670009_INSPECTIONS_20171231

r
NUH I H LAHULINA
Department of Environmental Quaff

Type of Visit: 0 �Zoultine
nce Inspection Q Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: Q Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 6A)KO W Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: tj 4 'T JO(L_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: 1-7 3 Ko
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Pouitry
La er
Design
Capacity
OU_ rent
Pop.
Design Current
C*able C►apacity Pap.
Dairy
I
El
Farrow to Finish
Layers
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
EjrPullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Cow
Wean to Feeder a
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current Dry Cow
Drr P,oult , C•_a aci P. Non -Dairy
Discharges and Stream Imaacts
1. is any discharge observed from any part of the operation?
❑Yes
No
❑ NA
❑ NE
Discharge originated at: El Structure ❑Application Field ❑Other:
a. Was the conveyance man-made?
❑Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑Yes
❑ o
❑ NA
❑ NE
2. is there evidence of a past discharge From any part of the operation?
❑Yes
o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑Yes
Ej No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 2/4/2015 Continued

Facility Number: IDate of Inspection:
Waste Collection & Treatment
4. ls,storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): cw
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
ZNo
❑ 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
[
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Ndo
❑ 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
CNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
ZNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
2 No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2f/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2!(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 ❑Ot r:
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ eekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking op Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VNo
— ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: _ t3 Date of Inspection:
24. ;Did the facility fail to calibrate waste application equipment as required by the permi . ❑ Yes VO
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 Zo
❑ 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 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 dNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0No
❑ Yes No
❑ Yes I� O
❑ Yeso
❑ Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question°#): Explain any.Y>E;S.answers and/or•any additional recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional:pages as necessary).
�S.) SGd NEEbS Ta 9E K(WjvvC_0, A S S(- VAY -D
Y✓ w��amp-
J
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
Phone u ,-
re: Date: a�
2/4/201 S

(Type of Visit: Q Compliance inspection U Operation Review Q Structure Evaluation U Technical Assistance
Reason for Visit: 6 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: 11 County: OMSL.OtJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Q NZA?� Q.A`e UO(_
Certified Operator:
Title:
Phone:
Integrator:
Certification Number: 3g�
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Design Current
Design Curren t
Swine Capacity Pop.
Wet Poultry Capacity Pop.
Cattle Capacity Pop.
rp'Feed:e:rto
Weao Finish
1-a er
DairyCow
Wean to Feeder t.(�
d
Nan -La er
Dai Calf
Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
D , P.aultry Ca aci P,©.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:]Yes �'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (if yes, notify DWQ) ❑ Yes M No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes YNo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: (a9 jDate of Inspection:
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
Identifier: 4A Grc DO
Spillway?:
Designed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): a.0
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 O/No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [2/No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [] Yes &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? ❑ Yes 0 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 �o [DNA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]'NO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:2�o
❑ NA
❑ NE
Required Records & Documents
f
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
e No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
jrNo
❑ 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.
ElYes
0<0
❑ NA
❑ NE
❑ Waste Application ElWeekly Freeboard ❑ Wasste 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
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: (07 - 9 jDatcof Inspection:[I-jItg
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes C2'No ❑ NA ❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E2 f No ❑ NA [] NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 0l 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes EJKo ❑ NA ❑ NE
❑ Yes E,_,�No ❑ NA 0 NE
❑ Yes &No ❑ NA 0 NE
❑ Yes fNo
❑ Yes VN
El Yes
❑ NA ❑ NE
[DNA ❑ 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Jo u u tAtz�vELL
Phone: E b � 4 6 ~,I 3 8g
Date:
24110ll

Type of Visit: &Co/mpliance Inspection Q Operation Review p Structure Evaluation p Technical Assistance I
Reason for Visit: QS Routine 0 Complaint 0 Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 3 l Arrival Time: ® Departure Time: Y p County: OAJSL b ln/ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �jQJ-r�qa R A gtJd(L Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 19 3 �b
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle er
La DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
DairyHeifer
Desn C igurrent Cow
D , P�ou1.. Ca a_ ci P,a , Non -Dairy
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -La ers
Beef Feeder
Boars
ALLOnlier
Pullets
Beef Brood Cow
Other
Other
!!keys
Turke Poults
Discharges and Stream_Impac_ts
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 E:j No ❑ NA ❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes [rNNo ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili on: Number: - Date of Ins ecti
Waste Collection & Treatment
4- Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes CZ 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: (JgGODJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
IDYes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[�('No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
EWNo
❑ 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 E3No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C2/No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes O/NNo ❑ NA ❑ NE
❑ Excessive Ponding - ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F3/N o
❑ NA.
❑ NE
acres determination?
No
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
6/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fait to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
FZ/No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install Yes
❑ Sludge Survey
NA NE
and maintain a rain gauge?
❑
❑
❑
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number: jDate of Inspection: I
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
2'S. Is the facility out of compliance with permit conditions related to sludge? If yes, check El Yes FfNo ❑ 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 �FNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [2No ❑ NA ❑ NE
❑ Yes []�i<o ❑ NA ❑ NE
❑ Yes 6o
❑ Yes No
❑ Yes YNO
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I Use drawinizs of facility to better ezolain situations fuse additional na2es as necessarvl.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: IrD / 4 i3 DO
Date:
1

Type of Visit: (3FCosfipiiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit:81'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 2 f County: DVSCAW Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: &l=pj,) q AA �dw-' _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Wean to Finish
La
Wean to Feeder
or
Non-L;
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
7Non-L;
Boars
Poults
Other I I IMI (Other
Phone:
Certification Number:
Certification Number:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: w
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?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
_Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes o
❑ Yes rit
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: -
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
t
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure Str
ucture 2
Identifier: �u
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 . 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 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 �To ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes WMo ❑ 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?
❑ YesYN!
Zo
[] 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
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[yNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
/No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design [:]Maps ❑ Lease Agreements ❑Other: 1-1
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes ZNo C] NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZNoo
NA ❑NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑Yes
zo
❑ NA ❑ NE
�5. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ ❑ 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 121<0 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 9,'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 R(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 U/N 0 ❑ 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 Mo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes j2]K ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does facility follow-up by
❑ Yes [ ❑ NA ❑ NE
Yes No NA
the require a visit the same agency?
❑ u ❑ ❑ 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 PaSes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: L GW G
Date: 4 A 13
412 J1I

Type of Visit: Q Co pliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine O Complaint Q Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: S O Departure Time: County: 4� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: p Title: Phone:
Onsite Representative: ytLrR>J !►� l��rJ�6l_ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
i)esign Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder 3gU b
Nan -La er
DairyCalf
Feeder to Finish
Design C*urrent
Dr, P,oultr..y Ca aci_ P,o
Layers
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [%�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ YesVNo ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FaciU Number: - Date of Inspection: Z
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: LA(-000
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): L
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 0 NE
❑ Yes /No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm7114
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? ElYes o ❑ 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 WNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes En No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes A10 ❑ 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
[—]Yes [7f No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes VNo
❑ NA ❑ NE
Yes ❑ NA ❑ NE
[:]Yes LJ No ❑ NA ❑ NE
❑ Yes hTo ❑ NA ❑ NE
❑ 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes WNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Ins ection: 9
24. -bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �' ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes 9X0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a FOA 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 ❑ NA 0 NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [—]Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes �No ❑ NA ❑ NE
❑ Yes 01/No ❑ NA ❑ NE
❑ Yes E14 ❑ NA ❑ NE
❑ Yes 0 lip ❑ NA ❑ NE
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 o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes [yo ❑ 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)............
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
rnone:\,:.Lt[.r
Date: 4 ( Z
21412011

a D1V1S1pOf Water Qna Itlit}
F Aft' °NumbeO'Dtvn!on of Soil and Water Conservation -
0
- =OtherA gencyi�—
Type of Visit �Coompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (31 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: .2 l "I Arrival Time: (7D6 Departure Time: County: oL�SWJJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: *1 ��� Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = I =1 Longitude: 0 0 =1 [= «
} Design
Current Design Current.:„; De'sigii Current ..
Swine Capacity Population Wet Pout CapactyPop'ulati nA Cattle Cap city Population
<< El Wean to Finish
❑ La er
El Dairy Cow
a we to Feeder 3 O
❑Non -La er
❑ Da Calf
❑ Feeder to Finish
M
❑ Dairy Heifer
❑ Farrow to Wean
a ❑ D Cow
❑ Farrow to Feeder
Dry„Po trW11y
° ' " "'
❑ Non -Dairy
❑ Farrow to Finish
[ILayers
Beef Stocker ❑
❑ Gilts
7 ❑ Non -Layers
El Beef Feeder
(] Boars
El Pullets
❑ Beef Brood Co
Turkeys
O#her„
❑ T urkey Poults
❑Other
10Other
�Number��'of Struc urges
- _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
[]Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
IJ�N
❑ NA
❑ NE
[I Yes
IJ No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
r
Date of Inspection 2
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
Identifier: �,Qryar,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 25`
❑ Yes dNo ❑ NA ❑ NE
El Yes El No ❑NA El NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �No El NA ❑ NE
[]Yes EJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes Ql<o ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes P<o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance altematives that need ❑ Yes U/ No ❑ NA ❑ NE
maintenance/improvement?
1 I . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes LEI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
O-No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El"No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LI No
❑ NA
❑ NE
Comments refer to question .: _ a
( q 4): Explain any YES answers and/or any recommendations or any other comments.,.., . . .
!Use Oir ings,of faciliiy.to better;explain situations (use additional pages as necessary)"
i
Reviewer/Inspector Name . 044 d
Phone:
Reviewer/Inspector Signature:
Date: j
Page 2 of 3 1 12129104 Continued

Facility Number: — Date of Inspection
Re uired Records & Documents
' 19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I 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
2fNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El No
❑ NA
❑ NE
24.
Did the facility fait to calibrate waste application equipment as required by the permit?
❑ Yes
Q4o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
EJ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[r No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L<o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
2 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, Freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VN
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 I2128104

type of Visit �C,00 pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit r Koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: S 14 Arrival Time: l S Departure Time: County: 6 NS�..y Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: (3a_x.)%►J �A`h►O�—
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 1= Longitude: 0 0= 6=«
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poaltry C►►opacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ DairyCow
Wean to Feeder 33
❑ Non -Layer
❑ Dai Calf
❑ Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Co
El Turkeys
Other
❑ Other F
❑ Turkey Poults
❑ Other
Number of Structures a
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes Gl"No ❑ NA ❑ NE
El Yes
El No
El NA
❑NE
[]Yes
[:]No
[]NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[! No
❑ NA
❑ NE
❑ Yes
[:4
❑ NA
❑ NE
12128104 Continued

i
Facility Number: G 1 Date of Inspection 5 b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA Cs-a"yIJ
Spillway?:
Designed Freeboard (in): .y
Observed Freeboard (in): L�Z
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 El Yes
Yes ❑ 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 U(No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes o ❑ 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 dNo ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
t2. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U ❑ NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El
o El
El
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
VNo ❑ NA
❑ 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
7o ❑ NA
❑ NE
Comments refer to question # Explain » ( q ) pain any YES answers and/or any'recominendattons 6 AnK li comments
Use drawings of facility to better explain situation's. (use additional pages as necessary) - � W ' -
Reviewer/Inspector Name �} Oi -I (L1J L L Phone: 1 U
Reviewer/Inspector Signature: Date: s d

i
(Facility Number: — Date of Inspection a 5 b
Re uired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes dN ❑ 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 ❑ Ch kl' is ❑ D ❑ Ma s ❑ Oth
ec �s esign p er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
0 No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ENo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L'I No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
d o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
7No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNO
❑ 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
2No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
dN o
❑ 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?
El Yes
�(
E I 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
[Z 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
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
o
❑ NA
❑ NE
Additional Comments and/or,Drawings a ,
12128104

Type of Visit (2fCo liance Inspection * O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 1 3o a°t Arrival Time: / ! Departure Time: County: A SL,61A) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 13fQtA RA`? A! c It.—
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: = ° 0 1 =
Design
Swine Capacity
Current
Population
Wet Poultry
❑ Layer
Design
Capacity
Current
Population
Design
WI
Cattle Capacity
Current
Population
❑ Wean to Finish
❑ Dairy Cow
® Wean to Feeder
39L40
3032
10 Non -Layer 1
1
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
I
❑ Layers
❑ Non-Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ o
❑ NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
Vo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
XNo
❑ NA
❑ NE
other than from a discharge?
Page l of 3
12128104
Continued

I
Facility Number: — Date of Inspection [ a o
`Waste Collection & Treatment
/No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: UA Cdb O
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 29
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EI/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
ONo ❑ 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
L1 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
EKO ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ff 'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? El Yes
Ef No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
'Comments (refersto question=#) Eitplatn any YES answers and/or any recommendations or any other comments.
Use drarnn s affacil�`to better ex Ia�n�s�tuahons use a d�honal; a es as,necessa • , -
g ty �r kP i ,;( p 1; rY)•
Reviewer/InspectorName I Phone: (Qyo) 744 73I
Reviewer/Inspector Signature: Date: a o
rpsC Z Vf J .'_w .nuca

Facility Number: 7 — Date of Inspection 1 e
`RecLuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [INA ❑ 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. ❑ VVUp ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[3 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
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
,El"No
(� No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
O'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L"J No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
{ENO
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Elkilo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ldNo
❑ 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
dNo
❑ 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
Phfo
❑ 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
ffNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L✓1 No
❑ NA
❑ NE
Additional Comments and/or;Drawin
Page 3 of 3 12128104

61
Type of Visit ecompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: y 25 J Arrival Time: Departure Time: County: (KI ILA r✓ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: �` Title:
Onsite Representative: _ 004A " &1;qA10 V Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = { Longitude: = ° = ,
Wet Poultry
wc
Design
Capacity
Current
Population
Design Cua.rrenpulation
CattleMCapacitvmpuUffion
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
Wean to Feeder Q
6T 3
❑ Non -Layer 1
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Dry Cow
ElNon-Dairy
❑ Layers
Non -Layers
❑ Pullets
ElTurkeys
❑ Turkey Poults
❑ Other
El Farrow to Finish
El Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Braod C o
Number of Structures:
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
0 No
ElYes
LdNo
❑ NA
❑ NE
❑ Yes if�No ❑ NA ❑ NE
12128104 Continued

facility Number:. —
Date of Inspection E]*
,*aste Collection & Treatment
/No❑
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: (A C op—)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): .S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L! No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
' No ❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmentTtbrat,
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
ONo ❑ 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
EXo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ONo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
<o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElLJ Yes
��No
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ElrNo ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 No El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
'_TUN e< 19 _ O CT -S I
Reviewer/Inspector Name Io� �, j�pro,} L�_ Phone: 73
Reviewer/Inspector Signature: Date: a

Facility Number: — Date of Inspection d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 12No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes O NNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desi n g [I Maps El Other !!
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U' o ❑ 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
L/ NNo
❑ 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
6/J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
21"No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
dNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
Q'NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWWMP?
❑ Yes
LI No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EJ 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
En 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
El Yes
,,��,,//
L'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
BIN
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EI No
❑ NA
❑ NE
,a,.��•
Addihonal:Comments:and/or Drawings "��
Page 3 of 3 12128104

Division of Water Quality
acility Ntimber �ji "] O Division of Soil and Water Conservation
0 Other Aqiency
Type of Visit
Crpliance Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
(6 Routine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: p I Departure Time: County: JA r0 k.) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
�e 04 014 g 00=6 =u
Latitude: Longitude:
Design Current Design Current.:.:,
{' , .Capacity Design .:.-. ,r..r. en
Cattle Capacity. Population.,,­,-
swine.,tCapacitY Po Population t Poultry Po ulation:;- :.._
❑ Wean to Finish
k❑ Wean to Feeder
3 4p
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ La er
is
❑ Non -La er
Dry Poultry
.m
Pullets
Turkeys
Turkey Poults
Other
Discharges & Stream ImRacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Daig Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures 4�
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 Ea/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
dNo
❑ NA
❑ NE
❑ Yes E rNo ❑ NA ❑ NE
12128104 Continued

Facility Number: (�? — Date of Inspection t 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: sQ GQo0
Spillway?:
Designed Freeboard (in): 'lid
Observed Freeboard (in): 27
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes RNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [/No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [?I o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes IJ 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 ElYes ❑ NA ❑ NE
maintenance or improvement?
Waste Application //
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes 3 No ❑ NA ❑ NE
maintenance/improvement? f
11. Is there evidence of incorrect application? If 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 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment? ❑ Yes
El NA
El NE
,KNo
L� No
❑ NA
❑ NE
[/No
❑ NA
❑ NE
9'10o
❑ NA
❑ NE
io
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or. any other CpmmentS. "s
Use.drawings of facility to better explain situations. (use additional pages as necessary):: ,
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Paze 2 of 3
k) FA
Phone: owj "779 6
Date:
12128104 Continued

. Facility Number: (�"j — Date of Inspection s a 7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes UrNNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ]o ❑ NA ❑ NE
the appropriate box. ❑ 11TT Tp ❑ Ch kl' ❑ D ; ❑ M ❑ Oth
ec 3sts esgn aps er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LEI 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?
El 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
O'NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
2 Noo
[3NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El❑mo Yes
o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[]fiA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑K ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[21�o
❑ 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
0'5o
❑ 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
Wo
❑ 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
1No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
ElYes
EJ2No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Division ©f Water Qaaty lr
Facility Number
9
O Division of Soil and Water Conservation
=
r
=-
Q Other Agency.
k
liance Inspection
Type of Visit ,.,70,
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Gtine
0 Complaint
0 Follow up 0 Referral 0 Emergency 0 Other El Denied
Access
Date of Visit: 4 r
Arrival Time: Departure Time: County: 0JUJt4AI
Region:
Farm Name:
Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
8""- I7
Onsite Representative:
N +���Q�
, Integrator:
Certified Operator:
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm:
Latitude: = c 0 g = u Longitude: = °
0 d = 4i
Swine=
LLs ❑ Wean to Finish
® Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
:• Other
❑Other
Design Current :` Design Current Design,,-urrex
A.
rapacity Population. Wet Poultry Capacity Population Cattle Capacity Populati
❑ Layer
❑ Non -Layer
Dry Poultry
uW.
❑ Lavers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Numbet of Structures 3. ;C
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 I No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑NE
❑Yes
❑ o
❑ YesYN'(o
[I NA
[I NE
[I Yes
❑ NA
❑ NE
12128104 Continued

Facility Number: 6 — Date of Inspection S �►
Waste Collection & Treatment
,_,,
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
E2"No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure i Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: li OdN
Spillway?:
Designed Freeboard (in): Z..6
Observed Freeboard (in): Z _
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ef 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
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
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑Yes
0"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
OX0 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
.�,,!!
[2 o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ONo ❑ 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) 6C42 SO
13. Soil type(s) /�jUTr_4V1LA./(_
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ❑'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ff No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
a No ❑ NA ❑ NE
[ANo El NA El NE
EfNo ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or anyother comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
_ A FLY-- t.'° °Kj C?.°ID
?LAT 00h/(�,
Sty 0 &-c Dwe__
Col L-WAATZZKA
A u r) 9&_"VN_ Q3 `i N 6 e-W SW6 (E.
Reviewer/Inspector Name 1 j�)4 A t%601-1 1 Phone�_710 /r76- %eZ
Reviewer/Inspector Signature: Date: c0 t

❑ Yes �No ❑ NA ❑ NE
❑ Yes dN0 ❑ NA ❑ NE
Facility Number: �y — Date of Inspection ►! ot..
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ W­Up ❑ Checklists ❑ Design ❑ 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
� o
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
WNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
�9-
[3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
��NXo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ff"No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C 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
' o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[E No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
21�o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

d Division of Water Quality <
Facility Number %�1�J'qO Division of Soil and Water Conservation
O Other Agency
Type of Visit Cpmpliance Inspection Operation Review Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 13135 OS Arrival Time: $ �S` Departure Time: County: 0tJ91 1 in% Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: -�ti' ���N°� Qlcn& WA(_L& teVn4,�Integrator:
Phone No:
Certified Operator: DtJ:; w..7 qYraolZ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o ❑ 6 Longitude: = o = 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
3'69'0 I L43cl (o I on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turke Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CovvI
Number of Structures: E
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes dNo ❑ NA ❑ NE
❑ Yes E o ❑ NA ❑ NE
12128104 Conlinued

eacility Number: (0') Date of Inspection 3a J
Waste Collection & Treatment
ZNo
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LP,6 oorJ 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L9 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental) threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
CQ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El 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
El Yes
,
!� No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
/No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
12<0 ❑ 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) llgem.MUC)A sG p
13. Soil type(s) (+-q \11-k,L e
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes UNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes dNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination, El Yes [:To ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes CP<o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [2 No ❑ NA ❑ NE
Comments (refer to question #) Explain any xES�answerstand/or,�yecamnnd�ahonsora�y other eomme�ts.
lse drawidrs t facility to better explain sitiiahons,'(use addihonal,pagessasgn essary
(A cL �iA a.w� e_ CU a,a f- IL 0 F.4'T 0 F S c�rV AN)7 trig s 1LC,%- <PJQD
(� ZMA_ A- 2Cto R.1C) S .s.t%i 6-ra t".. 514 A p 6.
Reviewer/Inspector Name y� �LLr f Phone• V 9 3S ,T 31 0 a� Zo3
Reviewer/Inspector Signature: Date: 313a105
I2128104 Continued

r
facility Number: (,-7 — Date of Inspection 3 3I- 05
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 ❑ Maps ❑ Other
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes []'No ❑ NA ❑ NE
❑ Waste Application [I Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspectionss E] Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes L9 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
L'1 No
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
El NE
W7NA
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EJ No
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No LJ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LEl No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,'
EI 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
ZNc
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/0 Drawings .. ;: � Y, .: ,r«,.�- Div �.1_ r' ` _ .K
12128104

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 10 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number D t. t: � Tome: I Q
0 Not Operational 0 Below Threshold
Permitted © Certified © Conditionally Certified © Registered Date Last Operated or Above Threshold: ....... �. �.
1
Farm Name: ...../�DR..J�..........�- �Rt�................................. County: ...Gl-aG� .......W....�.� ......__......._
Owner Name: ---....... /✓.�{1 � ,(1i -d ISIL�% A-aLvejPx.... .... Phone No:
MailingAddress: ....... . ................................................... ..
Facility Contact: ............................................ ....... ..._.. -...._ Phone No:
Onsite Representative: �� � 4-.._--- --_-----..------- Integrator: .C.rA&0JC1z?VA.... 4112Q�itm�
Certified Operator:
Location of Farm:
Operator Certification Number: ................. .............. ........
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 1 " Longitude • 4 94
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ;jeNo
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 WrNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? [:]Yes grNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ZNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _......_...................... ......... ....... ._..... ....... ............. ..................
Freeboard (inches): 40
12112103 Continued

Facilityumber: /0 T — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie// trees, severe erosion,
❑ Yes X No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancetimprovement?
❑ Yes PNo
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 ON
elevation markings?
Waste A hcation
10. Are there any buffers that need maintenance/improvement?
❑ Yes XNo
11. -Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes ;ErNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Ov load ❑ Frozen Ground ❑ Copper d/or Zinc
12. Crop type CT Dv
13. Do the receiving crops differ with those designated in tde Certified Animal Waste Management Plan (CAWMP)?
❑ Yes P'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ;io
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?
0 Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes ANo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes 2'1Vo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes Ergo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes 121'rlo
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 JaNe
Air Quality representative immediately.
Cornmesnts (refer tf gnesh0. Litplam any�YFS#a aswersEaadlor tiny recommendaisons orany otl;ercomments. -.-
Use dravnngs,oifac�Lty<to better expiarn srivatsflii� a add�� 1 pages as necessary) �. ❑Field Copy ❑ Final Notes
w" rr o tor74 146A.8zc �Ya e- Coo7gol
WEE-D5. SM trir CP-RPzrJ (oOF_e'6P_F_,3) C 40 beCr�
�)O U VD�O lmc ANC) 6&ed
r �Jr o i L �a��� C�Fo�� < �1 ��s-� C RoP.
�v3 -j o x t !� oo
0� 1. --to is 5 c EL_
Reviewer/Inspector Name MO N �s s
Reviewer/Inspector Signature: Date: / LO
12112103 Continued

t'Faci* Number: — Date of Inspection 1 D
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes ,!rNo
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 eNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E '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 �ZNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ANo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes J2Vo
27. Did Reviewer/Inspector fail to discuss reviewCmspection with on -site representative? ❑ Yes 0No
28. Does facility require a follow-up visit by same agency? ❑ Yes JO'No
29- Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes J214o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes O'Io
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 Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
JA
aUonal omrnents'andlor-Drawings = _ - _ = -
Lp�
a �K 49, PIP tJ 4;Qi s-rP� l_r� 0 tA f)T Wp't' EAS \�
To op .
12112103

(Type of Visit Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit ,O'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
]"ate of Visit: S OZ Time: Q = 00
`7
Q Not Operational Q Below Threshold
0 Permitted 0 Certified 13 Conditionally Certified j] Registered Date Last Operated or Above Threshold:
?.q +-� ofS l� vrse r County:
d n sl o,_ , .
FarmName: ............ ......... +......................%..................................._.... ty: -•-- -- -- -- -- - - -- -- -- -- -- -- -- -- ................
Owner Name: � f ' an �' ��''. a �"'� Phone No:
MailingAddress: .......................................... ........................................................................... .................................................................................................................
Facility Contact: ........................................................... Title: .............. Phone No:
Onsite Representative: r c,nlcz t•,a✓- Integrator: _F Ca►ti!d �' ��_ow��Q�
Certified Operator: ........................ Operator Certification Number:
Location of Farm:
_]-Swine ❑ Poultry ❑ Cattle ❑ FEorse Latitude • 4 Longitude 0' 6
Swine Ca' ace
P.o
Wean to Feeder
3 8 4 0
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ulation Poultry
'� :Design
Design.'-' Current -
ittle CapaCitV 'Population
1❑ Non -Layer =�on-Dairy
..
❑ Other
Total Design Capacity
_Tota1.SSLW
Number of Lagoons r r �`; ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holding Ponds / Sohd Traps _ ❑ No Liquid Waste Management System n w
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: [I Lagoon El Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes J3'No
❑ Yes []No
❑ Yes ❑ No
[I Yes [I No
❑ Yes �No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes�BNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ---------- I............... .... •--•--•--------•--•---
Freeboard (inches): Z. 7
_ - _ _.-C.r "."l[r �.�.'V�l.Yir]S'i'�~'�ri• 1,:}.i y �i Y 2 :�'Y1.^.�!'�'j Y'-•Y:Y:.... p.Y • i ln..
iMR,; 43••.'.•rtiSK�,:. {S' \ .� ..}..h[�i � -i5. •.� -- r_l� - .: .. �Y :r^:'. J?�F'.�i.T.Xd

V]/VJ/Vl
Facility Number: C,7 — � Date of Inspection S o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
c,unrtnueu
❑ Yes PNo
❑ Yes _ No
❑ Yes 21'No
❑ Yes ,fNo
❑ Yes ❑ No
❑ Yes- eNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes j0%
12. Crop type B e r-m Y.� p q b, _51) i _/% 6 /70;.n
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ''No
b) Does the facility need a wettable acre determination? ❑ Yes ONO
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?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soiI 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?
❑ Yes fa'No
[]Yes EfNo
❑ Yes ZNo
❑ Yes _ONO
❑ Yes ONO
❑ Yes ❑ No
❑ Yes .2(No
❑ Yes _'No
❑ Yes ffNo
❑ Yes fNo
❑ Yes ,214o
❑ Yes J'No
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Co enre e Fo cfuesfion pla�n;ap S answers andlor'an recommendations:or anyofher comments.
-gig
,Use drawings o�facil�ty �o=better_Vexpla�sit afions. use eddi#ional� a es�as' ecessary : ❑Field Copy ❑ Fina! Notes
_
J�. JZeco,-ds ire l,✓e(! ke � Ovgf�rll. r'►')r. �a7h�� nPevlJ �0 6E SL�re �{a cu/cvl�c
WG.I4e am or/� fi r dcrr eG}�UvrJ�:ti
C7� o(gif a�-��-•e ��j�1i c�.��ar, aveYt�S� �g �� s ��Q ai,�Rl},f�f dc1-�G��
urn- deeds 4"(ISC iy
t
Ay � � f4' i L � -ra Q SS : J4 )'r7 i n STct
�re¢bpctrcf" �►
Sr�tL1 �j2,r i n cie^ en4s fe" off roe..i �'arer of e �errtir, •mot _
4ve-Q1), -}l,c F'a c:l;-{ G,�e�, a-1d recorot J a?lope et well kF 4
?...°?rsi"F'RT`g"fT'
vie pe me
Re wer/Ins ctor Na
Reviewer/Inspector Signature:ssY Date: E /% oZ
--� C ._..s : _ - _ :� _ tt`^v'Y.^ ='Sr. -f.. _. •_1�F.rr..: �cRw fr.,t frh'YS��-.e'.�tr'r w. _ �...� fi t�-.tir..-.w.�--..-....r.w..�...........���.____�-.....�.�...... _��- - - _ . _ .. _

facility Number: 6 — Date of Inspection 4�
Qdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan biade(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?
ents and/or
❑ Yes ❑ No
❑ YeS.'ONo
❑ Yes—1Q'No
❑ Yes �PNo
❑ Yes _,O'No
❑ Yes _Q'No
❑ Yes ❑ No
05103101

Div!oon of Water Quality,
Q Division of Soil and Water Conservation
Other Agency .
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0 Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: l
Permitted 0 Certified © Conditionally Certified 13 Registered
Farm Name:
3 G Time: �Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: .........................
County: `S�Lt j......................................................
OwnerName:........................................................................................................................... Phone No:.......................................................................................
Facility Contact:.............................................................................. Title:................... Phone No
MailingAddress: ..........................................................................................................................................�.... ........ ....
.,...
.,...............
Onsite Representative:....,..... ., Integrator: _......1 .. _..�
....................................................................................... ....................................................................
Certified Operator:
Location of Farm:
.......................................................................... Operator Certification Number:
[]Swine []Poultry []Cattle []Horse Latitude ' ° 44 Longitude • 6 44
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
JEL"Wean to Feeder Lfd JE3 Layer I 1 10 Dairy
❑ Feeder to Finish JE1 Non -Layer I I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars EE Total SSLW
Number of Lagoons JE1 Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 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) [3 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 ONo
Structure t Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
IdentiFier : ....................................................... ........
Freeboard (inches): �1
5100 Continued on back

1
Facility Number: — Date of Inspection Printed on:
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 of
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?
10/26/2000
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 P(o`nding ❑ PAN ❑ HydrauIicy Overload
12. Crop type �hL-�Lc� �`� +-j t,2�5PC' d
13. Do the receiving crops differ with those de 'gnated 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? (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?
yi. . .... .deficiencies were noted during .... s. You .will . . . . e Rio further . .
correspondence. about: this visit ..: :::.:...:::::::. .
❑ Yes [�(No
❑ Yes P�No
❑ Yes No
❑ Yes] No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes Wo
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes gNo
❑ Yes �dNo
❑ Yes '9 No
❑ Yes XNo
❑ Yes •VNo
❑ Yes WNo
❑ Yes ZNo
❑ Yes 1�No
❑ Yes Al No
❑ Yes M No
❑ Yes &No
Comments (refer. to question 0- Explain any YES answers and/or any recommendation's or any other comments:
Use drawings of facility to better explain situatiomi (use additional pages as.necess(a�ry} r-
t�l� �,e5,� �4ee��►.-� �'-e2 ►- r'•� cct-�� cam, ,.� � �a&'As vu
o.
�v-e.r Cc s t►�. yo�ct 2 ,
IReviewer/Inspector Name e0�� �t^►- Q`Q I
Reviewer/Inspector Signature: Date: S100

J
A
'Facility Number:.Zr) — Date of InspectionQ i Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
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
No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
11� No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes`]
No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
$ No
_Additional Comments.and/orDrawings: _.
J
5100

L. a
rfi3:
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection (—Oo
Time of Inspection I d 124 hr. (hb:mm)
0 Permitted Certified [3 Conditionally Certified 0 Registered 13 Not O erational Date Last Operated:
Farm Name: ..... ...! .r^. :1. `^ .!'`�.-......L....�-.f°............................. County:.... + G!.........................................
Owner Name:
Facility Contact:
Mailing Address:
Onsite Representative:.t'" y
Certified Operator:,................. ..................
Location of Farm:
........................... ............................................ Phone No:..........••.....•.•.
Title:
Phone No:
........................................... .... ................. ..........................
Integrator: ...... L'--1 . . .. ..............................................
Operator Certification Number:
Latitude 0 6 46 Longitude 9 4 46
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes tg No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes El 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)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
❑ Yes ❑ No
❑ Yes 9f No
❑ Yes allo
❑ Yes �(No
Structure fi
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ANo
seepage, etc.)
3/23/99 Continued on back

I
t
Facility Number: 6 r% — CT 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 Anolication
❑ Yes XNo
❑ Yes �(No
❑ Yes WNa
❑ Yes ONO
10. Are there any buffers that need maintenance/improvement? ❑ Yes PjNo
11. Is there evidentof Over application? ❑ Excessive Ponding ❑ PAN [IYes JUNO
12. Crop type 1L_, � I 9
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 ONO
16.
Is there'a lack of adequate waste application equipment?
❑ Yes
�oo
Renuired Records & Documents
IT.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
VNo
18.
'Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes
)4No
(ie/ WUP, checklists, design, maps, etc.)
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
J;�No
20;
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ONO
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
O No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ONO
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
4No
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
N,0-yiQlaiiQns:o. defidehdipg W're nQiecl dur>frig {his'visit; Xoix wili eeeipe titi lFurthgr'
I.
coriesnonden ' e: about this visit: ....... .......................... :
se,drawings of facthty to `better explain situations (use adtLd©nal pages asznecessary) ` r�
.�
L�Q V-3, (6.6 dip a
Q

Facility Number: — Date of Inspection K�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes PNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 1�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes *No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes P(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 1 'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ®''No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes `ONo

.,
(a Division of Soil and Wi ter Conservation Operation=Review:
r
13 Division of Soil and'UVateir Conservation Compliance Inspection
®Division of Water Quality Inspection -
M
;Compliance
O:Other :aigency, Operation Revrew _
e
;
w
- -
u
!® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time or Inspection 24 hr. (hh:mm)
0 Permitted ® Certified [] Conditionally Certified (] Registered 113 Not O erational Date Last Operated:
Farm Name: ............... County: (.0 w.._........_.................... �r+ t ._...1A>,F_�.,c.P_T................................................w�. Q...
Owner Name:._..PR.IAnI Phone No: 91a Z98- 4599
.... ................................................... ....... I......................
Facility Contact: ....... .......�.N.:�0.K.................... Title: .................................................................. Phone No:...................................................
Mailing Address: ......�.� B �o.1?NT.Rf.!�!�i.Cj...... z......................... �utrPkl�.1t �..iM..f..N.G........... .............. .�.�?.EB..... ...... ........ .....
Onsite Representative BRIR!J Ri�`{NO2 . Integrator:
p.............................................................................
Certified Operator:..,, ,} ,,.,,5... �Z. `(,f-501Z ... Operator Certification Number: I 7 386
Location of Farm:
P......... oK�._a Svcs.R....l?r 9.....C25GoRY.....f..ore�C ..!�D TCE,ST....Pf3. 7' l�!��2.S�i[....o�u..:IQJG ci.T..-.7`4ikrzF
......... wrrc...... ON .... Ddde__...��..-..rnAg�.._R.>6�tr......��.-a�.e., ��._r�:.................................. . ......
Latitude ©' 6 Longitude '7'7 • ©° ®"
Design Current Design _ Current ; ` Design Current
Swine Capacity Population Poultry Ca acity Population Cattle Capacity Population.
® Wean to Feeder p a ODIC Layer ❑Dairy
❑ Feeder to Finish ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder > ❑ Other
❑ Farrow to Finish Total Design Capacity 3A46
❑ Gilts
❑ Boars - 'Total SS H5, Z a3
,
Number;of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding, Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
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 yeti, notify DWQ)
c. if discharge is observed. what is the esthnated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ,RNO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N�'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0_Lqo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): . 4d..................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IS&O"
seepage, etc.)
3123/99 Continued on back

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? ❑ YesuNo
(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 t�lNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes -T!rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes `-' `\
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes To
12. Crop type-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes OVO
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
WNo
Required
Records & _Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
Ek&o
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
j�Kqo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
ArYes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
'RNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
P�No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
ElYes
[�To
Oe/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
bRNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
i<No
0: o yiolaticjns ongthisv. .will ie.. doi.. rd#.....weenotd.s:.....................
....
correspondence. about. th s .visit
Coinmenis,(refer to question #). -.Explain,any�YES answers and/or any, recornmendairons or"any; other cove meii
UsCdrawings of facility to better explain situations (use additional pages as necessary)
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
3/23/99

Faeility Number:& — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )<No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes kNo
3U_ 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
_3 L Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 1KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes jXNo
hon ammettts and/or Drawiings:`
All
3123/99

0 Division of Soil and Water Conservation ❑ Other Agency
ElDivision of Water Quality
10 Routine O Complaint O Follow-up of DWQ insEection O Follow-up of DSWC review O Other
Date of Inspection j0 Z
Facility Number
Time of Inspection 24 hr. (hh:mm)
[] Registered 0 Certified © Applied for Permit © Permitted 10 Not Operational I Date Last Operated:
Farm Name:.....�1.. .5..(nr..............6.... � �. County:.... ...... 1 Uz c1`..............................................
----s-- --- ,c,,..n.... .............. >
OwnerName: ........ . ...... . .. . ............................. ........................................................................ Phone No: ........... Z....I.. ...:..1.................................
� e
Facility Contact: .. t l., G, ,�............ .. .................. Title:...... I'w Phone No:
cN n �! s —x c)vL
Mailing Address: .........................�V v....�............. ..... 17��............ •�� rr..�
Onsite Representative:.... g.................... ..Y...acv�.f............. .... �!-�r,�...................._............... Inte ........................... rator:..�.P.-roc%��
Certified Operator;.....1..4{.rrn...................... ....... }..Y! ... t..................... Operator Certification Number;.l.V' .................
Location of Farm:
Latitude 0• ' 16 Longitude 0• 06 66
Destgn Current
:. ; Desi Current Design Cul t
C:)pactty Populattan
Poultry.
Ca acit Po ulatton " c
P Y P Gattle; Capacity: Population
Wean to Feeder
o
1
❑ Layer 1
❑ Dairy
I
e
Feeder to Finish
`
❑ Non -Layer
❑Non -Dairy
❑ Farrow to Wean
❑ Other
3
El Farrow to Feeder
s.
❑ Farrow to Finish
Total Design Capacity
�'
❑ Gilts
Qa
Boars
Dial `SSLW
1 ❑ Subsurface Drains Present j❑ Lagoon Area 10 Spray Field Area
❑ No l uid Waste Management System
s M.,
General
i. Are there any buffers that need maintenancelimprovement? ❑ Yes J;4No
2. Is any discharge observed from any part of the operation? ❑ Yes I_No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes Flo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes EjNo
c. If discharge is observed, what is the estimated flow in gattmin?
d. Does discharge bypass a lagoon system`? (If yes, notify DWQ) ❑ Yes B No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes (2 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [HNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes j3No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JRNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes JO No
7I25/97

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes ONo
❑ Yes Q 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 fa No
It. Is erosion, or any other threats to the integrity of any of the structures observed? RYes ❑ No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immidiate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes &f No
Waste Application
14. Is there physical evidence of over application? ❑ Yes JJNo
(If in excess of WNW, or runoff entering waters of the State, notify DWQ)
15. Crop type.�............................................ � `--..--•...........................---.------..--------.................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes Z No
4
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes 10 No
18.
Does the receiving crop need improvement?
❑ Yes
jFel No
19.
Is there a lack of available waste application equipment?
❑ Yes
JR No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
R1 No
22.
Does record keeping need improvement?
XYes
❑ No
ForCertifiedor Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
.❑ Yes
U'No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
,9cc,,
Jt] No
0 No.violationssor deiicieneies4i e're-noted,durinlg this. visit.- You4i[I ireceive noItirther :
eorrespondence Atiout this:vitsit., : _
7- wz-eul
7/25/97

[] DSWC Animal Feedlot Operation Review a�
_. ® DWQ Animal Feedlot Operation Site Inspection
e. t
® Routine O Comnlaint O Follow-un of DWO insuection O Follow-un of DSWC review O Other
Date of Inspection U2LM
E 1-1 .. ............ =�U== Facility Number
Time of Inspection 24 hr. (hh:mm)
2LRegistered [3 Certified 0 Applied for Permit
/� © Permitted j0 Not Operational Date Last Operated: ..........................
Farm Name: ...... A.4(.. �.l%.4rY.z. ............... 1UV_�Cl, 5;w-I
County:...��'.,�?..........................................................
............. 1�
Owner iS`ame:...... L'rrYl.......................... .% �'..K........ ............... Phone \`o:...g......................................................1.........I......
/� `l
Facility Contact: . M.tL1.l.tart ...(.. �A.0......F�k ,.AZitle�:....®..lr. !!1 5........................ Phone No:.............................................�...
Mailing Address:....9�......,..f..lJ�-14, �`��........1 �� �1`!%1.�?Y.../1�,��.......................... zy.51 ?5
Onsite Representative:---:%k...................................
... Integratcyr:....1.✓.�� ....... I
Certified Operator;.......................................................... Operator Certification Number ..........................................
Location of Farm:
Latitude • 1 44 Longitude S 4 .4
�wme
tX Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
roputatton
Design Current Design Current.
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I I JCI Non-Dairy
❑ Other i I I -
Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds ❑ Subsurface Drains Present 110 Lagoon Area ID Spray Field Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c- If dischar-e is observed, what is the estimated flow in gal/ntin?
d. Does discharge bypass a lagoon system'? (If yes. notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of desi«n?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes [�o
❑ Yes L1J'IVo
❑ Yes ,E_ O
❑ Yes L'Qo
❑ Yes
a<0
eyes
Gdo
❑ Yes
ErNo
EKes
❑ No
❑ Yes
Yes
no❑
Continued on back

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes D-I o
Structures (La2oons,11olding Ponds, Flush Pits, etc.) ,- ��
9. Is storage capacity (freeboard plus storm storage) less than adequate? El Yes El lvo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard(fty............��...............................................................................................................................................................................................
10. Is seepage observed from any of the structures?
❑ Yes
K o
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
UM
12. Do any of the structures need maintenance/improvement?
❑ Yes
�o
(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
,,---,,,�
D-��o
Waste Application
14. is there physical evidence of over application?
❑ Yes
[r-No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...........ss .►............................•--....................................-------•---.........-.--...-.....................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
[3,No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
O-No
I& Does the receiving crop need improvement?
❑ Yes
13-N0
19. Is there a lack of available waste application equipment?
❑ Yes
[RrNa
20. Does facility require a follow-up visit by same agency?
❑ Yes
L9'wo
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
E?<o
22. Does record keeping need improvement? ❑ Yes ElNo
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes 2<o
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [D-Pdo.
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes 0 No
No.violations or deficiencies.were.noted-during this;visit. You4ill receive no further
correspondence about this:visit L.
Coiii>nents (refer to question #): Explain any -YES aisers..and/or any recominendalions or any Tither cainmenfs
Use drawings of facility to` better explain situations. (use additional:pages as necessarv}
1••' • .�V1` YS �� ��� YiL`}�.�� �� F-2_P4 -'e-,W4- A e/�Agtz", Lt'!•�y `'t't!iL.�
La �' �@c�s-►- 5:� s�-�rn �nl �v�£ 1� Z •-1�dr,�� �rri�u- � �f..�r� r� ,Q-
GvsS d� Gvh -����.a•► �,.�'' . .sD �, ��y-.� -,� �e>� ���� �� s g�
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature:. Date: �� !i

Site Requires Immediate Attention:
Facility No. �_
DIVISION OF ENVIRONMENTAL MANAGEMENT .
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: '7AX q , 1995
Time: 16 LI-.
Farm Name/Owner:
Mailing Address: —
County: DI1, If
tv-0
Integrator:...? �1�. _ _ Phone:
On Site Representative: r1hLT?_%'Z Phorie: 7Z-5'8- 5-RPZ
Physical Address/Location:
o-f S.e l 4 3,0
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 7,-f7' Longitude: -7 7 -3Co ' 3q, If Elevation: �'t�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 r No Actual Freeboard: 3 . Ft. % Inches
• Was any seepage observed from the lagoon(s)? Yes orWas any erosion observed? Yes 060
Is adequate land available for spray? Yes r No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? es or No
100 Feet from, Wells? es r,No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o N
jo
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 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)? Yes or No
Additional Comments:
• 11�Gl��b /N . C 664--/S
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.

UNE KHTIONS BRHNCH - WQ Fax:[phone] Jul 24 '95 18:06 P. 13/18
Site Requires Immediate Attention _ &Q
Facility Number: —
SITE VISITATION RECORD
DATE: 7k z� �r _ , 1995
Owner: 4 Af 14,yi r Farm Name:
County-.v S �drLiL
Agent Visiting Site: J J 'fir -- --- . T ,,.---- ,Phone: _?mn'! 77
Operator: li' f' dr Phone:
On Site Representative: phone:
Physical Address: s.c /.r•r 7 �e / , /« SbG� to s f o f ,'ti ��.r�
se A 23o
Mailing Address:
Type of Operation: Swine ✓ Poultry - Cattle
Design Capacity: _ 3 ,4-6 ._ Number of Animals on Site: l`
Latitude: c ' " Longitude: c ' "
Type of Inspection. Ground ' Ae'n-al
• Circle Yes or No
Does the Animal Waste Lagonn have sufficient freeboard of I Foot + 25 year 24 hour storm event
(appro.liniately 1 1;oot +$ inches) or No Actual Freeboard:. Feet Inches
For facilities with more than one lagoon, please address the other 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 l6
Is adequate land available for land application? 6"�r NO Is the cover crop adequate? r No
Additional Comments:
Fax to (919) 7 t 5-3559 Sianawre of