310095_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

'. Division of Water Quality
'Facility Number. - 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit: Co ance Inspection Operation Review Structure Evaluation O 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: 09 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: a- S Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Finish
_Lpellederto
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current
Wet Poultry Capacity Pop.
La er
Non -Layer
Pullets
Other
Poults
Design Current
Longitude:
IV0 J32-10
Design 'Current
Cattle Capacity... Po Popes
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [:]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes
o
❑ NA
ONE
❑ Yes2/t
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Facili 'Number: jDate of Inspection: Z /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier: 1-3
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5
1�- ) 3
Designed Freeboard (in): _
Observed Freeboard (in): T ��
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ENo ❑ NA ❑ NE
❑ Yes / No ❑ 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 [2-No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ffNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [fNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Rio ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes EiN�o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes -
❑ NA
❑ NE
18. Is there a tack of properly operating waste application equipment?
❑ Yes YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes EdNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili " umber. 71 jDate of Inspection: fS (%
2;:' Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [DIN o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ErNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge Ievels
ENon-compliant sludge levels in any lagoon 12t
List structure(s) and date of first survey indicating non-compliance: 2�h.26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ETNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No E31A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes E ❑ 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 [ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes E No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [:�INo ❑ NA ❑ NE
f
Comments (refer to gneshon#) Egpla�n any YESganswersµandlor any acidehbnalerecommendationsor any other�comments:,
drawEngs facHity to better necessary):
Use of explsin-§ituations'(uWadd itronal,pagesaas
T... ccor�S (o � ,yto 10
Reviewer/Inspector Name: (� (t r* --�� r
Phone: ` v 7, o y
Signature: �/"��
Date:
Reviewer/Inspector _ _^-
Page 3 of 3
21412014

11� ; O'bivision of Water Resources f
Facility Number. - O Division of Soil and Water Conservation v
O Other Agency
Type of Visit: Com nee Inspection Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: ORoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: 1 ?A 1 Arrival Time: Q D Departure Time: 0. 9 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title: Phone:
Location of Farm: Latitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Integrator:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -Layer
Non-L
Pullets
Other
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)?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes [] , o ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: 9 ( - Date of inspection: O /
V'
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? O Yes C2 No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑NA ❑NE
❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes VNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [?(No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dpYNo
6❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ 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 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 [6 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
9No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes 1� No
❑ NA
❑ NE r
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections OM onthly 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

acilt Number: - Date of Inspection: tzn
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ac
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes [ NNo
❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes [:]No
[;IAA
❑ 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?
Ise drawings,of,facility. to better -ex
any YES answers and/or -any addi
situations -(use additional hazes as
Q k
C_a ,%\(v
C0CR0(' o'�- t q) K0L.-5 f,
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
V, � (9 44 �r
❑ Yes [3/No ❑ NA ❑ NE
❑ Yes �ZNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �dNo
❑ Yes
o
[] Yes
ons or any other
c'ro L\ (\�
[DNA ❑ NE
❑NA ❑NE
❑ NA D NE
comments.
Phone: f r9 -7 mil( 7-?-.JC
Date:
21412015

Division of Water Quality ,
Facility Number - ® O Division of Sail and Water Conservation
O Other Agency
type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
leason for Visit: eRoutine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: : nth M Departure Time: 3R /bl County: Region: V, �V
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator:
Bach -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design "Current` :�
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle ..
Capacity .. Pop.
Wean to Finish
I
ILayer
Wean to Feeder
Non -La er
Feeder to Finish
3�0
Farrow to Wean
Design
Current
Dry
Farrow to Feeder
D PoultryCa
aci
Pop.
Farrow to Finish
Gilts
Boars
Other
_.
Other
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Dairy Cow
Dairy Calf
Dairy Heifer
Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharees and Stream Imuacts
1. Is any discharge observed from any part of the operation? ❑ Yes 7No ❑ 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
gfNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
Page I of 3 2/4/20I1 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 9,No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes)ZfNo ❑ NA ❑ NE
Structure 1 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 5314o ❑ 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
VrNo
❑ 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
ONo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
PNo
❑ 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
PNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes
�qo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
KNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VrNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
VI No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�TNo
0 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 VrNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes jd No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 9TNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes - ;j� No _❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes eNo ❑ 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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 concem?
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
V I No
❑ NA
❑ NE
❑ Yes
PrNo
❑ NA
❑ NE
❑ Yes
yNo
❑ NA
❑ NE
❑ Yes
I ( No
❑ NA
❑ NE
❑ Yes
/No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes �No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name: 7ys4i, 1 Da4a
Reviewer/Inspector Signature:
Page 3 of 3
Phone: aC 5) 36 ! — 2&
Date: J
21412011

Division of Water Quality
Facility Number ©- ® Q Division of Soil and Water Conservation
Other -Agency, :
Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: A Routine O Complaint 0 Follow-up O Referral Q Emergency O Other Q Denied Access
Date of Visit: Arrival Time: r Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �t�(�icsm Integrator:
Certified Operator: �� r L.� JVfJ �S Cert� ifcaiitin Number: �Qf�SCSI?
Back-up Operator: Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
-Design Current.:
Capacity Pop.
Latitude: Longitude:
n Design. Current
Wet Poultry Capacity Pop. . .
Layer
Non -La er
Design, . Current
D 'Poult Ca0aci 'Po
La ers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design ,. Currents:
Cattle. 'Capacity':��"P­
Dairy Cow
Da' Calf
Duairy Heifer
Dry Cow
Non -Da'
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
)�No
❑ NA
[] NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
[:)No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes#No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yeso
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - Date of Inspection: /
s
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ YestNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yeso ❑ NA ❑ NE
Structure I Structure 2 a3�Structure 3 Structure 4 Structure 5 Structure 6
Identifier: d (.
Spillway?:
Q
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
*No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
i
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
(DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
116No
❑ 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 Winndo�w� [] Evidence ofWindDrift [] Application Outs�ide of Approved Area
12. Crop Type(s): C,�'� �-`"- l�� l� i� < "-T_ j cc,
- -
- -
13. Soil Type(s): Ay= 0',­1 --
-
- -
-
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
V] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
QWUP ❑Checklists [DDesign [] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application Q Weekly Freeboard 0 Waste Analysis 0 Soil Analysis
❑ Waste Trans ers
Q Weather Code ,
❑a Rainfall ❑ Stocking [] Crop Yield °❑ 120 Minute Inspections FL] Monthly and 1" Rainfall Inspections
0 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 INo
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: - Date of Ins ection:
c
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes] No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
1�
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:
TTT
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
KNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes❑
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).- ;
T'4 (Cr---
lam l �f A-5 TR� G
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: 1
21412011

Division of Water Quality
Facility Number 3 - ® 0 Division of Soil and Water Conservation
0 Other Agency t/
Type of Visit: OkComptiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: lRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
I ii lily
Date of Visit: ��I�j� Arrival Time: Departure Time: County:
Farm Name: ` P - d J J� 1 m!� S 1 `� . Its -I 3 Owner Email:
Owner Name: �C,Z�S—T AG E 1' A Q OA IN C Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: iq IVY S LA t+ul [�
Certified Operator: V I Al &-6N 1 00 Q.%
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other.
Other
Latitude:
Integrator:
t�a I .l
Ce ffication Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I- :�d I La er I I El
Nan -La er
Other
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 DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Longitude:
Cattle
Region:
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
Daig Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes XNo ❑ NA ❑ NE
[—]Yes [:]No
[—]Yes [:]No
❑ NA ONE
❑ 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 No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: -t> jDate of inspection -
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I
Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the 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 Apiflication
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 XNo ❑ 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): 6 C :, � l.JlN % _ /W1 G I Z LC r
13. Soil Type(s): N b A Au Go R
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
kT
❑ 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
VNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
OWUP ❑Checklists ❑Design Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ Waste Transfers 0 Weather Code
Q Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility umber: - Date of inspection:
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 t
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ 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 KNo ❑ 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
30,
❑ 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 0 No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA
❑ NE
33. Did the Reviewerllnspectorfoll to discuss review/inspection with an on -site representative?
❑Yes 1 ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA
❑ NE
i„ mints Comments,(refer to question ).: Explain any YE answers_ and/or, any additional recommendations or.any other cam
Use'drawtngs of facility to better explain situations (use additional pages as necessary).
=.,,
�Z.1Q�7►� ��.� �a�.
lve.- D To c�a
Reviewer/Inspector Name: AMOND-4 6 01 j/ C S
Phone:
Reviewer/Inspector Signature:
Date: &J
/
Page 3 of 3
21412011

y� t,ivis
Factltty;Numbelr . '� � � �j `j OD�vs
Q°Ottee
Type of Visit Xcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ARoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: U IV Region:
Farm Name: P- 333 �aa� s �� 3 .' G " 13 Owner Email:
Owner Name: PQEs/-I 6E PjQQyms, INC. Phone:
Mailing Address: 1 �— � t�OX `� � 2 <a-1w TON /V C 0 ? S of 1
Physical Address:
Facility Contact: LAMR
�ome_s
Onsite Representative: . LAM R
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =o = d 0td Longitude: [= ° =1 [= If
Design Cu' enf
M
Design
Current`Desig Current
Swine Capacity Population Wet PoultryCapacityP;opulateoi
CY_ C�apacty� Population
❑ Wean to Finish
Wean to Feeder
❑ Boars
'
Feeder to Finish Farrow to Wean U �i �
El Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Discharges
❑ Layers
❑ Layers
El Non -Layers
El Pullets
❑ Turke s
El Turkey Poults
❑ Other
&Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑Application Field El 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? (!f 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 XNo ❑ NA ❑ NE
❑ Yes
[]'No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�No
❑ NA
❑ NE
❑ Yes�No
❑ NA
❑ NE
I2/28/04 Continued

Facility Number:
Date of Inspection S�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 f Structure 3 Structure 4
Identifier: f o — i SW f
- r
❑ Yes XNo
❑ Yes Cl No
Structure 5
❑ NA ❑ NE
[3 NA ❑NE
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 L 1 3 p�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes *No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes , '(No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
10 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) SGi LLe�1 CQQNJ
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
No
❑ NA ❑ NE
IT Does the facility lack'adequate acreage for land application?
❑ Yes
R'No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P(No
❑ NA ❑ NE
Comments refer toquestion uestion # • Explain an YES answers ( q ). p y ers andlflr any. recommendations or:anv ather comments, '.,•
Use drawings of facility to better explain situations.,(use additional pages as necessary)
ucceK CVV 1-3 cwcra sc l+E� F'(:NR- do10AL
Reviewer/Inspector Name M all 0A aN6' ' ._
Phone
Reviewer/Inspector Signature:
Date: 4 Q
Page 2 of 3 12128104 Continued

.Ii acititj Number: 3 j — rj'S Date of Inspection
Reouired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes X No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes NNo ❑ NA ❑ NE
the appropriate box.
0 WUP 0 Checklists . El Design 0 Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ Xnual Certification
0 Rainfall ❑ Stocking ❑/p Yield 0 120 Minute Inspections 0 Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ✓""C No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes N No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes X No ❑ NA ❑ NE
❑ Yes ❑ No `X NA ❑ NE
Add�tionalComnients an or Drawings: , ««
u C3R A7�an1 ��C a01 �
Pu,.1 coP Lis
OF 901 U 01 C_ C'a n-n L-211
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
RNo
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes 30 No ❑ NA ❑ NE
❑ Yes 14No ❑ NA ❑ NE
❑ Yes �d No ❑ NA ❑ NE
Page 3 of 3 12YI28104

-� A:r
❑
Wean to Finish
❑
Wean to Feeder
Feeder to Finish
43 c�
Ll
Farrow to Wean
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ Other
Facility. Nu be 3 q S
I t" r-.Agi
Type of Visit XCompliance Inspection O Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit XRoutine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: �]� Arrival "Tiime: F f Departure Time: County: uIV Region:
Farm Name: l i lOLA-� S J Owner Email:
Owner Name: PV_ eST-RCC 4afn 1V <-!1 Phone: �- S -4-4-1
Mailing Address: , 0. 1 Ox W S V CL--1 %y ► aW0 / Y IQS S 99
Physical Address:
Facility Contact:
Title:
Onsite Representative: ('��
Certified Operator: � )1 , �) � i~ 1 I !fie
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
C) S9335
Latitude: = 0 = Longitude: [� o = r
Design Cnrrent Designv
Swine Capacity;_Population We Poultry Capacity
❑ Layer
f fr-I XT__ T
T Y�r
m "
Dry Poultry '. ,
._ , » i
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
-E]Turkey Poults
❑ Other
Discharp_es & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
T
attle`
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
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 XNo ❑ NA ❑ NE
El Yes
[I No
El NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑Yes
o
❑NA
El NE
12128104 Continued

Facility'Number: —q S
Date of Inspection N
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 at 3\ ntr(cte 2 Structure 3 Structure 4
Identifier:
t ) mod' r 7
Spillway?:
Designed Freeboard (in): . 519.
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 XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes X No ❑ NA ❑ NE
❑ Yes J`N No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 XNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes �kNo ❑ 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 /� _n ,'
12. Crop type(s) f>L �1 L lv �1 X TF.(�- �7V�i�f f)[— 1 t 1 ! LL 1 L ] Clow
13. Soil type(s) _ ' L& Cp�'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes KNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes J�o 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 No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ' dNo ❑ NA ❑ NE
lam. {.�,
f - 3 ► o- �3
o/V / — `3 Ljq fmc
ReviewerAnspector Name I N F, 11'hone:
Reviewer/Inspector Signature: tftQ.N61Q Date:1 30
Page 2 of 3 12128104 Continued

Facility Number: —9 5 Date of Inspection
Required Records & Documents
N. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes *o ❑ NA ❑ NE
the appropirate box. El WUP 0 Checklists [] Design ❑Maps El other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes *o ❑ NA ❑ NE
0 Waste Application [] Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ❑ �ante Transfers )Anual Certification
0 Rainfall 0 Stocking El Crop Yield El 120 Minute Inspections [D Monthly and V Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel 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?
��j=-1j some COVFR41-- Oft P6 (SEE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
Pq No
❑ NA
❑ NE
❑ Yes "%No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
' No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
( No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
9No
❑ NA
❑ NE
Page 3 of 3 • 12128104

1 �� Division of Water Quality
Facility Number 3 9 O Division of Soil and Water Conservation
— - - - — Q Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: © Departure Time: County:
Farm Name:
Owner Email:
Owner Name: 1 C , -� -g az L Phone:
C..�A-5 � -r a R�s•rf� 6 r
Mailing Address:
Physical Address:
Region:
Facility Contact: Title: Phone No:
Onsite Representative: A mG ^
y",�i(3
Integrator:
Certified Operator: \Cr U l N 4Z�H r I y 1od 0—r Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: [= 0 = 0 Longitude: = o = d =
is
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder j
Feeder to Finish t-1 U �1594p ,
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[--]Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E3Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Covd
Number of Structures: E].1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes JNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes (XNo
❑ NA
❑ NE
❑ Yes XNo
❑ NA
❑ NE
12128104 Continued

Fagility Number:-31 — S Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes A No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i — I G' ! 3
Spillway?:
Designed Freeboard (in): f -I .'4t> 1 9. 'S
Observed Freeboard (in): (4 S L1 "S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No [INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 4 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 kNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yesk
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 [:3NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes §ZNo ❑ 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
O No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
I& 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
MNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JVNo
❑ 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):
Reviewer/Inspector Name I—lit.4m q Phone:
Reviewerlinspector Signature: Date:-1rgti%1
Page 2 of 3 12128104 Continued

I acilityNumber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists Design ❑ Maps
❑ Desi p El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes %No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
X No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
�I(No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
kNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
4 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Q�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
ElNA
❑ 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
14 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
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
q No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
T
Page 3 of 3 12128104

Division of Water Quality
Facility Number 3 QS 0 Division of Soil and Water Conservation
- 0 Other Agency
Type of Visit
Inspection
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit
hCo�pliance
U�'t�outine 0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other ❑ Denied Access
Date of Visit: Arrival Time: 1pp Departure Time: County: C)LAPt-343 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Phone:
Title: Phone No:
Onsite Representative: . TAMES LAwd Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Operator Certification Number:
Back-up Certification Number:
Latitude: =' [=] ' ="
Longitude: = ° =' = "
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non-Layet
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
E]Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a. past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
Cl Yes
eo
❑ NA
ElNE
El Yes
WINo
ElNA
ElNE
12128104 Continued

Facility Number: 31 — JS Date of Inspection ID
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: t,M fidb d t-3 LA&emJ to43
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LAI% 4L
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 E No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [(No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or envir7yes
ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [D No ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes id 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 KNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application /
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes B No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CJ 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
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
❑�No
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes
C4 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
YNo
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
M3 W6ED [on)s' m_ ► t(-OW.
QAIW, SPOTS aO LA&mx) I-3 41tC b GXAVJC Cct CK- 9ACt4 -i E
aC OXCctT W f LLS N to C9
I4�) tJElorJ tJ60 Ca 4-
T
Reviewer/inspector Name Jl Wf 1
Phone: 010 Id? - 7 38$'
Reviewer/Inspector Signature:
Date: I ;a &;LA g j
12128104 Continued

'4
Facility Number: 31 — %; Date of Inspection to z
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
L' Yes ❑ No ❑ NA ❑ NE
❑ Yes IJ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
Cl Yes
� o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
LI N
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�J No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
0No
ElNA
ElNE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
,[]
♦J No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo,
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
!J 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
[?4o
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,�
L`J No
❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O'N/o
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
PKNo
❑ NA ❑ NE
Additional Comments and/or Drawings:
12128104

B Division of Water Quality
r__IFaeility Number �j 5 O Division of Soil and Water Conservation
- - O Other Agency
F
of Visit ,C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
n for Visit C� Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: .�.i ` Arrival Time: e y s Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: jokm,! S LAma Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [::] o ='
= Longitude: = ° ='
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Other
❑ Other
Dry Poultry
No:
Pul
Other
Discharges & Stream Impacts
. 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 Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes JNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ ElNA
❑ NE
❑ Yes
El Yes
❑NA
❑NE
❑Yes
L�No El NA
El NE
12128104 Continued

Facility Number: Date of inspection Z 0
Wkste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3
Identifier: (..AG-DW 18-L LA i;nA/ /-3
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
Structure 4
❑ Yes CJ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes P No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes &o ❑ 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 Rf No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require E] Yes 0No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes CI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) WA MstA.F_T SGGG
13. Soil type(s) 06A i}u G 0-H ,
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ o ❑ NA ❑ NE
[N❑ NA El NE
o ❑ NA ❑ NE
LJN ❑ NA ❑NE
No ❑ NA ❑ NE
Comments (refer to question #1): 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):
krrH P C'.Pt' d¢ i�RkVs aJ Si`iSP�GT�I�j WM"14 'u LA(t,0S • CALL, NXVL&s
�
Reviewer/InspectorName Saws Ar aC—,l�u _ Phone:7 L —i3
Reviewer/Inspector Signature: Q266. Z11.410Date: Z o(a
Page 2 of 3 112128104 Continued

Facilify Number: Date of Inspection
Required Records & Documents ,_.,
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes 94o ❑ 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 ❑Other
jNo
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
ErNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
El NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the pen -nit?
El Yes
,['No
dNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
El No
El NA
El NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
[! No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
CZNo
❑ NA
❑ NE
Otber Issues
�
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
Yes
El,
El28. NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
WNo
❑ 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
EI/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ETNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[ No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Fa0i1g. umber
1
j Division of Water Quality
Q Division of Soil and Water Conservation"
O'Other Agency
Type of Visit 4 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: // / Arrival Time: 0/.S Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: �� �5�i9E�F /i4,P/Y?4rC Phone:
Mailing Address:
Physical Address:
Facility Contact: %%�� Title: �} one No:
Onsite Representative: l!#i/ ! 4�'m6 Integrator: S
Certified Operator: 1�f}i�Db/ ,60v]� 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
Back-up Certification Number:
!:PD
Latitude: [� 0 F--I I = Longitude: ❑ c = g = 4[
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Other
❑ Other - -----
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ 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
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?
❑ Yes No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
'10
- ❑ Yes ❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: lD fo3
Spillway?: Ab / Vp
Designed Freeboard (in): /�',� ITS
Observed Freeboard (in): _135
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes A 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?
10 Yes ❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
/11
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
J{
❑ Yes // 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 0 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
121No
❑ 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
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,Fj No
❑ NA
❑ NE
�R�'�:-'.sv�r. n•,.. .. �v� Sys,. '.:i,:>._ -:.r .'�.Y-wA.-::_: � ,:..-:-:%1."��.".�??u,.f% �:�l�.d:-,b._��*.�'i6.o.)F"�`.`"3i�'�`.' �=�..
j sore
Zo) W/4 P In.1v Nov r/Z5� ✓s �fAl� d� �imf_.JOFO„ ��F_ iQ�9TF
-1164 SuR,� ro �� /PFs N
Reviiewerlinspector Name rf �� p/I/ phone; D �—
Reviewer/inspector Signature: Date: /!
12128/04 Continuer)

i, . .
Facility Number: Date of Inspection / O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes No
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
)dNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
P(No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
'VNo
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ 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
El Yes
l 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
11No
❑ 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
X
El NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
Ef No
❑ NA
❑ NE
Xddihonal Comments and/or Drawings.:'
Zoo "nEo
Gt)4�c��- �
12128104

IType of Visit G? ConjOliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ((Routine O Complaint O Follow up O Emergency Notfication O Other ❑ Denied Access
Facility Number Date of Visit: 7A Time:
Q Not Operational Q Below Threshold
Permitted dCertffied 13 Conditionally Certified 0 Registered Date Last Operated or
,A.b�o�vJe Threshold:
Farm Name: .._______ -._ _ _ _ .. __ _ County: _ V i LZ-tJ-. ... .. . _ .....
Owner Name-
Mailing Address:
Phone No:
Faciilirty Contact: Title: Phone No:
Onsite Representative: 1y11, D'11 b i _.� _ .. Integrator. �C _----.__
Certified Operator: , _ _ ., _ . _ , , . , _ _,- , Operator Certification Number:
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Norse Latitude • " Longitude ' 4 Du
o Feeder
._;
Layer
to Finish
❑Non -Layer
FF:dto Weanto
Feeder
to Finish}
' TOtal DCSi€
-
S Y
"''r _ T
Gilts
Boars
Disci; es - Stream Imparts
L 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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: _ Z --
Freeboard (incites):
I2/12M Continued
❑ Yes dNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes dN
❑ Yes !_J No
❑ Yes 0N
Structure 6

Facility Number: - — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
1 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need matnteriancelimprovement?
❑ Yes
��
L�7No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
L3d'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
ErKo
elevation markings?
Waste Application
10. Are there any buffers that need maintenanoelunprovement?
❑ Yes
1='No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type rASLLL7 LG�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 040
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 01v'0
b) Does the facility need a wettable acre determination? ❑ Yes Q1flo
c) This facility is pended for a wettable acre determination? ❑ es [ fa
15. Does the receiving crop need improvement? [Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes Wo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes 0.90—
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 0410
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes to
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 34
Air Quality representative immediately.
Field CODv ❑ Final Notes
15,) GowTaiJVE WEED COAJ" o —
3 s%) rJ 6 0 D CALnP V rCu Fart,
ReviewerAkspector Name
Reviewer/Inspector Signature: Date:
171I210 Continued

It
Facility Number: — S
Date of Inspection
Required Records & Document;
21. Fait to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/inspector fail to discuss review/mspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
?9. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keepingrcrolp
DES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes No
❑ Yes Q No
❑ Yes H No
❑ Yes JNO
❑ Yes
❑ Yes E No
❑ Yes �/jrNo
o
Yes
❑ Yes 0
[a'/yes ❑ No
❑ Yes lz�o
❑ Yes [3
/ No
❑ Yes [2No
❑ Yves [�"No
Yes ❑ No
12112103

Type of Visit ?& Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Emergency Notification 4WOther ❑ Denied Access
Facility Number 3 Date of Visit: U= Time:
rO Not O erational 0 Below Threshold
63 Permitted MCertifled © Conditionally Certified [3Registered Date Last Operated or bove/Threshold:
Farm Name: ;.P�JC'�7 5� _ _ _ _ _ County: / /`i
Owner Name:
Mailing Address:
Phone No:
Facility Contact: T'tic: Phone No:
Onsite Representative: C/ kZ E, Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑Horse Latitude Longitude
Design Current
:5wtne
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer I I ❑ Dai
❑ Non -Layer I I ID Non -Dairy
❑ Other I l
Total Design Capacity
Total SSLW
Number of Lagoons Q J❑ No Lu u1d waste ManaSystem eementLagoon Area f❑ Spray Field Area
Bolding Ponds 1 Solid Traps
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
uu /!
Freeboard (inches): L
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes El No
Structure 6
05103101 Continued

I
Facility Number: — ,j Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
0/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?
El Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? -
❑ Yes
❑ No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
Cl No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
ElYes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Commepts (refer to questibn � Eiplarn�anv YES answers and/orfany r&bhi ndahons or auy other!comments, .a+;
Use drawings' ofafacthty o betterexplarn sltnahans (nose add,honal piig 41-1 nece ary m x s "
❑ Field Copy . Final Notes
': m , -,. i A - j .:>
- .' 5. §,. _ Y
�j'y '_1017 L L�fea �i lowel air®���'l f
v � 7L�r/�� v�� /r� �zzz.
/la f�C� �o ✓�t �- �iu `'
-
Reviewer/Inspector Name — - �- '' ; a
ReviewerAnspector Signature: 1,54,f le- Date:
05103101 Continued

Facility Number: 31 — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
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, aspbalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [--]No
❑ Yes ❑ No
e 9DD�u 1 7, P 0 lerirlva 04;6
we 1-1-
5 /�'•`!/ Di'd d'Cilyt CcrJsC �d��`a� �— tic<r dled
�DUi2 ���- f`s .Clsd /�G4 �l1/.1 C•��C�/ C 7��t �T �%%: ,/�'/,'x�.c /��v
O� Ale oli� �� ®ir ��dC1� r��at'iz�� k•,��1 � �/ls s l/l/iPl
f
05103101

Type of Visit A Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:
rO Not Operational 0 Below Threshold
Permitted [3 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold•
Farm Name: E s I` 5 County: P
Owner Name: 0• R. i t zZ Z Rau Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Q+R +
Certified Operator:
Location of Farm:
[,Phone No:
Integrator: i`��✓'C�-
Operator Certification Number:
VSwine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0° 0" Longitude 0' 06 0"
Design Current
awfue
Feeder to Finish ILr3Y91
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer V]Dairy
I
❑ Non -Layer I I J❑ Non -Dairy
❑ Other
- - Total Design Capacity j
Total SSLW
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps ❑ No Li uid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): !i
05103101 Continued

Facility Number: Date of Inspection] D
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. is there evidence of over annfication? ❑ Excessive
12. Crop type
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
Plan (CAWMP)?
16. Is there a lack of adequate waste application equipment?
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ YES El No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes )gNo
❑ Yes ZNo
❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
❑ Field Copy ❑ Final Notes
�/aTEs : Fm[� vu1�lP Umr•i� G✓r�.>< .�'�r_D,,l� �fl}ieoNvrrt � � Tsn /�i,�G�
ZNSPee -r &64 (fz44AS io—Oct)n),CR cJEXNfA AeDvT /Rye .5T.98CZsy,B�e/r3U0.9 �i✓ ��
OgWeR (7� /1/vrzFy A4 ems' /.�f X
Reviewer/Inspector Name
Reviewer/Inspector Signature:
-0:
Date:
05103101 Continued

.1
Type of Visit P Compliance Inspection 0 Operation Review 0 Lagoon Evaluation I
Reason for Visit P Routine 0 Complaint 0 Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted OCertified [3 ConditionallyCertified [3Registered
nlz2a,a Farm Name: � -s r` LqM
Owner Name: 0. K. 1 7-,7 AR n
Mailing Address:
Time: EMEI
Date Last Operated or Above Threshold: _
County:
Phone No:
Facility Contact: Q, Title: Phone No:
Onsite Representative: D. 9. `� ;r Z Z 8j_ Integrator: AE-5_e4a6:
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude 00 4
Design Current
awane Ua ac¢ry ro uranon
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
n Farrow to Feeder
Gilts
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairys
❑ Non -Layer I 1 10 Non-Dai
❑ Other
Total Design Capacity
Total SSLW
Number a f Lagoons ❑Subsurface Drains Present ❑ La non Area ❑ 5 pray Field Area
Holding Pond s4
1 Solid Traps 10 No Liquid Waste Management System
Discharges & Stream impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If 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? Cl Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier: + C'3 10 13
❑ Yes (�J No
El Yes /GdNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 0 No
Structure 6
Freeboard (inches): i Q
05103101 Continued

Facility Number: Date of Inspection Lldllf/p_'�
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?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
No
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
JVNo
VNo
.
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
/
P No
\�
Waste Application`
10. Are there any buffers that need maintenance/improvement?
❑ Yes
VfNo
11. Is there evidence of over application , ❑ Excessive Ponding ❑ PAN [�Hydraulic Overload
[� Yes
NR
�0
v
12. Croptype
r�Nti
13.
Do the receiving crops differ with those designate in the Certified Animal Waste Management Plan (CAWMP)?
Yes
V(No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
Mo
b) Does the facility need a wettable acre determination?
❑ Yes
o
c) This facility is pended for a wettable acre determination?
❑ Yes
9.No
15.
Does the receiving crop need improvement?
El Yes
XNo
16,
Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Reds & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
VNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
V(No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
7rN0
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
V(No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
PrNo
10
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
` L U WILL J u1�l %;LLLL LU UCLLCL CR !]Llil ]�iL1L111U1L1.= U]C iLILWIlULiLLr
" ILJFieldCovv U FinalNote
15) 10_-rLL�1JDfn25T
Fop, �� 8 pklyw U pr
5s
FAO . ©LD FF 4 F,- 1 Z-- F_c-D �50,�kF_0"L- E 7 (o 6F, 5 PAZG.
M-C� � k 5) 'Zoo 3 .
Reviewer/Inspector Name I'
Reviewer/Inspector Signature:
05103101
Date:
Continued

Facilitv lumber: Date of Inspection
dar Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 permanentitemporary cover?
Additional Comments andlar Drawinus:, °
lq').��E SURE o 5E Ra �ys2�
--Cio RFFLeC--r
(�E j Lk R�- o
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 9No
❑ Yes ❑ No
AVff\ (�GCF_nYr ". raGUF—� D
VM0 �PPI'z"F-0 F-op,
Fee), pv3f
7tf G
0 E i"� C� CO n. ��tJ Q �R�-(2� C� I p L Otj E(L EiG-oo nl
LF\)EL- 5 CL.0sIEZz S�o� P� Lry �� 0Ka
jt.{n�rnFl� P�NC)
to or-
Cam,
tR
05103101

i'
,
Type of Visit oComplianoe Inspection 0 Operation Review ' 0 Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint 12rFollow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number 3 Date of visit: 10757 D2 Time: I to . AD
Not Operational 0 Below Threshold
Permitted © Certified 3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: S*eA el S Fq r "''1 County: JD
T'
Owner Name: B / t S ! cl e d Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: OR B 1' z t r"' d
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Worse Latitude ' 0 04 Longitude 0' 01 U
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav 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)
e. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued
�/A

F'
FacilityNumber: T1 —9S
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments'(rpfer torquestinn #) Eirplatn any XES. answers andl�rany reeommendatioets or auv atlter edinrnents: , , -rt
Userawings of facelityto;better expisirisitnattonas. (aaddtdol_pages,as >teeessarv)] Field Conv ❑Final Notes
l7r. -Bi zzgs velal eel 4t,e q�� ref i� valve Ar`z4"t's' rind"
leek;-'5. ray. B 1��zzq-^a( he,.s also 4r cl a LVeV g61e icecf dehe aPLol
have -}'�P wo-4e PIa-.\ 'M "ClAd eOf otCGe�r A "1y . Mom. E -Z z� rags
was-�G Pam r 6W allaws -40.. Ae 6 e,-m vXo -F; eld .
�.•. ��� agfd e�`�'o��s yre appreCy4_-Fed- TL,,r Issves a7e4cck
iln -41 r previ OW C4 i acN Grove' 6eey, a��'�` r; a,� eN adjZjre_1SeA le
Reviewer/Inspector NameS-To►1Q i..! R:I?�� I.' I�'i r_5_i G/C_ "f V.0 ✓
Reviewer/Inspector Signature: Date: n
O5103101 Continued
1 +'� n 4r,vf 1 i stet n rl e--

Type of Visit
'O'Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit ZRoutine
0 Complaint 0 Follow up
0 Emergency Notification 0 Other ❑ Denied Access
Date of visit: 20 Time: �Cl
Facility Number
S
10 Not Operational 0 Below Threshold
0 Permitted
Farm Name:
0 Certifiejd
�T
13 Conditionally Certified
PAS �a `�
© registered Date Last Operated or Above Threshold:
Conntr: l vie 111-%
Owner Name:
O
Phone No:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
D� T.31,ZZ��oI
Title:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑Horse Latitude ' �• �" Longitude 0 • E
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: % — 3 ft0 — 1 3
Freeboard (inches): 35 -2S
❑ Yes EfNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes )/ No
Structure 6
05103101 Continued

4
Facility Number: 3( — j
Date of Inspection ZQ d
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type .T(,Aj,hoer A 4,7y4l Fes e-ve Pel-qu%f,Be✓'4i�!
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
I4. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc,)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes JZNo
❑ Yes 2 No
❑ Yes ja'No
Yes ❑ No
❑ Yes Zf No
❑ Yes ENO
❑ Yes ETlgo
di .S✓'� R'j �.IJ►1� r'r►
❑ Yes j2No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [:]No
❑ Yes CrNo
Yes ❑ No
Yes ❑ No
❑ Yes 3'No
❑ Yes 2�No
❑ Yes ZNo
❑ Yes .T No
❑ Yes ffNo
❑ Yes ONO
XYes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comthents:(refer to.questign #) any YES answers aadior any reco6iii 4ons or auv utfter comments. -:
^Explala a
U!se drawtags of facility to better expEarn situa on (use addtttotia€ pages ss ueressary) ❑Field Conv ❑Final Notes 4
tie z-1 �%ydreZ'd ( ij legk:�; �,leAs-' rePa'�.
fefa91e weeds -�o b� ;� ^c�'ed r►� -�1,� -�'es c �.e �',E (a[.
��
lq- rafowQ✓ sheuf�� GnrEs;dB� c'hp��-Ir►'�� �e✓�or►^�
�-H'�`�
new tVe-#g6re gcr�s and clvG�e o� �av1� i1 44e 4esG✓e . rawer
,q rFady Llas o�vi ,OA destJ,j ) b�f 4 new neap w"4k
Lue#'Ible 6r-re4 pwa 6 ef-i ine 1? Uci4)col-A .
Reviewerllns ector Name
Reviewer/Inspector Signature: Date: ZQ O2-
0510310l Continued

Facility lumber: 31 - 5 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation? V
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�No
❑ Yes �,io
❑ Yes/Iff7No
❑ Yes -[2�o
❑ Yes ❑ No
❑ Yes ❑ No
-Additional'Comments and/or Dra►viogs:
9 . T k) e YieweS4 Ge >^4W,'cg4e 0.> 6eve✓'o'ge is
w! IC send ,�k its ; t ;f AV41 labl e ,
1$. ��e Ia�cDoh ��� � yns GY'8 needed � �feel5e ('en�a�� Caun� 1
S4i>'
zs. fa'-4 or ¢l-le Feld '(Q'5,9noed be"".ludo 1,a7 ;S
05103101

sDiv�ston of Water Quality
M O' Ihvlsion of:Soil and Water Gonservatibn
0O ther Agegcy
�.,
Type of Visit 45 Compliance Inspection O Operation Review O Lagoon Evaluation
Beason for Visit XRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Jr 1 D Time: 1= Printed on: 7/21/2000
10 Not Operational Q Below Threshold
[] Permitted ❑ Certified. © Conditionally Certified ❑ Registered Date Last Operated or Above Threshold: .......................
Farm Name: .......... 7.G. r. `moils...T.`............................................................. County: ..
........................ ......... ....................
OwnerName: Q .............. t ,�.,..,..,, Phone No ......... ............................................................................................................
Facility Contact:
................................ Title:........
Mailing Address: .................................................
Onsite Representative: ...... 6 9 r .t zz 0�, —A—
.............................................
Certified Operator:
Location -of Farm:
............... I....................... Phone No:
Integrator: ,re S�ayjP.
Operator Certification Number:
ne ❑ Poultry ❑ Cattle ❑ Norse Latitude Longitude �•
��
` Design Current Design Current Design. Current
Capacity Population Poultry Capacity Population Cattle Ca
ci _' Po ulation
- can to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 3 ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder' ❑ Other
Y Farrow to Finish Total Design Capacity
Gilts
0-Vi soars Total SSLW
�Ntmatber' of t,agqo
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
x k
SoltBmg Ppnds / So1rd Trags '
❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
❑ Yes YfNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made?
❑ Yes gi No
b- If discharge is observed. did it reach Water of the State'? (If yes, notify DWQ)
[j Yes No
c. II'discharge is observed. what is the estimated flaw in gal/ruin?
M la
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes'0No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes .,O No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ,E'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes�No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: 1.10 .../.3 ...............1-3
..............................................................•-.----- ................................... .................................... .....
Freeboard (inches): T ��
...............................
5/00
Continued on back

Facility NlIF -mbe` r 3��GS Date of Inspection 11 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes o
seepage, etc.) TTTT
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes �o
(If any of questions 4-6 was answered yes, and the situation poses an .T
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN [IHydraulic Overload
12. Crop type J�_Y,,Y►wjpn f1�1tn�C{ �i �• h+CT 4,14wt OgA q, , Siti.a
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
❑ Yes �No
❑ Yes XNo
❑ Yes 11No
❑ Yes PIRO
❑ Yes KNo
(CAWMP)? ❑ Yes .(No
❑ Yes �No
❑ Yes o
❑ Yes .ffNo
❑ Yes )ZINo
❑ Yes'O"No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ONo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑
Yes No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes �No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes �No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 2 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ONO
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes _dNo
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 _VN0
�4,6•viola>fiQris'et- &f denies -W 're noted• ding this:visit' • Y:on witl-te;06W do futfte -' .
cor'respo deike. A0' 1A this visit.:: :
Reviewer/Inspector Name
Reviewer/Inspector Signature: ,.t _ Date:
5100

Facility I'umber. 3 / — S Date of Inspection I Printed on: 7/21/2000
O[1^iir Issues
26_ Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes []No
liquid level of lagoon or storage pond with no agitation?
2T Are there any dead animals not disposed of properly within 24 hours? ❑ Yes O/No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes�o
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes J]'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--E'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -0-1�0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

Dwision of$tirl and Watee�Conservation = Operation Review _
0 Didision-of Soil and Water Conservation - Compliance Inspection S
-®_Division ofWaterQuality -CompliancIn e spection
v.. © Other -Agency --Operation Review.
Routine Q Complaint O Follow -tip of DWQ inspection Q Follow-u of DSWC review Q Other
Facility Number 3 s Date of Inspection
Time of Inspection j j 24 hr. (hh:mm)
Permitted Q Certified 0 Conditionally Certified © Registered 10 Not Operational Date Last Operated:
1 L
Farm Name: ......7..a! ...li��!'15.............t.lY�.................-.......... County:...........i?I!..K................ .........
rj 7 o 2-14, /as
Owner Name:---........�. ......................... ( lrL •-- Phone iVo: ..� ...... ..
Facility Contact: ..Q.' I............ r..Z ri ' .......... Title:..... .I!??t ✓ . Phone No: ` jD �i..�.l `'.b....
MailingAddress: .................�..rr.......................................................................................................................................................................................... ..........................
Onsite Representative: ,..L.l.: l.. t3G...zz4.r- ... Integrator' .f.Dr............z.............................................
Certified Operator:.....J,,..:At .......................... . �!/. Z �% ........ Operator Certification Number:...... j P 7 r,....... ........
Location of Farm:
..........................
................................................................................................................................. ............................................................ .... . .. I ........... I ...........
................................. ........................... * .......................... * .............. ....... ........... * ............ * ........................................
Latitude Longitude �• �� C�« —
Swine Capacity Population Poultry Capacity Population • Cattle Capacity Population
❑ Wean to Feeder
JE1 Layer ❑ Dairy
JE3 Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Feeder to Finish
W ijo
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gil[s
❑ Boars
Number of Lagoons 10 Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ElOther
a. I1-discharge is observed, was the conveyance man-made'.'
h. I1-discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3- Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Struct re I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: %p "�35 G-3 Nsc.s�s)
Freeboard (inches): .....r.......zZ............... ............ 3, 1'..........................
❑ Yes tg(No
❑ Yes 41No
❑ Yes gNo
❑ Yes 9(110
❑ Yes gNo
❑ Yes I% No
❑ Yes 4 No
Structure 6 ``
1/6/99 Continued on back

Facility Number: 3 — Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
9No
(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.
[LNo
8. Does any part of the waste management system other than waste structures require maintenatice/improvement?
❑ Yes
5 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
14 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovement?
❑ Yes
No
11. Is'there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
�No
e,6 AZZ
12. Crop type V)
13. Do the receiving crops dif er with those desi nated in th Certif nimal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land applicationT
❑ Yes
RNo
b) Does the facility need a wettable acre determination?
❑ Yes
allo
c) This facility is pended for a wettable acre determination?
❑ Yes
UNo
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
r( No
Required Records _& Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
IV 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
[�YNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
UNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
51No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[4No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes CNo
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes [�No
24. Does facility require a follow-up visit by same agency? ❑ Yes 9No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P No
i'S10 violations:o. cleficier�... were noted di>Ht... #Ytis;v...... will reeeiye do fuether : ;
corres ons#ence about this visit. .................. ...... .
Comments (iefer to auestion #) uExplain any YES answers and/or any reco emendations o� any other comments
Use drawings of facility to better explatrs situations (use addrhgnal pages;as necessary) -
w .._ _ r - y
. r
'Px 17/t1�
o! AS Ca >'y �ryt1 J�7u p6 e�� /al�zhS
as s Y
Reviewer/Inspector Name
Reviewer/Inspector Signal
Date:
3/23/99

Facility Number: r — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes,<No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �No'
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 'N0
31 _ Do the animals feed storage bins fail to have appropriate cover? ❑ Yes _j�\'N` o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
J'Additional.Comments And/or - � ..r' raw►ngsc'-
__
3/23199

' -- [3 Division of Soil anB`Water. Conservation' 'Upeiatign Rrn, '
13 Division of Soil and water Conservabon .Compliance Inspection
�c - -.. - T
r j� Divssron of Water alt Qu ty :Compliance Inspection
i Utter Agency.'Opefatiori Review
10 Routine O Complaint Q Follow-up of DWQ inUection Q Follow-up of DSWC review Q Other -
Facility Number 3 Date of Inspection q
Time of Inspection Q 24 hr. (hh:mm)
JO Permitted 13 Certified [3 Conditionally Certified [3 Registered 0 Not O crational Date Last Operated:
1 �~ ..........................
Farm Name: 5-4,_, e ►LG n S Fa f' n1 County:...... l/......j i ►'�
.........--.0.................).....................................^........................................ ....-........--..---•--....................................:..
Owner Name'. ............0- e f / e-zq �/ U r' Phone No: ,� -.� ��
.. ......r ............................... �'L ............... .................
Facility Contact:.............................................................................. Title:.............
MailingAddress: . ............................................. ..........................
Onsite Representative: �� !� - �► t2 G(
...................... ....................
Certified Operator: ..................................
Location of Farm:
Phone No:
....................................................................................... .... I.............
Integrator:...., ��,°s��
Operator Certification Number:...
.................................. -
Latitude Longitude
Design Current Design- Current = a" Design Current
Swine
:.Capacity Population _Poultry ;:Caiacity= Po � ulation Cattle Capacity Population
❑ Wean to Feeder ❑Layer ❑Dairy
Feeder to Finish 3 40 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other ;
❑ Farrow to Finish Total.Design Capacity
❑ Gilts ;
❑ Boars = T661 SSLW "
�Number:of Lagoons Z ❑ Subsurface Drains Present[] Lagoon Area ❑ Spray Field Area
s Holding -Ponds LSotid.Traps I❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? If es notify DWQ)❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 29No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes JW No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Ja-a 1-3
Freeboard(inches): 3-3 �T ................. ........ I.......................... ......................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes ® No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 — S Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
', closure plan? ❑ Yes JK 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? X Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenarice/improvement? ❑ Yes R No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes )o No
Waste ADolication
I0. Are there any buffers that need maintenance/improvement? ❑ Yes 9 No
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN Yes ❑ No
12. Crop type CIU42 -P6,4are 5-&
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
EK No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Requircd
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
19 Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
X No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
9 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑Yes
®No
0: 'Vo yiblatitpris:or defcieacles -were poled di»tng #his:visit: Moir will reeeipe Rio further
.. .... ..........................
corres ondence:ab"fth' isit_-II-I.................. ............................... .
Use,drawrn _ _ of facih to•b #) Expp[atin any YES answers andior apn recommendations orany other comments - F
Comments (refer to ijuesbo
gs tv -etter ex lain situations use addjtibirt a- es as necessary`) Z -
_ _
f. L��oor 1-3 tnleeds Pt l L. d `
ve tea41"Oyl so tri,c e ro sites � el��nn �l s ab s� �vea(� rv217
e- orf� Td jt+ (ropey s Cover op?
11, ? � rmer a �reG� ate �esGuG �tis�ur•e ih �vj�e -���I �416r. rc
1 q. New WAS-k I n41 s;'s heec#ad.; kq dafeet 3/C 1
'dull 4i wile S) FANJ lot C ^o1vs� + PA N 6aaahGe ss1jQ�! 6_, eo✓'rVC+eX.
Reviewer/Inspector Name xO►'lG t n% 1_ _ ��:t.�'I , r4. a! J^^._ X )
�L _
Reviewer/Inspector Signature Date: do S`MG]
3123/99

Facility Number:.3/ — S 1)atc of Inspection
C.
Odor Issbes
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
M
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
8] No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
29 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
O No
tional Comments an or _rawtn
--.� w
AkI
3/23/99

0 Division of Soil and Water Conservation [j Other Agency
® Division of Water Quality
1§1 Routine 0 Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC• review 0 Other
Facility Number
©Registered U Certified [] Applied for Permit OtPermitted
FarmName:..... ........- .......................
Owner Name :..... .......... L;Z....................................................
Date of Iruspcvtion
Time of Inspection
?A hr. (hh:mm)
Not Operational Date Last Operated: ..........................
n
....... County: ....... ...{'1.......................................................
Phone No: %6
FacilityContact: .............................................................................. Title: ................................................................ Phone No:
MailingAddress: llC.....1.........C-..R\.................... ...... '........a.... 3................. .........................
Onsite Representative:....) .............. .. Integrator: ...
Certified Operator;...................................................... ...................................................... ... Operator Certification Number:.
ocati of Farm:,,p
Y.t..I ...... ca.. s...► .1. .- - ..s ...ti. i�........�.................. ........
Latitude ' ' 46 Longitude 0' & «
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
KNo
2. Is any discharge observed from any part of the operation?
❑ Yes
allo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
M No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
19 No
c. If discharge is observed, what is the estimated flow in gal/min?
M
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
(dNo
4. Were there any adverse impacts to the waters of the State other than from a discharge? -
❑ Yes
JVNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
19 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Q6 No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
�[No
7/25/97

Faciiity Number:*3
S_
,8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes k(No
Structures (Lay-oonsMolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ONo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (ft):
10. Is seepage observed from any of the structures? ❑ Yes KNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WNW, or runoff entering watrs of the State, notify DWQ)
15. Crop type ��. inb'.�:..
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?
0• No.violationsor deiiciencies:were noted -during this:visit.- You:will receive'n&ftirther
.•corresporideitceaboittthis:visit:•::�.:�:�::•::•..�::�:.:•�•:-�•:•:.�.:•.•:�.:.:-.
W Yes
JgNoA,'Vli�
Yes
❑ No
❑ Yes
No
❑ Yes
No
. .......................................
❑ Yes
NfNo
❑ Yes
O No
R(Yes
❑ No
❑ Yes
DI No
❑ Yes
9 No
❑ Yes
0 No
XYes
❑ No
❑ Yes
Dq No
❑ Yes
No
❑ Yes
,,
Lv No
Few1(-3�Jr
l 1° fi° Drt4 , 7/25/97

boll and water,
soil `and. Water:
' Water. Qpaiity
10 Routine 0 C.ompinint 0 t•ollow-up of MN'O inspection 0 follow-up Eft UtiWC: review @ Other
Facility Number 5
l).�rr rif ln�i�c csit,n
T'imt- o lnspvction 24 hr. (hh:mm)
p Registered 0 Certified p Applied for Permit 0 Permitted I&Not Op—e—ra-ti-o—nal—I Date Last Operated:
Farm name: Steliftei .Faran........................................................................................... County: Duplin WIRO
Owner Name:.O.R.......................................... Blizzard,.Jr.............................................. Phone No: 9.10-29.&.WR ..........................................................
Facility' Contact: ...............................................................................Title:............................................................... Phone No:....................................................
Mailing Address: i1 4.11I. 1�.1.1..S..9il3.Nis:................................................................ Kenansville..NC............................. ... 28M ..............
Onsite Representative: .............................................................................. Integrator.P.trRctagr-F.7.[. m....................
Certified Operator:0xiQrzR ............................... B.lizzand.Jr..................................... Operator Certification Numher: ISM .............................
Location of Farm:
Latitude ©•®' ® Longitude ©• © E _
Design Current
Swine Capacity Population
p Wean to f ee er
® Feeder to tuts
a
❑ Farrow to can
❑ Farrow to Feeder
p Farrow to Finish
❑ Gilts
0 Boars
mesign . %-urrent Lesign %,urreni
Poultry Capacity Population Cattle Capacity Population
❑ Layer p Dairy
❑ on- -Layer 13 on- atry
❑ ter -
Total Design.Capkity 4,3411)
Total `SSLW 585,900
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes p No
2. Is any.discharge observed from any part of the operation? ❑ Yes ❑ No
DischarFae orii inaicd at; ❑ Lagoon p Spray Field ❑ Other
a. If dischar��e is observed, was. the conveyance man-made? p Yes p No
b. if dischar�,e is observed, did it reach Surface Water') (If ves. notify DWQ) p Yes p No
c. if dischar.,c is ohservcd. what is the estimated flow in i*al/min`'
d. Does dischargc la,00n system? {If ves. notify DWQ) ❑ Yes p No
3. is there evidence of past discharge from any part of the operation? []Yes 0 No
4. Were there any adverse impacts to the waters of the State other than.from a•discharQe? ❑ Yes- ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require p Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? p Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge? p Yes ❑ No
7/25/97

r d
Facility Number: 31 _95
8. Are there lagoons or storage ponds on site which need to be properly closed?
p Yes
p No
Structures Laryoons,Holcfing fonds. I'iosh fits, ete.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
p Yes
p No
Structure I Si ictnre 3 Structure ; Structure 4 Structure 5
Structure
6
Identifier: ................................... ............... .......................
Freeboard (ft):
10. Is seepage observed from any of the structures?
p Yes
p No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
p Yes
❑ No
12. Do any of the structures need maintenance/improvement?
13 Yes
p 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?
p Yes
17 No
Waste Application
14. Is there physical evidence of over application?
p Yes
p No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type....................................................................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
r Yes
❑ No
17, Does the facility have a lack of adequate acreage for land application?
p Yes
_3 No
r
18. Does the receiving crop need improvement?
p Yes
p No
19. Is there a lack of available waste application equipment?
i7 Yes
p No
20. Does facility require a follow-up visit by same agency?
p Yes
p No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
p Yes
❑ No
22. Does record keeping need improvement?
p Yes
p No
For Certified or Permitted Facilities OTIIV
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
p Yes
p No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
E3 Yes
p No
25. Were any additional problems noted which cause noncompliance of the Permit?
p Yes
©No
fJ - eoveia§ otlonesg.oe�r �cienies"were.note uig t rs visit:. onwi .reeeive noF further . - .
:
- -.- . �WuttOisii;. . ...
Visit was made to assess if facility is a likely candidate for State groundwater study. Observations of spray field borders were made
from public roads.
Most of fields looked dry; however, some ponded water was observed at the lower end (west end) of spray field #1.
One house (brick/older) is located at northeast corner of spray field #1. A well was observed.
One manufactured home is located across Hwy 903 from northeast end of spray field #1 A well was seen (fake stone.cover)..
wo manufactured homes are located directly across Hwy 903 from north end-of.spray field #1. These homes both had -wells
(wooden covers). Approximately seven additional manufactured-homes-are'locate-d',b6hind,these two houses.
Two houses (newer) are located across Hwy 903 from northwest end of spray field #L Both had wells in front yard.
One house is located at northwest corner of spray field #I. A well was seen (wooden cover). 7)25/97
Reviewer/]nspector Name fAndrew'G HeIinimgery �- _ < r
�:
�-z a � ._ .tea'. .
Reviewer/Inspector Signature: C�, A3�R.� ^ Q� _ Date: Z
—r—�_.

01
I) Division of Soil and Water Conservation❑ Other Agency
❑Drvtston of Water Quality
10 Routine Q Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
F.DatcofInspection
10/31/Y7
acility Number 31 YS !
i ,;.Time of Inspection 13:35 24 hr. (hh:mm)
❑ Registered M Certified IM Applied for Permit 1] Permitted JE3 Not Operational I Date Last Operated:
FarmName: StrpltcaS.k ICtu........................................................................................:...... County: D.uplin............................................... W..IRQ.........
OwnerName: M&......................................... B.lizzair.d.Jr .......................................... ' Phone No: q.j0r2q6.-..ILj8 ..........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: 1.1b9.NIDl.C.11..&_'1..Q3.Hv:y'............................................................... Kenansville..NC ................................................... 2.83.49 .............
Onsite Representative:..O,.R..D..Ruard.................................................................:............ Integrator: Preslilfic..F.tArnls.....................................................
Certified Operator.Grion.1t................................. Blizzard.dr..................................... Operator Certification Number: .18.7.3.0 .............................
Location of Farm: ..
Latitude 35 • 50 3R Longitude 77" • 53 15 �
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
2. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?.
❑ Yes
[] No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
-Z No
4. Were there any adverse impacts to the waters of the Slate other than froin a discharge'?
N Yes
❑ No
5. Does any part of the waste management system (other than lagoonsAi6lding ponds) require
❑ Yes
X No
• maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in eflect atthc time of design?
❑ Yes
0 No
p.
7. Did the facility fail to have a certified operator in responsible charge'? _ -
❑ Yes
N No
7/25/97

Facility Number: 31--95
8. Are there lagoom; or storage ponds on site which need to be properly closed'? .
❑ Yes
No
Structu res (Laaoons,Holding Ponds, Flush_PJts etc.)
9. Is storage capacity (freeboard plus stone storage) less than adequate'? i
❑ Yes
N No
Structure I Structure 2 Structiiie 3 • ' Structure 4
Stricture 5 Structure 6
Identifier:
Freeboard(ft): ...............2............................ 1..6.............. .................................... .... ..............................
.............. ....................................................
10. Is seepage observed from any of the structures?
❑ Yes
No
• 11. Is erosion, or any other threats to the integrity of any of the strictures observed?
Yes
© No
12 Do any of the strictures need maintenancelimprovemenO
❑ Yes
N No
(If any of questions 9-I2 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the strictures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application f
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 ....... Coasta) B.cnnztdn..Gra.......... ......................k:s<5cztQ.............:...........,4txtiall.�izai�a.0 seat. F3arl� ................ summu.m uais..............
Iv)i�o, ({?atsl ) N Yes ❑ No
lb. Do the receiving crops differ with those designated in die Animal Waste Management 1' aft aWMI' '?
17. Does the facility have a lack of adequate acreage for land application?' '
❑ Yes
N No
18. Does the receiving crop need improvement?
® Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
No
20. Does facility require a follow-up visit by same agency'?
❑ Yes
No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22. Does record keeping need improvement?
N Yes
❑ No
For Certified or Permitted Facilities Only
23, Does the facility fail to have a copy of the Animal Waste Management Plan readily available'?
❑ Yes
N No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the PennitT
[] Yes
❑ No
-v,iolati4,ns:oe.defi�iee�cies.Wore:noted'dulriingtlt SNisit. Y•od M11'rbCe Ve•no•f`i>r1_her•
:::carres{wndence nbiouf fhis:vasati ...... I • .:.:.:.:.:..:.
4) Ponding in spray field could result in surface runoff impacts. Cautioned against potential impacts from grazing cattle in wet areas. +
t 1) Numerous areas of bare spots need extra attention to establish cover on lagoons. Should mow on regular basis to keep weeds from
shading grass cover.
14) Field adjacent to lagoon had area that holds water, tlnts needs to be repaired to address the standing water before using for waste
application.
16) Two fields indicated for bermuda HAY, but are currently grazed. Prodtice'r to have SWCD office address this in new W.U-Plan.
l 8) Several pastures heaviliy infested with weeds. Spray fields require good cover to assure that nutients are being utilized by `crops'
that are to be removed.
22) Assisted with establishing record keeping on IRR2 fora for solid set spray system. Certainly expect that these will be main$.fi WZp
Reyie►yerllnspector Name John IV' ilunf
ReyiewerlInspector Signature: Date:

Facility Number: 31-95 Date of Inspection 1Q131/)7
Y.�
AJ
7/25197

....... ::: .......... ..::...:..: .:.:. ..:::..:::.
............
❑ sion of Soil and Water Conservation '❑ Qther Agency
® sion of Water Quality Y
,f
® Routine O Complaint 0 Follow-up of DWQ inspection 0 Folloiv=u`p of OSWC review O Other
.;Date of Inspection 919197
Facility Number 3[ 95
Time of Inspection F 12:05 24 hr. (hh:mm)
❑ Registered SCertified E Applied for Permit ❑ Permitted JE3 Not Opera Date Last Operated:
Farm Name: StepJhcixs.Fat'.tttt.................................................. ............................................ County: Ruplia ............................................... W..Iti.O.........
Owner Name: 0,&......................................... B.lizzar. l..Jr.........................................:..... Phone No: 9.11)z296:425t�.....................................................
......
FacilityContact: .............................................................................. Title:....................::.......................................... Phone No:...................................................
Mailing Address: L1(..�1iY.C.31..c9r.9Q3.i ty........................................................... ,...... KenaKenum,11le—NC .................................................. 2.83.49.............
Onsite ve• Re resentatiY
p ..O.� Bliz�ax:d.................................................................:.:::.......... Integrator: l'riulage.FAruns.....................................................
Certified Operator:.Qriun.R................................ Blizzard,Ir................ ............:........ Operator Certification Number: .18730... ......................
....
Location of Farm:
Latitude 35 ' S0 38 Longitude 77 !_ . 53 15
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 El;Other.
a. If discharge is observed, was the conveyance man-made?�:.. ;
b. If discharge is observed, did it reach Surface Water? (If yes, noiify DWQ)
c. If discharge is observed, what is the estimated flow in gallinin?
d. Does discharge b}pass 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 ti-oin aldischarge'?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect of the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97 + '
0 Yes C9 No
❑ Yes No
Yes ® No
Yes CK No
n/a
El Yes ® No
[j Yes X No
❑ Yes " No
® Yes ©No
❑ Yes Z No
❑ Yes 0 No

Facility Number: 31-95
8. Are there lagoons or storage ponds on site whicli need to be properly closed?'. 0 Yes N No
=;,�, Structures (La2oons,Noldin2 Fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storni storage) less than adequate'? ❑ Yes N No
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: ktapla.......................... frS?i14............. .................................. ....:......................... ........
............. ... ...... ...........................
Freeboard(fl):.............. .4.`�.............. ...............3..3............................... .......................
................................. ...................................
10. Is seepage observed from any of the structures?
❑ Yes
N No
11. Is erosion, or any other threats to the integrity of any of the structures ob§6-ved?
❑ Yes
N No
12. Do any of the structures need maintenancefnriprovement?
® Yes
® No
(If any of questions 9-12 was ansnvered 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 inarkcrs?
❑ 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-D WQ)
15. Crop type .......�=Qasta] F3s�rzt>ud .firas...... ..................................................... 7...... ......................................... I .............. ...........................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWW)? ❑ Yes N No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
N No
18.
Does the receiving crop need improvement?
❑ Yes
N No
19.
Is there a lack of available waste application equipment?
❑ Yes
N No
20.
Does facility require a follow-up visit by same agency'? 1
❑ Yes
N No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
22.
Does record keeping need improvement?
N Yes
No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available'?
❑ Yes
N No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
N No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
❑ No
N X0'vi'olatibtls' or'd'efi"ieneies-We1'e_n.oted:duraing this-vi�iit.' �'ou will,reeeive'm) Tort-te'r
.carri . i . denee ab.ok -#hkiisit... ... ... .
5. A small amount of waste was observed leaking out the back if one of the houses. This lead should be corrected immediately. In
addition, steps should be taken to ensure no future back-ups occur. Also, waterway in spray field should be grassed. Avoid spraying
area until this is corrected.
12. Remove stone debris from lagoon wall.
22. Spray records need to be modified to include nitrogen balance calculations. Also, get soil samples taken.
Keen lid on dead box.
7/25/97 N
.......... m­ ............... ...........
Reviewer/Inspector Name Andre�y G Iietmen�cr
Revie-wer/Inspector Signature: Date:

Facility Number: 31-95 Date of Inspection )19197
7/25/97

.0
❑ ILP, R9
W,
OWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspect'....
10 Routine 0 Co!!!2laint 0 Follow-up of DWQ insp(Ttion 0 Follow-up of DSWC review 0 Other
Facility Date of Inspection
i Number Time of Inspection .4 �
24 hr. (hh:m
13 Registered 9 Certified 13 Applied for Permit Cl Permitted 10 Not Operational Date Last Operated: ..........................
FarmName: ..St ........ F_ .................. ................................ County: ... .........................
Owner Name* ......... Q ...... 1­ ................. ... Z.Z.A._A� ................. Phone No:... ...... Z.n..c ... . ... ...................
FacilityContact: ................................ . ............................................ Title: ................................................................ Phone No:...................................................
Mailing Address: ISA ...... AS N,f ....... !..I .......... > ........ 1. 0. a ......... .........
Onsite Representative: .... 0_1..�. .. .... I.A. i - I ... V e.�
..... a .. . . ............................................. Integrator:.,,? ........ . . ... . ...............................................
xx
Certified Operator: .................................................. ..................... ....................... Certification Number-, ......... ......
............. Operator Certir
Location of Farm;
w�q..a.,1...r....�.�.�... . ....... .......
...... WA.6,. ... .............................................. ...................................................................
Latitude 0 1 44 Longitude 0 4
M
Design Current
Swine Capacity Population
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design ..Current Design: Current
Poultry Capacity Population Cattle 'Capacity Population
I[] Layer JE1 Dairy I
JE1 Non -Dairy
El Non -Layer I I I
0 Other
Total Design Capacity
Total SSLW
Number of Lagoons / Holding Ponds 10 Subsurface Drains Present J111 Lagoon Area Spray Field Area
JE1 No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: El Lagoon [I Spray Field [I Other
a- If discharge is observed, was the conveyance man-made'
b. If discharge is observed, did it reach Surface Water? (if yes.. notify DWQ)
c. If discharge is observed, what is the estimated flow in "aUrnin'
d. Does discharge bypass lagoon system? (if yes, notify DWQ)
3, Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
27
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
0 Yes
[3 No
0 Yes
12 No
0 Yes
El No
0 Yes
[9 No
D Yes
IR No
0 Yes
KI No
0 Yes
5U No
Yes
[I No
❑ Yes
[RNo
❑ Yes
0 No
Continued on back

Facility Number: Z 1 — 9S
8. Are there lagoons or storage ponds on site which need to be property closed?
❑ Yes
KLNo
Structures (Lagoons,11oldin2 Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
ElYes
KNo
Structure I Structure Structure 3 Structure 4
Structure 5 Structure
L ¢l.rr�
Identifier:
Freeboard(tt):........2.:.......................... I-S............................................. ....................................
.................................... ....................................
10. Is seepage observed from any of the structures?
❑ Yes
RI No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
$j 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 �penr.crr.�_as�.......................
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.violations.or. deficiencies rvere;noted:during this.visit..You:�vill receive no further
correspondence about this:visit:-:
❑ Yes 8 No
❑ Yes 9 No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes P3 No
CK Yes ❑ No
❑ Yes PS No
❑ Yes 9 No
❑ Yes 19 No
5, A S t a e o. t o V 1 a Si-R- w ,L.S
k C. V S eA . 1-1.; S Lei. Id"- U yr r-&-O-Z d �� ..v, v, d t i r, p e� , �,rS S
S im-o v WL 6aL Ca. I V + b „� � *�{. b a c - u t S act. r, 1 5 o v4
3vm c see d . A-,j o i d v
Z2 5T r � c.o —LA, r t mod. % L 5^^-a d �� � v+ c:1 v � c; n � 4,—
G a lL w'4--i b-^j , Also
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: r-%- .._.tom I . t 1/1`1 , ` dA9.�, o Date:

Site Requires Immediate Attenti n: A10
Facility No. o� l
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERA TIO SITE VISITATION RECORD
• DATE: Z , 1995
Time: Id 44o
Farm Name/Owner: A) 33 2--
Mailing Address: -12-
County: LJiaL1
Integrator. Phone:
On Site Representative: _ f � 1 Phone:
Physical Address/Locanon:_ 22PI
Type of Operation: II /Swine \/' // Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: Longitude:Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year. 24 hour //storm event
(approximately 1 Foot + 7 inches! r No Actual Freeboard: �Ft. Inches
• Was any seepage observed from the lagoon(s)? Yes OWas any erosion observed? - Yes <9
Is adequate land available for spry? Yes or No Ishe cover crop adequate? Yes or No
Crop(s) being utilized: '► �fl�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. es r No '
100 Feet from Wells? ` e r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar, man-made devices? Yes If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
-��� -u,
Inspector Name Si ' ature
cc: Facility Assessment Unit Use Attachments if Needed.
If