310045_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Division of Water Resources
Facility Number❑ - L O Division of Soil and Water Conservation
O Other Agency
Type of Visit: & Cot�pliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: Q® County: W?LCLO Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
OnsiteRepresentative: �jcSLCY Auop.1o&c ,
Certified Operator:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: ' ! ✓bb a
Back-up Operator: Certification Number:
Location of Farm:
Swine
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Wean to Finish
Wean to Feeder
t(
Feeder to Finish
S b D
3 0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current
Dry Poultry Capacity Pon.
Layers
Non -Layers
Pullets
Turkeys
,Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes 2�o ❑ NA ❑ NE
❑ Yes yo ❑ NA ❑ NE
Page I of 3 21412015 Continued

!Facility Number: 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 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: Lkmtj L, (Aow
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
No
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
CZ
❑ 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 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [/No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �/No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [] PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of 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 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes WNo
0 NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes VNo
❑ 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
EalNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
dyes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
Weather
Code
Inspections
❑ 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
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
dNo
❑ NA
❑ NE
Page 2 of 3 214120I5 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 6 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 4o ❑ NA ❑ NE
❑Yes O/No ❑NA ❑NE
❑ Yes CJj < ❑ NA ❑ NE
❑ Yes [allo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes ��No
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
Comments"(ie#er to question # E" lain&,aoy, YES answers and/ar, amy,addstroaal recommendations or:an other comments 4
g ) gP y
Use drawin s of facility to"better-explain,situattons;,(use•additional pages°.as necessary) - " - F
} St_UDGE Sby?_U(i S rJc )(,
� �+vtiFl-LPL C o f T6� c.t-� Uo e LGIVILN Cr t o D,.rTC � ea t-� �srL M E D ,
Zurcrl [c�%C%y uryt., _rX5 cu IS l-Irr}i 5Uf +ws�v� �o r- IDTfLC_C'gf t,)
17SSC.N>Q GLCrc �l�.o w` LA &ez-tJ 1�U . CO NAP �c C6J
�o SzGNS 6F u,r+��,J�
�Y L Ast ' �Vc�r.
Reviewer/Inspector Name: & (LrJ E L A.f:Y jD 5? vJf--L -
Reviewer/Inspector Signature:
Page 3 of 3
Phone- [1v 15 C —13
Date:
21412015

I
It, V Division of Water Resources
Facility Number - © O Division of Soil and Water Conservation
O Other Agency
Type of Visit: Co Hance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Q Departure Time: f U County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: _ W's AbaxOirG Integrator:
Certified Operator:
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
Latitude:
Phone:
Certification Number: 1S3 66
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
------ I- HNon-Layer
lets
Poults
Design Current
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �o - ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[] Yes No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

i
Facili Number: - C1 SDate of Inspection- S 16
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 2Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAG" '-'try
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment t reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes7No
❑ 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 ❑ 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 o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rNo
0 NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
W 20. Does the facility fail to have all components of the CAMP readily available? if yes, check
❑ Yes VNo
❑ NA
❑ NE
the appropriate box.
❑WUP El 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 I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes o
Vo
❑ 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

Facility Number: jDate of Inspection:
24' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes n No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Zyes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ ilure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
��Non-cornpliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: i V
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes &No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 640 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Wo
❑ Yes �/No
❑ Yes El"No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes u No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
eoo ❑ NA ❑ NE
❑ NA ❑ NE
[:]No ❑NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
2g) 6 6T SLUDGE PaA 1Q R16-HT LA&CDW .DonX 30 DPi�'fS .
vJAs as 3OT U-VCt- rs CLo.'�c &X-V6, out,
Reviewer/Inspector Name: tT} }. 9gli ELL, Phonc lb2 11tf'
Reviewer/Inspector Signature: . ILw.J Y Date: S
Page 3 of 3 214120
5

p Division ofWater Resources
Facilily Number
-
0 Division ofSoll anti Water:l-onservation
.. b
Ya.
.., _
Othe r�Aenc,
g.Y�'"ia>
Type of Visit: Co fiance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: IL_-:?0J County: ( lP(�� Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: W C—S u_- A "� ( Integrator:
Certified Operator: Certification Number: f c7 b
Back-up Operator:
Location of Farm:
Latitude:
Design .Current.-
1
Swine: Capacity Pop.
Wet Poultry C
Wean to Finish
La er =T_
Wean to Feeder
Non -La er
Feeder to Finish
IGO
<0 6
Farrow to Wean
_ #1
Farrow to Feeder
- .'D ;:Foul C
Farrow to Finish
Lavers
Gilts Non -Layers
Boars
Pullets
Turkeys
. Other
TurkeyPoults
Other
F13ther
Certification Number:
Longitude:
sign,, ,urrent W Design 'Curren
acity Pop ;Cattle Capacity Pop
Dairy
Cow
Dairy Calf
Da Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
IL_I o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
20
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Facili Number: - Date of Inspection: S 5
Waste Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 /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: L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): AQ
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 21'No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ 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 I VNo
77
❑ 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 [3/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
FZ/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
2(No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
d
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
0 Yes
rN
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Othe :
21. Does record keeping need improvement? If yes, check the appropriate box below.
7es
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield d120 Minute Inspections Monthly and V Rainfall Inspections
❑ Sludge Survey
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
�o
❑ NA
❑ NE
Page 2 of 3
21417015 Continued

Facility Number: - Date of Inspection: ";ZtI2 Its- -1
24. Did tlee facility fail to calibrate waste application equipment as required by the permit. ❑ s No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Vyees [:]No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
El'Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EfNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes
No
DNA ❑ 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
C 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
do
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
O/No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
" o
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments ,
Use drawines of facility to better explain situations (use additional pages as necessary).
To z o f I-IJ a-tj SF6 CTZ-6NS 00 i Ri
ab) SLx G-E �6 A
V'toq--�r so
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone. ! to it 13 a
Date: S/14 1 lJ
2/4/2UI

0 Division of Water Quality
Facility Number ,T) - ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: pliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Co(Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: S s I Arrival Time: ILL_ J Departure Time: 7 0 __1 County: V UQ(Z—tW Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: �J ES LLC-'Integrator: / (J
Certified Operator: Certification Number: b p
Back-up Operator:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -Layer
Design
Current
Dry Poultry
Caoacitv
Pon.
Layers
Non -Layers
Pullets
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[—]Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
D NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes Wl�o
o ❑ NA ❑ NE
[—]Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: tAk6d L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ' I)- I_ ';�S
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 D NA
❑ Yes No ❑ NA
❑ NE
❑ NE
❑ NE
D NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm5No
hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [J/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 [Z No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �N6 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes E3/No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes []No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes FZ/No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [] Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes +10 ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes [%o D NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - 5 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
o ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [3 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
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
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
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[ZNo
❑ NA
❑ NE
I__I No
❑ NA
❑ NE
f No
NA
NE
Z
❑
❑
No
❑ NA
❑ NE
❑ NA
❑ NE
P�No
o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Lk
Phone: 9. 1, ` 13 D
Date: S 5_ j
21414011

II G Division of Water Quality
Facility Number - Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Co fiance Inspection Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: 7Rooutine O Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: © County:D URegion:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: i„)tYSi.C'`'� A tX (17n D&C
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
X Feeder to Finish %
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number: --
Certification Number:
Design
Current
Wet Poultry
Capacity
Pop.
Layer
Non -La er
Design
Current
Dry Poultry
Canacity
Pon.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current,
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Daja Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 6o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes eNoo
❑ NA ❑ NE
Yes ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facilifv Number: I 1 - (4 IDate of Inspection: iMi ? f?
- r
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 Strulcttu�re, I2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAGOO►` P, L TOWy L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JENo ❑ 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 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 YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [:]Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 0 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box
below. ❑ Yes 2No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes [7jj o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes Zo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes k�f No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Oth
21. Does record keeping need improvement? If yes, check the appropriate box below. 7es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Wastc 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 dN❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 614-
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

FaciH6 Number: - LtS jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes n No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z"No ❑ NA ❑ NE
the appropriate box(es) below,
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 9No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Z No ❑ NA ❑ NE
❑ Yes U�No ❑ NA ❑ NE
❑ Yes [Z(No ❑ NA ❑ NE
[—]Yes e/No ❑ NA ❑ NE
[:]Yes �No
❑ Yes��o
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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):
Zj r✓1 v5 G�,M �t�-�� SZ_v fl G-E Su RVc Y M A IkCH 2013 ANC 5c tj 1) Cn PY, v .Rv
ow (.
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
PhoneC �)7U ~ 3 D D
Date: i
21412011

UDivision of Water Quality
Facility Number - I �.J 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: /Q County: _[�RiX�J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: ALM--t-06-F Integrator:
Certified Operator:
Phone:
Certification Number: t% 15,3
Back-up Operator: Certification Number:
Location of Farm: Latitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish (�
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Other
Other
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Pullets
Other
Poults
Discharges and Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does 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:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ZrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:)Yes dNo ❑ NA ❑ NE
[:]Yes �To ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number; 3 - Date of Ins ection:
Waste Collection &Treatment
4ns storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I-A(sQohR) L L,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? [:]Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes L,LI 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes dNo
❑ 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 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
YNo
❑ NA
❑ NE
the appropriate box.
❑WUP [I Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
Eyes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑Weekly Freeboard ❑Waste Analysis ❑Soil Analysis
❑Waste Transfers
Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
ff No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes
jfNo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3k- Date of Inspection: 5
�24. Did -the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ErNo ❑ NA ❑ NE
Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q'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 ElNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ENo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [—]Yes dNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 21"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
0No
❑ 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
dNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
WNo
❑ 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 bett z>-
g ty better explain situations (use' additional pages�as necessary).
GCr 1•►W SLUDC E ""EVE`' NKX-- l Xjfj� 3o CALCuc. j=,)j oti1 act
50ays%� MTSL_CADz+�G.
Reviewer/Inspector Name:�1iQs11Fa�.-
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: J! Z-
2/4/2a11

Division of.Water Quality:
a Facility Number j `l O Division of•Soil and Water Conservation
0 Other Agency.
Type of Visit 0 pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Co7outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: l d d Departure Time: County: WPUn Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: 069L ' At-QXf D&(_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
[$ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Gilts
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 1 =" Longitude: = ° =
Design Current
Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
,Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poutts
❑ Other
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
-Design '" 'Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
lumber of Structures=: J �¢
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 [ J No ❑ NA ❑ NE.
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
❑ NE
❑ Yes
❑ Yes
20 ❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 7j — Date of Inspection Za IJ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: �E Otj 191 iA(se1J 9LC1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes / No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 21,No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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 �No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDIiC260n
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E4o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
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
0 o El NA ❑NE
LQ No ❑ NA ❑ NE
o ❑ NA ❑ NE
El NA El NE
�V,Na
o ❑ 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) .
w
Reviewer/Inspector Name �yj.%E(� £:,:.. Phone: D 6
Reviewer/Inspector Signature: Date: 12-4141
P 2 2 12128 04 Continued
age of

-Facility Number: — Date of Inspection 2,0
Reauired 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 ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes [No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections ❑ Weather Code
❑ Yes �No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes WNo
o [I NA [I NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ! o ❑ NA [I NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? El Yes :FNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ElYes E d o El NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document El Yes CJ No El NA El 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
,�
L'1 N ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
[IYes
No El
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
ElYes
[16 El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L� No ElNA
❑ NE
Additional Comments and/or,Drawtn s =' ��� °� �`�� "
T
Page 3 of 3 12128104

Fac�itty ¢Number ` 3
Division ofi
S `0 Division `of
0 Oilier Agen,
ex Quality u
and Water Conservatton
Type of Visit ,C.,,00mpliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit ( Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access j
Date of Visit: 1 2 16 rid I Arrival Time: Dd Departure Time: County: OUP Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ,.J 6H 0 AT -
Certified Operator:
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
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = = 6 = {! Longitude: 0 ° = 6 = ,,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: El
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes n No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No [I NA [I NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: —q
Date of Inspection 5
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: I A&.opJ ki,4i tA(svr,0 U P7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
[2fNo ❑ 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
environmentalWeat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
[ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[21 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CJ No ❑ NA ❑ NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
WNo❑ 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)
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
['JNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�7No
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
CkNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
DNo
❑ NA
❑ NE
12M M.1:A/ �r�SPE L`f'r4.o1� -T-0-L NJ 4&C-0 tb C e- aoI k ,
�.S 50 bAyS it, 06 7Ao9 5LUV6gufvc�. SCN19
Reviewer/Inspector Name ( t,E, Phone: !� Z �3 88
Date: Reviewer/Inspector Signature:

r
Facility Number: 3 ! — yS Date of Inspection 15
Required Records & Documents `
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElYes ,O N/o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes CJ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other ,_,(
21. Does record keeping need improvement? If yes, check the appropriate box below. E I Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard
� �❑ Waste Analysis ElSoil Analysis ElWaste Transfers ElAnnual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield [1 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Rf/No ❑ NA ❑ NE
- 23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E6 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
[dyes
❑ No
❑ NA
❑ NE
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes Q/No
❑ YesWNo
❑ Yes 13/No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �1�To
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
12128104

!6 Division of Water Qualsty
s, a^iSi4rL 'w
Faeilit�.N..urnber' � 0y6rvision of Soil and=Water Conservahon
60ther Agency Y
r v
Type of Visit C mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: t Arrival Time: Departure Time: County:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: I Integrator:
Certified Operator:
Sack -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
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o= i Longitude: 0 0= 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ on -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 21 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
o El NA
El NE
❑ Yes
El Yes
�Ivo El NA
El NE
❑ Yes
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number. 11— Date of Inspection S 6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 L
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes o
ElNA ❑ 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?
eat,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta7;14o
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes C�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes JNo
❑ NA ❑ NE
maintenance/improvement?
WNo
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 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/J o
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Zo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes �L,02o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
I" Mjjj 3JV sPE Crt oAlj A/66_0 T6 A� o a N F. 1-(AO s d&P6 ,00r- A/al ALL A,
ZS) IG�o�V R ft LIP" NFE5 FlIi-ThCa 49vlf to LASS
R Ga,0xWG a&J
q w
Reviewer/Inspector Name Phone: T b 3
Reviewer/Inspector Signature: Date: a
paop 7 nr 2 72/2R104 Continued

Facility Number: 3f Date of Inspection
%e wired 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 dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. EJ 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 L' 1 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes e o ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
❑ Yes
[No
❑ NA
❑ NE
6 Yes
❑
❑ NA
❑ NE
El Yes
No
❑ NA
❑ NE
El Yes
7No
❑ NA
❑ NE
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document 0 Yes No ❑ NA ❑ NE
and'report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
7(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
[2(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
o
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Page 3 of 3 12128104

U Division of Water Quality
Facility Number 3 5 O Division of Soil and Water Conservation
C) Other Agency
Type of Visit Q Compliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit O Routine O Complaint () Fallow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: INAPu IV Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: M I c-d ec- A (-DRiar
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o [= , 0 « Longitude: = ° = 4 =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish S-4400 $ Q�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharp,es & 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ® No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
® No
❑ NA
❑ NE
❑ Yes
9 No
❑ NA
❑ NE
12128104 Continued

Fagility Number: S — y Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ® No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ® No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ® No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ® No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ® No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ® No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ 4 No ❑ NA ❑ NE
maintenance/improvement?
1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
© No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
I] No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
® No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name D{ ! NES ,OHN F QNE�� Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Number: Date of Inspection i 1S
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 [)jNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ® No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
V1 No
❑ 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 fail to calibrate waste application equipment as required by the permit?
❑ Yes
[XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JK1 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
® No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
® No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
V1 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
([ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[7[No
❑ NA
❑ NE
Comments and/or
12128104

Division of Water Quality
{� t7 Facility Number - O Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit (` Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: !D a? Arrival Time: ® Departure Time: County: .Jt/►_LT' Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone No:
Onsite Representative: M sc�u w, ALv flSo 6C Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: [—] o [—]' = Longitude: [= ° =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish Si dab
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La cr
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
ElN ElNA
❑ NE
❑ Yes
El Yes
NA
❑ NE
❑ Yes
VNo ❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection is
Nast 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 &010 [.A &WL4 L
Spillway?:
Designed Freeboard (in): 11.57 t
Observed Freeboard (in): 24
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
P 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
t, notify DWQ
environmenta7Nv
7. Do any of the structures need maintenance or improvement?
El Yes
❑ NA
[I NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ 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
L' I No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E No ❑ NA
❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
1540 ❑ 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?
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
JJ No
L�No
�No
P(No
[]NA ❑ NE
El NA El NE
El NA El NE
❑ NA ❑ NE
❑NA El NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name p RA V Phone:(9�a 7
Reviewer/Inspector Signature: Date: 86107
12128104 Continued

Facility Number: — - Date of Inspection Y !a a 1
keguired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ 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
ec
Chklists Design Maps Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
O1No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2 o
❑ NA
Cl NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El
o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
'LI No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
111 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesO
ON.
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LYNo
❑ 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
JYNo
❑ 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
EJ 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
'Q"No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
jd No
❑ NA
❑ NE
Comments and/or
12128104

Facility Number ) ! ys
I
Q Division of Water Quality
O Division of Soil and Water Conservation
0 Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Voutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: y S Departure Time: �] County: t U Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: MICHACU � LQAIDGG _
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude: = o =, = Longitude: = ° = =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I I 0 Non -Layer
Other
❑ Other _.
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke
"71's
El Other
Discharp,es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
I
❑ Beef Brood Co
j
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?
Page I of 3
❑ Yes Ll No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
LI o
El NA
El NE
El Yes
[No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection '� O
I Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EfNo
❑ 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: ALDO.I WjC # 1(9 ALbAtO(,E.42tt''
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a — %•a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
`
6. Are there structures on -site which are not properly addressed and/or managed
ElYes
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 notify DWQ
threat,
7. Do any of the structures need maintenance or improvement?
El Yes
LI No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
E!(No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,�/
ld No
❑ NA ❑ NE
maintenance or improvement?
Waste Aonlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ldNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
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
Area
12. Crop type(s) Q cn-wwdA C 4) S Gy
13. Soil type(s) AI fl ij0 A
14. Do the receiving crops differ from those designated in the CAWMP?
_
El Yes
�f
L7 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
e No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
eNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2rNo ❑ NA
❑ NE
Comments (refer to question # ): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
w.) KC- G p CA LXG" -r's. V ra rU' '.j.Z-r h ZSC &LOS . 0,60(v 0SZQ4 G { t.o 0hkkn �. K"TA
Reviewer/Inspector Name F_ jA�►Et.rJ ---]Phone:
IPhone: C94 96 1;4 s
Reviewer/Inspector Signature: Date: 66
Page 2 of f 12126/04 c.onnnuea

Facility Number: 31 — q s Date of Inspection 1
• 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 ❑ Desi gn ❑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
❑ Yes L" I No ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
❑ Rainfall Ystocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I "
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Q Yes
❑ o
El NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
1a o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
l� No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LQ 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
U(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
ENo
❑ 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
[Zo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
Ll
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Division of Water Quality
Facility Number '=jam 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit (ZRoutine O Complaint O Foilow up O Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: %i County:
Farm Name: _ /¢lI1ZL4 .S �� Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: &02z:t'r��
Certified Operator:
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
Phone No:
Integrator Lr1/-1
Operator Certification Number:
Back-up Certification Number:
Region/et)
Latitude: [� o = s =ii Longitude: 0 ° = g = u
Design Current Design Current
Capacity Population Wet Pouitry Capacity Population
❑ Layer
❑ Non -La ez
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood CoYA
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes A No
❑ NA
❑ NE
❑ Yes )21 No
❑ NA
❑ NE
12128104 Continued

4't
%'/
Facility Number: —
Date of Inspection L� I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
❑NA El NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L55:r— Jo �G 'r
Spillway?: /"O /VD
Designed Freeboard (in):
Observed Freeboard (in): �32 25
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 10 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes V] No ❑ NA ❑ NE
through a waste management or closure plan?
❑ Yes A No
❑ Yes ❑ No
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes V No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window []Evidence of Wind Drifl ❑ Applicationj Outside of Ares
12. Crop type(s) �, 46M Lf,(J
t3. Soil type(s)
nm
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZUNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
['No
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
ElYes
/VNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�TNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesXNo
❑ NA
❑ NE
Reviewer/inspector Name Phone: fvo-3c1 31�X Z2l®
Reviewer/Inspector Signature: Date:
I_11Z51U4 C.onanuea

Facility Number: — Date of Inspection Z Q
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 jo No ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IV No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
to No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
O No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
/No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
[INA
ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
!Z
❑ No
❑ NA
XNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
rr
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[:dNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
21) 16t
2 Z:)&,5 It
V4y1jC'_
4V'D
A-w
`" �p/1 f � l0 �>r 7 l4 S��P � /� /� C� �/f�5 / 7S r�0�✓•42 T
12128104

_� ID i7ivisiQ�n;of Soil and Watrs Conservation _
i-.s �� ��' � ""� '�^ "'�`^ ���" '�"' Q��thei :�,genC7y °a - � ^ar '" .-3"� s .-x F � S- • �, "'T`",� c'"" �' S "tea --°max .
-
a
Type of Visit gCompliance inspection 4 Operation Review O Lagoon Evaluation
Reason for Visit XRoutine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number s- Date of Visit: Time: jfa66
r Not Operational Q Below Threshold
/"Permitted�Certifed ©,C,1onditionally Certified 0 Registered Date Last Operated ` ,orr Abbov}e Threshold: •------,.... _..
Farm Name: ..... lt7.i!!1.�._..%L ................ County: »......`.'.T �':!`�.................................... _........
Owner Name:.. - - —iV1i .! 1 t :....... , pl,� �rt. ..... Phone No: ...... .....................................................
MailingAddress: ........ . . . .......................................... .................... ............................. .. .............. - �..._�..... _...... .
Facility Contact: ... Title:.. .. _ ......... Phone No:
Onsite Representative:.. ..., �dr—za.PL?-E.._.............. Integrator: __B --
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude * ' " Longitude • 4 64
Desf n ;Current Deli Current - Design Curre�ut
Wine .'T •� Y• '" Tt 2 fR L.- Y 'T
L
Ca act „Po ulaiion e=Poaltry: _� =Ca" ..Po alatian Cattle T .Ca" act :Po Dilation ,,:
❑ Wean to Feeder - ❑Layer
- ❑ Dairy _
Feeder to Finish ppb s; ❑Non -Layer ❑ Non -Dairy
- -
Farrow to Wean
Farrow to Feeder ❑OtherWT
r
Farrow to Finish 3 Total DesignR C3pagty .
r
Gilts
❑ Boars e s T©mil $SLW
_.-. ._ . __
Nd&b of Lagoons $.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .........L................ ......_.........._................. _....... ... ............................ ..... ...... ....... ................. .......
Freeboard (inches): 713 2-1
❑ Yes PrNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
)yl
❑ Yes
ONo
❑ Yes 'P(No
Structure 5
12112103 Continued

Faeility Number: r` — Date of Inspection
• 5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes IdNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes F0
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? ❑ YesXNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes—�'!o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes o
elevation markings? /
Waste Annlication
10. Are there any buffers that need maintenancerimprovement? ❑ Yes �No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ YesXNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground [] Copper and/or Zinc
12. Crop type 60,M U.O /
A { 0) 5rVe) RLC' &gAiP SE E
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
I9. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes el
o
❑ Yes �1�To
❑ Yes j o
❑ Yes No
❑ Yes )dNo
❑ Yes 0 No
❑ Yes No
❑ Yes ❑!No
❑ Yes r
No
❑ Yes �No
_, _
:Comments {refer to quesbon ##) Eaph& any YES answers andlnr aiiy;recommendabons orany other cominen_ts. A '
iUse drawingstuis(ase gss neca) Field Copy Final Notesoadtyoeterxpudolbidiry
:._
._...._.r_, r
b�-Oi'\ CQrnPLAJ4J-T PC,Gf CovVgiA-TCV
1/03
S��oc SU2VEy , APlt Zj�
c L-zc� �� r� r� Dod E X
PLAT c.ls�. Be Do#-Jd P3 NAB-C'?A z
ZC og,DS LOOK
�-- .-
Reviewer/Inspector Name r is 9 max'
°.�j
?.d.A."' nip ae4
Reviewer/Inspector Signature: Date: 11 0
I2112103 8 Continued

Facility Number: 31 — Date of Inspection
Re wired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes (� o
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes / No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes Q�No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes /�N0
25. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes �No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Yes No
El/
2$. Does facility require a follow-up visit by same agency?
❑ Yes No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ YesXNo
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
j�Yes ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes X.No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ONO
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ 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 XNO
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall [:]Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

i
Type of Visit Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 40!rComplaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: C
3 t
0 Permitted 0 C/e�rtified 0 Conditionally Certified [3Registered
Farm Name: . l r-i^d pie t -Ae. —
Owner Name: '" l' CUe� H f'd t-
Mailing Address:
Facility Contact:
Onsite Representative: L/ ; h n 1 2je,, J%VW\
Certified Operator:
Location of Farm:
Title:
Time -
Date Last Operated or Above Threshold:
County:
Phone No:
No:
Phone No:
Integrator:�
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 F-7' Du Longitude 0 ° OK
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Ca acity Po elation
❑ Wean to Feeder 10 Layer I I ❑ Dairy Ii
❑ Feeder to Finish JEI Non -Layer I I JE1 Non-Dai
❑ Farrow to Wean -- - - — - --------- - -- - -'-- - --`
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish ! Total Design Capacity
❑ Gilts
❑ Soars Total SSLW
Number of Lagoons ❑ Subsurface Drains
Holding Ponds 1 Solid Traps ❑ No Liquid Waste A
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
reeaa ILJ Spray Field Area
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Oyes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: -7 — �f
Date of Inspection 4
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 main tenancelimprovement?
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? .,eExcessive Ponding ❑ PAN Xydraulic Overload
12. Crop type
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
'01),'es ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
,0 Yes ❑ No
13_ Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a iettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design. maps. etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewiinspection with on -site representative.)
24. Does facility require a follow-up visit by same agency'?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
�'es ❑ No
❑ Yes 21'No
❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
I© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit. ^
of fact"hty io better�explaia ssiitu ons .(use additttonii pages as neeessary). ; ❑ Field Copv ❑ Final Notes ,
`r2c'=d'an�d -�v r� Co•,.1Pl�;n-f �'.-o•ti-, ��ck �a�e show; �P,�i(;.t� j�.vr,�.�iJ
4%mo( ��obable d sGkcfit,aJc of a.>�r,'►^-�� J t,�as e FrOn rvrroff f:�o+, qv±
i ►^r : Oor �, evevq ' "b 44e Gva-iv,-r q _r4o 4c . Apr I, �.�-�; p�� rg-le Was
-� aQ �r�e-a� ->r - gaud ►=�; a,�,s . )sv -two reels Cues be ' a rya #mod
s i Ac b y s ]die q4 4Ite sang -�, �,•�e: -� �,`s p,.A c4i ee rl�eat� � �be avo^ d1d,
S,� w.p!¢r 4 P r G4 vies Ive re 4,q ken� R 1 se ; ejr eLknd WA is Cer" ; Ak5 -�•
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
OSIV3101
Continued

Facility Number: — S Date of Inspection 2 D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
-Additional CommenN-"and/or.DrawtngF., .. ..
�o s'vv�aG� on a, w4�-EwwAt� ih �� sp�''`��j�';e�!� -rvcti 4ka4
y or: :' � a4 c. d j4w A j4 e iR'vl�t OP iSGltGt '' o� C Gd ; ref-4 � � + h 4e 4 4e -<W414 G�
Wo! �GfS, 4L :.$ Ga nho� be Anx se G,Yf ea; ve
M v.S 4 ale -kr key 4,n �ere ✓e n -F 4l.,e d ;.rche? e g e w As � e
4e W A 4rif-f - A, l S O J we, • a ! e ]eel V r riCiT y of
KleA 'T'>ove-k c4vle-s and w;11 Mr. DauP�
d'
t4 ) / I] 00�i14eva y-
eib e e,t 4),e p re ee4 i n) i rc cr +'►�q� +G"'� t7 �l, 01'��
05103101

Facilitv Number S Date of Visit: Time:
10 Not Operational 0 Below Threshold
0 Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: ►-✓1 ; / ��l�r f1 �y�G County- _ul b i ^_
Owner Name: � r' Ic'-v ,G d✓ i d e Phone No -
Mailing Address:
Facility Contact: Title: Phone N :
r ^I V rhy-- t��own
Onsite Representative: _ _M + G kA e) l dr i Gt GIB _ Integrator: ��' ��� �� a� CA✓ol,%+�
Certified Operator: Operator Certification Number:
Location of Farm:
[]Swine ❑ Poultry ❑ Cattle ❑Horse Latitude 0' • OK Longitude '
-.:._ . -
-Design _:Current Design _ Current Designs Gurreot
: Swine " _ 's- Ca `acity ~Po ulation .'Poultry . - .'.: ':Ca aciiv ' Po ulatit n Cattle -_ Ca _city Po ulatton...
❑ Wean to Feeder 10 Layer er # ❑ D airy--
❑ Feeder to Finish ID Non -Laver I I Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder e ❑ Other
i-
❑ Farrow to Finish Total Design Capacity
❑ Gilts W
❑ Boars i. `SSI:W Total
Number of Lagoons 2 i ❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds `1 Solid Traps .- ❑ No Liquid Waste Management Svstem
Discharges & 5tream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ L.at;oon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection R Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: tf Z
Freeboard (inches): 1 3
05103101
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes A�rNo
❑ Yes _QNo
❑ Yes -JZNo
Structure 6
Continued

• Facility Number: 3 [ — 4 j
Date of Inspection Z d2
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?
❑ Yes O No
❑ Yes .2No
❑ Yes _lRrNo
❑ Yes ffNo
❑ Yes 2 No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding [I PAN El Hydraulic Overload ❑ Yes L dNo
12. Crop type -3e r W--,V �� tc y + Sma � rq ,'•-, _ /
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 2rNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes, L�rNo
b) Does the facility need a wettable acre determination? ❑ Yes ONO
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes XNo
16. 1s there a lack of adequate waste application equipment? ❑ Yes
No
Required Records & Documents /No
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ElYes
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? �y
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ,fNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) El Yes o
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes h3o
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes _]Ko
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes _Q"No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes _,ErNo
24. Does facility require a follow-up visit by same agency? ❑ Yes j'No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes _0140
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cammeitts:(refer.to question #}: Eirplain any YES'ansirers and/or any;caatimendations:©r-any other:comments
--
Use drawizies of facflityto better explain situatio©! . (i se.additional pages as necessary) - - � mm � Final Notes
- .. Field Conv
/
�+1,'S tGY+^'� +-r �ei►-`q Y►1A►yt�tiil'?B� �v} atLt exeelle1
The r'e r ,'4,5 Are -Ve,,, wef-7. T' e b+^ y1✓dq Crar ix eXcdl ck4,
—rAe 1�yaAY,sQna[.st.���.� hot�sP Aeer, A,-e
Reviewer/Inspector Name j -�p v 1 L'ri-
Reviewer/Inspector Signature: 1 Date: 2 % OZ-
05103101 .1 Continued

Facility Number: 31 — L(S 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'ZN0
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ��fo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 10,10
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 .1zN0
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 4 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes fZNO
32. Do the flush tanks lack a submerged fill pipe or a permanentltemporary cover? ❑ Yes ❑ No
Add itional"Comments and/or Drawinp-s:
0510310.1

Date of Visit: 2 6 j Ti
me• 1 © S
Facility Number 3 ] S
Not Operational Q Below Threshold
13 Permitted 13 Certified 0 Conditionally Certified [3 Registered
Farm Name: ....... F '.=.!.,..:... c............ ...........................
Owner Name:. ............... .'.G�`'`e�....A�....14 r '. °( � �.......................................
Facility Contact: ..... ................................................... I...................... Title:
Date Last Operated or Above Threshold:
County:.. !� �► ►•
PhoneNo: .................................................................... . . .......
Phone No: . ............... . ........ . .. .
MailingAddress: ............... . ............................................................................. ....
Onsite Representative: to " 6kcte) Integrator:...19W As
...................................................�........................................................................�r " ......... Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ° " Longitude • 6 46
. Design , " Current
Canacity Prinulatian
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number_6f Lagoons Subsurface Drains Present jrltagoon Area ❑ Spray Field Area
:Holding Ponds [Solid Trsps:; f ❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: L e l k3
..........................!..r................ ................................... ............. .......... ............ .....................................
Freeboard (inches): 4-z 31
5/00
❑ Yes 'VNo
❑ Yes ❑wo
❑ Yes �No
17 A
❑ Yes 7No
❑ Yes 6 No
❑ Yes 0 h10
❑ Yes 4XN0
Structure
Continued on back

Facility Number: j •- L Date of InspectionO J J
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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type G 2'- V--w - pc, � .
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (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?
N'-yiolatr;onjs:or d Je n-vtwre ¢tee >tr g hjs:VWj Jti • Y:o0 widj-teWye too fu> thtr
eorres oideike' ah6iif this visit`
Use`drawings of.faclity to ]letter e
❑ Yes J!fNo
❑ Yes ONO
❑ Yes ONo
❑ Yes [(No
❑ Yes ZfNo
❑ Yes )zNo
❑ Yes No
[]Yes XNo
❑ Yes P No
❑ Yes P No
❑ Yes XNo
❑ Yes Y—No
❑ Yes NO
❑ Yes JZNo
❑ Yes 14d No
❑ Yes JeNo
❑ Yes fNO
O
❑ Yes
❑ Yes ONO
❑ Yes PNo
❑ Yes )21 No
❑ Yes P No
r'1+� �a(�rGidle�5 �GiI:}� Q►`1D� S�✓R�-1 i'C�O�{ �JC �l�rLf k,,eIl V-%--;n4Ctt,P^1Ed.
lo be e 4o use A l wC�s-1 e C) n.R I S_: r 4et4ed
WI 'Ivi 64 Act s of � ffbC.04P0JN evenfs _ r
a•bt, e,rv.,;5e 44) rer,,5AA s 4 ee m ao I y ke)o_
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date: l L 5/a(1

n
Facility Number: 31 —3F5 Date of Inspection '--�-h-�l-�
'Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes XNo
liquid level of lagoon or storage pond with no agitation?
27, Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 9No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONO
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ YesZdNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes,,EfNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional, , otmments an or' rawings-
S/00

Drnston of Water. Quality e _
,:Dr' of it and Water Conservation
�' 0 Other Agency •
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit '$-Routine O Complaint O Follow up O Emergency Notification O Other —n [I Denied Access
Date of Visit: I/ h Time: Printed on: 7/21/2000
Facility Number
Q Not O erational O Below Threshold
Permitted ❑ Cert fie ❑ Conditional] ertified [3 Registered Date Last Operated or Above Threshold:
Farm Name: !Q:►tr !..I� Q V Y% 5 :Q •.. County: Dk��.ft? :........... . ..:.......
OwnerName:....... ... ...... ............................................ Phone No:.............................................................................
...... ............ ........ ........... ...... .......
Facility Contact: .......... �•f �=....... .... .. �t Title: S l3' ` . . Phone No:.. .................................................
MailingAddress:...............................................................................................................................
Onsite Representative „.(..� t�•• ._. l• Integrator jx
L�......... ... ...... ...............���. L!.............
Certified Operator: ................................................... ............................................................. Operator Certification Number: ..........................................
Location "of Farm:
to�wlne ❑ Poultry ❑ Cattle ❑ Norse Latitude 0 C « Longitude • 6 «
Des, Current Desi Curriaiot Desi C
t 1°� >�
Ca• ` i i Po elation:, ;'Pon]try Ca ci Po elation Cattle Ca ara "'Po u
Wean to Feeder
i`
eeder to Finish
Farrow to Wean
°=
Farrow to Feeder
.,
Farrow to Finish
Gilts
:.,
Boars
❑ Layer 1 ❑ Dairy
❑ Non -Layer I I ❑ Non -Dairy
❑ Other
Total Design Capacity,
Total:S$LW
rj>amber`pij;agpaps ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
_ -
H'otods o4ng / Solid Traps = ❑ No Liquid Waste Management System P
Dischar•ees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon El Spray Field El Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach,Water of the State'? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
❑ Yes 690
❑ Yes ❑ No
❑ Yes No
❑ Yes ❑ No
❑ Yes 9CNo
❑ Yeso
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes dTIo
Structure $I• Structure 2_ 11 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ......................................................... .�.............................
Freeboard (inches): 1 -4 ,L rl � j-,
5100 Continued on back

Facility Number: — Date of Inspection / / Printed on.• 7/21/2000 ��//
5. Are there any imme late hreats to the integrity of any of the structures obse ve. ? (ie/ trees, severe erosion, ❑ Yes �7No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes ®'No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ,`"No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes -dNo
Waste Application �
10. Are there any buffers that need maintenance/improvement? j,�,tiy r I a y,� & A ❑ Yes dNo
11. Is there evidence 0
ov lication? ❑ Excessive Ponding PAN ❑ Hydraulic Overload ®Yes ❑ No
12. Crop type J Ia p" \
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
b) Does the facility need a wettable acre determination? ❑ Yes -9NO
c) This facility is pended for a wettable acre determination? ❑ Yes D No
15. Does the receiving crop need improvement? ❑ Yes E3;No
16. Is there a lack of adequate waste application equipment? ❑ Yes _dNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes b�No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
- ❑ Yes 4No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes X&
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes KNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
��'
❑ Yes
(ie/ discharge, freeboard problems, over application)
.tom_
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes *0
24.
Does facility require a follow-up visit by same agency?
❑ Yes
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ❑ No
vi...........en... were noted .... � this:v.. . Yo. will receive Rio t.... r
:: ' Correspondence: A6 k this visit: :: :: :: '
Comments {refer to question #) Explain -any YES answers and/or any;recomiitendatians or any other eopments z
Use dra ' -_ -offacili to better'ex lain situations use additiioiiwl ii es..as-nec s =—
,,... �&� � t3' - _p - { . P S . essary) ; •.:
J � • 1,�yU I S Ov�-a p p � ��- s-,rah-�- v-� yr �b bra y'� - �-l�.ti ��
. ./L f�Y� c � � /a�v,�s � ry e-tom ✓{ � v-,-• r -i I�
t 17 ! � Y� s, �Pvlls (' a►r, ,c.d�l�� t r
;s `
l
l D�k s ci aac- ,
Reviewer/Inspector Name �:, , ' — C%
Reviewer/InspectorSignature: 14 Date:
/ /

'-^"V'r:€i6+'.iR',�w.,z.,.�lt.�ti-lin--+���.y.a..t:'.:;3�;N--;.G4•ii^��A.a-.'taa'.`vr�,..«l.+t.:..�'hS+.?- ,.-.,,`w:�,..:L. Yam. �^ �� .. ., as
•
!• Facility Number: — Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes i�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 ;t�Nd
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ElYes o
roads, building structure, and/or public property)
29. is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes
_,,O-No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 0�0.
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑i No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes o
5100

'Division of Soil and Water: Conservation - Operation Review;.
O-Division of Soil and Water Conservation -Compliance Inspection _
Division of Water Quality-- Compliance Inspection
Other Agency - Operation Review _
IR Routine 0 Complaint
0 Follow-up
of DWQ inspection
0 Follow-ue of D:SWC review 0 Other
Facility Number
Date of Inspection
zW11
Time of Inspection
Z.35'
24 hr. (hh:mm)
Permitted gvertified
© Conditionally © Registered JE3 Not O crational Date Last Operated:
FarmName: ............dV `.&!..... .....�....l
[Certified
G...._............. ...................._....
County: _...._ GQkk'...........................................................
Orvner Nante:....................r�1(y19z
............kllilf�!.............---...........................
j 1-
['hone No:....�7-SL�_itg'.3..`...........................................
FacilityContact: ...............................................................................
Title:................................................................
Phone No: ...................................................
Mailing Address: .... y.LA..........
Ekst.... ... 1k...�t
............................................
............ �............
t11AX.......4 11 N�............................ .2-25 �.Z.....
Onsite Representative:
r�
Am�� ..AQ
.P...........................................
..
�
Integrator:..... fiZ�t�..............................................................
Certified Operator: ...................................................
.............. ..............................................
Operator Certification Number:..........................................
Location of Farm:
.......................�12V 14
......�<....t.....�..^%.1........_....... :..6f........... os.L1.4............................................................................
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- -----------------------------
Latitude Longitude
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons Subsurface Drains Present ❑ Lagoon Area Spray Field Area
Holding Ponds / Solid Traps ID No Liquid Waste Management System
Dischart!es & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance titan -made?
b. II'discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate'?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: K L
Freeboard (inches): ...... ...... ......
3`..................................Z7........_..................................
❑ Yes 09 No
❑ Yes No
El Yes No
NIA
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes M No
Structure 6
1/6/99 Continued on back

Facility Number: �I --qS Date of Inspection j�/•q�
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, `—`}'t'❑`-'Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ® Yes ❑ No
S. Does any pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes VO No
9. Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
j 3No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
fj� No
11.
Is there evidence of over application? ❑ Ponding ❑ Nitrogen
❑ Yes
V] No
12.
1 I
Crap typeM4l i�'4g[.0......V`J....................d1... SM6......... ......................................................................................................................
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
(51 No
14.
Does the facility lack wettable acreage for land application? (footprint)
V Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
P No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
E10
r
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
ElYes
No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
M No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)R9Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
O} No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24,
Does facility require a follow-up visit by same agency?
❑ Yes
No
0_ N.oAkda'tions or. deficiendes .were noted during tfiis:visit:. You ill.re>ceive na further
corresO ' deuce; abbot: this visit.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:..:.:.............................. .
Coniments (refer to question #): -Explain any YES answers and/or any;recomrnendations'or any otltier comments._-_`
Use`drawings of facility to better explain, situations. (use additional pages as necessary)
7.
S�ftri �a �CVe�`�+nn GCO yac eta400r- t` SYwultl �e �g �rcVfk�
l.►�-�1�
Cyr bu.lrmLh� S t�t1 be ObS YV4 Sm.&V
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: tC } l4'm
1 /6/99

- ❑ DSIN7C Animal Feedlot Operation Review
j� DNA Q :animal Feedlot Operation Site Inspection
Q Routine WCumnlaint O Follnw--up of DXA-*O inspection O Follow-up of Dswc review O Other
Date of Inspection 9/j-jjjr
Facility Number 3 Time of Inspection 24hr. (hh:gem)
0 Registered q Certified 0 Applied for Permit ❑ Permitted JE3 Not Operational Date Last Operated:
Farm Name: ............... _:... County: ......
............. M,�aQ� ._... _.ts�x�s� _....�� �^ �t4 Owner Dame: _ ..�.... Phone No: _...�
Facility Contact: Title: Phone No:
Mailing Address:
OrkiteRepresentative:..,..�—i.��.... _�....p+Ca��....._...... �. lntenrator: .._. . ............ ... _
Certified Operator;.. _. T•. Operator Certification Number:
Location of Farm:
Latitude Longitude �• ��"
Design -::Current :` _ =Design::. trrrent . Design - Current„. . .
Capacity.Populat,on :::Poultry CapacOf :Populatiota .Cattle :Cagac�ty �o�iulatiant q`
Wean to Feeder
Feeder to Finish
j
0 Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
= ❑ Gilts
0 Boars
D Layer ❑ Dairy
❑ Non -Laver I 1 ❑ Non -Dairy
❑ Other
Total Design Capacrts` C
Total SSLW
Ttetimber:of Lagoons "/Holdrng:Ponds ...
`.
General
Or 1. Are there any buffers that need maintenancerimprovement?
2..Is any discharge observed from any part of the operation?
Subsurface Drains.Present 110 Lagoon Area
No Liquid Waste
Discharges originated at: ❑ Lagoon 0 Spray Field ❑ Other
a. If discharge is observed, wag the conveyance man-made?
b. If dischar--c is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flo„ in cal/min?
d. Does discharge btpass a Iarroon 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 pan of the waste management system (other than lagoons/holding ponds) require
maintenaneei improvement?
5. Is faciliry not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7P-5/97
Ui
pray Field Area
rXa N
❑ Yes ($No
❑ Yes IN No
❑ Yes EJ No
E3 Yes
0 No
N
El Yes
No
❑ Yes
No
❑ Yes
No
t Yes
[]No'
❑ Yes No
❑ Yes No
Continued on bask

F'acilit�• \umber: j � — !��
S. Axe there la,00ns or storage ponds on site which need to be properly closed?
Structures 11.agoons.Holdinw Ponds. Flush fits, etc.t
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure? Structure Structure.
Identifier -
Freeboard (fr) ... .... ._ . �. ._ _ _... ......
10. Is seepage observed from any of the structures?
1 I. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public stealth or environmental threat, notify DWQ)
13. �Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste ADMication
Structure 5
❑ Yes OtNo
❑ Yes M No
Structure 6
❑ Yes N No
❑ Yes ® No
ED Yes ❑ No
❑ Yes No
14. Is there physical evidence of over application? ❑ Yes ,ill No
(If in excess of WMP, or runoff e
ntering., 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 2�No
17. Does the faciliry have a lack of adequate acreage for land application?
1 B. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21_ Did Reviewer/inspector fail to discuss reviewfinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onhv
23. Does the facility fail 'to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
[j No.violations or deftcierecie's.were-noted-durinu this.visit- You'will receive -no ftirt er
correspondence about
❑ Yes 13 No
® Yes ❑ No
❑ Yes 0 No
® Yes ❑ No
❑ Yes M No
NiYes ❑ No
❑ Yes ES No
�j Yes ❑ No
Yes ❑ No
S, rjtti.ss�� Waicrw ,Y\, �,ela 4�1, be Y"
��. Co�%�r,v� e,�-�o `� t �Ne� �•ermA.u1�e-� eX. c�cer�icon��• r� I�_
}p ra l U�[ u� t �� G, cot lr
�10 Li
e ncv�cf e� o� t fLR�( �o' ,r'. �ct�a�r`
a, s � 4
y1unl\�'kr D � �U ICCh ,1 a�- n.i Sew oh. Str.G�,i1 �i^ tln �1 t�� � � � tbs/Ci[.. {L,,;
ps S�avW
OV
s vYl�y wL� mow-. r f elc 4 cr-d V .
bP�. (N � i r. ` rtt;►r.E'' I Odh S�a� Y 7/25197
Reviewer/Inspector Name 5
•� C1V
Reviewer/inspector Signature:
Date: 9 //7

Division of Soil and Water Conservation ❑ Other Agency
w� s -®Division of Water Quality F.a.a,
0 Routine 0 Complaint 0 Follow-up of MVQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspec:tiott
Facility Number t
Time of Inspection ULiZD 24 hr. (hh:mm)
© Registered © Certified © Applied for Permit M Permitted JE3 Not O erational Date Last Operated
Farm Name: ..1_ cg yr:.� I .....tea—s.,� County:.. .x1. ..�.s.. .................. .1... ..
5.......v:.r...........:...............................
............... .
O«rter Name:.......a..S �' .... .i.......�.r�....die........................... Phone \o: �� l..�l$..:..�t.Z.............................
Facility Contact: ,�.
.. Title• Phone iSo:.�q �. �...... �. —
MailingAddress: ..... 1JL_q........ uc,.A.A....... C............................................................. as _. .... ........t....1........ :.................. LIS..�,.L.
Onsite Representative: ... M, a..c-4�k...... 7�.-sri.. c}�q. Integrator: rator:.......................... �, .................... g ........:..............................................
Certified Operator;
Location of Farm:
Operator Certification Number: .........................................
.......... ....tar..,�....l.l..,....�.I
.rir.lt ,.vim r�.. _1 .....fit..... .....,.nl- t..t.....r...................... A
f Q•
:&vx. s. G. .> .r`: ......s co.i.xt l...... S..iP�.i. r .{�..................
Latitude •4 0« Longitude • 0' "
Design. Current• Design Current DestgiaW =Current
Swute •' Capacit Po ulatton, ; Poult. Ca acr Po` uli ion =Cattle CapaCtty Population
y P iY P.. ty P_
�. ❑Wean to Feeder n„ El Layer ❑ Dai
4 ry f
ElFeeder to Finish ❑ Non Layer ❑ Non Dairy
El Farrow to Wean . o
❑ Other
El Farrow to Feeder w
❑ Farrow to Finish Total Desi n Ca acit
❑ g P Y_ Gilts i=
y❑Boars TotaI:SSLW
u.
r
Number of La oons ! Holdzn Ponds : :34
l� Subsurface Drains Present ❑ Lagoon Area ER Spray Field Area
g� x'.©.
i
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
A. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes M No
❑ Yes 2 No
❑ Yes
EANo
❑ Yes
ti�
N No
❑ Yes
($'No
❑ Yes
CTNo
❑ Yes G!(No
❑ Yes IM No
❑ Yes (gNo
❑ Yes I_No
Condinued on back

• Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,liolding Ponds, Flush fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure ? Structure 3
Identifier: .
Freeboard (ft)•
Structure 4- Structure 5
............................................................................................................................
10. Is seepage observed from any of the structures?
1 L Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes [$ No
❑ Yes KNo
Structure 6
.........................................................................
❑ Yes KNo
❑ Yes [�No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an inunediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste -Application
14. Is there physical evidence of over application?
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...-. �r►�+-v..d-a4..........................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
0. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
• For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0. No.viola'donsar deficiencies. were: noted during this.visit.- Yodwill recei've:no.ftirtherr
correspondence about this.visit . • ..: . . : • . • - : • :: .: . • - .: " : .: ; " . • . � " .. .
A Yes ❑ No
❑ Yes Wo
❑ Yes ® No
❑ Yes XNo
❑ Yes CKNo
❑ Yes 9No
❑ Yes [ErNo
❑ Yes Wo
❑ Yes XNo
❑ Yes RNo
❑ Yes RNo
laYes ❑ No
j$Yes ❑ No
Cn�rnm�ts (refer to,questron #) Explainany YI;5 answers and/or any r�ommendations ar,,any other c�ttents: ,� f
�
draw��s exptairi
Use of Ea�cthty�to better situations �t►s� aaa,��onal pag� as n„ecessary� �� ry,��� �`�,� �`
F
t�����.
12 • v VV_A- . $u CA ram. e-c f r ire r, .•. ...1 u }.e-,rAYVL.; �r q e r� I-t. n I S e o c
V
dl� 1t•e. a.l
24. 2.5. 0 P �..-�'#4 r i s Q+p c e ! _'tom f t r o v i t.] �
QM Q �t (_V"t4 i i �Ol TI-N
�
�
A 4 0.
Jc.r�
a t y a i-t �t v- a l V e V'V 4% i•-t`
e—�� t i i e g- esn t 1'�� i t to �1 d�'� r
7/25/97
T
Reviewer/Inspector Name "IMS S,ll� q � � " 0"
T"ENT
Reviewer/Inspector Signature: Date: 4
c�

Site Requires Immediate Attention:
Facility No. 3 l - 4
DNISION OF ENVIRONMENTAL MANAGEMEIv-T
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
0
Ej
40
DATE: , 1995
Time: 17, : 05
Faun, Name/Owner:
Mailing Address: S'zt. 25 N a -
County:
Intea ator:
Phone: 293 — 3G o0
On Site Representative: Phone:
Physical Address/Location:
Type of Operation: Swine Poultry Cattle
Design Capacity: Z48'30 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 35 03 6$ ,'L7 Longitude: ' S7. Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches)Ye or No Actual Freeboard, -Z— Ft. & Inches
Was any seepage observed from the lagoon(s)? Yes oiD Was any erosion observed? Yes or�
Is adequate land available for spray? Qe or No Is the cover crop adequate? De No r
t -- p cry --osf ( err fe t � 5 t
Crop(s) being utilized:.,.. ��n�"a row � 5 coCA _ � �U � p J�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? 9or No 1
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes ore)
Is animal waste land applied or spray irrigated within 25 Feet of a USGS liap Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or To If Yes, Please Explain.
>.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
sprav irrigated on specific acreage with cover crop)? Oesor No
Additional Comments:
. {, - L, `
Inspector Name
cc: Facility Assessment Unit
Signature
Use aachments if Needed.

Site Requires Immediate Attention:
Facility No. _3 /5
DNISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995"
Time: Z:00 W01
Farm Name/Owner: Fom m F--*m 5 I h V e. A14 r;dZ
Mailing Address: Pry A NC 28 S 72
County: DO 01 ►�
Integrator Yawns Phone:
On Site Representative: Phone: 919— fig— (ozo&
Physical Address/Location: v M jC !✓o -e q03 /V -1
,je ors n' hf- 2 5 c/1 ur
Type of Operation: Swine Poultry Garde jai h 1
Design Capacity: 1060 Number of Animals on Site: (J
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 35 ' 03 ' 10.51" Longitude: V ' 4'8 C 000 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) es r No Actual Freeboard, 3 Ft. .60 Inches
Was any seepage observed from the Iagoon(s)? Yes or To Was any erosion observed? Yes o No
Is adequate land available for spray? Ye or No Is the cover crop adequate? es r No
40 Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet front Dwellings? osr No
100 Feet from VVeils? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste Iand applied or spray irrigated within 25 Feet of a USGS itap Blue Line17
.
Yes 4S
Is animal waste discharged into waters of the state by than -made ditch, flushing system, or other
similar man-made devices? Yes orNo 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)? (9or No
Additional Comments:
_ L L&AA'5
Inspector Name
cc: Facility Assessment Unit
Signature
Use Anachments if Needed.