310070_INSPECTIONS_20171231

NORTH CAROLINA
r
Department of Environmental Qual

Type of Visit: (3�Co-mpliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: lY'Routine 0 Complaint O Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 'cv County: Region4,0!
Farm Name: Wc�d j 4- -2— Owner Email:
Owner Name: { oK C, -eC -1-t V eJ AtC!!y W4oaIA�Wj Phone:
I
Mailing Address:
Physical Address:
Facility Contact: 12 (J �-r Tr` 114 S Title: Phone: r
Onsite Representative: l( Integrator: S,& t M�t` GIC"
Certified Operator: Certification Number: ! O y 73 O
Back-up Operator:
Location of Farm:
'Design ` Ee
Swine.,: Capacrty]
Wean to Finish
Wean to Feeder lb 1
Feeder to Finish
Farrow to Wean
Latitude:
�°�- eWet Pouf
Farrow to Feeder*
``=D try
Farrow to Finish
La ers
Gilts
Non -La ers
Boars
Pullets
-
Turkeys
Other,
Turkey Poults
Other2
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
Certification Number:
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cy ow
Cy alf
Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [ No ❑ NA ❑ NE
❑ Yes [�J o
[-]Yes 6"No
[]Yes �No
[:]Yes [ rNo
❑ Yes [!�No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 3 21412015 Continued

Faeili Number: - 7 0 jDate of Ins ection: i qa.c
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
E2*No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[�'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): d --
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
ETNo
❑ 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
eNo
❑ 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
[2'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
eNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3'NVo ❑ 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): �3 cw �,q S(� v
13. Soil Type(s): ILK
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes [2'No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes ❑'No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes [ ONo ❑ NA ❑ NE
❑ Yes [3"No ❑ NA ❑ NE
❑ Yes [a& ❑ NA ❑ NE
❑ Yes []'1lo ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ef—No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E:rNo 0 NA ❑ NE
❑ Yes Eff No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Foeility Number: Tj - 7
IDateof Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? 6 Yes [TNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 2"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 [2"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [r'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 C31No ❑ NA ❑ NE
❑ Yes E:rNo ❑ NA ❑ NE
❑ Yes EXNo ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes
[�No
DNA
ONE
❑ Yes
❑ Yes
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 panes as necessarvl.
CQL4-41V -'? -
s14Ar' sul---t—
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
C,i Ito- q33-3 3
Phone: 10' 1r' b f S(
Date:
21412015

(d Division of Water Resources
Facili.,'-y Number 0 Division of Soil and Water Conservation
0 Other Agency 'i
Type of Visit: Co Tor,
ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: 19iQ County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title::
Onsite Representative: �J �.�^ �.., 00 ++� �T ltlr�f
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: q � _5'-T_) S_
Certification Number:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Non -La er I T=
Non-L,
Pullets
Turkey
Other
Poults
Design Current
Discharges and Stream Impacts
I . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Cow
—.Dry
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ZrNo 0 NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes ❑ ❑ NA ❑ NE
❑ Yes . N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: - 1712 jDate of Inspection: YA(,
Waste C0 lection & Treatment it I
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
•
❑ Yes
E No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
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.)
jk
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
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
ONo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ONo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
dNo ❑ 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
ffNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E-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
No ❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
14. 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
Tj No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall
Inspections
❑ S udge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facility Number: I - ? 0 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ s No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes [:]No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
9Non-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 Ko ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes jZNo ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the [:)Yes No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ 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 o ❑ 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).
2 2r 3 MA- ��, srt�,r � Jam. 'DlA s
0 J S 'r, r 5%(' (' [, A� 1 • `"-� 7 zt/ .`.S t r /'► Mks�'c .. f� 4/� `
� �, s F. r_� �-- ps �-, C !,? /07 G 3 Y)
c
Reviewer/Inspector Name: J u — + Ct " to `,e (/
Reviewer/Inspector Signature: 7
Page 3 of 3
Phone: R Id 71G 73,0y
Date: L(t q i �
I If
21412014

(Orbivision of Water Resources
Facility Number '3 - ? D 0 Division of Soil and Water Conservation
0 Other Agency
rype of Visit: o ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
[season for Visit: Routine 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: Title: Phone:
Onsite Representative: 43,! ran 41 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
]dean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number: I E.5 73 L
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
L
ayer
0i t0°
Pullets
r
Poults
Design Current
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dai Heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes LUJ"}`1O ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes [:]No ❑NA ❑NE
❑ Yes E41/o ❑ NA ❑ NE
❑ Yes E rNo ❑ NA ❑ NE
Page l of 3 21412015 Continued

>~ acilitykNumber: 31 7767 Date of Inspection: I jr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El"No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1
Identifier: I
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): Y
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes E]"No ❑ NA ❑ NE
❑ Yes E3-1�o ❑ NA ❑ NE
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 1J "'o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes �No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ❑'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes �No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �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 eNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? �es ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes Ff 'No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes �o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes E(No ❑ NA ❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[]
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[—]Yes
ErNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design [:]Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[:]Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
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 3 21412015 Continued

Facili Number: °j� - Z9 IDate of Inspection:
I
_
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
ElYes
❑ No
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
D Non -compliant sludge levels in any lagoon I- J ") �.
2
') 013 rl p� _ %
(i j 0/i -
f S_
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
©-Vo_
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[] No
E NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ffNo ❑ 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 [D 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 <o ❑ NA ❑ NI?
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? 0 Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to, question #)::Explain any YES answers and/or. anyadditionalarecoinmendations oUany.other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
)s . -,eQd C"-f-�0t �P, et�S
5 (kj,e- ct,►E„'K
ZS, VtA�_r I /Z ("oof,�
1
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a � f� f,�,.s r � ���1 i �e. � � ji,:6
o poi
pfa9n �c,?j'•� s 7 a r_ L��..—sin ar' �ti.r
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Chr �
Reviewer/Inspector Name: 00 V.1 C ro L-�(/
Reviewer/Inspector Signature:
Page 3 of 3
a�
Phone: U0 T 94 73 (:;,Y
Date:
21412015

0
Type of Visit: 0 Co pGauce Inspection U Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: L Arrival Time: � Departure Tlme:IJQ O D , I County: wAI�/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: - n)12(j_' fili Nv Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number: -W5 �3
Certification Number:
Longitude:
-
wDesign � Current �; Design Current. Design Cu7 rent
to Swme rr Ca acE r .Paper ����WetPouitry " Cap4c�tyPop Cattle' F Capaci#y Pop.
.".:*�:i?'eti^ .:?e+• vx ,r.w .,m:',r .« :� .. .r
Wean to Finish I.a Her Dairy Cow
Wean to Feeder Non -La er Dairy Calf
Feeder to Finish ` "` Dairy Heifer
Farrow to Wean es.iurrent.y Dry Cow
Farrow to Feeder D; Psoult . ' -A aci Po Non -Dairy
Farrow to Finish Layers Beef Stocker
Gilts! Non -Layers Beef Feeder
Boars Pullets Beef Brood Cow
,,, K � Turkeys
Turke Poults
Other 3 Other
a
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes io ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes RNo ❑ NA ❑ NE
❑ Yes YNo❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility Number: IDate of Inspection: q
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
Structurre``I
Identifier: Urrrebly
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 1E3 No ❑ NA ❑ NE
❑ Yes 2�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat, notify DWR
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes io ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes To ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes P ❑ NA ❑ NE
Page 2 of 3 21412014 Continued
7. Do any of the structures need maintenance or improvement?
❑Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes
[::]YesLd
l"e
❑ 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
�To
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑Yes
� "o
❑ 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 0Failure 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?
0Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑Yes
[2-fro
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
Q'�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
�do
❑ 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.

Facili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes 0 ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes �zo ❑ 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 N ❑ 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 4o ❑ NA ❑ NE
❑ Yes I <dNo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes y
[:]Yes No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments refer to :. E� lain.an YES answers and/or. an additional_recommendations or an other comments g tton P y Y. _ y 4e
Use drawings of facili '-ta better ex lain situations use additional, a es -is neces"sa -
P ( P g ry)--
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9
Date: kti
21412ol

i' 0 Division of Water Quality
Facility Number ©- ® 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: 0 7Routine
pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Q f County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: �Ds�}G, Aj ic-L
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Phone:
Title:
Phone:
Integrator: Certification Number: O p
s r%3<?
Certification Number:
Latitude: Longitude:
Design
Current
Wet Poultry
Capacity-
Pop.
La er
Non -Layer
Design
Current
Dry Poultry
Canacitv
Pon.
Layers
Non -Layers
Pullets
Turkeys
,Turkey Pouits
Other
Cattle
Design , Current
Capacity. Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
J
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)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes LdZo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: jDate 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA6AP %
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3Z
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 L3 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 7 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ YesE�to
❑ 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 PA) _
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes io
❑ 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
ff 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
E2No
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes
[]
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[:;14
❑ 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
VNNo
❑ 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
D<o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
490
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
FBXNoi
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: 3 - Date of Inspection: 3 I
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 E(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 YNo ❑ 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.
M Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes [3/No ❑ NA ❑ NE
❑ Yes D40 ❑ NA ❑ NE
❑ Yes Ef(No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
ff�No ❑ NA ❑ NE
[:<o ❑ NA ❑ NE
❑ Yes C 'o 0 NA ❑ NE
❑ Yes ���o❑ 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 exvlain situations (use additional nages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone
Date: As
21412011

U Division of Water Quality
FIcility Number O Division of Soil and Water Conservation
Q Other Agency.
Type of Visit: 7Routine
pliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Complaint 0 Follow-up 0 Referral 0 Emergency O Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: sV& � Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: D oic-n kV.'1CNS Integrator:
Certified Operator:
Sack -up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder 1040 O
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
. Other:
Other
Certification Number: 9S513A
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
'Design Current
Pullets
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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:
Cattle
Design Current -
Capacity Pop.
Dairy Cow
Dairy Calf
Heifer
—.Dairy
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
[:]Yes iNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
El Yes [yVo ❑ NA ❑ NE
Page
Page 1 of 3 21412011 Continued

Facili Number: - Date of ins ection: Z 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&MO
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3(a
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 ❑r1Vo
❑ 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 C2'1lo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZINo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ 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
[24o
❑ 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
[lfo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[:J'�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 C;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 o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes VNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - p jDate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
WNo ❑ 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?
❑ Yesro
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
o ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[2<o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
[:�No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
[ZNo ❑ 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
[2No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW?
❑ Yes
�o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�--[3 NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Comments (refer to question it7: Explain any YES answers and/or any additional reeommendatiods or any other comments. .7—]
Use drawings of facility to better expiain:situations (use additional pages as nec6ssary) . a R,...
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 016b —
Date: Z/
21412011

C0 Division of Water Quality /
Facilely Number - 0 O Division of Soil and Water Conservation
r O Other Agency
Type of Visit: 0 Co
pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: O Complaint 0 Follow-up 0 Referral 0 Emergency Q Other 0 Denied Access
Date of Visit: l i Arrival Time: t Departure Time: County: APL233 Region:
Farm Name: WGNoy ti-1 % Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: acxiG ATl moi 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
Boars
Other
Other
Phone:
Certification Number: q$5'73
Certification Number:
Latitude: Longitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
t� 4 o tp 1 RNon-Layer
Non-L;
Pullets
Turkey Poults
Other
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ 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 ['No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes [2No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facifity Number: -11<3 Date of Inspection: I I I�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&ow)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): TL43
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [DNo ❑ 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 dNo
❑ 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 El 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 16 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo
❑ 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 [2"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ff No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [3No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Ej No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[XNo
❑ 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
C] NE
the appropriate box.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
2 L Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [3'�4o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facipty Number: - 0 Date of Inspection: 12jill,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E� No ❑ NA ❑ NE
25. 1S the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes
[� o
❑ NA
❑ NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
gNo
[DNA
❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [Z�No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes [/io
❑ Yes [a No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes c ❑ NA ❑ NE
❑ Yes [3 No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments:
Use drawings of facility to better explain situations (use additional pages as necessary).„
,j ) /ti1EC05 &u s5 o (J Ta f of LA&vwJ
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 04)ILL _` 19
Date:
2/4/ 0 1

Facility Number ` (�
1.
e(Divisi©n of Water Quality
Q Division of Soil and Water Conservation
.- n.
0 Other; Agency
Type of Visit co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: li Arrival Time: ® Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ;l' K�.A�� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = e ❑ 6 ❑ Longitude: = ° ❑ 6 ❑
Current-' ,: Desi n C
urrent. "'
Swine Capacity Population Wet Poultry Capacity Population Cattle C
Design Current --r-Desiapacity- Population.,
10 Wean to Finish I I i
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
Other
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
Ell]
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number` of Structures ' L31 -
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
'.
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ Yes VN
❑ NA
❑ NE
❑ Yes !CJ No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Fj q ility Number: 3 —
Date of Inspection �► I D
e Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: r 'Q 6j
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 0NNo ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thyeat, 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 lLl 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 I3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ElNA ❑ NE
maintenance/improvement?
It. 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
[✓1No
❑ 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
�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
[INE
18. Is there a lack of properly operating waste application equipment?
ElYes
ZN
L
❑ NA
❑ NE
Comments (refer to question #) _ Explain any YES answers and/or any recommendations or any other coin�iients
situations. -( use a -
Use drawings of facility to, better explain situations. use additional pages as necessary)
Reviewer/Inspector NamePhon
Reviewer/Inspector Signature: Date:
Page 2 of 3 V 12128104 Continued

r:
Acility Number:. Date of Inspection 1►
' Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ldNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes Ld No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
?'No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
LJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
1 To
.❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[3/N'o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
1 No
❑ NA
❑ NE
/o
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ZNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
21"No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�,/
Lam! No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
ElE
//
2 NNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
WN o
❑ NA
❑ NE
Additional.Comiments and/or Drawings:...,"
rawings:...
Page 3 of 3 I2128104

Facility aNumber ,
3 1
Division of�Water Qualrty � � �.��--
4 G Dwision of$oil and .Water Conservation'
ek
-Other Agency {.
Type of Visit co�Mpliance Inspection Q Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit O Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I it 7 i • Arrival Time: `lO0 Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: Q)') SA. Arltc.W
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
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: [= 0 0 i Longitude: = o 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
10 q 66 1 on -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pou Its
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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: E]
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes dNo ❑ NA El NE
❑ Yes zNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

r
Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
L3/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
VNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
VNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
9/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑o El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate ManurelSludge
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
E o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ll No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
;?"No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Xo
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
/E
❑ NA
❑ NE
Reviewer/Inspector Name
<. d _ '"r = xA� Phone: ro 3
Reviewer/Inspector Signature: Date:

Facility Number: — Date of Inspection I'L
6guired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (� o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes U(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
EJ No
❑ NA
❑ NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ENo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
E�No
❑ NA
ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
12 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
C;�No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Vj o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
`No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
eNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
&No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
,,��..,,//
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
El Yes
L� No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
12128104

Faz�ltty'�Number:
��Q�hDivision ofWater Quality �'
Ql iivt ton of Soiland' waterConservat,on
Q.Other:Agency
Type of Visit
��Q�hDivision ofWater Quality �'
Ql iivt ton of Soiland' waterConservat,on
Q.Other:Agency
Type of Visit
Compliance Inspection
O Operation Review Q Structure Evaluation
O Technical Assistance
Reason for Visit
&Routine O Complaint
O Follow up O Referral O Emergency
O Other ❑ Denied Access
Date of Visit: Arrival Time: I A6 G Departure Time: County: "L:Eb) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1)5 tJG AT 1LTW.5
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Phone No:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: c = [ « Longitude: = ° = g = {1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
5 a ❑ Non -Layer
❑ Wean to Finish
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 ZNo El NA ONE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ o
❑ Yes [Z
[3NA
[INE
❑ Yes IJ No
❑ NA
❑ NE
12128104 Continued

Faciliiy Number: 3 — O Date of Inspection
4al a 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: LAG ra AJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Lf q
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
(
u No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
/
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
ElYes
[3 / No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Q/No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
El Yes
,/
LiJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
IJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
t�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
EfNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
dNo
[INA
❑ NE
17. Does the facility lack adequate acreage for land application?
ElYes
WNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2/No
❑ NA
❑ NE
Reviewer/Inspector Name 6 t,J 1 Phone: / — %3
Reviewer/Inspector Signature: Date: U 17-4 40
Page 2 of 3 12128104 Continued

1
Facility Number: 3 — "70 Date of Inspection 1
RcQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes (:3/No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Ur/No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
ChTo
❑ 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
dNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
. %�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
0'*No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
CIo
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
LJI(NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
dNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
��
I No
El NA
El NE
29_ Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
}J 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?
El Yes
ETNo
ElNA
ElNE
33. Does facility require a follow-up visit by same agency?
ElYes
��OEl
NA
❑ NE
Additional Comments and/or Drawings: ..7
Page 3 of 3 12128104

Q Division of Water Quality
Facility Number Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit GY/Routine 0 Complaint 0 Fallow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: j 1► I Arrival Time: } 006 Departure Time: County:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: nn -- Title: Phone No:
Onsite Representative:y) U C- Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Region:
Latitude: = o ❑ , Longitude: 0 0 = ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
}O ` k> 2W 1 ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
E]Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stockei
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: E]
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ' No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes LI No ❑ NA ❑ NE
12128104 Continued

r l`acility Number: — 10 Date of Inspection l
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes E No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes WNo ❑ 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 Q o ❑ NA ❑ NE
maintenance/improvement? 11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes -1,.
� No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Cl o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JC14o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
,o
[I NA
El NE
18. Is there a lack of properly operating waste application equipment?
El Yes
VNo
❑ 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):
1.d,) (Pt-sr-roO o f Co r- NA010CU t 0'+bo wl"-4iJ A90 L AC-a-oJ-J ib(_- SXCr
Reviewer/Inspector Name Phone: 7/U `j
Reviewer/Inspector Signature: Date: 1 / o
12128104 Continued

Facility Number: — Date of Inspection o
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ONo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CA readily available? If yes, check
Yes
El No
El NA
El NE
the appropiate box.
[IWUP El Checklists Design El Maps El Other
21.
Doe ecord keeping need improvement? If yes, check the appropriate box below.
W(Yes
�o
El NA
El NE
aste Applic tion ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis El Waste Transfers
[I Annual Certification
❑ Rainfall ; Stocking (3 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
[I NA
❑ NE
23.
if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
E�//No
NNo
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�L-
la ivo
❑ 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
[I/No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[}<A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ICI
.lam No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection dial the facility pose an odor or air quality concern?
❑ Yes
To
❑ 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
y"'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?
❑ Yes
4E No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NA
❑ NE
Additional Comments and/or Drawings:
12128104

Facility NumberQ
4
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 2rCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 1" Routine O Complaint O Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: 1,fo 4 Arrival Time: Departure Time: ��County: l-.r
Farm Name: Owner Email:
Owner Name: /Gi4.�M.5 C� G{. Phone:
Mailing Address:
Physical Address:
Region f LJ
Facility Contact: ,,// Q Title:
,(f Phone No:
Onsite Representative• !� _o T 94Pe: Z?y4r- i77fl,.i' Integrator:
Certified Operator: - 4ygr10 Uzz_ Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: E-1 o =1 ' E-1 " Longitude: = ° = 6 0 is
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I I ❑ La yer
Wean to Feeder I ZV 4001 I[I.Non-Layer
Feeder to Finish
❑ 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?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Bcef Brood' Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: E_1
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
1�1No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes /ElNo ❑ NA ❑ NE
❑ Yes 7 No ❑ NA ❑ NE
12128104 Continued

Facility Number: f —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 41/
Spillway?: AlD
Designed Freeboard (in): / 1..5
Observed Freeboard (in): *D
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 ONo
❑ Yes ❑ No
Structure 5
El NA ❑NE
❑ NA ❑ NE
Structure 6
❑ Yes)No ❑ NA ❑ NE
❑ YesANo ❑ 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 oNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes // No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 44
9. Does any part of the waste management system other than the waste structures require ❑ YesNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [j 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 I0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of,Accept.abl�� p Window ElEvidence of Wind Drift El Application Outside of Area
12. Crop type(s)�iP/Yl �lfj K� V• Cl•✓f�ILS�
13. Soil type(s) #6L19Av 7—VA)
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 ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 9No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes C�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):
5A;[D �y,�LA/�Y /�5 ���J ©r+F_ ��� /%/�R����
r W� T� 1 rJ4 VQ[.JS �JJ�r
/i%D %f.` �li/�-��� f ��`--" �- �f"n1Q GC ��'t�2�5 ��i� t� Od►i� o
Reviewer/Inspector Name [ r Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

a . Qa
Facility Number: ,7/ — Date of Inspection Z
Required Records & _Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ YesXNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps
p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes /f 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?
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?
Additional Comments and/or
❑ Yes ,,El No
❑ NA
❑ NE
❑ Yes ;Z'No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes )ZNo
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA ONE
❑ Yes P No ❑ NA ❑ NE
❑ Yes J� No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes PINo ❑ NA ❑ NE
❑ Yes Z� No [INA ElNE
ElYes RfNo ❑ NA ❑ NE
Page 3 of 3 12128104

,W Division of Water Quality
Facility Number O Division of Soil and Water Conservation
Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
X(2_
Date of Visit: Arrival Time: eparture Time: County: Region:
Farm Name: / Owner Email:
Owner Name D C-'-v Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: r 2!J �� Integrator
Certified Operator: , xv 9Z - - 7it : 7 _ Operator Certification Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Latitude: = o = 1 Longitude: ❑ c =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
fd0 ❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
Cl Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
A, No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104
Continued

Facility Number: —
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Struc ure ] Structure 2 Structure 3 Structure 4
Identifier:
A,
1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Z
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 XNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
❑ Yes /Vj No ❑ NA ❑ NE
❑ Yes PNo ❑ 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 I" No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes gNo ❑ 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 j�No ElNA El NE
maintenance or improvement? //
Waste ADDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes oNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN [:IPAN > ] 0% or ] 01bs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Ap lication Outside of Area
12. Crop type(s)
13. Soil e s
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
9No
[]NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
O No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`❑ Yes
ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes
VNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZI 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):
lill-If-7- 141vo Z4P,4*e_,e9
e-C4914
Reviewer/Inspector Name ] (gyp Phone:
Reviewer/inspector Signature: Date: 2
12128104 Continued

Facility Number: — V Date of Inspection /L p
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 ❑ Desig
n El Maps ❑Other
❑ Yes�No El NA El NE
ElYes )dNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes )ZNo
❑ 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 XNo
❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
—VNo
❑ Yes [ No
❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
'VNo
❑ Yes ❑ No
❑ NA XNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
XNo
ElNA
ElNE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
;�No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
Additional C6imment9 and/ or.Drawings
12178104

(Type of Visit jOrCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Ja*floutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Date of Visit:
0 Permitted 13 Certified © Conditionally Certifi 0 Registered
Farm Name:.
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse
.. `Swine - t�a�ac�ty -Pent
Title:
251 Tune:
Not Operational O Below Threshold
Date -Last Op__/or Abo a Threshold:
County:
Phone No:
Phone No:
Integrator.
Operator Certification Number:
Latitude o• 4 'C Longitude ' 4 «
Des-gn Curie
v
<Poniilafion ;Cattle Caparsty .'`Potrah
Wean to Feeder
U VOO
_
=uJO
Layer
Feeder to Finish
Non -Layer
Farrow to Wean
Other
Farrow to Feeder
Farrow to Finish
Z.
r s To81 DeSl�
Gilts
Q
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structuue 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
.. /
Freeboard (inches): �l
❑ Yes �No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes gNo
❑ Yes P No
Structure b
12112103 1
Continued

Facility Number: • — t] Date of Inspection �C
5.� Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes I ZNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yesNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes UTNo
8. Does any part of the waste management system other than waste structures require maintenance!improvement? ❑ Yes WO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level [3 Yes ZrNo
elevation markings?
Waste Avolication
10. Are there any buffers that need maintenancelunprovement? ❑ Yes ZNo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ yes PVo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type II')P r n4v L41n L_ " J / /N
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ;ff'Ro
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EfNo
b) Does the facility need a wettable acre determination? ❑ Yes P'1C4o
c) This facility is peaded for a wettable acre determination? ❑ Yes [;?No
15. Does the receiving crop need improvement? ❑ Yes P'No
16. Is there a lack of adequate waste application equipment? ❑ Yes ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ yes Lallo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ONO
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes �No
Air Quality representative immediately.
❑ Feld
- ���� ��i�s � esl�lo1KrGr�:
4�aV/vo,/
1%eur /-Z
10-ear-06r
Reviewer/inspector Name
Reviewerliiispector Signature:
Date:
Final Notes
»,».A2

Facility Number:3 ' Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes XNo
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
WUP,
❑ Yes ZNo
(ie/ checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes a21Go
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes Ergo
25_ Did the facility fail to have a actively certified operator in charge?
❑ Yes 2140
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes J;;�No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes 0,50
2$_ Does facility require a follow-up visit by same agency?
❑ Yes $rNo
29. Were any additional problems noted which cruse noncompliance of the Certified AWMP?
❑ Yes ONO
N'MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes AT40
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes Cl No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112/03

o,.
Dwision of Water ,Qualrty y
i.: k y '
Q Division of Soil and Water Conservation
t Q Other Agency
Type of Visit /'" Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine 0 Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
Permitted El Certied- 1 ©Conditions Certified 0 Registered
Farm [Name: aik—woV !4KI 2—
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Title:
Time:
Date Last Operated Above Threshold: _
County \10L2/✓
Phone No:
Phone No:
Integrator
Operator Certification Number:
iswine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 4 " Longitude ' ° �6
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
rffWcan to Feeder JE1 Layer I I W—Dairy I I :d
Feeder to Finish ILI Non -Layer I I ILI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds 1 Solid Traps
Subsurface Drains Present
No Liquid Waste
Discharees & Stream Imuacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c_ If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
Area ILI Sarav Field Area
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection &, Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 5
05103101
❑ Yes ?(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes PdNo
❑ Yes X,No
❑ Yes �No
Structure 6
Continued

Facility Number: 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or �No
closure plan? El Yes
(IE any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) A
7. Do any of the structures need maintenance/improvement? ElYes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes VNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes joNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes /No
11. Is there evidence of over application? ` ❑ Excessive Pond* g/ 4 PAN ❑ Hydraulic Overload ❑ Yes �fNo
12. Crop type
13. Do the receiving crops differ with hose designated in the Certified AniVal 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
�fNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Y(No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
VNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
vNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
jp�No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
No
24.
Does facility require a follow-up visit by same agency?
El yes
V!o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cmments(a:r any of ercomments ' rnny°YESFanswerrand/or.any reeommendahonso
Use .drawl ngs of facillty to better ei viiiin srtuatiomfuse'additgonal pagesras necessary) Field Co nv ❑Final Notes
. , ,.. _ •� w,
Reviewer/Inspector Name ill., 771
Reviewer/Inspector Signature: Date:
O5103101 Continued

Facility Number: —7-L/ Date of Inspection
QdOE 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 o
❑ Yes ONo
❑ Yes F(No
❑ Yes o
❑ Yes No
❑ Yes ❑ No
Aiidet�onal,�Comments, andlpi�Braw�©gs.: °�. : > - *s��,,; • ;: � .� : �;� r:. ,:.
05103101

(Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation J
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other [] Denied Access
Facility Number
Date of visit: 13 D 1 Time:
Q Not Operational Q Below Threshold
D Permitted 0 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:... ._ . _. ..
Farm Name: "...1!.�Yt 1, �J ... .. ..........................% County: . IT ` ............................... ...__... __.
Owner Name:..........}}!. ... °7..r LLIL..... Phone No: . ....................................... ..... . . ... .......
Facility Contact: .....................:....................................................... Title:................................................................ Phone No: ................ .............
_ .. .
MailingAddress: .............................. .................................................:....................... ......... -....... •....... ..... ............................... .... .....................W..
Onsite Representative: ....... ....�...L'... �`...I............... .-- .. Integrator:.. 1). f .. _..........._
_....._........
Certified Operator .............................. ...................... Operator Certification
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ° 66 Longitude • 6 ILK
Design _Current Destgo Currenf Design Current
wine Ca aci Po illation„ .Poultry -• _ : Ca acr Po" illation ;Cattle .Ca ci :. Po elation .
❑Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Wean to Feeder ❑Layer
Farrow to Wean
Farrow to Feeder ❑Other
❑ Farrow to Finish - TOM Des>Egn Capacity
Gilts
Boars 'Total S,SLW
Number of i.agoons '., ❑ Subsurface Drains Present ❑ Lagoon Area . ❑ Spray Field Area
_..
Holding Ponds / $olid:Traps:: ❑ No Liquid Waste Management System w
w
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ..............._.1............_.. .........................................................................................................................................
Freeboard (inches): 93
5/00
❑ Yes
No
❑ Yes PNo
❑ Yes ONO
)I l ti
❑ Yes 0
No
❑ Yes )ZrNo
❑ YesIo
❑ Yes /0 *No
Structure 6
Continued on bark

FacilityAmber: 3) — 71j Date of Inspection 13 d
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 'ONO
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes �No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes N No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ',,dNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes P�No
11. Is there evidence of over application? ❑E,xcessive Ponding ❑ PANHydraulic Overload es ❑ No
12. Crop type Fe r M 1/ d q i ' 1y�/�4�"4 1
13. Do the receiving crops differ with those designated in the C rtified Animal Waste Management Plan (CAWMP)? ❑ Yes 'ONo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes 'P440
c) This facility is pended for a wettable acre determination? ❑ Yes No
15. Does the receiving crop need improvement? ❑ Yes 2rNo
16. Is there a lack of adequate waste application equipment? ❑ Yes ) ND
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ZNo
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 eNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 9No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,dNo
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) ❑ YesA!j'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes IRNo
24. Does facility require a follow-up visit by same agency? ❑ Yes oNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes _;2(No
yigih�igi�s :o dtrf c}e k es vv re nQtt dhehis:Yei 0Rofuh or
tv..et
;corres�oridence: about this visit
�:ommeats tt�er:to quesuon l xpratn any . x r a answers anafor any recommenaanons or any omer commens.
Use drawtng4 Tof facility to better explain situations. (ttse additiglrw=pages is necessary) �. � r ' �
a
;,=
)], mere Were _.re se mslccnces jn tvhlGk + rep app]iG��iar}� L�;era�
rhGid4e On-q 1P _<0fVVL& r-it 1h SvGGeSSio►v i� -Tah1U1S7 � .<
r'01 rcV#ij
i rvtz a re l tu•, 44@ I;..��, w►y jo1Wt v r►-ti 1r tq j ah A)I o Led ''^ 4Az
tvhs�e .flan qoe�^ da1�.. .
(.J✓er�i1 -1�� ��Gi1 i-7 g rla+rds Ctr¢�[ ]<eiUa:
I
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: �•3 (�� 5/00

Facility''Number: Date of Inspection 1
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below j2r4yes ❑ 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 ,J�YNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes XNo
roads, building structure, and/or public property) /
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes,4 ] No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or 1
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �ZNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additirnrnentsandfor,D
5/00
5/00

Facility Number Date of Visit: JI Time: �d Printed on: 7/21/2000
Not Operational Q Below Threshold
Vf Permitted © Certified 0 Conditionally Certified
ii © Registered Date Last Operated or Above Threshold: .........................
Farm Name: P. gkld Nv rse.y- 'S Z County: .T'!10 .1.t'._........................................................
..............�..................................................................
Owner Name: .......... D.r, F�^_!( Phone No:
Facility Contact: ........
................................ Title:....
Phone No: ........
MailingAddress: ..................................... ..................................................................................
....?.....
Onsite Representative:.{•QT y .!�(^4� l.''t r .01.L�h .... Integrator:.. U,%�1ytt
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location 'of Farm:
cM Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude �• �� �«
Design Current
S+ re Canacift PODulation
- Wean to Feeder
144,00
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
- Gilts
= Boars
-. Design .Current S
-Curetut
Poultry Capacity Po uldon Cattle -o r. _
'Pulitio
n .
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other =
Total Des 'Capacr_ty
Total SSLW
Nttiuber of Lagoons ❑ Subsurface Drains Present 0 Lag -an Area ❑Spray Field Area
` H Poi & I Solid, Traps ' ❑ No Liquid Waste Management System
- x
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation? ❑ Yes J'No
Discharge originated at: ElLagoon [ISpray Field [IOther
a. If discharge is observed, was the conveyance man-made? ❑ Yes _Z 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 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: ....................... .....................................................................................................................................................
Freeboard (inches):
S/00
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes &No
Structure 5
Continued on back

Facility Number: 31 — f7l) Date of Inspection Printed on.• 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, El Yes J;TNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes J!j 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 maintenancelimprovement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes `4;4 No
Waste Apl2lication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ONo
12. Crop type ��r?-II/A u�-�� '' l01gvr, PC,
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 RNo
16. Is there a lack of adequate waste application equipment? ❑ Yes t4 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes `R�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) WYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes J'No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes IN No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative'? ❑ Yes §jNo
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
o-yiblafioris:or- deficiencies' .were noted- diW fig this:visit; • Y:oi� will-reeeiye iiti further
rokrespondenc'e: about this visit. : :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A.
M TSB O."� uo, AC,✓C'�A}F -l�'� �aJ4e ��✓,n ®h IQt r Z�S,
Be su re o doss J'\,k& r nor �� 4a, � S�,�^-1 J� f •
Reviewer/Inspector Name S?-QtgtG 41 Alc;-4.ice
Reviewerfinspector Signature: _ _ Date: WOW 5/00

Facility Number: — J701 Date of Inspection J) Printed on: 7/21/2000
Odnr Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below M 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 ONo
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 Iand 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 t4No
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:
5/00
5/00

0 Dtvrston o#•Soil and Water Conseirvation Operation ' Review c -
viston of Soil and WatOr Conservation-: ompli
knee Inspection
Division of Water uali - Com lianee:Ins echoi
®Q tY p_ . W P
Other Agency'= Operation Review.:
y
i(ILRoutine 0 Complaint Q Follow-up of DWQ inspection Q Follow-u of DSWC review Q Other
Facility Number '3} r] p Date of Inspection (f)
Time of Inspection ;QQ 24 hr. (hh:mm)
Permitted [3 Certified © Conditionally Certified Q Registered 13 Not O erational I Date Last Operated:
Farin Name: .. .wal............QIkS....... )......r......................................... County: ...............D.1!1$��A-.11i......................
Owner Name: 3) - ` ra��5 Phone No: I� lac(
..............................................................................................................q ).... 43�i .s,.+--44�3
Facility Contact: i rr A':- �Zli (�,►b)a-� �3
............. q................... _..........cn..............---Title:--........-.....................................Phone No:.. ......
((A .Zk4 -�165 t jar,
MailingAddress : .................................................... .........-....-. ............. .
Onsite Representative, ...e .............L"' } 21 .......... InteS� <ttar:.......f \ r[`............................................................
Y
r....
Certified Operator: { C >r ��-�- Operator Certification Number ,,,,� �,,qr 4
............................................. • i ...
Location of Farm:
A
............................................
......................................................... ............................... .................. .................................................................... ..:..................................................
.... ....
Latitude • ° Longitude • l:
Design, Current
Swine CaDacity - Population
M Wean to Feeder
tp i400
❑ 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 I ILI Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area
Holding Ponds / Solid -Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. 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. Dees discharge bypass a lagoon system'? (If yes, notify DWQ)
❑ Spray Field Area
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
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
NA
❑ Yes X No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
tt
Freeboard(inches): ...........3. ..............................................................................................................................
5. Are there any immediate threats'to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ®No
seepage, etc.)
3/23/99 Continued on back

FarAity Number: 3i —`its Date of, hiss t'l'tion tl—t0-
6. Are there structures tin -site which arc not properly addressed and/or managed through a waste management or
closure plan'? ❑ Yes EK No
(If any of questions 4-5 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 [4 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement" ❑ Yes [9 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'? ❑ Yes [R No
Waste A122lication
10. Are there any buffers that need maintenance/improvement'? ❑ Yes r-71 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?
16. Is there a lack of adequate waste application equipment'?
Required Records & Do_cumenLs
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'?
(ic/ WUP, checklists, design, maps. etc.)
19. Does record keeping need improvement? (le/ irrigation, freeboard, waste analysis & soil sample reports)
24. Is facility not in compliance with any applicahle. 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?
(ic/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency'?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: o.yiolatibris'oi-• deficiencies -were potted-ditrktig 4his:visit: Yob will•reeOV16 rite further; -
corres• ondence.abaut•this_visit. .. _ .'. .'.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Nt)FA+�tnti i5 Qcv�tr(ecI �r We} p�C� ALree�G,Q Caere-tt+tiina:i0v� tt µ- si.rel �� Show;Y.a� �LLrl
bat r sry E• 1 J J
❑ Yes ® No
❑ Yes ® No
❑ Yes [9 No
❑ Yes E4 No
ig Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes r$ No
❑ Yes EK No
❑ Yes C4 No
la) jllrrGl �ukO`s or. T.7,V,- L 4rrAS , Peep T— ZR- /
/�t� 1ot�oa►1 des +�5) i,�. ruecaV.,. .
Xt. rm5 reek
A�
Reviewer/Inspector Name (�rri{r Mckitlul-Isl i eivol
Reviewer/Inspector Signatu
Date: )/—/0—
I 0 ) 39s- 390V .tol JL5- 3/23/99

)Facility.Number: Mite of luspection I 11-10
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
Yes
El 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
K 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
[gj No
30.
Were any major maintenance problems with the ventilation fan(s) noted? Ox. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
KNo
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

13 Division of Soil and Water Conservation 0 Other Agency
V Division of Water Quality a
Lo Routine O Complaint O Follow-up of DWQ
inspection O Follow-up of DSWC review O Other
Date of Inspection
Time Inspection
Z3
24 hr.
Facility Number I 3 L 1
of
(hh:mm}
0 Registered 10 Certified Applied for Permit
]A Permitted 0 Not Operational Date Last Operated:
11[3
Farm Name: lllf�tn.�. .....�.t �1C '.).
.Z Countv: .........
b4zN ............................................................
OwnerName: ........ . ............. .... ..............................................................
Phone No:.................................... --...... ....................
Facility Contact: ...............:. ....................... Title:.................
Phone No:
MailingAddress: ......... 6..iz ...... QM to ... e.......................................................... ........... pa, nslr,e
...t. i`1 c.................................. .... 3.....
Onsite Representative: ......... CAR 1fvg;.tw....................................................._
Integrator:.................
.....................................................-.
Certified Operator: ..................................................
Location of Farm:
Operator Certification Number .........................................
h......fMr1% .s,........s ......p ......... 15?_111 )...2�....mt s......iieS ...... o..... SE..L.I0.............. ........... ........ ...............................................
......................... ....... .... ....................................................... .. FV
Latitude • 04 046 Longitude rY�• o6 "
zavnne ouapa9ty roputauon.
Wean to Feeder
a Loo
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
M-- --Design
Itry Capacity "F
.aver
❑ Other
Total
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
[' No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
® No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[9 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
0 No
7/25/97

Facility Number: 3l — Z�
$. 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 2
Identifier:
Freeboard(ft): ........................... I .... ............. .......................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancetimprovement?
(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 AMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .................sL 4-............... ...... l: r........---................................------...
❑ Yes
19 No
❑ Yes
® No
Structure 5 Structure 6
❑ Yes
0 No
❑ Yes
EM No
❑ Yes
® No
❑ Yes
M No
❑ Yes
® No
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?
No.vitilations-or. de. ficiencies.we're.noted- during this.visiL- You',W'if re'cei've:no_f&tlier',
:-:•correspondeticeatioittfuis:visif.•::.•: ;�:•�•. : . :.::-:•:•:•.•:�::::�:. .:.::�.•-:-
❑ Yes M No
❑ Yes No
® Yes ❑ No
❑ Yes ® No
❑ Yes [P No
❑ Yes 0 No
Yes ❑ No
❑ Yes W No
❑ Yes C& No
❑ Yes ® No
It. %at"1 - � GOC fey .
22. Corru. Q�� s4,a,��ei be lwb�lt� oLv.ivc,+•i rYearclS. S�coI ,�,eccr
W UP �.\�� �o� Zz-S Ids c. i ,VS}i S S�ou�� 6f- w,"e tO N -ba� I�r �w
ov"krr.- or er S �1 y, %r.. 40h, `g`1-11 1 as ?er 4-, UJ%* G,r�,p (Ih {)Qda h1ts r
of _A, s+� a {c.gO4\ aeS�gY� SkOA be- M `�a, rtcUVJ%.
7/25/97
Reviewer/Inspector Name ��:
p� a�r� t, �..re 1tt
�� 7 Q
. v_ z .
Reviewer/Inspector Signature:
Date:

Facility Number 3 a
Farm Status: ❑ Registered ❑ Applied for Permit
ElCertified ❑ Permitted
©ate of Ittspection
Time of Inspection I 1 D : DD 24 hr. (hh:mm)
Total Time in fraction of hours
1ex:1.25 for 1 hr 15 min)) Spent on Review
or Inspection (includes travel and processing)
NotOperational Date Last Operated:................................................................................................................................................
Farm Name:..1`!1...Fu=�cr,�.....1....U�l.#..E..ar+- Z� County:..,.u....t....................................lA�.i.. Q
Owner Name:.. .tt. �!:. .. a . ..t.l..�...... m ..y.x .�..... Phone No. .................................... ........................... ...................
Facility Contact: . �Y �r..[_R._..... ............................ Title:................................................................ Phone No: ... CA t 4...`t.�Z...Y.,.i..`� ( J•:
;?'Tailing address:.,••, Z ....................
Onsite Representative:....r�.1r. G �....s7.�4M5 .. .. .t..0 !' Integra tor:......t.........
Certified Operator: ........................................ ......... ............... Operator Certification Number ...................
Location of Farm:
Llr.,....r�..o.r. �..a,s:i;.....s..i..t�....a ....,.�..... ..l..i.�.,,.....m. ....r.A.�.a..�arw.n... . ......�........raa.,l..l..e........V..�c..x:Y:-11...... ... +.��.
................................................................................. F,-
Latitude Longitude
Type of Operation
Swine
Design Ctirrent Design r Current Design ,: Current
Capacity Population Poultry Capacity, 'Population Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Other
FNumber of La>oons /=HolcitnQ Ponds ��` ❑ Subsurface Drains present ❑ Lagoon Area ❑ Spray Field Area
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a, if dischar-e is observed, was the conveyance man-made'?
h. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c: If discharge is observed. what is the estimated flow in eal/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/holding ponds) require
maintenance/improvement?
4/30/97
❑ Yes ® No
❑ Yes EJ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes I1 No
❑ Yes R) No
❑ Yes .LNo
Continued on back

Facility Number:
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?
8. Are there lagoons or storage ponds on site which need to be property closed'?
Structures (ia;oons and/or Holdin; Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
.2-,I..>�..r.........................................................................................
❑ Yes Wo
❑ Yes $] No
❑ Yes ® No
❑ Yes ELNo
Structure 4 Structure Structure 6
...................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
BNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12.
Do any of the structures need maintenance/improvement?
❑ Yes
$[.No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
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 b.r n-+.u................. .5!^^-s ...�3 A.:.. N .....................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
ERNo
17.
Does the facility have a lack of adequate acreage for land application?
[] Yes
ER No
18.
Does the receiving crop need improvement?
❑ Yes
ELNo
19.
Is there a lack of available waste application equipment?
❑ Yes
®No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
®'No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
For Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
24.
Does record keeping need improvement?
,� Yes
❑ No
-V Y V e—,t 4 V Y . i V,, ^
0t,N��i�� Lti`C� �, 100Its gooµ.
Reviewer/Inspector NameAls
Reviewer/Inspector Signature: (� _ �� , t p ,(1 , _ , , Date: 8
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4130/97

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
. ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE.:'- j-Z� , 1995
Time: / / • 1�
Farm Name/Owner:
Mailing Address:
County:
F-.-4-,m s
c r75cl I,
w E 5 a 4-
z8459
Integrator: PV j h t4 Fes' ►? 5 _ Phone:
On Site Representative: fJl'(1ce L-V -"W-7 5 _ _ Phone: Z S 1 Z 1 ( j
Physical Address/Location: 32Ce De-!1 H U r ! I /t'12G17�1 Zg q" 5 3
Type of Operation: Swine Poultry Cattle I%1Ur5e/ y
Design Capacity: )L) .5 DO Number of Animals on Site: 1(', zoo
DEM- Certification Number: ACE DEM Certification Number: ACN_EW
Latitude: 34- - ;,7 4 7 " Longitude: _7F ° Q G ' 5 .(�oZ;' 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) (Por No Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o No Was any erosion observed? Yes o No
Is adequate land available for spray? Ye or No Is the cover crop adequate? Ye or No
Crop(s) being utilized: rmod 2
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o 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 o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)
Additional Comments:
I-td z
Inspector Name
L
Signature
51
cc: Facility Assessment Unit -Use Attachments if Needed.

•
Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: �� ZOO , 1995
Farm Name/Owner:
Mailing Address:
County: - D�
Integrator: _ /"I tlr� n i
On Site Representative:
Time: 1 ' !O gle,
P.M. ?rrn 5 Z
759 ffbse !fi ( Z�458
Phone: -Z 89 - _Z 1 1 1
Phone: 2�1-Z ! 11.7
Physical Address/Location S_Sh V ►'►'t� �(esir-n. c-le- Kd^ l�2gI �2 Z � 53
Mum 5k'- 104-- S---F- 1 I 1 R
Type of Operation: Swine _L,�� Poultry Cattle Nu�Sery
Design Capacity: 10, 500 Number of Animals on Site: N Ib SC�a �w� :� /oc)
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �� _' 7 Longitude: ' ' 3 qElevation: 5�s K
Circle Yes or No, 4 -Z
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Ye or No Actual Freeboard:- Ft. i 1 Inches
measure
Was any seepage observed from the lagoon(s)? Yes or G)Was any erosion observed? Yes o No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes r No
Crop(s) being utilized: �� �51 z _ PrrMudz Gg:t�`4_,
Does the facility meet SCS minimum setback criteria? 200 Feet. from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes. No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes r No Additional Comments: P ►+ re, C of00- — re_ gde-, DUMD in 1-2AC &I
Ms m �-leed with ki�05f ` iZ-
ert R_ _dInGe
L ew r 5
Inspector Name
Signature
41
cc: Facility Assessment Unit
Use Attachments if Needed.