310048_INSPECTIONS_20171231

NUH I H LAHUL#NA
Department of Environmental Qual

.f
Drnsion of .Water'Resources
x _. .. m-�IvsinFacil*rty Number L� ooSoil an�°
-
'O Other Agency',:'
Cype of Visit: Compl' ce Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: ORoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: l03 o Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: ' y/ P r c f ,i t� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
esag urren ;, - esign u
=' `Swine.-
Capacity " Pop. Wet PoultryCapacrty ; P
can to Finish
Layer
Wean to Feeder
I INon-Layer
Feeder to Finish
Farrow to Wean
Design "Cu
Farrow to Feeder
-D " Poult ,? Ca aci � 1?
Farrow to Finish
Layers
Gilts
Non -Layers
Boars
Pullets;
Turkeys
Other
Turkey Poults
r—Tother
Other
Certification Number: Z— G -.
0 7D
Certification Number:
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑-N ❑ 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
No ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
too NA
❑ NE
of the State other than from a discharge?
1
Page I of 3 21412015 Continued

Facility Nuipber: - q Date of Inspection: 2. 47
Co
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: ( 2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 37 �3 t_ 36 `_( D
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
rNo ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre t, 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
o ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes,
Ef No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
P40 ❑ 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
ICJ N 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
� ❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes
rNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
r rNo.� ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
F2-<o ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes VNo ❑ 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 [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes Eeo❑NA ❑ NE
Page 2 of 3 21412015 Continued

Faciii Number: jDate of Inspection:L-71
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA ❑ NE
25; Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
FO/Non-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: 2 20l 6
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes MNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ONo, ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑'No NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [:]Yes No ❑ NA ❑ NE
s 3( _09�
},a s �� �.�
��3c�n�vl �(,t/
3J aPL(�
14'
Coc,
'C'(,
P r7--a.. f E �i a f ��� I n / ern , �o u` len6^
r
G Z�2_rf6 Sjw e �%'/� sue'' /n4ll
L¢yaor- 5/1 it z I —tD
514)e S--/-L�fy /z�'(1//' ©-
Reviewer/Inspector Name: U0 t/ t ({ 1A
Reviewer/Inspector Signature:
Page 3 of 3
rA
Phone: TP ZrO2---y
Date: 2: l(o
214r Ors

0 Division of Water Resources
Facility Number L.? r - ® O Division of Soil and Water Conservation
O Other Agency
Type of Visit: 0 Co Dance Inspection Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 19N Departure Time: Ou ti. County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: _Dere & gjrQ6-z", Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: 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
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
1q3Z ) Layer
Non -La er
Discharges and Stream Imaacts
Non-L�
Pullets
Turkey
Poults
Design Current
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
1. Is any discharge observed from any part of the operation?
❑ Yes
Lam,
❑ 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
EJ�No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E'No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - 4 IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i
Spillway?:
Designed Freeboard (in): �--
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes D<O ❑ NA 0 NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes to ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [r'go ❑ 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 Ej No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ©-Tlo_ ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. []Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [5"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?
IT Does the facility lack adequate acreage for land application?
❑ Yes
[I No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Ree uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes
DNA
❑ NE
Does the facility fail to have all components of the CAWMP readily available? if yes, check
[] Yes
rNo20.
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [-]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall O 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 Nol ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [/No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

b'acili• Number: - Date of Inspection: i S'
IF
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E]-TNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes El -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA Q'lgE
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Ej 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 ENo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss reviewtinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes Ej"No
❑ Yes [J'No
❑ Yes dNo
❑ Yes [3/No
❑ Yes E11<0
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature: a.v{/l Date: 2/2
Page 3 of 3 21412015

ivision of Water Quality
FadUtyNumber - ® 0 Division of Soil and Water Conservation '
0 Other Agency '
Type of Visit: iffCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 9ruoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
I'MWean to Finish
Wean to Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Title:
Latitude:
Phone:
Integrator:
DI
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer I I Ed
Design Current
Dry Poultry Canacitv Pon.
Layers
Non -La ers
Pullets
Turkeys
Turkey Poults
Other
Longitude:
Cattle
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry 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 DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate of inspection: 5-14—
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure Strut 4 Scture tructur 5 Se 6
Identifier: 1�1 13� �� tru
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 environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ 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
[] 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
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
DNA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - LK jDate of Inspection: ]f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ❑ 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
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 ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA D NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes [:]No
❑ Yes ❑ No
❑ 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: ;LQ736 Sh
Date: r! j 1'
21412011

Division of Water Quality
Facility Number ®- 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 6Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: d Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: FUA County: J �(w►
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone:
Region: W 11RD
Onsite Representative:
Integrator:
O erator:Certification
p 6-y%t
1% ze�Y\
�,
Number:
OLbD3b Dr3Certified
Back-up Operator: 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
Other
Other
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
�:::::] I La er
Non -La er
Design Current
Dry Poultry Canacitv PoD.
Layers
Non -Layers
Pullets
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes VrNo ❑ NA ❑ NE
❑ Yes C ] No ❑ NA ❑ NE
[]Yes ❑ No [] NA ❑ NE
❑ Yes ❑ No
❑ Yes E�No
[:]Yes EfNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

�r
Facili Number: S 1416 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: t I— ;_'
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
Structure 5
G?f'No ❑ NA ❑ NE
E!rNo ❑ NA ❑ NE
Structure 6
❑ Yes 2TNo ❑ NA ❑ NE
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
ONo
❑ NA
❑ NE
waste management or closure plan?
-
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
12] No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
[:]Yes
ONo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:)Yes
Q30ONo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 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
P?TNo
❑ 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
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;3'No
❑ NA
❑ NE
Required Records & Documents
19. Did facility fail have Certificate Coverage
the to the of & Permit readily available?
❑ Yes
[EfNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
allo
❑ 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.
D Yes
eNo
❑ 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
allo
❑ 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 2/4/2011 Continued

� r
FaciliNumber: '2 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J�TNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes C2'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? 0 Yes J?TNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes. J;�*No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than -normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
2rNo
❑ 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
Z No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
ffNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JZ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
allo
❑ NA
❑ NE
Reviewer/Inspector Signature: Date: 5 I Q / 1�>
Page 3 of 3 21412011

Division of Water Quality
Facility Number - ® 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: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 Arrival Time: Departure Time: County: JI/ Region:
Farm Name: S jpG fxl��Q h �� 2 Owner Email:
Owner Name: G t� 1�(ZQI.I�� _ Phone:
Mailing Address: ��Q Rd V5C- K(L ! VC 9&7 g-(�- -
Physical Address:
Facility Contact:
Title:
Onsite Representative: ?2A_GLA_'v)/ Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Non-L;
Pullets
Other
Pouets
Design Current
Dischames 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)?
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
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes tNo
o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [] Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Faaili umber: - I Date of Inspection: ) J
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 1tt Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: �t`^
Spillway?:
Designed Freeboard (in): �q5 1 �. 19•
Observed Freeboard (in): I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
*o
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
O No
�\
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ATNo
❑ 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 J4 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 WindDrift❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s): V,) > No '_>
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes U"'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 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 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes rNo
❑ NA
❑ NE
the appropriate box.
QWUP EDChecklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
0 Waste Application 0 Weekly Freeboard ❑ Waste Analysis Q Soil Analysis
T
❑ Waste Transfers
Q Weather Code
Q Rainfall ❑ Stocking Q Crop Yield ❑ l20 Minute Inspections Q Monthly and 1" Rainfall Inspections
Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of .I
21412011 Continued

Facltity.Nufnber: -Z 1 -k V I IDate of Inspection: 737 J 7M
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
No
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
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
j No
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
8 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any. other comments::.:;,
Use drawings of facility to better explain situations (use additional pages as necessary)..
t-VQ7�o�1
TO aoja o�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�H��wGEj� r✓�L� r C i �&�E
Phone:
Date:
21412011

O(Division of Water Quality 11
Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: u Region:
Farm Name: _ a�i�� Owner Email: +
Owner Name: `���--� �- t ��-��N Phone: 913—rD + r3919(o
Mailing Address: KY40 S/ooz 6 i4e Al�U Vos(e �AL,Ac an8U-S9
11
Physical Address:
Facility Contact: ,, . \ ,Title:
��n
Onsite Representative: � `�
Certified Operator: Qc A"Ls�_ '�) eQC1L
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: = c
Phone No:
Integra tAr•
Operat� or�efication Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
<, 0Longitude:
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Daia Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: E
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
El Yes
El No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
ElYes❑
t
NA
❑ NE
12128104 Continued

N
Faeility Ntfmber: [ —
Date of Inspection_
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: Si'�W IWAOL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): -14
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 A No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 1] No ❑ NA ❑ NE
❑ Yes ANo ❑ 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
ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ YeskNo
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
/ No
El NA El NE
maintenance/improvement?
, \
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
KNo
❑ 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 ElEvidence of Wind Drift ElApplicationOutside of
Area
12. Crop type(s) _�FL7uSC.e- Z e �L S C
13. Soil type(s). .r��
R
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No ❑ NA [I NE
17. Does the facility lack adequate acreage for land application?
El Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
jirNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any iecommendations or.any other corninents ..
Use drawings of facility to better explain situations. (use additional pagesas necessary)R.
Reviewer/Inspector Name Mt2,4 S Phone: q16 '�9�0 - 3
ReviewerAnspector Signature: Date: vg1111-
Page 2 of 3 12128104 Continued

H7_
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ElNA ElNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El No ❑ NA ❑ NE
the appropriate box. El WUP 0 Checklists
0 Design 0 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 0 Soil Analysis ❑ Waste Transfers ❑.04nual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections El Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes b(No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No 0 NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
�YVallo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Additional Cornments and/or Drawings:
C4UG 9-A_noN pu �Ol
o G- Sl`c�►DGC QoIN AsAp. �fluC LUXNT)L- ��%a�%!� To
1 S (qc � -N
1C (W'F0 CLAM t RNcC
6, i e
Hy
Page 3 of 3
12128104

D�vtsion of Water Quality
-�
Facfltly Nnmber.�� 5 O Dtvision of Soil andWater Conservation
.O
Agency
Type of Visit eS7Routine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ?L� io Arrival Time: 00 Departure Time: County: t Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: _w_4 Title: Phone No:
Onsite Representative: �� R-t"Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
�o
Latitude:
Operator Certification Number:
Back-up Certification Number:
a Longitude: = ° =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
PEI
La er
Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
rR Feeder to Finish
�Q�V
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
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
❑ Dai Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-DaiKy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 1 of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Vo ❑ NA
ElNE
❑ Yes
ElYes
ElNA
ElNE
ElYes
. Zo ❑ NA
❑ NE
12128104 Continued

j
'Facility Number: 3 t — Date of Inspection of 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 54o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6-ozrJ (..Ar,97r..% 2.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): gV
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes WNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, 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 d 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 [3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes NJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 ENNo ElNA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes E3 o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes LY No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ENo ❑ NA ❑ NE
❑ Yes 9�o ❑ NA ❑ NE
kx>T G-=u_ o or s -i p- -EL W\E 'V8 .T►.� A4, Z01 `
?LA-ASE 1gOo2fS5. _7L'o cR-s-kc�r 7_Lv,_ , FZ4 .
Reviewer/Inspector Name ;�-�� �`� Phone: i 3�
Reviewer/Inspector Signature: Q Date:
1. 12129104 Continued

Facility Number: — Date of Inspection
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 LEI No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps
p ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
[Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E3 NNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
WN
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
o
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E�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
dNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,�
IJ 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
d
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L No
❑ NA
❑ NE
12128104

FaciLty Number 3
i Division;of Water: Quality
w
Q-Division of Soil and Water Conservation
�,Ottier-.A.gene
Type of Visit XCoompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (O Routine O Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: C-xOPLMki Region:
Farm Name: Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative:
Certified Operator:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [� c [� i [� ff Longitude: ED c =' = [I
Swine
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer I EEA
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
FR&6
a66
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Discharges & Stream Impacts
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
1. Is any discharge observed from any part of the operation? '
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
•
❑ Yes UNo []NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
El NA
El NE
❑ Yes
❑ Yes
VN ❑ NA
El NE
El Yes
❑ NA
❑ NE
12128104 Continued

A -
Facility Number: 31 — $ Date of Inspectiion is o
Waste Collection & Treatment ,_
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El2 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: n1 1A LACIoowt if 1A6MJ 2
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S6 3 SS 4%,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
ENo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
JNo
❑ 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 tfyreat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[J1 o
❑ NA El NE
8. Do any of the stuctures 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
1
it I No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
VNo
❑ 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?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
ffNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
d o
[I NA
[I NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
2S, LaC.ars�i• Ig .5L00(wC 5t12VC.q NsGt4 o.*j OLD PAPEQ.Wof-K k C0AAPt,4.r16 wE Gj SkeE
20 5EC ..LP paa Vitt.4, OeE _- 25 Th Isc- 00006 .
Reviewer/Inspector Name Phone: 11,1 /76
Reviewer/Inspector Signature: Afm Date: 41107
Page 2 of 3 12128104 conanuea

A
Fdcility Number: 31 — g Date of Inspection (/ o
Re aired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Qther
❑Yes U�No El NA El NE
❑ Yes 0 No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ENo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes
No
ElNA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ s
,LJ
ICJ No
El NA
❑ NE
25.
Did the facility fait to conduct a sludge survey as required by the permit?
Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
L✓I,,o
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
U N//No
❑ NA
❑ NE
Other Issues
28. Were anv additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑'I o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI 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?
El Yes
,�
�I No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
L3"No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
' N
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number 3 �(
Q2 Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
iType of Visit mpliance Inspection Operation Review Structure Evaluation Technical Assistance
ReasonforVisit rRoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: tool Departure Time: County:Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
a�T
Onsite Representative: -G**G ga.")o
Phone:
Integrator:
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: = o = f Longitude: = ° = 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish $4t.o Caro
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ La er
❑ Non -La er
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures: F1
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [�`No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
12128104 Continued

Facility Number: 3Date 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: CPC4yrd A (.l1GOon� 1 �G�nw�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): N�Gu C1. &,C 315
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes C�No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,_,(
6. Are there structures on -site which are not properly addressed and/or managed [I Yes d No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental tth at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes I[J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? ❑ Yes fNo ❑ 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 Ej"No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P 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 o
❑ NA
ElNE
15. Does the receiving crop and/or land application site need improvement?
ElYes WNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes d o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes Y
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes L No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
?Ut.L, -Z3C3 (& 6$ c,c mS Nrao 4%?DCAuiscr oVEYULcWtD. VCVVe 09-Y YeAC, �„��. -ssjnE C14OU D
rJEu6rz EKc_&_E7 I0S rru+3. 3Cv-w\. I wca-tE'D c)N VkA . j c.Nw4C_'� Vak— %,Lkrorc ►Mz&/.
A5I F-,c cAtiEFL/L drJ ri.tsl3R�
wo,2.eL. afC/ ►�SI�E apt-C-s �vSp� OJT � C.�+�►1'3.w11JG �'1�{�
LACsar�N ►'3 -1EEDS t�oR 6C- S4L"n 3J') rmft'%' 6'"" c"G KL?0?_T,
Reviewer/Inspector Name J6 116 E • Phone:( 9/D) 711 -1j a
Reviewer/Inspector Signature: Date: O g
l L/40/VY l.Vrl NV"4"

Facility Number: 3j — 8 Date of Inspection I 3 ti
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does cord keeping need improvement? If yes, check the appropriate box below.
Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Yes
Nc
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
z Yes ❑ No ❑ NA ❑ NE
❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes YNO�o ❑ NA El NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ 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 13/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
l'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CJ 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
ElX1�f Yes
�, f
L.o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
,�
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
FNo
❑ NA
❑ NE
Comments and/or
12128104

Facility Number
0 Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
,coompliance
V Routine ()Complaint
O Follow up O Referral O Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: 0 �� Departure Time: County: �tZW' _ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: �� '`J 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
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 = Longitude: = ° = 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turt
❑ Turkey oults
❑ 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 Stacker
❑ 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 L"J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
o
El Yes
,❑
Ll No
❑ NA
❑ NE
❑ Yes
LdNo
❑ NA
❑ NE
12128104 Continued

Facility Number: �;s 1 -- Date of Inspection ti 7
Waste Collection & Treatment
/No
4. Is storage capacity (structural'plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: iAGm0 Q 1 S14L
Spillway?:
Designed Freeboard (in): 15.
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E�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
dNo ❑ 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?
2(yes
`26 ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
2No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
El[ Yes
�--,,��
o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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
D ivo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑Ko
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Zafgo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ErNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O'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):
9) LA &wo N Su 2 P(t&_D3 SS ca OF -a- w a E-C. •
Reviewer/]nspector Name o ruJ Phone: Q/d)
Reviewer/Inspector Signature: Date:

- c
Facility Number: j - g Date of Inspection t 4
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes d<No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [jio ❑ 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
ErNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E2' Vo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[Xo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E3<o
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
E 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
❑l10
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑-iqo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
L' --o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
El -No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes
Zo
❑ NA
❑ NE
Comments and/or
12128104

Division of Water Quality /
=Facityumber ?j !� Q Division of Soil and Water Conservation /
—.=••��'• elOther Agency ✓✓✓
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (?/ Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: O T Departure Time: County: D&4a2 Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Latitude: = o = I 0 Longitude: = o =' E_—] "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
8 tv0
5�-t6z3
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other I --
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Pouets
❑ 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
El Beef Stocker
El Beef Feeder
El 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?
Page I of 3
❑ Yes EJ'No -EI NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
� o
ElNA
❑ NE
ElYes
ZNo
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 1 V13Kj
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?
Struc�ture I Structure 2 Structure 3 Structure 4
Identifier: (ACoo"iA 6002-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): cs�-7 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 O No ❑ NA ❑ NE
El Yes ❑No [I NA El NE
Structure 5 Structure 6
❑ Yes L'I No ❑ NA ❑ NE
❑ Yes O/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 R(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 R(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,�{
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes L'J No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E(No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) Fe:SwG {y) 1&ER-1AyIpA L6) S 6 6
13. Soil type(s) VJ, 0e13
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
dN.
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
U/ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ErNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
El Yes
�ONo
U! No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
LA 6 00" 2. rr%►rz.0, N Lfos REPr✓R Gt 6sT 440"ZO & P2 p 0%_. StAtt T U VE L ��-
•
lFLNgp,zaJG . Inflow
w1e`C CNERGD FOIL_- 7 %Ok- 5PA0(FkPPLXrATVve V5ED 4XGI4E0LPAd)*V
VjWe Av30h%_,e5.j7S ,ans
,q d'2ec� i,,4 Jp etl -1'0 R.i17xix7 j AM9L4hL_ C JLV- r DaaE �&Y MA2. (t us(a
AOL"C wueA-k Cows NAVE, T_0& J FXELD N&CID Ta r3E A000--k-5SQ.
Reviewer/Inspector Name �- �N1�1Q�Ft� l� Phone: Q!D
Reviewer/Inspector Signature 11 Date: 2113�6L
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection t3 0 4
Required Records & Documents _,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElE 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 appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
G3 Yes
[-INoEl
NA
❑ NE
[I Waste Application El Weekly Freeboard L�J Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
PrNNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Lf No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
[Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Lr Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
['No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[TNo
❑ NA
❑ NE
Other Issues ,,.�,,//
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [2 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LI 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?
[3'�j 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
EfNo
❑ 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
d
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
7No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

CFacility Number'
3
g
Qf Division of Water Quality
O Division. f Soil and Water Conservation R
a
O Other Agency ;.. .
Type of Visit 95 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 0 Routine O Complaint O Follow up O Referral
--0 Emergency O Other ❑ Denied Access
Date of Visit: 2 D Arrival Time: Departure Time: County: Region:&�
Farm Name: \�, �D�G/i%� �/�!D ri�iP�? Owner Email:
Owner Name: , f Cam' —DGcJ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: %�Phone No:
Onsite Representative: 6Gf6!W , d-Z-6� "' lntegrator:�69!r "t"
i
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
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 d Longitude: = o= 4
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
- j ❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
LUT—urkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
1 Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
JZNo
❑ NA
❑ NE
❑ Yes
RTNo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of inspection 3 D
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;,No El NA ❑ NE
a. If yes, is waste level into the structural freeboard? El Yes ❑ No ❑ NA ❑ NE
Structure 1 Stt�ruc ure 2 Structure 3 Structure 4 Structure 5 Structure 6
Spillway?: /✓n /Lb
Designed Freeboard (in): J e?„5
Observed Freeboard (in): 23 ZS
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ;Z No ❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 0 No ❑ NA
❑ NE
through a waste management or closure plan?
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?
ElNo ❑ NA
ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes [7No ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes O No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes /'--' No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or to lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
VbJp)
12. Crop type(s) / /SJL'll�.� [ ( /�I-F� 60 / ,VO4 ��ftZr� .
/ Git
13. Soil type(s) alp, /Lie B
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
A No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[dNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
[;YNo
❑ NA
❑ NE
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
JVNo
P(No
❑ NA
❑ NE
Commentst(refer to questroa`#) Explain any YES answers andlor;any repotn anon or any other comments.
Use draw�ngs'�of fac�ltty to better eaplam srtuat,ons (use addtttonal¢pagesas�necessary):
.xq,�'4 �.ar. e-:s'�...�a�,w.,++. .. `�i�.:�'5 :.,•F. _�t:n�r..��a,xY�`�w-. w .'4�.,xb'i �.
ZO NCO Goa. �5 /� FOR /Q.9�frGF_y L�GaO•� Nis 9 /Z, ��-�5,� �9✓�
� NT26C A 60,60 r-pvz / 20 10*v • 7:�-J 5PF C /J .
C'o,�j
No WA5 fnVA-7 6&_F
Reviewer/inspector Name ' f p .' • Phone: -Is 9- y
Reviewer/Inspector Signature: Date: �J p
12128104 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists [/Desi n g El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfali ❑ 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
W No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VI No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
RfNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VfNo
❑ 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?
Elfl' Yes
,�,'
E No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
A 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?
El Yes
_,[
/LI No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[Z No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
LNo
❑ NA
❑ NE
Additional Commen'ts;and/orFDrawings
zo}
(,) 2 z, r- ��
r 6, 4- r en,o y
� vD 4,9z, 6 Eck
7c— DC10A.41e,
�EF-r ' e4VPy
AF MOD )C,AD
-46- FRe. Foy
�;70' rlsOC,
;r of ��,1�?6nl.��f `o �. ✓ ,�
r/f
tjl 46+5 ��U /GZZO -5 XZU D
(��}-9C� �02 L1,j4-5>,e= ✓�/�r✓Ot.V�. �Z � ��SPa� L OsJnl a�TT�-o�JS �R
12128/oa

it
_ �: Divion of Water Quality �� v
a O ihv�sion of Sod and Water�COflSe`V9t1fl11 m y
Ts Otli
Y �0 er-Agency S
�.�_ _ .. ,�-.s,-. '.�-�� ...�..c � ' �.. -. _.w, _ _... _ _ .,��'_ws�° � _ �` '^.f. • r..: ., � ._ . ;'�' • _.."�':: �i� - .. "� .. _ m m, x: ad,... -;ems: -.. .,�__ ,m.m,..gs:a�sr.. ��._._..5
(Type of Visit Of Compliance Inspection Q Operation Review O Lagoon Evaluation f
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: �Z Time:
0 Not Operational 0 Below Threshold
.,,,#Permitted Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ..................
Farm Name: ...... dG�CS ...�1.� ...C. rl� ........................................County: _...._. _ ....».... ...». --------
OOwner Qom,,
wner Name:..101MO......6.4................. t.Jp �!vN ............................................ Phone No: _... -
Mailing Address:.. _ ............................. ..... ......................._ .
Facility Contact: .................... ..... ....... ._......._-Title:.. .....------------ — .._.. .. ... .... Phone No: � .�_
Onsite Representative:.., Ai .--f->,a .-_. -..._ ..............................� _ ... Integrator. . „ .....�1 ��✓` A_...
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 64 Longitude • 6 46
�Designgn CiillF4t -� h,; I?esign Curr+
ACM, Po uiiation 76gitryCaoadiv. Poiii a
Wean to Feeder
Feeder to Finish
g b
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
�71❑ Layer x.
0 Non -Layer
>< Other
r
1 Total Desig
z "✓� a ;r+' ��Tt
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes VNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made? ❑ Yes ❑ No
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 gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Struc re 2 Structure 3 Structure 4 Structure 5
Identifier: .............. j ............................ ..............................
Freeboard (inches): 25 aG
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes YJ No
❑ YesXNo
i
❑ Yes I
Structure
12112103 Continued

Facility Number: 31 — 4 Date of Inspection 1
S. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 11No
seepage, etc.) /e
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or El Yes pl No
closure plan? f
(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 XNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ YesXNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes '4 No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes ONO
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type (-CSc (0 KIW26 (C.) mr1a SiwAw 6c,* dll6l't x-cy
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes [ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes No
b) Does the facility need a wettable acre determination?
❑ Yes�No
c) This facility is pended for a wettable acre determination?
❑ Yes o
15. Does the receiving crop need improvement?
❑ YestZ
16. is there a lack of adequate waste application equipment?
❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes [�N0
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Ye o
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
❑ YesXNNo
Air Quality representative immediately.
C6 &&Qifer to question #) Explain any YFS answers anci/o any recommendations or.any ottier comments.'- a
Use drawing- necessary F_ield Copy --❑ Final Notes -
o_ y-dii—h� sittaz_ addi'tS".<` n� pges as.�
'.l _ F
Fses� J
Wa=• z'... .- .o _:_...., r_ __=x:...e.»-'=� _. _.�2= ... �:.:'. .: ,w: ..� _..... �,-=�r:. �- -».e'-;,.:,-=:13:r .V' -' .. .� = .a.. d ..Z'
Io&jtjta, Nt-eQs Tb mcf A sr Rec.&-T C, C at)-b Paz mtr Akg4 rfl.C-cams.
+
j?k m ou e o LD 13At,E s + f �A ?�' dAJ e_E(f,-Nt"L )' P4Cl4a,f 6_h -r(C TZi gRy)9.
SUJL)Fr � S'C&V ce Apub 'CA"rAjr�/ NEI0 ra & Cq"jUgj/ /3 1-1
Reviewer/Inspector Name �� V_..
_ - ..
Reviewer/Iaspector Signature: Date:
12112103 1 Continued

Vacilit.rNumber: 3 _ Ll Date of Inspection I I+ V
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
X Yes
❑ No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
z No
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
YNo
❑ 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?
❑ YesNo
X
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes�No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
28. Does facility require a follow-up visit by same agency?
❑ Yes
o
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
/[1I o
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 3I-35)
Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�dNo
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit j2 Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit RrRoutine O Complaint O Follow up 0 Emergency Notification O Other ❑ Denied Access
11ate of Visit: Z 6 Time: J J % 30
Facility Number 3
N'ot O erational QQ Below Threshold
0 Permitted © Certified 0 Conditio��naliv Certified [3Registered Date Last Operated or Above Threshold:
Farm Name: �4 a ' ^�'TjjC cL FA_ County: —
Owner Name: ` a d �� D tN » Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Z) 6 y" t T✓ aW h Integrator: e o w ri s
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 �" Longitude 00
Design.. -Current Design Cucrenf Design ; <- Garment
Swine -Ca acity .Pa iilaaan=° Pouttr _ .Ca achy _Pa ulatioa _ `Cattle__ Ca achy °Pa iielatlon -=
❑ Wean to Feeder i ❑ La er ❑ Da'
❑ Feeder to Finish ID Non -Layer I 1 10 Non -Dairy
❑ Farrow to Wean
ElFarrow to Feeder g _ ❑ Other
❑ Farrow to Finish - Total Design Capacity' -
Gilts _ �
❑ Boars Total'SSL"W
Number of Lagoons �� ID Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
M IioldtagTonds / Solid Traps- N �, El No Liquid Waste Management System `Vr
Discharges & Weam 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 galimin?
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: 1
Freeboard (inches): '79
05103101
❑ Yes La/No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 9No
❑ Yes XNo
❑ Yes�o
Structure
Continued

01
Facility Number:
Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed?. (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ElHydraulic Overload
12. Crop type Fe 6 ve r, r�i+v'� e r ri. d t 6^q i e _ 01 ,, � W h
-r
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 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/laspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes &No
❑ Yes j2fNo
❑ Yes VNo
❑ Yes [2rNo
❑ Yes PrNo
❑ Yes ZNo
❑ Yes j2rNo
SO 14 Ll 1'^-(
❑ es 2� No
❑ Yes A No
❑ Yes14 No
❑ Yes .12TNo
❑ Yes PrNo
❑ Yes ZNo
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ONO
❑ Yes ONO
❑ Yes JL�rNo
❑ Yes '211"
❑ Yes /�No
❑ Yes JZNo
❑ Yes ,dNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer fq;gttestion lf) Explain anv YES aoswer&and/or any recontmeandattons or any;outer"cowrnents:
Use drawitigs of facility to better eiplatn sititattons: (ose addeteonal,pages:as neeessam) { `
_ _
Field Cory El Notes
e
r 6 e ,'r J i�+�q : ✓�-} a + YIe4� i-I a >n- Ek CB Il e `► j �' o ►-t d +-� o �1 .
_4e ,-ecop-df Are Very wccll Aer�. __r,�e Gro1ot are beiwell
►'mot a1 a e dl ; -J 1-, a �e r r� dt a to Lv�► S s pr i eGsr - Lt,Ts a
Rlsa� �'ke,-e iS ��
will es�abl�'.skeOf. ice' of n;Ge �f �es�ve .
ine 1'2Drl.Ses resell krll.
�L,t �rBci grLoL4Kd nd-��,e�ia9oonl qre
Reviewer/Inspector Name i
Reviewer/Inspector Signature: Date: 2-
05103101 Continued

Facility \umber: 3 j -14Date of Inspection
dor 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 anv 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 �T\To
❑ Yes ZNo
❑ Yes zNo
❑ Yes No
❑ Yes XNo
❑ Yes ❑ No
-Additional"Comments and/orDrawimp:
18 . Pl ea se 5 �od h A, r
�1,C 1n oah des � yn Fa 4 ke l
A e,ses 1-4 q ,4 kee w ►' -1 -� t,� Yecd�d s
A4 awm bGI �'e,ve zV,6;vc-^a�r h Li been
ISsicd -�'d� 44e 4&vO 4A/r-tS. `jaL&�'efvice)
i4 is VI73)]t aft—g�e oRV^ � rG//��tf�I G ,��� iKtfae���6+-t . P
%'I d +'1C�lt�iSG� 0[7-�kih
t civC:' Gla ✓,' %q ble ?d✓ 711spee-li dti .
AVn-Ic T n,?ed Gh4ngc -Ae go rr ir.t,qr Gars +at� FLO-le
✓ be,r ��' III — 2175 -ao9Z eL,-"
05103101

Type of Visit 'Compliance inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit Q Routine 0 Complaint . 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
l: acility Number [late of Visit-
Permitted ❑ Certified 0 Conditionally Certified © Registered
Farm Name: Ot C 0 C T l t 4
Owner Name: O"el )d e+ 3►l ep W YA
Mailing Address:
Facility Contact: Title:
Onsite Representative: De rC k_
Time.• � 3
Date Last Operated or Above Threshold: _
County• 7) 1�►Ol ►t-� - -
Phone No:
Phone No:
Integrator: ?rc[ln S d ��p1►r,
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0• �" Longitude 0 �� 0
�.-Design Current -Design Current' - Dest- `:. Current
Swine Ca gcity Po Mahon:' ;. Poultil Caiacity . Po ulatic n =• Catfle : Ca achy Pa nEaban `
" [] Wean to Feeder ❑ Layer I I Dairy
ElFeeder to )"inisb 4 ElNon-La er '< Non -Dairy t
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
Farrow to Finish Total Des_ is Capae>Ity
❑ Gilts
—w
❑ Boars Total SSLW
Number of:i.agot►ns 0 ❑ Subsurface Drains Present ❑ La oon Area ❑ S rav Field Area
:Holding Ponds / Sofid Traps •: Oq w ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lai~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 ves. notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: i
Freeboard (inches): Q
05103101
❑ Yes 7No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes -121'No
❑ Yes ;?'No
❑ Y es"ZNo
Structure 6
Continued

Facility Number: J1 Date of Inspection Z �Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes ONO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes J2`No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes j2rNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes JZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Cl Yes JNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ZNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes l( No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes JENo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes �eNo
b) Does the facility need a wettable acre determination?
❑ Yes 0190
c) This facility is pended for a wettable acre determination?
❑ Yes /6No
15. Does the receiving crop need improvement?
❑ Yes _,eNo
16. Is there a lack of adequate waste application equipment?
❑ Yes ZNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes /[-er!,No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
ElYes _�DrNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 'o
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes �No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes_RrNo
(ie/ discharge, freeboard problems, over application)
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 )2rNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes _'2 No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commentefer to_ uestmn # E !a€n YES answers and/or any recommeadati�ns or anv other comments:
( 9 �) P �y
�. _
Use"drawi s of factl ta;better ez Isin srtusttons..(nse adtlttsonal pages as neeessarvj
_ — ❑Field Conv ❑ Final N
Notes
.44 .-.-t �� b�ia-.g a pc�a- cod vrtd�►' 4Ae taw,e t..fa she �1 ��.
w►-i S�nrE;•-.� ��ea� ���w, �A�,'I'�4, 31-gg, Tie-ASe see m
e)PC
Reviewer/Ins ector Name w viC o
p
Reviewer/inspector Signature: Date: g ZG O�
05103101 Continued

Facility Number Date of Visit: Q li% Time:
Q Not Operational Q Below Threshold
13 Permitted [3 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: �. �...... ._....
FarisName: .......................... ' . .......................I......`.�. •---- County:... ............. -............... .......
OwnerName:........ � r- E.O�... C DW'''...................................................I............... Phone No:........................................................................»....»� .
FacilityContact:.....................:........................................................ Title: .......... I..................................................... Phone No: ................... ............. .._ »... »
MailingAddress:.......................................................................................................................................................................................................... ..........................
Onsite ..
Representative: „ r�'!tn�gtV Sa ul 1�L�GS h) ° In grator: �ro t..i't: rQF .... _..
....... ..... ........... ...... .................
Certified Operator:,,,,,,, .. Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ° 66 Longitude • 9 64
Design Current .,Des
ign' ,Current Design Current
Swine== 'Ca ci Population Poultry Cap
a aci Po elation:. Cattle Capacity.'Nlidatmn ';
❑ Wean to Feeder ❑ Layer I I Dairy
❑ Feeder to Finish ❑ Non -Layer =: ❑ Non -Dairy
❑Farrow to Wean :.. _-
❑ Farrow to Feeder ❑ Other -
❑ Farrow to Finish Total Design Capacity
Gilts
❑ Boars Tota15SLW
- Number of Lagoons 2-0 Subsurface Drains Present ❑Lagoon Ares 0 Spray Field Area
Holding Ponds] Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes �fi No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes 91ko
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
❑ Yes XNo
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Yes_'No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes 0No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ YesoNo
Structure 1 Structure 2 Structure 3- Structure 4 Structure 5
Structure 6
Identifier: ....L}'.Z.................. .................................... ................................... ...........................................................................
Freeboard (inches): .j
5/00 Continued on hack

Facility Number: 3 ( — 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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type C o,- n
13. Do the receiving crops differ with those designaA in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Reuuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection 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?
�V0 yiQl;atiQgs;oir deljeJ ncte5 v gre ppt;e�10pring �]�js'vjsit; Yojt wiij>reeeiye o urtper
correspoiidence: about this visit.:
refer to question ft �Euplaun;any YES answers and/or any recommendations-or,any Ether
❑ Yes JZNo
❑ Yes )2rNo
❑ Yes ONo
❑ Yes )2 'No
❑ Yes No
❑ Yes ONo
❑ Yes gNo
❑ Yes ,0 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes ONo
❑ Yes ENO
❑ Yes �d No
❑ Yes ,fNo
❑ Yes Iff No
❑ Yes VNo
❑ Yes RNo
❑ Yes ZINo
❑ Yes B'No
❑ Yes ,,ffNo
-Ttie tacG,I ._ CLk-La( records a'fe n�afit7 ��p�. �eGi'1 C"Of aPpAeAzs
- ,0 h4:eC dov1 ) w.II . I
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

Facility Number: 31 B Date of Inspection B 01
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 'RNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes XNo
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 INo
31. Do the animals feed storage bins fait to have appropriate cover? ❑ Yes JZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
lAdditionWiUommentsancVor°Drawings:
J
5/00

Division of water l2ualtty.
_.
0 Division of Sail and water _Conservation
Type of Visit VCompliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit )O� Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 Date of Visit:
Permitted 0 Certified 0 ConditionallyCertified© Registered
Farm Name: e G t '1 �'► rr` 4 �'°1
........k........................
Owner Name:........!' .......1�.... ..........
Facility Contact:
MailingAddress: .......................................................................
Onsite Representative: ..... 9 0-r ns
............................................
Certified Operator:
Location of Farm:
Time:© Printed on: 10/26/2000
771
Not Operational O Below Threshold
Date Last Operated or Above Threshold: ••...
County:.....V'.'1........................................
Phone No: .........................................
Title: ................................................................ Phone No:.....
..................................................................................... ..........................
Integrator:..,..!! n rl�.. �...�!-divi.................
...................................... Operator Certification Number:..........................................
Swine []Poultry []Cattle []Horse Latitude ' �� �« Longitude • 4 it
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder JE1 Layer I I ❑ Dairy
Feeder to Finish 517190 JEI Non -Layer I ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts 1EEj
❑ soars Total SSLW
Number of Lagoons ubsurface Drains Present ❑ Lagoon Area Spray Field Area
Holding Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imaacts
1. Is any discharge observed from any part of the operation? ❑ Yes -2�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ElOther
a. [f'discharge is observed, was the conveyance man-made? ❑ Yes EfNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes -0No
c. If discharge is observed, what is the estimated flow in gal/min? A? I A
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) []Yes P No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes -ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifierr:...... ......... I .................. ......... . ""Z ................
Freeboard finches): Z 6 046
5100 Continued on back

Facility Number: 3 — $ Date of Inspection 2 B Printed on: 10/26/2000
5.,Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
_
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
�(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
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
OYes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
KNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
I'No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
ElYes
M No
12. Crop type cc C-1h e,q so t e q h ;j .:s­m i
13. Do the receiving crops differ with those designated A the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
gNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
J'No
b) Does the facility need a wettable acre determination?
❑ Yes
NNo
c) This facility is pended for a wettable acre determination?
❑ Yes
5jNo
15. Does the receiving crop need improvement?
❑ Yes
9No
16. Is there a lack of adequate waste application equipment?
❑ Yes
IgNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes A No
18. Does the facility fail to have all components of the Certified Animal Waste Management PIan readily available?
(ie/ WUP, checklists, design, maps, etc.) 9—Yes. ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes .KNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes PNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes JRNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes C"No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ONo
24. Does facility require a follow-up visit by same agency? ❑ Yes 19 No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONo
.: �10 •viola�igns:or• def ciencie5 -were noted• during �his:visit! • Y:ou ivi�l •r. eeeipe �iti fui-thgr • , . -
correspofitience ahauti this :visit:
Commenti (refer toques
Uiez-drawtngs of fi kility t
on #): Explain any YES answers:and/or any recommendations or any other rbmments.
better explaiii situations. (use additional pages as necessary):
$. -7-kere Are ler,ks of fete Ar-en-• a 4el-e--41 b-,4 -[..e heuses ba Ae
,CIV54 jAik r'ePair Jenks.
119, Alced letjoe des1`94 ireto A&,- olefe- 1 joan ,
17, Ajeed e)eWe_Sj Lcr ; 'GQc'1 of jnaycrn, e a v►d 6emerctl Per,-�I j.
l9►Need 4-o tietve, fA54 t eL-54r, .irtlyst? iI reGards.,$`e�-ldl vvie eti Co
0{ Wa-4e [ZhgV�aiS )mr"eo�►Awe PriaY -fo tie 1%i!% l.oqs c gnOl SrrJr•
Be s v re ->� had p�G,gc g J eye Zi K -- T-s m.14r L, L\Iq s�e rIc,% " weN ale acrer my
IV
Reviewer/Inspector Name S-Ao L-Vq I I me,yh rs
Reviewer/Inspector Signature: wd4k, Date: I112 f Oe 5100

Facility Number. f — Date of Inspection Printed on: 7/21/2000
Od( r Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below ❑ Yes 0No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes &No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional Comments and/orDrawings:
M(�vhl) i& -eure use TAIV edlat-,14Kc - Ai^awr LJA-91e
J
I �f1 • O� J��J �'S•
.
T
5100

Type of Visit O Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint. O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3I 48
Date of Visit 5-10-2000 Printed on: 5/16/2000
O Not Operational O Below Threshold
Permitted MCertified [3Conditionally Certified E3Registered Date Last Operated or Above Threshold: .........................
Farm Name: Stackinghead.Eairlm.........................................................
County: RupUh ...........................
OwnerName: Greg ........................................ Bro'.".._._..................................................... Phone No: ............__.................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: P.0..Box.48.7.............................................................................................. rsaW...1Y.C.......................................................... 283.98.............
Onsite Representative: ........................................................................................................... Integrator: .,..................
...............
Certified Operator:,lerrmy..S ............................... Carr................................................... Operator Certification Number:20.16.8 .............................
Location of Farm:
.......................................................................................................................................................................................................................................................................
iaattt.oi scat arxariAlse....Qa� .Sti .X.apttr�x.. t.�oatl�.SQ�uth �itana.H�ty.SQ...............................................................................................
.......................................................................... ............................ .........�---�---- ............................................. ...................................................................... .........--- ..
N Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 1 34 *1 54 Longitude
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 gallmin?
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 N No
❑ Yes No
❑ Yes N No
❑ Yes N No
Yes N No
❑ Yes N No
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: north........................saut]x........................................................................................................................_................................
Freeboard(inches): ............... 23................ ............... 23................ ................................... .................................... .................................... ....................................

Facility. Number: 31-48 Date of Inspection 5-10-2000 Printed on: 5/16/2000
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes OK 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 OK No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN IR Yes ❑ No
12. Crop type Soybeans, Wheat
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? [] Yes No
b) Does the facility need a wettable acre determination? ❑ Yes N No
c) This facility is pended for a wettable acre determination? ❑ Yes [K No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
I & 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 AW1vT?
......iAl ....:....ircieRci....reoted:during this -visit::... . ...iv:e nip ... :
cn'rre'sririsaileri�-A ahri�it'kTiis.visilf•_'. . .'.'.'. .'.'.'.'.'. .'.'.'.'.'.'.'.'.'.'.'.'.'.
11 & 19 - Field 41 - Hydrant # 04, on 7-30-99 had hydrolic overloading
Hydrant # 14, on 7-30-99 had hydrolic overloading
Hydrant # 15, on 12-16 99 had hydrolic overloading
Field #2 - Hydrant # 02b, on 8-12-99 had a small amount of hydrolic overloading
Hydrant # 03b, on 8-12-99 had a small amount of hydrolic overloading
❑ Yes IR No
0 Yes [9 No
❑ Yes N No
M Yes ❑ No
❑ Yes ® No
❑ Yes IR No
❑ Yes 0 No
❑ Yes N No
❑ Yes 9 No
❑ Yes 9 No
AL
T
Reviewer/Inspector Name JohnrIIege :;

Faeilify Number: 31-48 Date of Inspection 5-10-2000 Printed on: 5/16/2000
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
El Yes No
❑ Yes M No
E] Yes No
0 Yes No

m t.
[3 Division of Soil and:;Water'Conse- vation -Operation R'evtew f -
'3. Division of Soil and Water Conseriatxon =.Compliance lnspct eion
a
-
Coen leance Ins ection
Division of Water Quality p p
r
Other Agency- Operation Revtew r ;;
_ _
IQ Routine Q Complaint Q Follow-up of DWQ inspection Q Follow -up -of DSWC review Q Other �
Facility Number 3` Date of Inspection t{ -j
Time of Inspection 24 hr. (hh:mm)
I$ Permitted © Certifiedr, (] Conditionally Certified [3 Registered JE3 Not O erational Date Last Operated:
Farm Name: ............S Ki1 (1Aa .......t i.................. I....................................... County: ........b.V.ofr............. ............... ......... -
Owner Name :........... .....C?K q......-............... G.li ................... ....... Phone No:......�
44 )...................................
FacilityContact: ............. �11mM..........Vk e.0 ..................Title:.................................................................. Phone NO: ...................................................
Mailing Address: ...01oJ'r........ 4V................................................................... ...............L0J)MV �?r...N�................................. ...2-
s�n&.......
Onsite Representative: ........... .S v.1Mf........1/.L1!h5.............................................. Integrator: ....... 1.1Xlx.V.a.S..........................................................
Certified Operator: ....................... ........................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
0u,....... 1a3 ..... .....0.......5 ......-� ?`fit.. D�....... r+�i� p s...�a . .............. ............... ��.. a�r
....................................................................................................................................................I.............. •. -- ... - ......---.................._...:.........
Latitude ' & •1 Longitude 0 • ° "
Design Current 'Design_- Current
:Swine , Capacity Po ulation ' PoulE ; -
p ty I'y ,Capacity:- Population Cattle
❑ Wean to Feeder
Feeder to Finish
s-74 a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design Current
rapacity Population
Number of:Lagoons Subsurface Drains Present ❑ Lagoon Area j�Spray Feld Area
Holding -Ponds /Solid Traps a ❑ No Liquid Waste Management System
_J --.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ❑ 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: )-rL
Freeboard(inches) . .............5Z............. ..........................................................................
❑ Yes J�) No
❑ Yes] No
❑ Yes No
❑ Yes 1 [] No
❑ Yes [$3 No
❑ Yes [A No
❑ Yes ® No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3123/99
❑ Yes [n No
Continued on back

Facili��r Number: — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improverent?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
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?
N6-'yoati6is;oe- &ficiendewire npd• drini.�is.visit.. - Yoit will-"eceye Rio futthee:: u
6rres�6fide' nee' about. this visit.
❑ Yes ® No
❑ Yes fig No
® Yes ❑ No
❑ Yes M No
❑ Yes ® No
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes [ 1 No
❑ Yes in No
❑ Yes ® No
❑ Yes 5No
❑ Yes 1W No
❑ Yes No
09 Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes [SNo
❑ Yes PLNo
❑ Yes �jNo
❑ Yes JANo
Comments (refer to question #}: Explain any YES answers andlor'anyrecomnienilattons or apygother comments.
teter_ addiUsedrawings.offacilitin{usnecey snsary}— .- _
$. Ua4l 0Lk aAoIAj dCf� �t'JL_ Oct c-c'-j- -to &�V'O wtJ
I �+t 16 Shj b,- Irc�le+it A i`r3
or\ y m. r"-r (ate r, ode
tstl_ 1-a � �-
rv-� c.04 o,
gy &
1 . `liiu Cas�h, d \oe_ �Gbs?.u� a, MR -2, Arpy s.
Reviewer/Inspector Name e P
Reviewer/Inspector Signature: 1 - Date:
3/23/99

•l R,c`►djty Number: 3 — 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 ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
3123/99

Division of Soil and Water Conservation [ Other Agency ;
Division of Water Quality
Routine O Cam laint O Follow-up of DWQ inspection O Follow-u of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection EHlEA24 hr. (hh:mm)
0 Registered T Certified 0 Applied for Permit Wermitted 10 Not Operational I Date Last Operated:
Farm Name: S... .... County:......b.11 ltm.........................
J
Owner Name: .......................
.v%....................(�irt?tn?h............................................... Phone No:..� `!.� �.� `1 :.. 2............................................
Facility Contact 6 -inr.........-s.......................... Title ...... Phone No:(v-- ........
MailingAddress:............ 4...... &-A.......qn............................................................................. ....................................... .. nn..........
Ousite Representative: ..............G.6i........ btx-u`--s................................................... Integrator:........&wn'&.............
Certified Operator: .................................................. .......................... .................................... Operator Certification Number,.............................
Location of Farm:
............. 1........ wa.-i...... 5,.W........ al ..... 5R..... L9s1t.... f} ..5 ..r �i.... ...... ......,......... 5.......LIM..........................................................................
................... ............I.......................... ....................... .. .
Latitude 00 6 " Longitude • �6 66
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 ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? Of 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 ( No
❑ Yes 141 No
❑ Yes No
❑ Yes] No
❑ Yes P No
❑ Yes EP No
❑ Yes [ No
❑ Yes No
❑ Yes ® No
❑ Yes YU No

Facility Number: 3 —LR
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,11olding Ponds, Flush Pits, etc.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I
Freeboard (ft): ........... '................. ............
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
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 ................ �?rYl................alla............ �-�. A-.- .................................. .....................
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?
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 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?
❑ Yes
[3 No
❑ Yes
El No
Structure 6
❑ Yes
[a No
❑ Yes
® No
f� Yes
❑ No
❑ Yes
No
❑ Yes
No
0 No.violationsot defidencies.were`h6ted-during this:visit. You4ill recei�v`ito Airthei-
:: c61'rO9066de4ce about this:visit:-
60 YT-foo
❑ Yes 0 No
❑ Yes � No
❑ Yes �2 No
❑ Yes [A No
[I Yes ® No
❑ Yes ® No
PYes ED No
❑ Yes (] No
❑ Yes (P No
❑ Yes P No
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: /<01- _ / /,1A1_ Date:

Facility Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
0 Permitted M Certified p Conditionally Certified p Registered 113 Not Operational I Date Last Operated:
Farm Name: Stordnglxead.Farm..................................................................................... County: Duplin WIRO
Owner Name: Greg ........................................ Brown.........
Facility Contact: .....................................................................
Mailing Address: PQ.Rox..4.87............................................
Onsite Representative: ..........................................................
Title:
Phone No: 91II-243:2984..........................................................
Phone No:
Warsam..NC.......................................................... M98 ..............
Integrator. Bro.w.a's.Hof.Caralftwjtac..................................
Certified Operator:Jrxemy-& ............................. Carx ................................................... Operator Certification Nuniher:20168 ............................
Location of Farm:
a..;na.....am,�..sx.s d...ax.Si.Z..1Q�8,.....Aailr.sa�......:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: _ ........... ...................... .... ............................................
mn
Latitude ®.®� ®« Longitude ©• ©� ©{6
esig" ...' urrent
Swine ty_�P
Ca act Po ulation
P
p Wean to Feeder
® Feeder to tuts t
p Farrow to Wean
❑ Farrow to Feeder
p Farrow to Finish
p Gilts
p Boars
Num6er'of Lagoons - ® u sur ace rains resent p agoon rea ® pray ie rea
Holding. -Ponds. Solid Traps: p o Liquid Waste Management System
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? Yes No
Discharge originated at: ❑ Lagoon p Spray Field p Other
a. If discharge is observed. was the conveyance man-made? []Yes []No
b. If discharge is observed, did it reach Water of the State? (If yes; notify DWQ) Yes ❑ No
c. If discharge is observed, what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) []Yes p No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes p No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? []Yes []No
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? p Spillway ❑ Yes p No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
Freeboard(inches): ...............la...............................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
3/23/99 seepage, etc.) Continued on back

.
.IFacility Number: 31-48 Date of Inspection
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?
0 Yes
[]No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[:]No
Waste Application
10. Are there any buffers that need maintenance/'improvement?
❑ Yes
p No
11, Is there evidence of over application? []Excessive Ponding ❑ PAN
❑ Yes
[:]No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
[]Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
p Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
p No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
U - No'vIDtat.io.n.s-.or..de.fi.c.i.c
.if.ei.es...w.e.r.e'.n.ot.ed.-.d.ur.in.g.f4i.s visit. - Yclir will'receive nti further.
- .COIreS�"deki Aoirt( #]lls.vlslt, .
[C61nfnents;(refer to;quest�on #) Lxpla�n a©yYES answers and/or any recommendattons or any other carriments
Use di awnigs of facil�t to -better ex lam s.�tuations use addrt[onal a es as necessa %
ood cover of grass and well maintained lagoon. No problems detected.
Reviewer/Inspector Name ,Dean THunkele - -.Max FowlerTDLQ
Reviewer/Inspector Signature: Date:

`Mime of Farm Facility
Location of Farnt/Facility
Owner's Name, Address
and Telephone Number
a... - __ r - -- - -- - r -- - -
T`aGI� i hCA l►----rry-? 3 /— ! 8
l;r, Cb
Date of Inspection Names of Inspectors P RF _
Structural Height, Feet Freeboard, Feet �• S Y
Lagoon Surface Area, Acres 3 6L tir_ e_.— _ Top Width, Feet ZY 14—
Upstream Slope,xH:1 V Downstream Slope, xH:l V /
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage? r Yes _�No
(Check One, Describe if Yes)
Erosion? k/ Yes No _ f {' Sion an in n � red _
(Check One, Describe if Yes) V443-fro r1 ov e4.2+
qr;# j
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes v No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes L,�No
Engineering Study Needed? Yes _�o
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes " No
Other Comments
I
�. ... -.. .. - •._t .:.'•��.='.-___. .y: .fir ___._ .:_ '.. _. . .. ';:T�. -.-. "r=�. _.

[3 Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
G Routine O Com faint O Follow-up of D1V ins action O Follow-up of DSWC review Other
Date of Inspection 3 q
Facility Number
Time of Inspection 124 hr. (hh:mm)
13Registered P Certified [3 Applied for Permit Permitted 10 Not Operational Date Last Operated:
Farm Name:.........�.lvc& n�.. p �1... ►tc�................... County: ..hiJ.tl6 ....................
Owner Name: a
..........�Y.�..... k: ...... ........................................................................ Phone No: 1.T10.. L . .Z-�................i<P.:: L�.0
Facility Contact: .........L.T...Lv�Soxs ............................. Title:....... ..................................... Phone No:..�i��.:'..�1F'�............
Mailing Address:.
.... o.... 1pk.....'4V ................................................................................arsay.,.AL................................................ZM...........
Onsite Representative:...., . ........................................................... Integrator:..... RaQL1 .........................................
Certified Operator;.......:A-r 1G....... ..... C►t.................... Operator Certification Number, .... p1.{e.....................
Location of Farm:
.............�� -1 .56i...1. ...xh� .:�.�.. r............ %
Latitude • ® G 0 « Longitude ©' =' 1 i ii
Design
_Curren#• -' Design Current Desigd. ;Current
Somme Capacity
Pbpulatioi Poultry Capacity Population Cattle Capacity Population; `
❑ Layer ❑ Dairy
❑ Non -Layer ` ❑ Non -Dairy
A'W; w
J❑
Other
Total Design Capa qyo
z
Total'SSLW �� 7 toaa
Number of Lagoons 1 Holding
Ponds ❑Subsurface Drains Present I[] Lagoon Area ❑Spray Field Area
n
� o id Waste Management
❑ N Liquid age System
❑Wean to Feeder v
y
. _ _.
Feeder to Finish
[] Farrow to Wean
❑Farrow to Feeder
[] Farrow to Finish
❑Gilts
❑Boars
General
I. Are there any buffers that need maintenance improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at; ❑Lagoon ❑Spray Field El Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DR'Q)
c. If discharge is observed, what is the estimated flaw in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/bolding 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
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Cl Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
Continued on back

Facility number: 31 ` 43
8. Are there lagoons or storage ponds on site which need to be properly closed"
❑ Yes
❑ No
Structures iLagoons,Holding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Yes
❑ No
Structure l Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier_ 14-7—
Freeboard(11) .........0�..�............................. ..................................................
.................................... ....................................
10. Is'seepage observed from any of the structures'?
❑ Yes
❑ No
It, Is erosion, or any other threats to the integrity of any of the structures observed'?
❑ Yes
❑ No
12. _ Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
i
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
❑ No
Waste Application
14. is there physical evidence of over application'?
❑ Yes
❑ No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type............................................................................................................................................................................................................1.
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes [I No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes ❑ No
18. Does the receiving crop need improvement? ❑ Yes ❑ No
19. Is there a lack of available waste application equipment? ❑ Yes ❑ No
20. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
2l. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
22. Does record keeping need improvement? ❑ Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ❑ No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Permit? $4 Yes ❑ No
0 No. viola' dons or deficiencies w' ere noted during this:visit.- .You.will receive 'no further
eorrespondence about this'.visit.;
Comments;Oifm to.question`#): 'Explain any YES answers and/or'any recommendations or any other c©ixunents
Use'drawings of•facility to better explain �situaticins. (use additional pages as nece5sarv}
Lt�mi� i�pS ��.5„�t�L,G�-� K�IOOv�U• ��QdS� c,�J<� S�1A�t �j� raW
�� Cam. YT-st41" 6L "�'--
�'1 +t tnwnvux'nx
1 s i 2Y �s� `� }�e nr. t-
�a ac�ol o cs�sc�a far �ur�l of Dk . 4"c . �c rsw
Ctsa �os p1���� 0't
�1tss.,�i� WAt ir4
gmurit �? •1-#4 Inoan. w
t� s c �
ZS E ¢+r► mck VSc6 m C_ �r%ne.ry
i_'U ty. sY5�'e, -d~
��h5 � JR,
to, cw, , %kr,ii,, i�x.
,
V��-Soot bn,,, C,,,Arn.ctul A j��1
�ti;tl
.
sus
,
7125/97
Reviewer/Inspector Name
C -
Reviewer/Inspector Signature: 4 _X A 4__—__ Date: -X,/4 )qk

�P,.
❑ DSWC Animal Feedlot Operation Reviewy
�DWQ Animal Feedlot Operation Site Inspection
� v
O itoutine O Cum laint O Foll(i%v-u of D-VV ins ection O Follow-up of DSNVC review O Other
Date of Inspection p
Facility Number
Time of Inspection
rM hr. (hh:mm)
E3 Registered [] Certified © Applied for Permit MPermitted Not Operational Date Last Operated:
` ...... ...li....k .............................. .W.t Farm Name: ...-i.��r l.v�. q�-a--..... r +^^ .......... County r� #`
OwnerName: ..............C. ................. ... ................... ... ........ Phone \o: , 1. � 1. d..�..�.�.�...�..� �.�.Q....................... ...... .... ..........
Facility Contact: ................................................i...... Title: Phone No: C91 Q-...o...�i..:.3
MailingAddress:......�).......a........�..�l.............................................................. ... W':C.Pa,.....C✓.............................. ..�.. q.Q..
Onsite Representative: ... J-1 ......-C'J r.Y7 ......................................... Integrator:....---..Q
Certified Operator;............................................................................................................... Operator Certification Numbers.................. .
Location of Farm:
!v?sn....ta.S.!~....Li.r�.�t....� .....tiS... �1�. .......r��. .ru.y.�..r^�t....... (J.-,S....kr►.,.......... 1h te.�.Z�...a
J" t'- .� .4.£ �.a . -t :ti. k s..i �1. 3.-.......F..fs. .........c:-i.'.........---a..... ...... ....>^-+.....Y-ox,4............................................
Latitude Longitude �• f ���
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 I I❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons/ Holding Ponds ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
❑ No Liquid Waste Management System
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge ori--inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated low in oal/min?
d. Dees discharge bypass a lagoon system? Of 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?
❑ Yes ®,No
❑ Yes ,® No
❑ Yes ® No
❑ Yes ® No
❑ Yes El No
❑ Yes R1 No
❑ Yes KNo
❑ Yes Ot No
❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes KNo
Continued on back

I AY f
i Facility Number: —
r
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.11olding Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure
Identifier: ......
Freeboard(11):........................................................................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
..............................................................................................
1 1. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
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 C a- ..rs.............. ............... ................ �'-----------------------.- ----- .1 .xra. ..............................
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?
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 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?
❑ Yes
® No
❑ Yes
Ja No
Structure 6
....................................
❑ Yes
&No
❑ Yes
MNo
❑ Yes
RNo
❑ Yes
g No
❑ Yes
$KNo
❑ Yes
RNo
❑ Yes
ANo
®- No.violations or. deficiencies were -noted -during this,visit. Nou.rvill re'ceiv'ho farther . -
;�:�cotrrespondenceaboutthis.visit:.; :�.: ::.� ..... .....:.........:.....:......�......�....:..:.
❑ Yes 0 No
❑ Yes RNo
❑ Yes lR No
❑ Yes K No
CR Yes ❑ No
❑ Yes RNo
❑ Yes ® No
❑ Yes l[ No
Comments (refer to question #): Explaidany YES answers and/or any. recommendations or any other comments.
Use drawings of facilit to better ex latnFsttuahons. use add.itiifoal a es asnecessa
y p p . g. ry}.
-0a , ..... n. _,. s
22. 6--t C'_LT , t w 444 ,q-1 16� i
Y. G c-c rd t`U-R. V c �• s a t{.a�; i�. �, , ` o�- �. f f r v i 1 L+� v t_ c4 V- 1-' i r +n _a o
i V +� Q v r s q '.�^� r!- c-p r .
[ p o z i, 1 -LL r ow-o a i Le K1 ar t rRAI�
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: gn _� t M 4 Y 6,,,_-,_, Date: is f L I "7

•
Site Requires Immediate Attention:
Facility No. A
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
Farm Name/Owner:
Mailing Address:
County:
Integrator:
On Site Representative: )).i4LI.K _
Physical Address/Location:
1 rn!� r�
Type of Operation: Swine JV Poultry Cattle
Design.Capacity: c1 �[OC7 "%i7? Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude: ' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches or No Actual FreeboarA�Ft. Inches
Was any seepage observed from the lagoon(s)? Yes 0(
Pe
as any erosion obsery ? Yes r No
Is adequate land available for spray? Yes or No Iscover crop adequate Yes r No
Crop(s) being utilized: lio AC-tX'S___�G�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling . es r No
100 Feet from Wells Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream. s or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
Inspector Name S
cc: Facility Assessment Unit Use Attachments if Needed.

OPERATIONS BRRNCH - WO Fax:[phone]$
Aug 1 ' 95 10 28 P. 03/13
Facility Number:
Sl'1'E VISITATION RECORD
DATE- ---7 _i —7 _;1995
Owner: = C g P -;ram Farah Name: d" -
Gouaty: % 1) n k
Agent Visiting Site: Phone: 9/6 - a9 f. - Z 1 a. t _
Operator:
Phone:.
On Site Representative: _ __ V kip vl__ Phone; 410 3 CZ)
Physical Address: V ` I !17 to fo a S A I/
Mailing Address.
Type of Operation: Swine ✓ Poultry _ Cattle
Design Capacity: q Number of Animah on Site /,,y 0 . _
Latitude: a . . ' �° Longimde: ________,_a
Type of Inspectioa: Ground �� Aerial
Ckcle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes a Nv Actual Freeboard: — Feet '+ Inches
For facilities with more than one lagoon, please address the. other lagoons" freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes o No as there erosion of the dam7: Yes ooNo
Is adequate land available for land application? Yes or No Is the cover crop add uate? Yes or No
Additional Comments:
Fax to (91.9) 71.5-3559 Sip. atvr�"' of Agent