310134_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Reason for Vi
Date of Visit:
Farm Name:
Owner Name:
sit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
4 Arrival Time: Departure Time: County: !ir? Region:
4:�I(;Vj Owner Email:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: jMCtj&,0 ff1A f Uy[
Certified Operator:/J1 �j/[�(/►�
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: j PA
q
Certification Number: r Q U L /Q
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
Wean to Finish [4L;yeF
Design
Cattle Capacity
Da' Cow
Current
Pop.
to Feeder
Non -Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Dr. P,oult . Ca aci Pia ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Non -Layers
Boars
Putlets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes P'No ❑ NA ❑ NE
❑ Yes [—]No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
D No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: -I Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes WfNo ❑ 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 PNo ❑ NA ❑ NE
waste management or closure plan? iii'''"'
If any of questions 4fi 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 VNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes QjNo ❑ NA ❑ NE
maintenance or improvement? TT
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VfNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes �No [3 NA ❑ NE
❑ Yes k6o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes )ENo ❑NA ❑NE
❑ Yes ❑ NA ❑ NE
YesWo
o ❑ NA ❑ NE
❑ WUP []Checklists [:]Design [:]Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspectionnss / ❑ Sludge Survey
I � Na
No
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

0-
Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo
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?
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 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:
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes effNo ❑ NA ❑ NE
❑ Yes ❑ No �NA ❑ NE
❑ Yes 'O"No
❑ Yes �No
❑ Yes I ,YNo
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ YesNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ,�/� No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes` — No ❑ NA ❑ NE
Comments (refer to question #)c explain anyYES answers and/or any additional recommendations;oe any other.comments :.;
Use drawings of facility to better explain situations (use additional pages as necessary). 3
kW io fie* , L-i Fe� A,wIvT (1W,V(W
KceA 1p+ t vt FeurG�s .
'likk Wak ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: "I,1JY
Date: '% k � I I
21412015

(Type of Visit: C7 CoTp' liance Inspection U Operation Review (.) Structure Evaluation U Technical Assistance I
Reason for Visit: G(Routine 0 Complaint 0 Foilow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: 3"QJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: 1 Title:
Onsite Representative:^��"f j�-�j�j`{ l + €L i/C).{�-
le
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Wean to Finish
La er
Wean to Feeder
Non-L�
Feeder to Finish
r, P,c
a ersGilts
PF7L
Farrow to Wean
Farrow to Feeder
Farrow to Finish
on-LBoars
ullets
Other
Latitude:
Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes
❑ Yes ❑ No
❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes LJ N ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

FacilityFacitity Number: - Date of Inspection:
{�
Waste Collection & Treatment
4. IS storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 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
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
2fNo ❑ 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 environme al threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ElYes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes En No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
s
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
YYes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VN o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yeso
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
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 I ,�' No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfer ❑ 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? 0 YesVNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fagility Number: jDate of Inspection: 3
24: Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dlNo ❑ NA ❑ NE
25' Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E/No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 �o ❑ 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 d/No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes E N ❑ 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
D 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
<o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�To
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
&N/o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
15, C.1-W 0(nE V .
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Gffykf-Facer
PhonC%/C> I
Date: 31
2/4/2 I5

Type of Visit: Q Co pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: 12015 Arrival Time: Departure Time: ® County: ® Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: j 6 N ftuA,_) &1 (,LirK Integrator:
Certified Operator: Certification Number: r . 1
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design10
Swine Capacity
Wean to Finish
Current
Pap.
I
Design C►urrent
Wet Poultry C*apacity Pop.
ILayer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
iNon-Layer
I
Dairy Calf
Feeder to Finish
" a
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oul Ga aci_ P,o
I Layers
Dry Cow
Non -Dal
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Ot
Other
Turke s
ey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No E] 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 VNo
NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3
21412014 Continued

Facility Number: Date of inspection:
J
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,, No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed freeboard (in):
Observed Freeboard (in):
r
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E] 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?
'onmental threat, notify DWR
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or 7y"es
7. Do any of the structures need maintenance or improvement?
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
�[:r]o
❑ Yes o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes ZNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes X4o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes WNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes F No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [%(No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? El o [3 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes gXNo ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

lFqcWty Number: 7 - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ej"VNo ❑ NA ❑ NE
25` Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes F(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 YNNO, ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes j'No ❑ NA ❑ NE
Other Issues
r
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
[]
❑ 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
1Vo
❑ 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
❑ 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
9Xo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
❑ Yes
ONo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ 'No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
❑/ NNo
❑ NA
❑ NE

Type of Visit: Q Co pliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: i 3 d _ Departure Time:® County: 01J� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: t� fl��-- Integrator:
Certified Operator: Certification Number: 0 1 b
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Design Current
Capacity Pop.
Design Curent
Wet Poultry Capacity Pop.
La er
Cattle
Dairy Cow
Design Current
0_2 C 1 t:YM Pop.
on -Layer
Dairy Calf
Design Er.rent
Di. Ploul_ , C+_a Wei P,o
Dairy Heifer
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layer
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
ZNo
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ 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
❑ o
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
'LJ 1V
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FaciW Number: -
Date of Ins ection: j
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
6Z/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure -I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: !1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yesj16'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 �To ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes hTo ❑ 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. ❑ Pa
Yes � No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[Z No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑Yes
ErN❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[—]Yes
rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
e N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[� o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
6;�O_�
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
U410
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
WNo
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facili Number: - Date of Inspection: al
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo ❑ 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 Ey"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
�No
❑ NA
❑ NE
[:]Yes
No
❑ NA
❑ NE
[:]Yes
ZNo
❑ NA
❑ NE
[:]Yes
ON
❑ NA
❑ NE
❑ Yes E N
❑ Yes N !'
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
[—]-NA ❑NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C 1L0
�
Date:
2412614

Type of Visit: d Co pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint 0 Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: ® Departure Time: ® County: `JUp Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title:
Phone:
Phone:
Integrator:
Certification Number: 1 0 0 9 {o
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
SEENELD Current
D . P,oultr. Ca aci P,o ,
La ers
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
i
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
_::�Jm
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes WNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No 0 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
[:]Yes eNo
[:]Yes �j�No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility Number: - { Date of Inspection: q
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L"A�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[:] ❑ 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 2No ❑ 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 [� o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E�No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E2No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EJ/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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 [7No ❑ 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 E✓ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
❑ Yes
[�No
❑ NA
❑ NE
[:]Yes
[3"'No
❑ NA
❑ NE
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
[To
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E(No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[—]Yes
21�
No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 3 ( - Date of Ins ection: q1to,
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes �rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes o
NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes g�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes lia ❑ 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 �o ❑ 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 Z No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ❑ NA ❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes L N❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes L "`" ❑ 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 exulain situations (use additional napes as necessarv).
I,
Reviewer/Inspector Name:
Reviewer/Inspector Signature
Page 3 of 3
g,3 F-iq (ak_ Phone: C 91D
Date:
2/ 61

(Type of Visit: Z) Compliance Inspection U Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: QfRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: r V1 Region:
Farm Name:+ "it6%Owner Email:
Owner Name: L. —ajx Deln Phone:
Mailing Address: Va. ?( �24_-fh 9Neu1ity-" i- i r!1146 26A OLM
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator: , Certification Number: iD ! �ex d��3
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Fa- -C i t-VI E P,ap. Wet Poultry Capacity P.
Wean to Finish I JLayer
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
I
INon-Layer
I
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow to Feeder
Design Current
D , Plouif Ca a
Dry Cow
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other.
Other
keys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
[:]Yes g!rNo ❑ NA ❑ NE
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
21 No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E!rNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection -
Waste Collection & Treatment
4. Is heavy
storage capacity (structural plus storm storage plus rainfall) less than adequate?
❑ Yes
[TNo
❑ NA
0 NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[]'No
❑ NA
❑ NE
Stride 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identi fter: �•
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 47ao S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Q'No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[ o
❑ 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
[2-No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[fNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2 No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ o
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Cj3'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�' o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
6No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
21"'No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[ o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[r 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 Er No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [—]Yes E�J_No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes allo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate 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 E f 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 06No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes dNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes Zr 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 dNo ❑ 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
ZrNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
`
[:]Yes
EINo
❑ NA
❑ NE
33, Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[:]Yes
U!rNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
O No
❑ NA
❑ NE
Cornmeiits (refer to question #)..Explain any YES answers -and/or any additional recbmi mendations or any other comments
used of faciEify, t©-better explain situations (use additional pages. as necessary
" VW "f�k C-n3'.C� I
Reviewer/Inspector Name:
`1 C"I L --
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
T
Date:
21412011

Type of Visit: 0 Coplpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r' Arrival Time: L10/0 71 Departure Time: 0= County: VL/i ' Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �JaM ft j `AP f ' Utg, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Wet Poultry
Ron-Layer
Design
C►apacity
Current
Pop.
Design Current
Cattle Capacity Pap.
a' Cow
Wean to Feeder
a Calf
Feeder to Finish
'
OP,,TTu-
D.
L
Ns
Pullets
Turkeys
e Poults
EOther
Design
C•a aci
C*urrent
P,o
I
, Heifer
Cow
on -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
eef Stocker
Gilts
Boars
eef Feeder
eef Brood Cow
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes ZNo ❑ NA ❑ NE
❑ 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes❑
VNo
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

{+
Facili umber: -12, 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?
Structure 1
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
EYes No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [TJ 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 O/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 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ s ❑ 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 C2(No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o 1V
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes V
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? [—]Yes o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes TNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. []Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes �To- ❑ NA ❑ NE
23, if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes 6"N/o ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Waciljty.umber: - Date of Inspection:
24.-Did {he facility fail to calibrate waste application equipment as required by the permit? ❑ Yes LJ c ❑ NA ❑ NE
th 25. Is e facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Yo ❑ 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 N ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes VNo ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZN ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
[] NE
NA
❑ NE
�/NN❑
91Z�❑NA
❑ NE
❑ NA
❑ NE
Comnnents refer to question # : Ea lain an YES answers and/or an addrtional�recommendations or an otherRcomEnents "
am g' s of fa'
) P y Y_ y
lity toaietter_egplain situations (use. addrrionalpages.,as necessary)
Reviewer/inspector Name: — '3�4 K( jAajyau
Reviewer/Inspector Signature:
Page 3 of 3
Phone: WWM6
Date: 9i 1Z
21412011

m
Type of Visit: 0 Co lance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Q Arrival Time: p? p Departure Time: i [3a- County: ► Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �y A—JUA Il rrgaL kI:12 Integrator:
Certified Operator:
Back-up Operator:
Phone:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine C►►opacity Pop.
Wean to Finish
Design Current Design C►urrent
Wet Poultry Capacity Pop. Cattle Capaclty Pop.
Layer Dai Cow
I INon-Layer I Calf
airy Heifer
Wean to Feeder
Feeder to Finish
Farrow to Wean
Design Current
D , P,oul_ . Ca aci $a
Layers
I Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
keys
Turkey Poults
Other
Beef Brood Cow
Other
Other
Dischart<es 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
YN,,o
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:]Yes
No
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

FaciliNumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes No ❑ NA
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A Grt'o tj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 0_J6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA
❑ Yes Ej No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment I threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo/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 ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu., Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[:]Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Fxlo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes YNo
❑ 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 E�I o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers [] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes FNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: --I oil
24.1'bid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes W(No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yesr2e❑NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
X Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. 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
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
�7 No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes
✓ N ❑ NA ❑ NE
9E "' ' ❑ NA ❑ NE
0 ❑ 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 pagesas necessary).
Reviewer/Inspector Name-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: C lb% 79 b — ff
Date: n ! It
21412011

Divtsion of Water Q�uahty wa `
Facility'Number r 3� o D�vesion of Sod and Water Conservation
- roOth�
er�,Agenc
Type of Visit .6 Co Hance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: b Arrival Time: Departure Time: county:.Jc-.ELLA Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: = o = ,
v Y De' s g ' "Current
17
- �Destgn Current Y ' Des n CU Trent
.,.et..� q %-' rvT'"
`Cbapaety
ka .m^sV " -'r �Y°
-
4 C �Ik—� -
W=: ,.q
SR ine P ptilation Wet, Poultry Capac�tvf Po.pulation.
Cattfe e Opacity_ Popun
_ -:. x
❑ La er
Dairy Cow
❑ Wean to
❑Non -Layer
Dairy Calf
N
"' .
w ��. a -
:y❑ Dai Heifer
DryPoiiltry
D Cow
Non -Dairy
El
Farrow to Finish
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes CJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
o
❑ Yes
WNO
❑ NA
❑ NE
❑ Yes „No [DNA ❑ NE
Page 1 of 3 I2/28/04 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 0 No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:U4(—c� 4
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 2 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 Xreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes WNNo
No ElNA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes ❑ 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 LI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Y s
0 No El NA
El 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
0 No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
L/J NN ElNA
❑ NE
18. is there a lack of properly operating waste application equipment?
El Yes
No ❑ NA
❑ NE
r6ons orany other commensComments (referto question #. 'Explain, any YESanswers and/o-
:Use"drawings of facility twbetter°explain-situations {use.add�honal pages,as necessary)
ISJ (4n6 AfEC-P(O, /icef IIZCK67,
Reviewer/Inspector Name ; //�/ r ° Phone: 9l t & 73
Reviewer/Inspector Signature: y Date: / I I6 h Q
Page 2 of 3 1Zia6iv4 Uonunueu

Facility Number: — L3 Y Date of Inspection
e wired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Uj N ❑ 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 ❑ Other
/
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain
Inspections/
❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
ElYes
LQ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
LJ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IT No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[/�No
❑ NA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O'/No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
<0
❑ 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
❑ N
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

13
Type of Visit (rCoo pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (O Koutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: J'o+.sA`r 146d M,%L-A _ + 0—
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o = 6 Longitude: 0 ° = [ = 11
Design Current Design Current
Design Curren#
Swine Capacity Population Wet Poultry Capacity Population Cattle
Capacity Population
❑ an to Finish 10 Layer ❑ Dairy Cow
❑ an to Feeder ILI Non -Layer I I ❑ Dairy Calf
Feeder to Finish
6
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ ❑ Beef Stocker
El Farrow to Finish
❑ Gilts
❑N on-Layersers
❑Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
❑ Turkey Poults
❑ Other Number of Structures:11
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes 2 No ❑ NA ❑ NE
x
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
ElNA
❑ NE
❑ Yes
El No
❑ Yes
LyN
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104 Continued

r
Facility Number: I — Date of Inspection h a
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?
Structu e 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ Yes 9No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [21 No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes IJ/ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes fNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,
9. Does any part of the waste management system other than the waste structures require ❑ Yes CJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes MNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LLd No ❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
2 No ❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
LI/No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
d ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
L No ❑ NA
❑ NE
Comments (refer to question #): 'Explain any YES°answers and/or any„cecommendaU©ns oar aA 11ther omments�`�
Use drawings of facility to better explain situations._(use additions[ pages as necessary),:
Reviewer/Inspector Name C �a Phone:910 7�
Reviewer/Inspector Signature: Date: Z
12128104 Continued

Facility Number: — Date of Inspection o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes WNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other ,�
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L'L 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 [ /No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ET�o [INA [INE
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
ElYes
[o
❑ NA
❑ NE
ElYes
1N\
El NA
❑ NE
El Yes
o
❑ NA
❑ NE
❑ Yes
LyNo
❑ NA
❑ NE
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?
Cl Yes[2/No ❑ NA ❑ NE
Cl Yes Q N ElNA ❑ NE
ElYes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
El yes MNo El NA El NE
❑ Yes LJ'No ❑ NA ❑ NE
12128104

13'
Type of Visit OrCo pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: g 7 O Arrival Time: Departure Time: County: �I/r°lRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:AT14A � PA.!
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = ' E__1 Longitude: = ° = 6 =
Design
Current
Design Current Design Current
Swine C►apacity
Population
Wet Poultty Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ Layer I I
❑ Non-Layer-1—
❑ Dairy Cow
❑ Wean to Feeder
❑ Dairy Calf
Feeder to Finish
zOb
'31i Z
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to FinishEl
❑ Gilts
Dry Poultry
❑ Layers
❑Non -La Non -Layers
❑ Pullets
❑ Turkeys
❑ Dry Cow
ElNon-Dairy
Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
❑ Boars
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�/N
❑ NA
❑ NE
[I Yes
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 31 — Date of Inspection 1 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c
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
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
environmenta7that, notify DWQ
7. Do any of the structures need maintenance or improvement?
El
❑ 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
ElYes
o ❑ 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
2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? El Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? VY Yes ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes 1J N El NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes U/ No ❑ NA ❑ NE
1 Q = (25 t-A-C v E p
Reviewer/Inspector Name I Phone: "LD�'7`+
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 1 — ] Date of Inspection d
Ueguired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
M No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
7�0
[INA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
Id No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L3 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
V(No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
d o
[INA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
7No
❑ NA
❑ NE
AdditionatrCommei►ts=and/orsDrawtngs
J
T
Page 3 of 3 12128104

(Division of Water Quality
=Facifityumber O Division of Soil and Water Conservation
0 Other Agency
Type of Visit ZRoutine
pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: li Arrival Time: ® Departure Time: County: i0N Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Titlee:! ` Phone No:
OnsiteRepresentative: i_ 6iV��1H11!�U.h/t Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = 4 = Longitude: = ° = 1 0 «
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Nan -La et
Dry Poultry
Non-L
Pullets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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?
0
❑ Yes ixo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
12,128104 Continued

Facility Number: — Date of Inspection I
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E7/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): ,
Observed Freeboard (in):�
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 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 th eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes U/o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes LEI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ld No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes J!J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O 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
Lko
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
U1vo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
P*o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Mo
❑ 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):
2j.) UPpn( ' tMQCZNG
Reviewer/inspector Name c. 'JA Phone: 71dj f7 J fff
Reviewer/Inspector Signature: Date: U 0
12128164 Continued

FicHity Number: — Date of Inspection ! ! O
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
E' `No
ElNA
ElNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
,�
L'I Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
2No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2�o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L✓J N
[INA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
CO/No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EZ/No
❑ NA
❑ NE
Other Issues
J
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�El
,VNo
NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
❑ 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
to
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
VN9
❑ NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
El Yes
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
El Yes
VNo
❑ NA
❑ NE
Comments and/or Drawings:
12128104

31
Type of Visit (5 Co pliance Inspection O Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (7 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 'Lj2 oS Arrival'rime: Io u S Departure Time: County: O UPLX-4 ^ — Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 6,E." cf iC"- OjEo
Certified Operator: Z 6+ D I-A►Ss rz
Back-up Operator:
Location of Farm:
Swine
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0= d 0 Longitude: = c=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
U Feeder to Finish
36 Z
`Lai
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
12128104 Continued

Facility Number: 31 — I-Sq
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: LA&oo►.i 1
Spillway?:
Designed Freeboard (in): !"y
Observed Freeboard (in): 'Lei
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 E No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes /No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ENo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers; setbacks, or compliance alternatives that need ❑ Yes El No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Ll 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. Croptype(s) 13E2vy»CJA CO) GG-0 C5vj
13. Soil type(s) AV (3 L-t3 A hIo{�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ir No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
Yes
�LJ
L3"No
❑ NA
ElNE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NNo
❑ NA
El NE
18. Is there a lack of properly operating waste application equipment?
ElLY Yes
,ff
No
❑ NA
❑ NE
'Zp) t A (--0,J S-L-f A� -LA" FrLEE-g a A SL.n , 6.-AR:LV,1( L-i-tTIA CQ..F,3PE cr To Mt�aL �GE�
2.t.) I" "jA t,f(;LL AND Ca-Oe L;sGLD 13E ovaF. 510 c-",JGr ANo IYJ�JvA(_ CEcr ucEP Coi'%;0,
le") V__EEp GoP`; 4 CX kW0 �CRNi�i
IReviewer/Inspector Name Phone: I
Reviewer/Inspector Signature: Date:
12128104 Continued

Facility Ni}mber: Date of inspection
Reauked 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 E31yes ❑ No ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists dDesign El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
eyes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil alysis ElWaste Transfers
EfAnnuat Certification
[--]Rainfall Stocking L'I Crop Yield El120 Minute Inspections Monthly and 1"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[?(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[y o
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[Zo
LYN
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
[�No
tlNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[L No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
3/NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
El<o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
LJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�,/
L_J No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
/
32. Did Rev i ewerA nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[f
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit (2(Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time: / r Art
10 Not Operational 0 Below Threshold
OPermittei'N Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
Farm Name: A f m i L t% County: _ Ul7 irlt
Owner Name: Phone No:
Mailing Address:
Facitity Contact: Title: Phone No: Onsite Representative: (;nA5 IvAALdq Integrator: _ `% L 140k ote lcf
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 00 1 " Longitude 0 6 �u
"Design _
= Current ,
Design Current:Design
Current .
Swine f Ca aei �.Po
Mahon x`Poultiy ,.,
Capacity Po ulation= . ;.;Cattle
Capacitv Population .
❑ Wean to Feeder
Layer
❑ Dairy
Feeder to Finish
E❑
Z
❑ Non -Layer
`
❑ Non-Dai
j'
❑ Farrow to Wean
❑Other
y
❑ Farrow to Feeder
❑ Farrow to Finish
Total Design' Capacity
❑ Gilts
❑ Soars
Total SSLW
=0 Numb1. er of Lagoons
❑Subsurface Drains Present ❑ Lagoon Area
❑ Spray Field Area
HoldingPonds / SohdTras
❑ No TiqZ Waste Management S stem
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 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 1
1I
Freeboard (inches): .21
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. ,Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered ves, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do anv stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10, Are there any buffers that need maintenance/ improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12_ Crop type C JM. W'K US
It
13. Do the receiving crops differ with &ose designated in the Certified Animal Waste Management Plan (CANVMP)?
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?
Reouired Records & Documents
17. Fail to have Certificate of Coveracye & 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 notifi- regional D) Q of emergency situations as required by General Permit?
Oel 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 AV NT?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
oniimeots {rr fer to q ession =Explain any YES ansi�ets-andior atryi_ommeadat i►ns er.iii,v-oti►er m entk J.
Use drawings of facr7rty to better ezplam situations (use addrddnal pages xs necessary)' : 0 Field opy ~ ❑ F Notes
?.I3`��§"'f...�cI•`�``: .er?'.."'-...�e�d:v,..;r�:,:at�a"`3.:��t.�"-�i;..:�.:;_ ;���:w'5`-. <•r'�G¢k r�.`,#?x-.,.max..-.�-v,m � .�•..-b.�C
LC.ora 5 Fares. (d o 9 ro .
eviewer/Inspector Nameeviewer/Inspector
E
Signature; Date: y
051031VI IT,
Continued

Facility Number: Date of Inspection
Odor Issues
26, Does the discharge pipe from the confinement building to the stoi-age pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
24. 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
orbroken fan blade(s). inoperable shutters. etc.)
31. Do the animals feed storase bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
❑ Yes ❑ No
❑ Yes ❑ No
El Yes ❑No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
05103101

Facility Number Ti / 3 Date of Visit: Z Time:
rO Not Operational 0 Below Threshold
IS Permitted 0 Certified [[3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: 1410A Lot n %Ar,' County: _ Au d i"L
Owner Name: Phone No:
Mailing Address:
Facility Contact: f/ Title: Phone No:
Onsite Representative: Cs�d /�/t/1�/L U Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 K Longitude 0 =1 � u
Design.
3'
Cprrent . Design Cu�n'ren`t
`Ca
Design Current
Swine
Ca aci
P.o utahon._ Poultry,: aci ., P.o ulation Cattle
Ca aci P,o elation
❑ Wean to Feeder
I
: ❑ La er 10 Dairy
Feeder to Finish
-` ❑Non -La er I I' ❑ Non -Dairy
❑ Farrow to Wean
=
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSi.W
Number of Lagoons ❑ Subsurface Drains Present ❑ La oou Area ❑ S ra Field Area
Holding Ponds / Solid Traps
❑ No Li uid Waste Management S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes KNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? Cl 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 4 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes R No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 10 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: 1
Freeboard (inches): 33
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes Q.No
seepage, etc.)
b. Arc there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes KNo
(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 ZNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes �ZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes [9No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes R No
11.
Is there evidence of over application? ❑ Excessive Pondmg ❑ PAN ❑ Hydraulic Overload
❑ Yes
WNo
12.
Crop type L' W
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
QSNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
(@ No
b) Does the facility need a wettable acre determination?
❑ Yes
[RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
L[ No
15.
Does the receiving crop need improvement?
❑ Yes
R No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
V9 No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�B 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
�RNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
U[No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(Z 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
C4 No
(ie/ discharge, freeboard problems, over application)
23_
Did Rcviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
El 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
[KNo
E No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (re(er to;questionr#} ExpAii'* any YES answers and/or any recommendations or any other ctianments r..
Usesdrawiogs of facility to /letter ezplatnsttuatioas :(use.addttaonalpages as necessa �')'
' El Field Copy ❑Final Notes
Ac d rWs Ldo 1—s e�v e
Reviewer/Inspector Name-
42
Reviewer/Inspector Signature: Date: i
O5103101 Continued

Facility Number: 3/ — Date of Inspection 62
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes P[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 EK 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 allo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ®No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes O No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ® No
Additional Comments and/oi•, Drawinps:.,
05103101

Facility Number Date of Visit: E 1 4= ( Time:
rO Not O erational O Below Threshold
CKPermitted 13 Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: �.0 ......... .... ""* "`1'`z................................................. County:..... ...... ............................... ..........I........
OwnerName: ................................................... ........................................................................ Phone No:.....................................................................................:.
FacilityContact: ............................................................................... Title:.................................... .... Phone No:
MailingAddress: ..................................................................................................................... ........................................................
------............1--...
Onsite Representative:.. �?G�.-g...�-�........................................... Integrator:....
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
[r 4 AL
14 �1'vJ
7
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �4 &A Longitude �` �` �69
Design- : Current" = . Design . Current Design Current • ;_m
Somme „y Population Cattle acipoultry Ca aci Po elation a aci Po elation
G ❑Wean to Feeder I[]Layer ❑ Dairy
Feeder to Finish a, ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean -
❑ Farrow to Feeder ❑Other
?a = ❑Farrow to Finish ToW Design Capacit
All Gilts -
❑ Boars TOW SSLW
Number of."Po ns _ ❑ Subsurface Drains Present 10 Lagoon Area 10 Spray Field Ares
;.
$ol ' . Ponds "/ Salid-Traps ❑ No Liquid Waste Management System
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes tfNo
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 XNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Wo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes I&No
Structure l Structure 2 Structure 3- Structure 4 Structure 5 Structure 6
Identifier: .................................... .................................... ................................... .................................... .................................... ....................................
Freeboard (inches):
5/00 Continued on hack

Facility Number: •"3 — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes RNO
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes KNo
(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 KNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes gNo
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 6ttg S_G_ 'd t* I ci l^ I1 iE-- - -
v % `. 1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N' •yiolaWris :ot- 40f clendos w*re rioted dvrring thjs;vjsit; - Yoo wii� �ecviye no fui-thgr"
correspo deiice. al)6 k this visit.
co
lie.diraw of facility to ]better fzplatnesituatrons (tree additioral pagesxa
p
1�;) - ( t � " �
ham- �-�- ��1, � � �-.� ►, � . � t-��,.
❑ Yes X No
❑ Yes 14,No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes , No
❑ Yes ONo
❑ Yes b No
41'es ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes MNo
❑ Yes ',No
L`
Reviewer/Inspector Named ',A[n
Reviewer/Inspector Signature: Date: iq.-ja 1 $lpp

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ 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 DNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P No
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONO
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes J�WNo
Additional. omments-an or ra :
f d
AL
z'
66�% PAR
r��" n�75 4- �Ve
1
J
c 36-
L�
ur
DHb T
T
5100

'Division of Water Quality
0 Division of Soil and Water Conservation
-0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ((Routine O Complaint Q Follow up O Emergency Notification O Other ❑ Denied Access
3 Date of Visit: 3' dG `time: �� Printed on: 7/2112000
,„oFacility Number , _. 0 Not O erational 0 Below Threshold
-*ermitted 13 Certified Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: �� �� County: ...................
..........................................t..�-................................................ ........................................... .
OwnerName:........................................................................................................................... Phone No............
Facility- Contact: ...............................................................................Iritle:................................................................ Phone No:...................................................
Mailing Address: .........................................................
Onsite Representative:...,. � ^���^.........................................................I..n...t.e...f..r..a...t.o...r..•......-.....- ..,.,.,.-............................................................................................................................................I.
Certified Operator ............. „•..- , , -- Operator Certification Number: -
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �� Longitude
Design Current
Swine Canacitv Ponulation
❑ 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 Po ulation
❑ Layer I I d I[]Dairy T I ==j
❑ Non -Layer I I JCI Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I j 107Subsurface Drains Present ❑ Lag,,,,n Area JE1 Spray Field Area
Holding Ponds / Solid Traps I ❑ No Liquid Waste Management System
Discharges & Stream Ipacts
1. Is any discharge observed from any part of the operation? [-]Yes jd'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. II'dischane 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 9No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes PqNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .....................................................................................
Freeboard (inches): 3
5100 Continued on back

Facility Number: 3 j — i-�3 Date of Inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
ZNo
(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?
9Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
jq No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? -
❑ Yes
ONO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
n(No
1. Is there evidence of er application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑YesNo
rJ57cv
12. Crop type C��
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
IN No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
N[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
NfNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
gNo
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?
❑ Yes
VNo
(ie/ WUP, checklists, design, maps, etc.) ?
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ONO
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
-D'No
21. Did the facility fail to have a actively certified operator in charge'?
❑ Yes
rXj No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes JXNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes qNo
24. Does facility require a follow-up visit by same agency? ❑ Yes RNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ,D'No
0: N6-yialatidns'oi-• de#iciencies were patted• during 4his'visit: • V64 will •reeeiye nio further • : :
Corresporidellce.ahaLtth'' i it.'.'.'.'.'.'.'.'.'.'. .•.•.•.•.•.•.•.•.•.•.•.•.•.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
A.
i) �°� '�s a�je�-vt„�-��� Y w�� 1 Q��-, ►�, eels
��---..ass
-(9�1'Z06 gl-k IaLC. � �� _Q_KceQ '7 occi
l �,5_54 L-4�i N-VL r2ce( h5 q S ll YELS
Reviewer/Inspector Name Q Y1 —3 ` 0o x^�
Reviewer/Inspector Signature: Date: 5100

Facility Number: Date of Iaspection Printed on: 7/21/2440
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge At/or below X 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 9(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
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 [�l 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 pfNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes RNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes &No
All
5100

Name of Farm/FaciIity
Location of Farm/FaciIity
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1 V
Embankment Sliding?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report
33LI
-2A9- 767
Names of Inspectors -Z�Vld--& c-'
Freeboard, Feet
Top Width, Feet
11
2 ' / Downstream Slope, xH:1 V Z y
,Yes No
Seepage? Yes No
(Check One, Describe if Yes) - -
Erosion? X' Yes No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(�s ees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Yes �T No If Yes, Depth of Overtopping, Feet
_Yes No
—Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
Other Comments
f /d,
Yes_ No
�,w. k a
a(-Q4m r'l

13 Division of Soihand Water Conservat,o>a - Operation.Review
a } Division of Soil and Water' Conservation :CompLance Inspection
Division of Water Qu'OW-:Complianee Inspection
F - =
Other Agency,-9peration Review s
IQl�Routine Q Complaint 0 Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other �
Facility Number Date of Inspection Z 43
Time of Inspection .' 24 hr. (hh:mrn)
Apermitted 0 Certified 3 Conditionally Certified © Registered E3 Not Operational Date Last Operated: ..
" fil-CAR'd. ..4- &,;i � , ....!...'.fir............ County- .. 1J 1!!')..Farm Name• .....-..... ...`...%r.... ... ... -. �. .........� ..../...........................�v........
/y,�,� /
Owner Name:..--.V�.
drYL li°Phone No:Facility Contact: .... ...............�,Fj, .. ............... Title:.. �%%h'1, .. 1lC.eL S...... Phone No: -. J �i .—r AV
i'IailingAddress: ...... �t1v.........ff�l�? ..lI.0........................
.s d.0...
Onsite Representative:. �r... (7...... 7�i ... .............. Integrator: .........................................
J _
Certified Operator:.......... (.0 ...................... J.11......................... Operator Certification Number:..........................................
Location of Farm:
Latitude 0 4 Longitude 0 6
Design Current. Design Current Design Current
ne .pCattlCapacity Population ;Swi-Capacity ,,y e
❑ Wean to Feeder ❑ Layer ❑ Dairy
ceder to Finish 7�, ❑Non -Layer ❑Non -Dairy -_
❑ Farrow to Wean
" ❑ Farrow to Feeder
❑ Other -`
❑ Farrow to Finish Total Design Capacity
❑Boars LL ;=- _.' ,.' Total SSLW
Number'of Lagoons ❑ Subsurface Drains Present ©Lagoon Area ❑Spray Feld Area
Holding -Ponds / Solid Traps 10 No Liquid Waste Management System
Discharges & Stream Impacts
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 ➢WQ)
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
Identifier:
Freeboard(inches): .... ................................................................................................................................. ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes 00
❑ Yes �No
No
Yes
❑ Yetr TNO
o
ElYes
❑ Yes o
❑ Yes N0
Structure 6
❑ Yes No
Continued on Lk
3/23/99

Facility Number: — 3 Date of lnspection
6. Are there structures on -site w ich 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 maintenancelimprovement?
11. Is there evidence of
11of overt application? ❑ Excessive Ponding ❑ PAN
12. Crop type J7t�f� LJLI - C _ 1�
r -�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit 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? (iel 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?
Gel discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: Rio. .W.. fi6 is:or• deticiencie9 ►were noted• d&Mg phis:visit. - Y:ott ivill•eeoeiye dd furthgr
CO- rresponcieirce. A4o f this visit.
❑ Yes �'No
kfYes ❑ No
❑ Yes §4No
❑ Yes qNo
❑ Yes] No
❑ Yes No
❑ Yes
E�No
❑ Yes
KNo
❑ Yes
4No
❑ Yes
(XNo
Yes
NQ�z
❑ Yes
O No
❑ Yes VNo
❑ Yes (*No
❑ Yes 14 No
❑ Yes [(No
❑ Yes A No
❑ Yes 0 No
❑ Yes- XNo
❑ Yes VNo
❑ Yes 19No
Comments (refer to question:#): E lain any YES answers aniUor any recommendations oVany outer co inents.
Use drawings of.facility to Metter explain situations (Else addiiii6bal pages -as necessary)
IYU1114 a 1'7) 01-1hia4e dl"Os alz
y
r5&A is f
x
Reviewer/Inspector Name 1 - =_—
Reviewer/Inspector Signatur . Date: /Z Q 3 - �l
3/23/99

Facility Number: fate of Inspection
{
Odor Issues
,,VJA-y Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ANO
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 ANo
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 [moo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XN0
/Y/� Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
_ ittona .� om ents au or_ _raw►n
3123/99

U Division of Soil and Water Conservation ❑ Other Agency
s •°" ®'Division of Water Quality
0 Routine ® complaint e Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Date of Inspection Z It 9
Facility Number Time of Inspection } 24 hr. (hh:mm)
[3 Registered ® Certified © Applied for Permit © Permitted 113 Not O erational Date Last Operated:.,,,,,,,--
-
Farm Name:...f S.�- � L e�` q ...... County• ..p... 5.. ...... .................
OmmerName: ................... .+a..t..rr!...................................... Phone No:..�.i.�..�..... .�...-...` ............----........
Facility Contact: ......................................... ........ . Title:................. .... Phone No:
Mailing Address:.... S.D.12 ... ...T-A.................. ..&r-->?... ...... -......................... �..$..�..�.�.....
Onsite Representative:-t--is,.�.-. .. t. ? ,r ._ ....... Integrator: ... a .... '!:Sl.-�1.....................................................
L
Certified O erator;...-.- ...tt►..�n.lit„nl............................ Operator Certification Number:... [..$..II..4..�t.----...-......
Location of Farm:
Latitude ' = 1 44 Longitude • = 1 if
WN F Destgnr Current
Design Current:' t DesYCurreiat, r
,, Burins ,rxa Eapacaty Population Poultry V CapacttyPopulatton Cattle Capacity. Population �::
R...
...°.
❑ Wean to Feeder
Wean
❑Layer Dairy
Feeder to Finish
[I Non -Layer ❑ Nan-Dairy
❑Farrow to Wean
�„ ...;': gz ,x ._;,� ter.• > gam:
F� . .
s El Farrow to Feeder
❑ Other d�,
z. d:
❑ Farrow to Finish
r
F v
Total Design Capacity Z
. ❑ Gilts
,3
.
SSLW Lj
❑Boars
=� .:Total 9 s 7
Number of+Lagoons / Holdmg Ponds',- 0 0 Subsurface Drains Present 110 Lagoon Area JO Spray Field Area �.
r ...... .. .....
❑ No Liquid Waste Management System
=•���< �; ,� ,� �
�
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gaL/min?
-d. Does discharge bypass a lagoon system`? (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
Y maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes
Eff No
❑ Yes
RtNo
❑ Yes
® No
❑ Yes
® No
❑ Yes
CR No
❑ Yes
MNo
❑ Yes
1$No
EU Yes
❑ No
❑ Yes
O-No
❑ Yes
VI -No
Continued
on back

Facility Number:3t — W
8. Are there lagoons or storage ponds on site which need to be properly closed'?
Structures (La goow,.11oldint! fonds, Flush Pits, Wo
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: �,..x 5...........
Freeboard (1t):....................................
10. is seepage observed from any of the structures'?
11, Is erosion, or any other threats to the integrity of anv of the structures observed'?
❑ Yes N No
i[ Yes ❑ No
Structure 5 Structure 0
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)
U. Do any of the structures lack adequate minimum or inaximum liquid level markers:'
Waste Annlication
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ) _
15. Crop type 1:,.u..-sn............................. ........... ....... .............. .........................
....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMI')'?
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 were noted during this.visit..You.Wi11 receive no ftirtber
correspondence about this', visit. -,
❑ Yes R No
❑ Yes R1 No
❑ Yes 0Vo
❑ Yes RNo
Yes ❑ No
❑ Yes
® No
❑ Yes
0 No
Yes
V No
❑ Yes
19 No
M Yes
❑ No
[I Yes
25 No
19 Yes
❑ No
❑ Yes E� No
❑ Yes R] No
❑ Yes -. No
(refer to question #): _Explain any YES answers and/or any' recommendations or any 'othe'r comrnents
4 r
Use drawings of.facilitv:to better`explain situations.`(use additional pages'as neeessarv).
r 0-i .t iS
t �) • 5.. ,�.R : r�-a r p a,-" e � w O � k- rev -i a �S.S ?iv.�� Tt w o J wL
t t t
0✓0 0 i k V w% p e� t V-1 t � 0_ p Y i D f t o ro� � •, �^^}t , o p,-e-v�-� F o '- -
i 8 . L� ,► a,r c .� �1 1^^ v a tr la t, �a-.,�.1 ��, b a vc �: 4 �t�(�t l� .a t w 0-x v ,•� i w
3(I4,*- w!x �?-�`'''�"j + {t-3zi-- �^i`� r r-�c-0 v.1 S• at �� o ""` i'�-tC C Ric. —� t S fl P^•�a�
7/25/97
Reviewer/Inspector Name i`
Reviewer/Inspector Signature: Date: g Z
.w)
t= •` e S 1 a v` ti o 1a LLn.,...t-� L-R-H- 'V" Uti` . (-- "` fNs� Lc . W c r ti, w V rt j+ o o et -

Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
10 Routine O Complaint�0 Follow-up of DAVQ inspection O Follow-up of DSWC review O Other �
Date of Inspection oil
Facility Number
Time of Inspection 24 hr. (hh:mm)
0 Registered ® Certified 13 Applied for Permit © Permitted E] Not Opera Date Last Operated: „......,
Farm Name:.... ..... m.,n.l. ...� .................. County:. u.#r.��.!!.....................................i11�.�.. ..
1
Owner Name: V.1 SAI., . ....................................... .... Phone No: ..... I 0 2R — ........................
Facility Contact: .... ................................ . Title: .... Phone No:
Mailing Address: .+ . ...............
GJ.Q 6.......�.D.�t..r4..�..r\,�.U:x.d.).1�.....�.,�:................. ..�.g...uL..d!n.l..t..� .�r..�........:`.,.�..... �"R.S �... ....
Onsite Re rentative:.�ea.sj
r.�...... L� ' to rator:.... ......................
...........................
Certified Operator:.... ....... rf ..... ......................... Orator Certification Number,...IX05..4............
Location of Farm:
k....s�-Q.ar., ......�....t ...t.:. .�. .Z..S..7...... ....r n.x �.s,r-�a.... ... ........ ........
.x..l .e..... .�t ...... .....1.�► .. d! ... .... .... .....
SCc(..�........ .... ...............I.................. ......
Latitude EE�D' ®1®" Longitude • ' 44
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes CKNo
2. Is any discharge observed from any part of the operation?
Discharge originated at: [I 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 gal/min?
A. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge -from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
5. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25197
❑ Yes [RNo
❑ Yes B No
❑ Yes ® No
❑ Yes
B No
❑ Yes
RNo
❑ Yes
allo
❑ Yes
RLNo
❑ Yes
ERNo
❑ Yes
63No
Continued on back

r�
Facility Number: — 13
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La oons Hold in Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
t2.
C cane
Structure I Structure 2
ldentifier: z• 5
Freeboard(ft):................................
Structure 3 Structure 4
❑ Yes JRNo
❑ Yes RNo
Structure 5 Structure 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 structures observed?
'Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
RNo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
ENO
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ..,r..... .i�`a .r..................�„G.r.. rn ....................... ...................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
aYes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
S No
18.
Does the receiving crop need improvement?
iR Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
JK[ No
20.
Does facility require a follow-up visit by same agency?
EdYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
19 No
22.
Does record keeping need improvement?
❑ Yes
RNo
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
RJ No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
RNo
C]. No'vio[ations: or. deficiencies' were, noted_during this'visit.- You:will ike' i:ve-h'further, : :
0&600ndeb6e Ahoitt this.visit:• "• ::.
..� : t 3 "s .� rz � r.., �
Comments (refer to quesho t # ;< Exp1 any YES answers sn�/or aay,recammendattons oar ppy outer eomtttents:
i(u�se addr '1
Use draw ngs of i ci4ty_ better eatp,am s� uahonS ona! pages asp essary) f � <EN
Z, t-,o pi i D vt w p 6. l C 0�, T
t-�-+-- '-O
1 C.R•r �`+� ri ,� e �a S r GO r ,+. 1�Jr� Q 1
1s R-�"'a a [ '' 0 �`i �n 6 ✓+^
S
p..,r. W I+,-x-EL� F .,� (,�v tD 1 x . 2� ?ram rS
0 h t`y e e v t t. i„ rI o. t—
V-%X-,
c,1 COv-V. (, I V4�vv, X S�c.t42-1 th "+,sw - vU�2rC.
/
r L
kl 0 r l� o h Go �r - q S j-o f •� w u i-Qir1rLQ�✓v�aj �$ i-�AF��.Ri✓1 �I
�1� C 9 W t! `//25/97
j
W_" to r
rewer nspector Name „CRsr }, F3A
�.. �,.
rRe'viewer/Inspector
Signature: Date: j
P4A.,,,,
ej,-
W

3a—)3
AGRIMENT SERVICES INC
PO BOX 1096
BEULAVILLE, NC 28518
[phone], [phone]
11/22/97
Mr. Andy Helminger
Division of Water Quality
127 Cardinal Drive Ext.
Wilmington, NC 28405
Dear Mr. Helminger,
This letter is to address the 11/6/97 annual inspection that was conducted for the Richard
Lanier facility (FN 31-134).
Farm 31-134 had several deficiencies:
1. Erosion problems that threaten the integrity of the lagoon.
2. Soybeans were in a field designated for continuous corn.
Mr. Lanier has begun repairs to the problem areas on the inner walls of the dike.
Mr. Lanier has mowed large dog fennel on inside tow of dike. Mr. Lanier plans to
repair all areas in question over the neat several weeks weather permitting he may
contract out this work to Triple S farms which are now doing minor/major repairs
to lagoons.
Agriment Services has attached an addendum to the WUP to include a
corn/wheat/soybean rotation on the field that was planned to continuous corn.
A copy of the addendum was sent to Duplin SWCD.
I hope this information will address the Notice of Deficiencies that were noted, If you
have any questions please feel free to call.
With Kind Regards,
Ronnie G. Kennedy Jr.
11
Technical Specialist
Agriment Services, Inc.

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
�. ANIMAL FEEDLOT OPERA.TIO S SITE VISITATION RECORD
DATE: 10Y 1995
Time: / j - ov.
Farm Name/Owner:
Mailing Address:
County:
Integrator: N&-!/!f
On Site Representative -
Physical Address/Location:
r
Phone:
Z
437
'?_19-Y-237
Type of Operation: Swine Poultry Cattle
Design Capacity: .36 -7xi Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number:
ACNEW
9
Latitude: 3t- ° 1 a 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) es r No Actual Freeboard: n Ft. Inches
Was any seepage observed from the lagoon(s)? .Yes r N as any erosion observed? Yes r N
Is adequate land available for spry 9 Yes or No/�, Is the cover crop adequate? Yes or No
Crop(s) being utilized:r/t�l�l�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling l Ye r No
100 Feet from Wells Ye 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 (I 1�9 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spec acreage with cover crop)?, Yes or No
Additional Comments:
Inspector Name
Si
cc: Facility Assessment Unit
Use Attachments if Needed.