑ Layer ❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
❑ Dai Heifer
® Farrow to Wean
3 a on
1^ao
pry Poultry ❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Beef Stacker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Outer
El urkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page l of 3
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
12128104 Continued

I
Facility Number: (e`j — Date of Inspection S a41
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ 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: LA6oa,J 1 Uck&ch*N L LA<,M J3 tJ4CimN y
Spillway?:
Designed Freeboard (in): 114 3 S S
Observed Freeboard (in): 1A
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[fNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
/
E No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes
CJ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
E'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 El Yes
,_,/
IJ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
LdNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
Vo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
['No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
R Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ENo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
N
EVNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
❑ NA
❑ NE
15) ;,fths rfEE� t.i t€ igNr� wtto Lor►tfL.X-, c.utt-.�aL„ OE6v91 i» aE 00MC VOa, GRASS 6jt6WTq, +
D0,WVAA6f ( ALL-t*VUoDS.
j$L_M GpY eC UVIV ►34St'6 ANALgi,ZS.
"
,La., 066r�, Nt-W QL* wIZT14 000"t-S urs���t,R6, ,464o03 15 88
t,rA& oo -j Z a(3TA.xu sLu o G9 S0JL_4C ; Io S(0 (ji0 p CuodEo 0►11', �
Reviewer/Inspector Name j VAPA) Phone: ( Vd) JqL_ 13 7% _
Reviewer/Inspector Signature: Date: o
rage z uJ .7 -.. Vl vv ...........�..

i
Facility Number: — Date of Inspection D I
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ld No ❑ NA ❑ NE
20. Does the facility fail to have 1 components of the CAWMP readily available? If yes, check EYes [I No ❑ NA ❑ NE
the appropirate box. 5WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
LI Yes
❑ No
❑ NA
❑ NE
Waste Application ❑ Weekly Freeboard dWaste 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
E?(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
eNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�dNo
L✓JINo
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
El0 Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
L!I NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 014o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EJ-Ko
❑ 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
,.
l' I No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31, Did the facility fait to notify the regional office of emergency situations as required by
❑ Yes
ETNo
❑ 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
�,�
�I�No
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
1a No
❑ NA
❑ NE
AdditionafCumriients and/or Drawings #.e ': ,• s sky Y f � s�.a � ��a 5 t ° '"n�.°�.; �� ..
Page 3 of 3 12128104

I
Type of Visit CO pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit td Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 07 Arrival Time: 8 3 O Departure Time: County: _aN,<A4 Q Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: Kfiw ,ttoo!�j _ , 1 C fj W aop , Integrator:
Certified Operator:
Phone No:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 6 =66 Longitude: = ° u
Design
Current
Design
Current
Design
Current
Swine
C►apacity
Population
Wet Poultry
Capacity
Population
Cattle iiiiiiiiiiiiiiiil�g
Population
❑ Wean to Finish
❑ Layer I
I
Dairy Cow
❑ Wean to Feeder
I JEI Non -Layer I
I
Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
91 Farrow to Wean
3ocx,
3vso
Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
El Beef Feeder
El Boars
El Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑Other
INumlJer
of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
El Yes 2No ❑NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
[IN E
❑ Yes
El No
❑ Yes
B Noo
❑ NA
❑ NE
❑ Yes
E?5 o
❑ NA
❑ NE
12128104 Continued

Facility Number: (p7 - Date of Inspection Z. o
(-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E?rNo ❑ 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: ` (-o 'L 3 [�
Spillway?:
Designed Freeboard (in): �-`'� _ _ '� 3 5 `.+
Observed Freeboard (in): �`� Z 2- LIS / S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes L' f 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 R(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
L/J No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[3No
❑ 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
,--,�
Ld No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ff No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
"❑ No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0Yes
QTo ❑ NA
❑ NE
I6. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9T_No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
L✓1 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)•
�Sj tAN"GtAiU� Wc-ev gAr_K C"&Mut �[Et.� 1 -44 NaG-ta CCEAIJ +
s t-No vra FpX- G of r O—CCG '-- =CGn.S e ,
Reviewer/Inspector Name V Phone(�/0
Reviewer/Inspector Signature: Date:
1650 G Vf J —f-w —
a. v.•••r•wcw

'Faciliity Number: & — Date of Inspection 2- o
Required Records & Documents .,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LI 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. ❑ VVUp ❑ Checklists ❑ Design [I Maps El Other /�
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 2 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 El"No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ 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?
❑ Yes
[TNo
ElNA
❑ NE
ElYes
2 No
❑ NA
❑ NE
❑ Yes
WN
❑ NA
[I NE
❑ Yes
[:1 NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
❑ Yes O No ❑ NA ❑ NE
❑ Yes E]4Qo ❑ NA ❑ NE
❑ Yes Q Ko ❑ NA ❑ NE
❑ Yes d No ❑ NA ❑ NE
❑ Yes �ENo
❑ Yes "CI No
❑ NA ❑ NE
El NA ❑NE
Page 3 of 3 12128104

46 Division of Water Quality
Facility Number 7 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit (5CO 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: off, Arrival Time: Departure Time: County: 4102- hl Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 [= 4 = Longitude: = ° =1 ' =
Design CurrentY
.,Capacity., ,'P,opulation Wet Poultry
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
30two
Auwo
❑ Farrow to Feeder
❑ Farrow to Finish
`` ❑Gilts
❑ Boars
Other
❑ Other i
actty Population;`; e
I❑ Non -Layer _I _ I �r
Dry Poultry -.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turks' s
❑ Turkey Pou Its
❑ 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?
y Cow
y Calf
y Heifer
Cow
LJ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
l
Number of Ztructuies,__'
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
❑N [I NA
El NE
❑Yes
El Yes
F ❑ NA
❑ NE
❑ Yes
[ No ❑ NA
❑ NE
12128104 Continued

Facility Number: ? — Date of Inspection YI ILQIp�
If �T
'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: LA46vo.J T LA&ao,y Z LA. G-ao•) I LAQ:q J -i
Spillway?:
Designed Freeboard (in): Xg a-0 3 �- 119
Observed Freeboard (in): 5 1
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 L✓J No ❑ NA . ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes LJ 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? ElYes 2hrNo ❑ 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 eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 6 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O 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?
011yes.
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
F(No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ir No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ED40,
❑ 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):
IS,) Fr( --LADS NEED WC -Co C.onrTQaz.oL .
IrJMN& tA-rc 01U SoLZL0 5 t✓t C AL=B2AT.=G0-
Reviewer/Inspector Name ! v &K" ]'+4dta tLA_ Phone: L90 7c66 - 7a- (. S
Reviewer/Inspector Signature: Date: L(
Yage 1 of 3 IZ12&04 Continued

e
Facility Number: 7 — Date of inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Ye YN ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LrJ No El NA ❑ NE
the appropriate box.
❑ WUP El Checklists ❑Design El Maps ❑Other ��
21. Does record keeping need improvement? If yes, check the appropriate box below. El Yes E2 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
1vo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Lj'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VN
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
L'J NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EJ,4o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ICJ 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
Z 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
VNo
❑ 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
EYNo
❑ NA
❑ 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

1. 4
Ii ype or visit V compliance inspection V uperation Kewew v structure tvawauon V i ecnnicai Assistance I
Reason for Visit 91 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 0'f Arrival Time: /d/ Departure Time: ;D(J County:
Farm Name: �Ar5 f Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
Swine
_❑ Wean to Finish_
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
❑ Farrow to Feede
❑ Farrow to Finish
❑ Gilts
❑ Boars
I
Other
❑ Other
Title:
d�-0m) Region: Z'C/IWV
Phone No:
Integrator: %
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = 0 Longitude: = ° = 6
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
-�� Non -Layer v
Dry Poultry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ®i
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?
El Yes 0No El NA El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

Date of Inspection
Facility Number:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
JZ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 StrZt 4 Structure
5 Structure 6
Identifier: 7i 3
Spillway?:
Designed Freeboard (in): 21 s
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
m 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
F 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
0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
VZ 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
3 No ❑ NA ❑ NE
maintenance/improvement?
eI-
11. Is there evidence of incorrect application? If yes, check the appropriate box below, Yes
GN-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
Z Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) Lr1'_9a'--&_Ag�'a �_D
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ElYes
X No ❑ NA El NE
15, Does the receiving crop and/or land application site need improvement? ❑ Yes
V No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',[] Yes
[Z No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes [Z No
❑ Yes Z No
El NA ❑NE
❑ NA ❑ NE
/i 1JJ�l� ��GyGf}-7zv�✓s� � Sm� r�i�9-�'' �d✓ (lCi��v P!�/t1��� Dur�zo�
v` PZ-Z 7 '6tJOAvO v�J �� �.4 Zoe ` �Ppl�Cft�'a sN No �. Arlo A-0
S
. f_
Reviewer/Inspector Name_ , -- x Phone: - Aa ,
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes © No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
(A No
❑ NA
❑ NE
23.
If selected. did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[3 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
A NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
El
and report the mortality rates that were higher than normal?
to
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[;5 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
12f No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
O No
❑ NA
❑ NE
Additional Comments and/or Drawings:
tr Dtc"Vveiz S7'4RrF�
'41 o 1,4,0 7V e4w N vr� 5
IV �-� 5 P F_ C�Pv� i F� �vti�w Dcvr�4,�✓ �,rs� r
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� '-p.-'-• g �" d .� � Y - :s' - ... -.. - - 6 yam.. ��
� � � � Division of Water Qpality
0 Divisionlof Sod and -Water Conservation
,. Other Agency a .�� W
Type of Visit R Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ denied Access
Facility Number Date of Visit:
Ef Permitted [3,Certified © Conditionally Certified [] egistered
Farm Name:.,%Jf1�' ..5 - »� .�............ .
Owner Name: V f �lJ &? ,F......F1a.m_i C._............ }......
Mailing Address:................„.........
Date Last Operated or Above Threshold: ...._._._ .._ ..
County:_If���(�..........................................
Phone No: �_ .. .._� _. .... - ..- ......W.
FacilityContact: .................................................................. _ Title:...................................................... Phone No: .. _ _ ..�_ ...... ...... .... ....
Onsite Representative: ........Ell° .. Integrator:.t.... .__[.Z=!.Ce2 .....
'RK16,4a G1auo :SF-fF Woof)
Certified Operator:.. ........... _..... �...._.._-...._..... Operator Certification Number:.... .....................................
Location of Farm:
)21 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 64
Discharges & Stream Impacts
1- Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑yes
❑ No
c. If discharge is observed, what is the estimated flow in gal min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
;2%
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
UrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
XYes
❑ No
tructure 1 Structure 2 Structure 3 S cture 4 Structure 5
Structure 6
Identifier: Zr.
Freeboard (inches):
12112103
Continued

i
Facility Number: Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? )i '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 PIKO
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '090
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 4!fNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes 21No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes �No
28. Does facility require a follow-up visit by same agency? &Yes ❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) /XYes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes )2fNo
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ,QNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditiozial Coruments andlor V,,!gs
/ IQ
/� �E�Pjn�DA �EcO s I
J
f z�z�z rron? 7i� a�>.9U �uI- NfAo � e4� C'� r =
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K,<e F, ,oRRD L3
ct
& O 3.� 3./ fl� �
3
12/12103 Ep p 11 - f p3 y/
4

acility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes eNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
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?
J&Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes VrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
XYeso
elevation markings?
e�t
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes O'No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes )eNo
❑ Excessive Ponding ❑ PAN draulic Overlo ❑ Froze Ground ❑ Copper andX Zinc
,❑
12. Crop type/Y uF c
13. Do the receiving crops differ with those designated in the Certified A ' al Waste Management Plan AWMP)?
❑ Yes 0 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15. Does the receiving crop need improvement?
KYes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes 9No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes 9110
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 9No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes XNo
Air Quality representative immediately.
:Comments (refer to queshdn #} Eaplam any YFS sweis aad/ar any irecommendats4as orany otltiier comments."_ = _
,Use dr_ swings of fae�ty to better explarn sftaat,ons.(ase addstioual pages as necessary) , Field Cop ❑Final Notes
�❑ Y
M vVj ZN C_, Ft ou! �ZPF_ 5 ! �o/� /9G�ON 1 rNro /gillQ
,
3 1*.40
Reviewerftspector Name Z _;
ReviewerAnspector Signature:
Date:
i ui ciw a.v�ssusueu

h�
3 Ihvrsron of Wa#er Quality
t C 1
O:Division.,ofSol�amd��'Va_ter Conservation
x Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine Q Complaint QZ(Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted [3 Certified [3 Condid rally Certified
Farm Name:
Owner Name: ... . .... . .. .............
Mailing Address:
Not Oaerational O Below
Date Last Operated or Above Threshold: ... . _ _..._..
County:_ ._...
PhoneNo: ....................�... ............. ....... __.
Facility Contact: .. . ................................... ...................N/1? Title, - Nob,,
No:... .
Onsite Representative: .% Integrator.f1rr/•-_,-
Certified Operator: r w.�.�.�.�.�._.......------ --.. Operator Certification Number:
Location of Farm:
Swine ❑ poultry ❑ Cattle ❑ Horse Latitude
�• ��
Longitude
�•
/�"
DeSrgnr ` sCurreut` Dessga Current �4- {.nrrent
�+
rfllfOPe+[I ..1i istEAn _.,.. Po�trv.''� %>-"EiAna&, 'V.�. pAllfltA A�1 '-i-- Cattle - - -=[`anaMfv .-:�A'Htfla"n 1.
Wean to Feeder ❑Layer ❑Dairy
t_
Feeder to Finishry ❑ Non -Layer ❑ Non -Dairy _
Farrow to We
Farrow to Feeder Other
:f Farrow to Finish T©tom Design, CSpSC1ty
10 Gllt$
Boars y f T©tkai SSL W'
� II
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation? ❑ Yes 0 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) El Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaUrnin?
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 )z No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes J6 No
Striiucture I Structure 2 Sfucture 3 tructure 4 Structure 5 Structure 6
At I
Identifier: .....?�I....................................... ... ...f....:3.......... ..... ....._.#�_ - - - -............. ....._._..
2 Q
Freeboard (inches): IN ✓!/ �,7
12112103 Continued

k
'[Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or 0 Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
1 1. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Fmzen round ❑ Copp and/or Zinc
,r
12. Crop type z S �j
13. Do the receiving crops differ with thos designated in the Certified Waste Management Plan (CA )?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately.
,Comments {refer to quesieon #) plain any YES-apswers and/or any r+ecommendaboas or airy other comments. _
Use drawl of fa9t t6 better explaia situations: (ase idtnonal as necessary?. _Final
pages❑Field Copy Notes
47
-n/S�ECY�aiv ,On�� %�lAi►�G f O / v�,�kJ L��`1._ L�vGS+
L,4 .. �� LF ✓,Et-S �or� �/
r/
.4S5 LA:),�.) A�3, Zoe-oalI$
�%iti►D �� ��VL` �5 �/�Z/)')�R� ��GoaNS (��459� �Ga"'S 8f/
y P4,C7 � �F GL�4ccS
/�_ /Ii.4zN>.N�n 4-z
-
T
ReviewerAnspector Name d
� �- . �j.. `Grp �.. _ :: i-� .�'.�'�.:..* .off=•-=° 1�s-�='"�"�.=-�}£ F � , �"�-�_i
Reviewer/Inspector Signature: Date: Jr
12112103 Continued

Facility Number: — Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ 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?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall [:]Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes XNO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes (2rNo
ElYes X No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

:r
Facility Number 57 1 Bate of Visit: 21111Z004 Time: 1000
rO Not Operational Q Below Threshold
El Permitted ® Certified 13 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:..............
Farm Name: N.v.09ffJFarms.aiae.(AG)....................... ........ County: OB,51o.w .............................................. [�LEtQ.........
Owner Name: ................................................... Nuthaff.Fairm-Im ............................... Phone No:
Mailing Address: �Q.SOX.31�........................................................................................>rt11Xi1k..N........................... 18...............
Facility Contact:.............................................................................. Title:.................. Phone No:
Onsite Representative: JiAnlaly.,N.CILQfia...TIM aY..(;.r07af........................................... Integrator: N9.Uh0f.Fairm%.1nr.............................................
.
Certified Operator:GXegivry.E ............................ IY.I,t rsk1bllm.................................... Operator Certification Number:16$22 .............................
Location of Farm:
+forth of Albert Ellis Airport. On South side of SR 1225 (Coston Rd.) approx. 1 mile North of SR 1221. Turn at large wood
;ign with hog on it. w
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 ' S1 37 Longitude 77 • 35 25
Design Current
Swine Capacity Ponulation
❑ Wean to Feeder
❑ Feeder to Finish
® Farrow to Wean
3000
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons 4
u.,�a:.... n.,,.a� r c„1:a ry-..­
Discharges & Stream Impacts
Design Current., Design Current
Poultry. Capacity Po ulation Cattle Capacity it Population
❑ Layer I0 Dairy
❑ Non -Layer L I I0 Non -Dairy
❑ Other
Total Design Capacity 3,000
Total SSLW
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 l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............... ##2............... ...............G ............... .................................... ................................... .....
Freeboard (inches): 12 18
12112103 Continued

Facility Number: 67-1
Date of Inspection 2/11/2004
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 stuetures 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 Pouding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type Fescue (Hay) Coastal Bermuda (Hay) Small Grain Overseed
❑ Yes ❑ No
❑ 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
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
a n.. ;
nients (refer Comto question-4 Eiplain any_YES answers and/or arty recomine ndationmm s or-anyother coents .
Use drawangs of faedity toibet#er explainsituations (use;additianaipages as necessa . ❑ Field Copy ❑ Final Notes
- Inspection conducted because of permitting issues. Met with Carl Dunn and Betsy Gerwig from
A,
the Division of Soil & Water.
Lagoon levels high. lagoon levels for lagoons #2 and #3 need to be lowered. Unclear as to what the
required freeboard will be since there is no designed storm storage within lagoons #1 and #4. Currently,
waste flows by gravity from lagoons #1 and #4 into lagoon #3. From lagoon #3 waste can flow into lagoon
2.
7) Outside lagoon walls for lagoons #2 and #3 need to be maintained to the toe of the slope. The walls
had been maintained to about midway of the slope. The rest of the slope was covered in briars and other
overgrown vegetation. Could not really inspect the rest of the wall. Dike wall needs to be maintained so
that it can be inspected for potential problems such as leakage, erosion, and damage by animals.
CONTINUE ON NEXT
PAGE
Reviewer/Inspector Name 'Ches Pabb :. -John Fsrnell
Reviewer/Inspector Signature: Date:
12112103 Continued

"'I Fatality Number: 67-1 Date of Inspection 2/11/2004
Required Records & Documents
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
❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
dditional Comments_and/or Drawings -
7)-- Storm water drain by lagoon #4 needs to be maintained. Some wash out had occurred. Also,
7
some type of grate needed over opening.
R NOTES:
Approximately 147,397 cubic feet of sludge has been removed.
Fescue had been planted in the fields containing Pulls 1 through 5. Bermuda and small grain
overseed cropping system will remain for the other pulls.
Carl has been working with the owner with the issues concerning permitting this facility. Carl
presented some information concerning the WUP and lagoon designs.
12112103

Type of Visit 9 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit C1 Routine O Complaint O Follow up O Emergency Notification (� Other ❑ Denied Access Date of Visit:
Facility Number
Permitted [3 Certified © Condi��rtified 0 Registered
Farm Name:
Owner Name: e
Mailing Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Location of Farm:
Ida'I vTime: l- -1—I %Je1 I
10 Not O erational 0 Below Threshold
Date Last Operated or ve Threshold:
County: � Jtl — - -
Phone No:
Phone No:
Integrator: CL►��-.� �`TCrul
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 o [C Longitude a 6 Du
Design Current Design Current Design Current
:Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ID Layer 10 Dairy
❑ Feeder to Finish Non-Layer❑❑Non-Dairy
❑ Farrow to Wean
—
❑ Farrow to Feeder ❑ Other n;
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
' Number of Lagoons �G; ❑Subsurface Drains Present 30 Lagoon Area 10SprayField Area
-Holding Ponds 1 Solid .Traps _�' ❑ No Liquid Waste Management System
Z:�•.
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:�C Q d C
p
Freeboard (inches): D
05103101 Continued

Facility Number:
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor 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
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAR'MP)?
14_ a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ 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 D V Q of emergency situations as required by General Permit?
(iel discharge. freeboard problems, over application)
23. Did Reviewer/lnspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
E3 No violations or deficiencies were noted during this visit. You will receive no further correspondence about "visit:
Coattjnents'(refer to gaestioa ft 'Uptam:any YES answers andlor any ttenmm�datusa5 orMatav ai �comrduents. _
Use drawings of facility.to better explaan situations. (use additional j�a- as n&eiswy) _ ❑ Field Copy ❑ Final Notes_ '
Lft! �
Ails
{ i , C't' � r
D
QP Q 4+ft w L4� I rk[ lG aT' V geej
.
Reviewer/Inspector Name - ' ., _
Reviewer/Inspector Signature: Date:
05IV3101 Continued

/X
Facility Number Date of Visit: % 2 Z LYI- Time.
Not Operational Below Threshold
[] Permitted [3 Certified © Conditionally Certified A /' 0p Registered Date Last Operated or Above Threshold:
L.,Farm Name: A)e. � o �r Ee #"% s., �G. l l�� County
Owner Name: �; ^� ^ T _ N c L' �AtC _ Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: `�/ �- G �Ri&llttegrator: N eu hofir
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude rya Du Longitude 00 0�
- -Desi = --Current..., Des` n =`"Current;. -
Swine Ca actt = Pa ulatwn -: ,Pout m
- : _Ca actty_ -po pulatipn _._ C
❑ Wean to Feeder +~: ❑ Layer [
F
❑ Feeder to Finish
�s
:
❑ Non -Layer
,
is
[
❑ Farrow to Wean
❑ Farrow to Feeder
} ❑Other
(
i' Tots1 Design G
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number;of Lagoons l ❑Subsurface Drains Present JQLa oon Area ❑ S rev Field Area
Hotdtng Ponds! Soitd I raps _ ❑ No Liquid Waste Management Svstem
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation.?
❑ Yes ZNo
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 ZNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 10 No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 2 33
Freeboard (inches): �-
05/03/0I Continued

Facility Number: 6 f? — )
Date of Inspection 1-1 2 Dl
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 Iiquid level
elevation markings?
❑ Yes No
❑ Yes 0 No
❑ Yes ZNo
❑ Yes ONo
❑ YesXNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,�YNo
11. Is there evidence of over application? ❑ Excessive Ponding El PAN [] Hydraulic Overload El Yes JZNo
12. Crop type �e--m,,Ac, i�4 S�"1Q�{ 4r-4ir(yc,-_cce_d
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? El Yes J❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ,0 No
b) Does the facility need a wettable acre determination? ❑ Yes fNo
c) This facility is pended for a wettable acre determination? ❑ Yes )?I No
15. Does the receiving crop need improvement? ❑ Yes ,ONo
16.
Is there a lack of adequate waste application equipment?
❑ Yes X� No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ONo
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 ONo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes EffNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes PNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes'0No
22.
Nail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes 9No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes Z'No
24.
Does facility require a follow-up visit by same agency?
❑ Yes 0 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ONo
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Comsneiats (refer to (iuestiozi #): Ezplatn aiiy(YES:"answers andlor_an}'recommeadatzaas or stzv atlzer cunaments.
Use drawings of fariltty to,better ezpiasn sifizahorts (tzse ado ddtnal pages ss necessary) ❑ Field Copy ^ ❑ Final Notes ,
-fit.,; f;3 well AETP�. -T7jF ✓rzoeoff awe Ytee O✓�a►tiZ�dR Iq nd
_7" is
r v v- I ke& . i,, g ma zv o k ✓tot -4Zt e s u> % h e h e tti s e s *tf nc,01 y
Tt,e rye Crop �S �s ��l�.s��h� i-vell en 4t,e me- NeAo�f
hti� �ad� Gi.h. e ��,eerti-►� .tC;�,..� c�,,��t e1e la.��a�-, ev�,lva�� ��� tva�k .
Pima. /vevkOPF W-T-f 1-J ob+et; \ GIrtd Serer me 'ill 1'g9eo-1
(� � ecew► b e � 31 f 2 0 0 2 � e i oct r Con. ve''�I n', -�o�ia y - �l� ,`r S �.o u 1 a( �c� �,�,�e�d�
Reviewer/Inspector Name ;= !1 - h J
Reviewer/Inspector Signature: Date: Z Z QZ-
05103101 Continued

Facility lumber: — Date of Inspection r'2 �--
Y
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, andlor 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 )Zf'No
❑ Yes 0 No
❑ Yes In No
❑ Yes ,O'No
❑ Yes "Feno
❑ Yes ❑ No
Additional Comments acid/or Drawings: _
(Ce �� �' e x� e d 04 j, dpe ..1 �} ; .- y �p�n cP<j too,- A
�Ctgn 1JD� 40 �DG(✓ e-P�L`t 1 70 1vltV''1 fR+✓1 7�1 f�j r+L �►1 cJdlld
05103101

Ihv stun of biter Quality
.
Q Division of Sod as3d WaterConservatton
OtheAgency+�x .
Type of Visit A Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Dale of Visit: Tijne: GGO Printed on: 7/21/2000
Q Nat Operational Q Below Threshold
E3 Permitted Certified �( Co/nditional�lyy Certified [3 Registered Date Last Operated or Above Threshold: ---.--.--------- .-
Farm Name: VC1``-z ] 1^�T .►��5 S-6W County:. G....................................................
Owner Name:... ................................................
Facility Contact:
MailingAddress:............................................................................
Onsite Representative: _.....,-
Certified Operator:
Location of Farm:
Phone No:...
Title:................................................................ PhoneNo:...................................................
-• .....................I..._......_.._.._. ............. .
Integrator:....-1..........................
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 L° Longitude • 4 &L
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
%Farrow to Wean
OCSO
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity population Cattle Capacity Population
❑ Layer I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSL W
Number of Lagoons ❑ Subsurface Drains Present IF0 Lagoon Area ID Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste 1-lanagement System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? ❑Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed; was the conveyance man-rnadc? ❑Yes []No'
h. If discharge is observed, (lid it reach Water of the State? (If yes, notify DWQ) El Yes ❑ No
c. If discharge is observed. what is the estimated [low in gal/tnin?
d_ Does discharge bypass a lagoon system? (1f yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes allo
3_ Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes CR�No
Waste Collection & Treatment
4_ Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Yes ❑ No
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: .................................... ........ �.......... ................................. .................. ................................................
Freeboard (inches): a7 33
5100 Continued on back

Facillly Number: — Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes `�(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ANo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes glo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �TNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? (Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes )2fNo
11. Is there eviden e of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes QNo
12. Crop typey� =7 1 slv a
t 1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
10-yiolati6iis;or deficiencies were npted- during �. s.vJsit' - Y;ou'Will -reeeiye iio further ;
icorresp6fidence. about this visit.
❑ Yes 19 No
❑ Yes Nf No
❑ Yes 0 No
❑ Yes kNo
Yes ❑ No
❑ Yes '- No
❑ Yes &No
❑ Yes JqNo
❑ Yes VNo
❑ Yes KNo
❑ Yes 4No
❑ Yes I<No
❑ Yes b(No
0Yes ❑ No
❑ Yes ,bdNo
Cominetits_(refer to question #)s Explain any YF.S answers and/or any recomrtendafioas or'any other conintents.':-
Use drawings of facilityto better explain situations. (use additional pages as necessary);
� � �e � � ��Q� �e.►� u�. Gt-� �.-.� i,l �7 't��,--per � .� K�
..T
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: e�;L- ! Q{ 5/00

Facility Number: — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AJor below rKVVes ❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
[(Na
2&
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[kNo
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
ONo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
3I.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
�IN0
32.
Do the flush tanks lack a submerged fill pipe or a peimanent/temporary cover?
❑ YesrNo
J
5100

4.
v Division of Water Quality '
Division of Soil and Water. Conservation
0 Other Agency -
Type of Visit lVompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint 10, Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: ®Time: l ilk Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
Permitted ❑ Certified ❑ Conditionally Certified © Registered Date Last Operated or Above Threshold: .......................
Farm Name: �!ff'�.�....\Cs Countv: • � 0--
.................................................
OwnerName: ..............................................................................................................
Facility Contact: .....
....................... Title:
PhoneNo: ............................................
................................................. Phone No:.........
Mailing Address: 't............. ............
Onsite Representative:.... ,1 ..-.. ....1}.................................................- Integrator:...-
.........................
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �° ��� Longitude �• �� �
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer I I JE3 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons In Subsurface Drains Present ❑ Lag—n Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
I. 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 dischar«e is observed. what is the estimated floe- in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑Yes
❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
❑ No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
❑ No
Structure I Structure 2 fqri6kaa, Structure Structure d Structure 5
Structure 6
��
Freeboard (inches): IaA e'Zr) ia`
5100
Continued on back

w�
r �
• acility Number: r, — Date of' Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenancelimprovement'?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ 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?
(icl 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
:: �'Vo yiolatigris:oi-• deficiencies •mere pgfe'd• d'&' i'ng fib' is:visit; Yoi� ;wii! r Beery' a �iti further
' rorres o deice: ab' *f 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):
U`�5 c� ��yL. ►-��'�— eve O K v-,.— ,►-�
4 � _ ( ,.•- rey �
Reviewer/inspector Name
Reviewer/Inspector Signature:
a - 2 . � c, �} . aa�
Date: 'a 5100

•1
Division of Soil and Water Conserva`tro�n Operatiton'Review w -1 �,„
4
Dmsron_ of Soi and Water Conserva4on .Com Lance t,oi 4�:,=
�" _DivlsiDll of V4�ater Quality Complkwce Im4pectton-
77
3
'z'-%^ w+ `,.-f Qther;A en © CiatlanReYl@W-: 14
Routine 0 Complaint 0 Follow-up of DWQ ins ection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection GC1
Time of Inspection 24 hr. (hh:mm)
�ermitted Certified [a Conditionally Certified © Registered [3 Not Operational Date Last Operated:
Q
..........................
FarmName: ........... ... ` .. h _.,._................................. County:............ v................. ................ ..... ..................
OwnerName-- ----- - --------------------------------------------- Phone No:---------------------------------------------------------------------- -- - -
FacilityContact: .............................................................................. Title:.......................................... Phone No:
Mailing Address: ................. ...................
OnsiteRepresentative :1.� Integrator:�t.,.
Certified Operator:.--.............................................................................................................. Operator Certification Number: ..........................................
Location of Farm:
Latitude 0 d 64 Longitude 0 6 °°
Design Current r
�_ Design �Cufrent :_Design : Current
n _ -
, ,-
;$wine = Ca ace Po elation Poultry Capacity -Population Cattle _Capacity °Populate
om
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean
w Q
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Numberof Lagoonzs
m
❑ Subsurface Drains Present ❑Lagoon Area
❑Spray Field Area
_ N
r HoEding Ponds;/ Solid -Traps
`
❑ No Liquid Waste Management System
r y ry
._ _.
DischaEges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ' No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes C�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes UNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): .............. ........... �
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 0'No
seepage, etc.)
3/23/99 Continued on back

\,
w, ti
Facility Number: — 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 maintenancelimprovement?
P(No
❑ Yes
Yes
❑ No
❑ Yes
0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? XYes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes NNo
11. Is there evidence off over application? ❑ Excessive Ponding ❑ PAN ❑ Yes fgNo
V12. Crop type `' , S U
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 fora wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? XYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes( No
Required Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available?
18. 'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20 Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Mb atigris:or• deficiencies were itoted d ...ing :Y66 VH1-trebvW6 Rio fui-th& .
'-�-corres orideace.abotiti#his visit'- -------- ------------- - - � - • .
Explain a
❑ Yes ONo
`ftes ❑ No
WYes EfNo
❑ Yes gNo
❑ Yes XNo
❑ Yes tZNo
❑ Yes M No
❑ Yes JS(No
9Yes ❑ No
V�-� -{- v�
M �'
�a`SG�' y`S `'tS i>G�rl-elr5 G1. e Q� 3)
zi
Reviewer/Inspector Name C -'` f- ,L „`"_
Reviewer/Inspector Signature: �t �- Date: S ! a • C}O

Facility Number. -- a1 Date of Inspection QCJ
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Ayes ❑ No
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?
rrt
IE'4
AL
v%,�L be
p LY
_V CQldw__,F �Q Le-
❑ Yes �( No
❑ Yes No
❑ Yes RJNo
❑ Yes 9No
❑ Yes ONO
❑ Yes [PkNo
A611

Division of Soil and' Water Eonservattiori :Operation•Revrew
' Division of Soil and Water Cohservatioh=.Comp6ance.Ihspectroio
r Division of Water Quality - Compliance inspection f
13
Other Agency Operation=Review - -
Routine 0 Com taint 0 Follow-up of DW ins ection 0 Follow-upof DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
© Permitted )R`Certified C] Conditionally Certified [3Registered 10 Not Operational Date Last Operated:
Farm Name:
Owner Name: ............................... Phone N29i -... . a-`rL '`'"1 go"t
............................................................
Facility Contact: ............ Title: .... 1..`. ess-1... 0.. ...................... Phone No:
MailingAddress* ........................................................................................................................................
Onsi€e Representative:........................................................................................................... Integrator:.••\ l` ........ ki ,...................................................................
Certified Operator:................ ...................... Operator Certification Number:., .. ...
Location of Farm:
----------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
E
Latitude �•�� "�•i Longitude r 46
Design Current. ' ;': ' • Design._ Gurient Design Current
Swine Ca aci Po ulahon foult` r :. =-Cattle'
ty p ry, Capacity Population Capacity Pouiaaon
❑ Wean to Feeder
❑ Feeder to Finish
arrow to Wean
'3Qt5G
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons, Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds% Solid -Traps �`'—�� ❑ No Liquid Waste Management System
...: w _ L__�. _ d
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
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
Strut ure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: �j—
Freeboard(inches): ...................`................ .................. ........................................................................................ ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes 1� No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [N No
[:]Yes �(No
❑ Yes P'No
Structure 6
...................................
Yes gNo
Continued on back

Fal!`ility Number: /r_1 — 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 evidencg of over application? []Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired 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?
0 To yiol'atigns;o..... en... mere noted ut�i>ng this;v.. will i-eeeiye Rio; 'uiths'r ;
correspondence. about this visit ' • . .
❑ Yes Of No
4Yes ❑ No
❑ Yes gNo
❑ Yes XNo
❑ Yes bjrNo
❑ Yes (WNo
❑ Yes OKNo
❑ Yes 9No
❑ Yes (3'No
❑ Yes nj No
❑ Yes YNo
❑ Yes ONo
❑ Yes XNo
❑ Yes O(No
❑ Yes O�No
❑ Yes 4No
❑ Yes (XNo
❑ Yes No
❑ Yes No
❑ Yes C�No
❑ Yes [XNo
Comments (refer_;to question'#): _ExplainFany YES answers'and/or any recommendations or anyother comments
Use;drawings of facilrty'fo better explain esttuations [use addrtional pages as necessary}
Wrwl
Reviewer/Inspector Name ` — - (Q .'
i
Reviewer/Inspector Signature: Date:
3/23/99

Uitcilfty.Number:'fi,�T Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes kNo
2& 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 O(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 VNo
31. Do the animals feed storage bins fail to have appropriate cover? []Yes RNO
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes XNo
MM ominents and/orravings:.. -
l
�t 5 1
'd)Ron
3/23/99

Revised Apri120, 1999
JUSTIFICATION & DOCUMENTATION FOR MANDATORY WA DETERMINATION
Facility Number - Operation is flagged for a wettable
Farm Name: acre determination due to failure of
On -Site RepresentativePart 11 eligibility item(sj F1 F2 F3 F4 :
Inspector/Reviewees Name:R�_,-.LC�
Date of site visit: ��1_9'1[
Date of most recent WUP: � �5'_ CN
Annual farm PAN deficit: ��pounds
Operation not required to secure WA
determination at this time based on -
exemption E2 E3 E4
Operation pended for wettable acre
determination based on P1 P2 P3
Irrigation System(s) - circle #�ard-hose traveler, 2. center -:pivot system; 3. linear -move system;
4. stationary sprinkler system w/permanent pipe; 5. stationary sprinkler system w/portable pipe;
6. stationary gun system w/permanent pipe; 7. stationary gun system wlportable pipe
PART 1. WA Determination Exemptions (Eligibility failure, Part 11, overrides Part I exemption.)
V E1 Adequate irrigation design, including map -depicting wettable acres, is complete
and signed by an I or PE.
E2 Adequate D, and D2/D3 irrigation operating parameter sheets, including map
depicting wettable acres, is complete and signed by an I or PE_
E3 Adequate D, irrigation operating parameter sheet, including map depicting
wettable acres, is complete and signed by a WUP.
E4 75% rule exemption as verifiedin Part Ill. (NOTE:75 % exemption cannot be
applied to farms that fail the eligibility checklist in Part II. Complete eligibility
checklist, Part If - F1 F2 F3, before completing computational fable in Part 111).
PART 11.75% Rule -Eligibility Checklist and _Documentation of WA Determination
Requirements. WA Determination .required .because -operation fails -:one of the .eligibility
requirements 'listed below-
_F1 .Lack.of:acreage-whichTesultedin:over-mpplicationmfwastewater�(PAN) onepray_:
field (s):accordingfofarm'siasttwoT- ears nfirrigation-xecords.7:
- F2 UnclearjIlegible, or lack of -information/map.-
F3 Obviousfield-limitations-(numerousz iitches;failure:-foAeductTequired
_:_.
bufferlsetback:acreage; or25°/a'.oftotaf:acreage�dentifiadanLAWMP_-:includes=
small; irregularlyzhapedflelds=-fields:less7fhan-b:acresfiortravelersior.lessfhan - .-
2 acres for.-stationarysprinklers).
F4 WA determination required because CAWMP credits field(s)'s acreage -in excess
of 75% of the respective field's total acreage as noted in table in -Part 111.

-- Revised April 20, 1999
Facility Number -
Part Ill. Field by Field Determination of 75% Exemption Rule for WA Determination
TRACT
NUMBER
FIELD
NUMBER'-2
TYPE OF
IRRIGATION
SYSTEM
TOTAL
ACRES
CAWMP
ACRES
FIELD
%
COMMENTS3
FIELD NUMBER' - hydrant, pull, zone, orpoint numbers may be used in place of field numbers depending on CAWMP
and type of irricafion system_- If pulls, etc. crossznorelhan'one field, inspector/reviewer will have to combine fields to
calculate 75% field by field determination for exemption; -otherwise operation will be subject to WA determination_
FIELD NUMBER2 - must be pleady delineated on -map.
COMMENTS' - back-up fields with CAWMP acFeage�exceeding?5% of its total:acres and having received less than 50%
of its annual PAN as -documented in the farm'spreviousfwo years' (1997 & 1998) of irrigation records' cannot serve -as -the
sole basisforrequiring a WA Determinafion:;Bacic up3�eldsznust�be-noted in the-comment�ecfionand must be accessible
by irrigation -system_
Part IV. Pending -WA'Determinations-
P1
Plan :lacks:following information:.
P2 Plan revision-may:satisfy-75% rule based on adequate overall PAN deficit and by
adjusting -all field -acreage:to -below 75% use rate
P3 Other (iefin process of installing new irrigation system):

Division of Soil and Water Conservation [3Other Agency
@ Division of Water Quality
IgRoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection b
Facility Number
Time of Inspection . Y0 24 hr. (hh:mm)
© Registered U Certified © Applied for Permit PUermitted 1 Not Operational Date Last Operated :..........................
C� County:............ph. Farm Name: .... Meu-1 2.YY..........Y"iff
Owner Name:...A&l.I..l�6E�..... L...... .... 6. 1 _ ................f.0, .. Phone No: �j .L.....71� .....z l.............................
Facility Contact: ......... t.. ✓'H-ti-1........ .(v, 4&.;, f.:�.05.. Title:...... v '. ............ Phone No: .
- e _ Z`7b'SCa
Mailing Address: T P �Qc .l ,1..'.' .t ......,'../I.... fiJlx,:...................... ..C,.T.. fif'rl/i.Jk:��.�r......�...1.-__----..........
OnsiteRepresentativc:,-..j.w!r'rr.......... utrC� ... .. .. Integrator:...f`..................................................
.... ......... ....................... .................
Certified Operator,.A.(tidA............................. ...... a-..jg : 't............................ Operator Certification Number...................
Location of Farm:
Latitude • 0' " Longitude • 4 0"
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes] No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes © No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes 21 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes (a 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
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [ eNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 10 No
7I25197

IT Aility Number: 7-
8. Are there Iagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (LagoonsMoldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard ft
10. Is seepage observed from any of the structures? ❑ Yes B No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12. Do any of the structures need maintenancelimprovement? ® Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes ® No
Waste Application
14. Is there physical evidence of over application? ❑ Yes .KNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .......... �,... 4.................................................... !!& ..%.................. ................................. ..............................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ER(No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes jo No
18.
Does the receiving crop need improvement?
❑ Yes
19 No
19.
Is there a lack of available waste application equipment?
❑ Yes
12 No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
El No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22. Does record keeping need improvement? ® 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 4Q No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ,Yes q No
25. Were any additional problems noted which cause noncompliance of the Permit? ArYes M No
0` No.violations-or d6irciencie's:were noted-dluiing this:visit.- Nodwill rece'ive°no°Furth:er
.:-corresp�ndenceab:oufthis:visit:•:.-:•:-:•: ":•:•:•,.::.:•:•.•.•.•:�::::.:.:.:....:...:.:.� _.
!z• L�G� ,rytA2L'��5 �eil�� �.�— ��-- /�v-t-%moo•[ fJ�' ��h- �s ��...�-�•e�
� 2 . d.�.�. t7 -m �3 Fs r �. (c.c��-�'"� L� r� ��l /� c.�r•�5 !-�z�C� _ � � 3
C y
Di �3 • ��i4i tic ,.t JUJ A,,rv,LS ` m % 4 �hc� r� 14F�I %25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:

5z
Feedlot_-Qp&kationReyio'
101 0 �11 PL
Routine 0 Complaint 0 Follow-up of DCVO inspection 0 Follow-uo of DSWC review 0 Other
Facility Number
Farm Status:
Total Time (in hours) Spent oaReNiew
or Inspection (includes travel and processing)
Farm Name: Z) 4!2�145f Z
Owner Name.... 2 92 9---- Phone No:
Z6
IN -failing Address: 0 lr2. 00( Aw
Onsite Representative: __-AC_S4&fd Integrator:
Certified Operator- Operator Certification Number: __—....
Location of Farm:
Latitude F771 F - 7_1 Lonaitude a
M
10 Not Operational Date Last Operated:
- ry-pe of Operation and Design Capacity
2,
"- X_Nt<mberM Pou otUM e ,
e
.,Number
El Wean to Feeder
10 Laver
1-7J."'10 Dairy
El Feeder to Finish
3-[0 Non -Laver
JEJ Beef aF
Q Farrow to Wean
0 Farrow to Feeder
ELFarrow to Finish
2ACW e of Livestock
Number of Lagoonsrf Sold>hg Ponds rFSu`bsurface Drains Present
F0_La7go_onAi Spray field Area
m-'an
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, noii& DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notif-v DWQ)
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?
El yes 9 No
0 Yes 10 No
El Yes R No
E3 Yes X1 No
El Yes M No
0 Yes [3 No
❑ Yes P No
Yes 0 No
5. Does any part of the wane management system (other than lagoons/holding ponds) require
maintenanceArnprovement?
__ A, L-

6. Is facility not in compliance with any applicable setback criteria?
7. Did the facility fail to have a certified operator in responsible charge (if inspection after 1/l/97)?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La dons and/or IloldinQ Ponds
9. Is structural freeboard less than adequate?
Freeboard (ft): Lagoon 1 Lagoon 2 Lagoon 3
/. 7
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 DWQ)
11 Do any of the structures lack adquate markers to identify start aad stop pumping levels?
Si'aste Auplication '
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 ArES Ge.s r
16. Do the active crops differ with those designated in the Animal Waste Management PIan?
17. Does the facility have a lack of adequate acreage for Iand 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?
2I. 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 Revieweplispector fail to discuss review/'inspection with owner or operator in charge?
❑ Yes \`o
❑ Yes
Q Yes ❑ No
❑ Yes ® No
Lagoon 4
❑ Yes R1 No
Yes ❑ No
® Yes ❑ No
® Yes ❑ No
❑ Yes 10 No
❑ Yes jj�No
Al Yes ❑ ; io
Eff Yes ❑ No
❑ Yes El No
Cl Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
® Yes ONO
❑ Yes 4 No
X
..,.
���;4'�...: ��- ��"�(i<:�55 Old h�f,NG- �Ti�o r � ��� G'£�i i.i�ca-r«• �vrY►.�-
iS
GRPeiv.
Reviewer/Inspector Name-
Reviwer/Inspector Signature: - Date:
cc. Division of Water Quality, Water Quality Serdon, Facility Assessment Unit I I II tl96

IJ
Facility Number:-
Division of Environmental Management='x ;
nimal Feedlot Operations Site Visitation Record
g r.
.A
Date: -g�
Time:/2°�
"Yarm Name: �Iuc nr rz.cl t�e,�T,�s � _County{/hcf��li�
Owner Name: y _ Phone No:_a...� 3,(zl-? Z
On Site Representative: Integrator:
Mailing Address: Pla 60x Gi5
Physical Address/Location:Zz-
Latitude:_/ 51 / 51 Longitude: -T 7
Operation Description: (based on design characteristics)
Type of Swine No. of A,�}iType of Poultry No. of Animals Type of Cattle No. of Animals
Q'Sow _ 1L1_` �% 0 Layer El Dairy
0 Nursery ❑ Non -Layer ❑ Beef
0 Feeder
OtherType of Livestock Number of Animals:
Number of Lagoons: -3 (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoon(s) freeboard less than 1 foot + 25 year 24 hour storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
❑ Man-made ❑ Not Man-made
Co ver Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the crops which need improvement)
Crop type: C Q v. da / & & Acreage:
Setback Criteria
Is a dwelling located within 200 feet of waste application?
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
ADI -- January 17,1996
Yes ❑ No
Yes ❑ No
Yes 0' No ❑
Yes ❑ No Z--'
Yes ❑ No ❑
Yes ❑ No Q-'
Yes ❑ No ❑
Yes ❑ No ❑
Yes ❑ No ❑
Yes ❑ No ❑

Maintenance
Does the facility maintenance need improvement? Yes ❑ No 0
rls there evidence of past discharge from any part of the operation? Yes ❑ No ❑
Does record keeping need improvement? Yes ❑ No
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No ❑
Explain any Yes answers: �y � 6 � a n n _ JJ c ` -j �t &,lam ah,_ , a It
i
Signature: ��•h-+!� S _ _ - _ Date:
cc: Facility Assessment Unit Use Attachments if Needed
Drawings or „ Observ_atian '
AO[ -- January 17,1996

Facility No_
- _ - _ 4 NTAL - • - ?vlE�i T - _
DATE: g , 1996,,`s
`- Time: ' 3T
Farm Name/Owner: ; /L'Gi—D_ _ 4 oc,4j6Ti C
Mailing Address: Z �STF p. ,P. '- - �.���(«, S Zfr_,5_7f
County: 0✓1S-
? Integrator: /v t` Phone:
On Site Representative: 13 Q.(AA_� Phone:
Physical Address/Locadon: 1 Z Z S �' I.--. le ..,,,.,� S2 _ 1-2 2-1
Type of Operation: Swine X Poultry Cattle
11 Design Capacity: �`1 >•`� 5� Number of Animals on Site. ,4.b
DEM Certification Number: ACE - DEM Cerdr cadon Number: ACNEW
Latitude: Longitude- Elevation: Fee,
Circle Yes or No
Does the Animal Waste Lagoon have sufficient :Eeeboard of 1 Foo=_ - 25 year 24 hour storm event
(approximately I Foot 7 inches) Yes o o Actual Freeboara: --L_Ft. Incites
Was any seepage observed from the lagoon(s)? Yes orb Was any erosion observed? �or No
Is adequate land available for spray? or No Is the cover crop adequate? �O or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet Lot= Dwellings?(n or No
100 Fee t x om Wells? Vs or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line S i-e am? 0 or No
Is animal wasteland applied or spry irrigated within 25 Fee, of a USGS TvIap Blue Line? Yes ore
Is animal waste discharged into waters of the state by man -trade ditch, flushing system, or other
similar man-made devices? (tD or No 'If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific ac-zeage=with cover crop)? 0 or No
Additional Comments:_j5c&&, P�e_ �- , �spue 13CO r0 ��v�c�✓ : ��_ �F�+�
it r�=
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Inspector Name
cc: Facility Assessment Unit
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S iA re
I s,- Au_-,AimLnts if Needed.-_

} Site Requires Immediate Attention:
Facility No. (:,7— 1 X
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE_ 3 Z , 1996
Time: ' 3
Farm Name/Owner: clue n eS
Mailing Address: Lf c Z - 6OSTF_nJ e,C'e
County: ✓zS 1 o1J
Inte?rator_ - I-) Ev .g2uti5 Phone:
On Site Representative: Phone: z 5F— OSF
Physical Address/Location:
Type of Operation: Swine X Poultry Cattle
Design Capacity: 7 45 J 1-�) _5occ/ Number of Animals on Site '' SLV
DEM Certification Number: ACE DELI. Certification Number: ACNEW
Latitude: Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes o ' o Actual Freeboard: I _Ft. Inches
Was any seepage observed from the lagoon(s)? Yes orCQ Was any erosion observed? rl5lor No
Is adequate land available for sprav? or No Is the cover crop adequate? 40 or No
Crop(s) being udEzed:
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellingsz!n or No
100 Feet from Wells? Vs or No
Is the animal waste stockpiled witihm' 100 Feet of USGS Blue Line Stze:m? 5 or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or(D
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? (0 or No -If Yes, Please Explain_
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? 0 or No
Additional Comments:3n-kSn, , J�Noutr` 13£ rQ �t%N�zc?✓ :►� A/
P,Q P.�faA��, i�-Fy 7y i
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IL l S , n0ca BIZ-
Inspector Name
r
Signature �^
cc: Facility Assessment Unit
Ls, .ate.:�rr�ents if Needed.-..

Site Requires Immediate Attention: cix_3
A,NZMAL'-FEEDLOT OPERATIONS SITE VISiTATiON-RECORD
DATE: 3- Z- O _T, 199.6
Time:._i6, ad
Farm Name/Owner:_ _ AC� P A n.I e' ID
✓ Mailing Address: 40 Z- (f-0 5 S ri � �.c.P� � e k jz,.tk<Z -7 \c
County: _ IV.� Ou
Iritegrator. IL)J � �� - - Phone:
On Site Representative: f ' AZ 4A 8: � `Phone: 3 Z {f 14
Physical Address/Location:
Type of Operation: Swine \x/ Poultry Cattle ALI
Design Cauacirv: Number of Animals on Site:
DEI4 Certification Number: ACE DEM Certification Number: ACNEW
Latitude:_S1_' 31 Longirude: 1� ' 35 ' Z6 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour stoma event
(approximately 1 Foot T 7 inches) Yes or6W A``ctuual__Freeboard: Ft-.' 6-7Inches
Was any seepage observed from the lagoon(s)? Yes or i�l�w as any erosion observed? � or No
Is adequate land available for spray? or No Is the cover crop adequate? 0or No
Crop(s) being utilized: _ �t5c�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dweilin gs? (!M or -No
100 Feet from Wells? q�R_ or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line SU-eam.? Yee r No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o 0
Is animal waste discharged into waters of the state by roan -made ditch, f ussiina system, or other
similar- man-made devices? Yes ot(jo If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)' or No
Additional Comments , � ,-- l -r o._ ; t �rLk_-t- '#—v -0v --_y_1A,,,2, y c e tte s
C'.
J Inspector Namel
Facili€v Assessrnen€ Unit
Signature
Use Auachmenis if Needed.

Site Requires Immediate Attention: _ �
Facility No. L�eZ-
DIVISION OF ENVIRONMENTAL MANAGENEI iT
A_NTAAL FEEDLOT OPER.kTIONS SITE VISITATION RECORD
DATE. 7- z-O , I996
Time: , Q d r ID Z qv 0
Fain Name/Owner: DNA N c. C D T tC
Mailing Address: _ Ito Z- C-a 54-6:7ti 4ce, _ ��.�!-� Crh�n! _ 29S'-7�
County: ©!l% S O W-2 _
Irate -orator. A! J b (� £� - - _ - Phone:
On Site Representative: L A-Ir Phone: 37-Y euo 54
Physical Address/Location:
Type of Operation: S wine - \!/, Poultry Cattle : LI
Design Capacity: `L,�jSw_ s Number of Animals on Site: 5 ��
DEM Certification Number. ACE DEM Ce,=-carion Number: ACNEW
Latitude: Longitude: Elevation: Fee:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes orLI Actual Freeboard: Ft. _% Inches
Was any seepage observed from the lagoon(s)? Yes or DOW as any erosion observed? Zgor No
Is adequate land available for spray? (9 or No Is the cover crop adequate? -por No
Crop(s) being utilized: �t5�� l � -t . Ste_ C-'--s 6-9
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings?(n or No
100 Feet from Neils? V�'R or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? (e br No
Is animal waste land applied or spray irrigated within 25 Fee; of a USGS Map Blue Line? Yes of9jo
Is animal waste discharged into waters of the state by man-made ditch, flushing sv_ stern, or other
similar roan -made devices? Yes opco If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific' acreage with cover crop)' or No
Additional Comments:' v-" . 4) -e-f `C4.F Le 7 L e_ .v cam. t rn (J .. L _L., , C I.z.,s
_ el ry let- vi,, , a
t r
J Inspector Natn
Facility Assessment Unit
Signature
Use Airacliments if Needed.

Site Requires l,ediate Arten 'on:A
Facility No.
DIVISION OF &NVIRONMENTAL MANA-GLMEti" I'
A—N, U AL FEEDLOT OPER.ATIO S SITE VISITATION RECORD
DATE: yZ , 194
Time: Vz : a 4
Farm Name/Owner:
Mailing Address: _
County: 401 -C
P,
-ela 2 Cosro AJ AD ,�r-,, -,a-wb S 28r7 q
Inte- ator. _ IVE:VH01
On Site Representative:
Physical Address/Location:
Phone: J2;�- a - yge I/
Type of Operation: Swine Y Poultry Cattle
Design Capacity: & I'Xh -LO&) Number of Animals on Sire: SOO
DE1�I Certification Number ACE DEVI Cerdacaron Numoe. ACNEW
Latitude: LonEirude: Elevation: Fee:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot = 25 yew 24 hour storm event
(approximately l Foot + 7 inche Ye r No Actual Freeboard: ' Z Fr. Inches
Was any seepage observed from the lagoon(s)? Yes low- as any erosion observed? Yes r No
Is adequate land available for spray? IIYes or No Is the cover crow adequate? Yes or No
Crop(s) being utuized -
Does the facility meet SCS minimum setback criteria?. 200 Feer from Dwe?lingsrYeer No
100 Feet from Wells? C!eosoobr No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line S tre :m? Yes o 1 0
Is animal wasteland applied or spray irrigated within 25 Feet of a USGS titin Blue Line? Yes o�NoJ
Is animal waste discharged into waters,cf the state by man-made ditch, flushing system, or other�y
similar man -trade devices? (5�r No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes or manure, land applied,
- - - - spray irrigated on specinc acreage with cover crop)- es r No
Addidonn��al��Comments: _ %l ✓1 �7i/G�r Jam- Z//���}i�'
fZL®I�` JVIAP G/r ' IA-% , l'1�G/"11G� T�ti11nKY��
wWtly SR %Z 2,r , A7Q • 9;/r
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Inspector Name
ern azure
?AE; wde6
re Afu
WT7 C, _ GI PtD
cc: Facility Assessment Unit Use A[rachments if Needed.
iW192. .5.po j L %gm /' R5 a^/ t7/q or
k&)"16ajn% APT" 4 /1 xanNFAa f� ��, 711z196 .

OPERATIONS BRANCH - WQ f'ax:919-715-6048
Jul 24 '95 18:04 P.05/12
Site Requires Immediate Attention 1V6
Facility Number %—
i SITE VISITATION RECORD _ -
DATE: ,� u cr_- 1995
Owner: _Alou nu42P 55.ri, -lAic Farm Name: Me 0 o-(� fu, .,AT - u<-_
County: l W-
Agent Visiting Site: � kcC _ `Phone:
Operator: O U i _ - - _ , Phone: 3
On Site Representative: Phone:
Physical Address: -- 4 0 z ci�
Mailing Address -
Type of Operation: Swine ✓ Poultry Cattle
Design Capacky: %/�117-0 _ Number of Animals on Site:
r
Latitude: �" " Longitude: P"
Type of Inspection: Ground _ci Aerial
. Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard.of 1 Foot + 25. year 24 hour storm event
(approximately 1 Foot +$ inches) 0 or No Actual Freeboard: z Feet y -- Inches
For facilities with more than,one lagoon; please address the outer lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or o Was there erosion of the dam?: Yes or 'a
Is adequate land available for land application? 'Ye^ or No Is the cover crop adequate? 40or No
Additional Comments:. % f C,- i,FK�li /6,3 /jj, rL 4rf ear o
Al-7" rr.7-�.�[rr� li. ,. .. J/_I
Fax to [phone] Sig ature of

C�6tr/// , J"'f�
Site Requires Immmediate Attention: PO
�I Facility No. 6, 7 —
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 % , 1995
Time: _
Farm Name/Owns
Mailing Address:
County: �-^4104AJ_
Integrator: Phone: 3-3 C/
On Site Representative D/ Phone- 3 a'6--6, 3 �—
I S2 12-_
Physical Address/Location: -s/6 /z Zl�l_ 7D (mot _/4W 00
�, wry► � , ,�c.��'. �..�,.,•� � �-r�[,rct� `�
Type of Operation: Swine Poultry U Cat/tle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° S/ 3 7 " Longitude: 7 7 3 S d Elevation: a2 n Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard'of I Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard: 3 Ft. Inches
aWas any seepage observed from the lagoon(s)? Yes or No as any erosion observed? Yes or lie
Is adequate land available for spray? Yes or No Is thefcover crop adequate? Y se Qr No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes r No
100 Feet from Wells? Yes r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or6)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes oYNo
Is animal waste discharged into wate�the state by man-made ditch, flushing system, or other
similar man-made devices? Sor o If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
n
(Z i mom- s ` " �`r�-� I�.�/J_��
Inspector Name } Signatures
cc: Facility Assessment Unit Use Attachments if Needed.