310150_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Type of Visit: (,.Woroucine
nee inspection U Operation Review () Structure Evaluation Q Technical Assistance
Reason for Visit: O Complaint O Follow-up Q Referral O Emergency O Other Q Denied Access
Date of Visit: 1 uj��/7'Arrival Time: ' Departure Time: j ; Zv County:
Farm Name:fjji, �i'/�7- Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: &kzt - / Title: Phone:
Onsite Representative:
Integrator:
Region:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pap.
Wean to Finish
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
► / .
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D� , P■■oul Ca aci lPo
,
Lavers
D Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
0 Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
[:]Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
d
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
[:)Yes
WNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: - J5V jDate of Inspection: n'
Wgte Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[a &o DNA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ io ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
u
Observed Freeboard (in): 32 I)L `Z -
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.)
No
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[/] ❑ 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 reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 VNo
❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ]o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P3<o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 11O LJ 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 Ej No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ YesF�Jto ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes [; to ❑ 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 to ❑ NA ❑ NE
Reauired 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 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes N
NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 0 No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facili Number: -
24.LDid 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 2'Yes ❑ No ❑ NA ❑ NE
the a ropriate 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
❑ 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
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
ZNo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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?
to
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes 21No ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
❑ Yes <14o
❑ NA
❑ Yes NA
❑ Yes No ❑ NA
ins pages!iwnecessar"y}
f�p
❑ NE
❑ NE
❑ NE
Phone:
Date:
21412015

Type of Visit: ompliance Inspection 0 Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Grffo�utine O Complaint O Follow-up 0 Referral O Emergency Q Other, 0 -Deemed Access
Date of Visit: I
�Z Arrival Time: p eparture Time: County: Region
Farm Name: �)�exl Ai— Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
G
Certified Operator:
Title:
Phone:
Phone:
Integrator: % /�
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Non -La er
DairyCalf
DairyHeifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
D . P.oultr.
Design
Ca aci
Current
P,o ,
D Cow
Non -Dairy
Im
Farrow to Finish
Layers
Non -La ers
Beef Stocker
Gilts
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes .,E] No ❑ NA ❑ NE
❑ Yes 4�f'No
❑ Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [No ❑ NA ❑ NE
❑ Yes r� No ❑ NA ❑ NE
❑ Yes ff No [DNA ❑ NE
Page I of 3 21412011 Continued

Facility Number: -
Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2-No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
M
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 �NoD ❑ NE
❑ Yes XNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
ZNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management. system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
JU
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
gNo
❑ 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? fe
20. Does the facility fail to have all components of the CAWMP readily available? Ifyes:/�h`eck
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes �o
❑ Yes ,�,No
❑ Yes ZlNo
❑ Yes _[�r'No
❑ Yes 4�!fNo
"40
❑ Yes L3 No
❑ Yes �No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes '[2-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 E!fNo 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ..E!rNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued
❑NAh❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑ NA
❑ NE
❑NA❑NE

Facility Number: - l - 7e jDate of inspection: 27
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes jo No
25.4s the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No
the appropriate box(es) below.
dailure 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 P, No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes "No
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�No
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
e2fNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
�No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
JZNo
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ZNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
[:]Yes
No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
7_1
Use drawings of facility to better explain situations (use additional naves as necessarv).
�- iee
� zb � /z �� � � I
pax-
Reviewer/Inspector Name:
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
21412011

Type of Visit: 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: parture Time: County: Region:
Farm Name: Owner Email: Ta4an
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: I -Am 1C &11W_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Swine CWv—acitv-irop.
Wean to Finish
I
Design Current
Wet Poultry Capacity P,op.
JLayer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
D . P,ouI Ca aci_ P,o ,
ILavers.
Dry Cow
Non -Dairy
Beef Stocker
Gilts Non -Layers
Boars Pullets
Turke s
Other Turkey Poults
Other Other
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes JZ'No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes ffNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes eNo ❑ 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 E!fNo ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 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 l of 3 21412011 Continued

Facility Number: Ds ection: O
Waste Collection & Treatment
4. Is -storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
b�
❑ Yes IILJ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes f No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ 2�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ,E7 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 -6 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 7No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ZI No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes C2 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 ,fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes )2rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes 0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes FrNo
❑ 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 Z[ No
❑ 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 121 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes O.No
`r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes C`No
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
M Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
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? ❑ Yes P No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �]+ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes PNo ❑ 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)...
tk_) 4 — I—,-) If 730 3 ct re- 40 66 1:;
-J)1gjl2 1.09 2
�. of
3)00
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
ReviewerMspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
)2�No
❑ NA
❑ NE
❑ Yes
PNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Phone:
Date:
4%l0

Fac11ify °Nur>iiker F
Type of Visit
Reason for Visit
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
.'�ivisi©n of Watei
0 Division of Soil a
0 OtherAgency
tty .
ter Conservation = "-
(Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
outine O Complaint O Follow up Q Referral O Emergency O Other ❑ Denied Access
V
Arrival Time: - C)a Departure Time: Y C7 Q County: Region:
v"A_'�a{ Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: ✓] h _ _ _ Integrator:
Certified Operator: Operator Certification Number:
id �l
Back-up Operator:
Location of Farm:
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Lam. ❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Back-up Certification Number:
Latitude: [= c = 4 = Longitude: = o [= 4 [= ,;
sign Current g Design ,Current. »1
'Papulatioi , 'Wet Poultry -Capacity' Population Cattle C
►actty, .
❑ La er
❑ Dairy Cow
❑ Non -Layer
:
❑ Dairy Calf
t '
ryy Poi l ry ` "
❑
Dairy Heifer
El
Dry Cow
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑Me Poults
❑ r
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood
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 2 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
ElZ Yes
,ICJ
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: - Date of Inspection:
—14
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2 Structure 3 Structure 4
Identifier: % 2
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 1
5. Are there any immediate threats totthe�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?
Structure 5
ONo ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ,E:rNo ❑ 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 LDNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ZNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes [�r`No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes JZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes PrNo
❑ 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
_P�_No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
5no
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
YJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
JZ No
❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes [ZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes P 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 oil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ M thiy and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes �No4❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes J2] No
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facili Number:^Date of Inspection: LL
�f
24. Did the facility fail to calibrate waste application equipment as required by the pe ? I /1 Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check •%❑ Yes ZNo ❑ 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 [XN+ o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ON'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 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 eNo ❑ 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 KNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes TI /f No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes d No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes VNo ❑ NA ❑ NE
Comments refer to question # • Explain an YES answers and/or an additional recommendations or an other comments. r
{ q }. p y y Y x
Use drawings of facility.to better explain situations (use additional pages as necessary).' -
al lC r
A--1 f\-o 5 fame-
S u�
-71 r` 1l / r -7 L l�^ arc C-\(-
C ` 3 ' N o Ce li bca�S6lt
X, 3 Cecarks �Qok �P(A f
2-
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: �Z,7 11Z
2141201

Type of Visit"�Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit�outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: % Arrival Time: _ eparture Time: County: Region:,
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Laz
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = n = 1 = Longitude: = ° = 4 =
lugs-ig!5Z Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry C**opacity Population
Cattle Capacity Popnlation
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer I 1
❑ Dair Calf
❑ Feeder to'Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ DEY Cow
❑ Farrow to Feeder
[INon-Dairy
❑ Farrow to Finish
El Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co
❑ Turke s
Other
❑ Other
FE]Turkey Poults
❑ Other
Number of Structures:
Discharp-es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 R3 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
[l No
❑ Yes
V1 No
❑ NA
❑ NE
❑ Yes
Vj No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: ' — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes VrNo
❑ 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): e571l�
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 threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes tZ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application J,
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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
7No
❑ 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
[Z No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
'Com
rots (refer to question ft Explain any YESanswers and/or airy;recommendahons or'any�otheer corn exits
"
Use drawings of facility to better explain situations (use,additional pages as necessary)
Iw')f elge �/!2l -S Calr�ai'cz eul�
a!
rt ed4 p uypbt r
Reviewer/Inspector Name I
Reviewer/Inspector Signature:
Page 2 of 3
liCo%�.fC
/v C,o 4,vA_
,7/0- '3 So -- a66 y
Phone: !L:
Date: /O
121200,
Continued�

Facilit:�Number: — Date of Inspection I Zd
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes dNo ❑ 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 ElWaste Analysis ElSoil Analysis ❑ Waste Transfers [IAnnual Certification
❑ Rainfall ElStocking/ I_I ekChop Yield ❑ 120 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?
24 id the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes ETNo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ��No ElNA ElNE
ElYes ONo ❑ NA ❑ NE
Page 3 of 3 12128104

—JO-Vivision of Water Quality
Faculty Number 1 O Di-tlsion of Soil and Water Conservation
-- --- O Other Agency
Type of Visit C'tompliance Inspection O Operation Review O Structure Evaluation
Reason for Visit RIkoutine O Complaint O Follow up O Referral O Emergency
Date of Visit: / G7 Arrival Time: Departure Time: County3
Farm Name: Owner Email:
Owner Name: Phone: _
Mailing Address:
Physical Address:
0 Technical Assistance
O Other ❑ Denied Access
Facility Contact: Title: Phone No:
Onsite Representative: Integrator: AR
Certified Operator: Operator Certifi ation Number:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Back-up Certification Number:
Region. �
Latitude: [= c [= 1 Longitude: = ° =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
jI ❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dai 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?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

I
acility Number: ' Date of Inspection
i-
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Struct� re 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 threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i
7
Reviewer/Inspector Name �/l Ice -Phone:
Reviewer/]nspector Signature: Date: a
i
12128104 Continued

+ . Facility Number: Date of Inspection J/1p y
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Grawe� s?�r �/ fiQdP oz,. -epr qS -" r"
lGC�s� fira-f'2 4-L .SGcrQ l�
e5 1 Zt�r
o4 L
VVI
Page 3 of 3 12128104

jo Division of Water Quality
Facility -Number ©� If` O Division of Soil and Water Conservation --
• 0 Other Agency.; V
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: LT71 Ar ival Time: �- Departure Time: r_� County:
Farm Name: s Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
h� Phone No:
integrator.*— `ter
Operator Ce 'fication Number:
Region:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = e = 6 =Sd Longitude: 0 ° 0 6 = 11
Design. Current Design Current : Design "'Current,:
Swine Capacity Population Wet Poultry "Capacity Population Cattle Capacity, Population
❑ Wean to Finish I
❑ Wean to Feeder f
eeder to Finish 00 j
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts 1
❑ Boars
Other "
❑ Layer
❑ Non -La er
Dry Poultry.
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number:of Structures E
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 I of 3
❑Yes 1`❑No I--] NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
[I No
❑NA
(I NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: , j 1— l Date of Inspection
i
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier: /
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): iZ 7
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as: necessary):.
Reviewer/inspector Name 1 &4a_ •L�� _ I Phone: / f
Reviewer/Inspector Signature: Date: 6rc
pavo 2 of 3 12 R/04 Continued

c
FaciKty Number: 3 — Date of Inspection
Reuuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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
❑ No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have.an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
0 Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
71,4 yle,,
' f/I ���o an SSs� s 6v/ �PG Gr
s SAL
3/lI
v
Page 3 of 3 12128104

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visitxl�toutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: lL'C Region: Zzafo
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facilitv Contact: Title:
Onsite Representative: atkz
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator: Zlol—r7
Operator Certificati Number:
Sack -up Certification Number:
Latitude: = c = I Longitude: = n = 1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Laver
r I ❑ Non -La et
Dry Poultry
❑ La ers
❑ Non -La ers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes _ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
ZfNo
❑ NA
❑ NE
12128104 Continued

Facility Number:-3 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): vZ
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes O'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,EI No ❑ NA ❑ NE
❑ Yes .ENo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acce table Crop Window% El Evidence of Wind Drift El Application Outside of
Area
12. Crop type(s) if r a L S W
13. Soil type(s)
T,.
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
El Yes
❑ No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA ❑ NE
Reviewer/Inspector Name l._ i w I "_ phone:
Reviewer/Inspector Signature: Date:
12128104 r Continued

Facility Number: — Date of Inspection Q
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L2'�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check ❑ Yes J21No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. - Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking • ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes �No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes -ETNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ N*NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWNIP?
❑ Yes FNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ZNo
❑ 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?
,�+
❑ _NYes✓ o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ETNo
❑ 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 Uf�o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes EJ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
-20 Q t.LA- o
C-O j a� F c�Y Y.� 1 r� 4?
c.�r�Q-�S 1 S
4e U 0 "A�_
12128104

IType of Visit Q'Cornptiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 0111outine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number I
Date of Visit:
rmittedrtified M Conditiona5y Certified 0 Registered
Farm Name:
Owner Name:
Mailing Address:
f( %CJ G T"une:
Not Operational O Below
Date Last Operated or AboveThreshold:
County:
Phone No:.. _ . ...�. .._.
Facility Contact: Title:._ _ .. __. Phone No:
Onsite Representative: z
�1��i7�J _ Integrator:
Certified Operator:
Location of Farm:
Operator Certification Number..____—_
pl'swi i uttry ❑ cattie ❑ Horse Latitude r��• �" Longitude • 4 Du
DischM*ges & Stream
1. Is any discharge observed from any part of the operation? ❑ YesA!rNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes _E3TIo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O-No
Waste Collection & Treatment �,�
4. Is storage capacity (freeboard plus storm storage) less than adequate? [3 Spillway ❑ Yes Cf go'
Strur 1 Strur 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): i
12112103 Continued

Facility Number:. — Date of Inspection D i�
S. Are there'any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes,r�o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑yesNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes j�Wo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ®'No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes 0'No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ,allo
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes .FNo
❑ Excessive Ponding ❑ PAN ❑ Hydrlic Overload ❑ Frozen Ground ❑ Copper anor Ziic+�•f �C-
12. Crop type a e'ail S Li1 / • . J G �C? Lt' �s"f
13. Do the receiving crops differ with those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
T�
Animal Waste Management Plan (CAWMP)? ❑ Yes -ETNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes A3No
16. Is there a lack of adequate waste application equipment? ❑ Yes .04o
Odor Issues
I7. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below ❑ Yes J'Ro
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes --allo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes . 2M
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes LlWo
Air Quality representative immediately.
Field Copy ❑ Final Notes
llo(llmfe rCluj 11)2vx-jP- e k e iv
Ol
A �����laic 0'�'n e k1
<< �e4
ReviewerAhspector Name
Reviewer/Iaspector Signature:
Date:
12112103 / Continued

Facility Number: _ Date of Inspection
Re aired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard 13'OVaste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29_ Were any additional problems noted which cause noncompliance of the Certified AWMP7
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ,.O'No
[I Yes O No
,O'Yes ❑ No
❑ Yes O"No
❑ Yes 2-No
R
❑ Yes G�
❑ Yes 13-No
❑ Yes L],No
❑I Yes 'Q-KO
..]'Yes ❑ No
❑ Yes ONO
❑ Yes .0 No
'Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? 0tes ❑ No
35: Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. P' Yes ❑ No
[Stocking Form EIrCrop Yield Form .Rainfall Olnspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
j�o200
o 6 •���G �. � its � U /c�Ile w
AA
E��c:C /�E' c�r��f C/rr✓� y2'A�
1-,-r ih
0211
/max
D ;F'�✓�C
i/ S P C 'llai.l
3
121I2/03

r
Facilit<• Number hate of Visit: d Z3 Z Time:
Not Operational Q Below Threshold
M Permitted [-Certified q Conditionally Certified ©Registered Date Last Operated or Above Threshold:
Farm Name: dH r/l7 Counh•:
r
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative:w •f P.-- _ Integrator:U✓�/11/
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` �" Longitude ' 1
Discharges &. Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): Zy �Z
05103101
❑ Yes 9No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑Yes
Wo
❑ Yes
1EINo
❑ Yes [�tNo
Structure 6
Continued

Facility Number: 3— LQ Date of Inspection < 3
(: Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe rosian Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes] No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7- Do any of the structures need maintenance/improvement? ❑ Yes QNo
Does any part of the waste management system other than waste structures require maintenance/improvement? ® Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes 2.No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 9No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAIN ❑ Hydraulic Overload ❑ Yes Z�No
12. Croptype yLP//hr �l� �� �l�f��ll�'l��t (/VP�SfY�,` f� lash ��n•7�,Y
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ER:No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes WNo
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
MNo
16-
Is there a lack of adequate waste application equipment?
❑ Yes
TZNo
Required Records & Documents
17-
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WliP, checklists, design, maps, etc.)
❑Yes
(.No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20-
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
2.No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
9 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
&No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
E[No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ONO
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments {refer to.questJon #) Explain any YES answers and/or any recommendations or anv other comments mT -
Lse drawings of 6ity to better ezpiauf sEtnatioas REase addit;ot<al pages as aeeessary) ` ry ' l t
C] Field Cop, El Note,';
L4�oor► is 64w k / SOit[ CrcS��en ►'all'P.t9 -Iro,, .14e, �p,�?cs 77uf Lost 7 *t
lip �IvdSe4 . �y �yrcit! �¢ rlrr� traSlOrt.
Ike, becA l "50►r in f`, 1' Cl� %3 �`5 lle��h� d- gec-fin Jr-l� ttX
445 )riff- 6cGh 0rtf On 4iAe_
NC W C 1[ t k 4 Rew / tif/ie,
�
Reviewer/Inspector Name-
Reviewer/Inspector Signature: Date: d
05103101 U Continued

v
Facility Dumber: 3 — �� Date of Inspection /D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads. building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentltemporary cover?
❑ Yes W No
❑ Yes t5�No
❑ Yes CE�No
❑ Yes [2�No
❑ Yes ® No
❑ Yes No
❑ Yes ®..No
Additional Comments and/or Drawings:
/VB7�Gr f XeeR -/I A:A - 4t4 SrKWt & level bj -/ic j ZAf00/t4_ ��tOwl
6C LPL 10(h"I u/0 � �Jo,'h-� Ld e,-e i�� Ae C 4lf �o e
CSC en re- W /
05103101

Type of Visit OO Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification •O Other ❑ Denied Access
Facility Number 31 150 Date of Visit: 11/1/2001 Time: 13:211 Printed on: 11/512001
0 Not Operational 0 Below Threshold
® Permitted ® Certified 13 Conditionally Certified © Registered Date Last Operated or Above Threshold: .:. .. -- — -- -
Farm Name: Doug- oadlaria---------------------------------------------------------.. County: Vaoju.................................... WjRQ.......
Owner Name: �Qug------- --- - ----- �Dnd- --- ----- ----- - - - - - -- Phone No:
MailingAddress:C.Jiwx.54.................................................................................... 3'.4'allasx..N.C........................................................... MAO ..............
Facility Contact: ...........................................................Title: .............. Phone No:
Onsite Representative: D�ug�opd111,yyangie�9nd�-----_------------ Integrator:Murpjtx�amjly��Cm�------------------•
Certified Operator:!'.l.?iltnue.;.............................. Rond .................................................. Operator Certification Number: 1123.-............................
Location of Farm:
Southeast of Pinhook. Farm is on East side of Hwy 50 0.8 miles past SR 1525 (Pender Co.). Farm sits between Hwy 50 & SR A,
1831.
N Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 • 43 i 30 Longitude 77 • 45 6 30
Design Current =
Swine
_Ca act Po ulatton Poult
r3'-
❑ Wean to Feeder
N Feeder to Finish
11016
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
11.016
SSLW,,,;. 1 1,487,160
Number of Lagoons 3 N Subsurface Drains Present ❑ Lagoon Area ®Spray Field Area
:.
Holding Ponds / Solid .Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
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)
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
[]No
❑ Yes
2. is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ... ...............--•--................-------•-- •----
Freeboard (inches):

t,' 'v�iv�
unruturu
Facility Number: 31-150 _ Date of Inspection 11/1/2081 Printed on: 11/5/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
❑ Yes
❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer to'- ( question #)ExplamrvanyYEKK andor anyrecommendations oranyother comments,
S. answers
Use drawings fac,lity�to brvetter explain situations�(use=sddt Eonalpages as necesary).� �°
zof ❑Field Copy ❑Final Notes
performed this inspection because as I was riding by the facility I noticed that spray irrigation of animal waste was occurring in a field
contrary to the wettable acres design and waste management plan for the farm. Mr. Bond told me that he has sold his aluminum pipe and
us cannot make the applications in the referenced field according to his wettable acres design. I told Mr. Bond that he has to spray
according to his design. Mr. Bond said that he knows how he is supposed to spray in the field but he did not know that I would be
coming by.
Reviewer/Inspector Name StonewalLMath�s ___= s
Reviewerlinspector Signature: Date: ! J` 01

Type of Vla t 0 Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit ORoutine O Complaint. Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number
Date of Visit:
3 r � d
© Permitted U Certified E3 Conditionally Certified [3 Registered
Farm Name: ...... 6!f1'a»' a'? d.__F_C4.!!.:.'."...n......................................................
OwnerName :.....» dt ! .....Rp.} A.........................................................................
Facility Contact: .............................................................................. Title:.........................
Mailing Address:
Time ) 3. 3 D
Date Last Operated or Above Threshold: ........................
County: v�l> n
PhoneNo : ................................... .............. ............. ...
»
Phone No:
�ar4. l3Prtd ryJ
Onsite Representative: ................ 4.i!,�rk.•P„,,oh Integrator: '" t �� » »
Certified Operator: ................................................... ............................................................. Operator Certification Number: ................... _...... ».... ........
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' 64 Longitude • 4 O66
Design Current'
Swine Ca ci - Po . ulation
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
1—I Boars
De_sigq Current Design Curs
Poultry.'___ _' Ca ci Po uliidon - Gattie ' Ca aci Po uh
❑ Layer I Dairy
Q Non -Layer I I ID Non -Dairy
❑ Other
Totaitign Capacity Ne
'Total SSLW--
Number of Lagoons : ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
j
Holding Ponds / Solid Traps. ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes JXNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ,fNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) 0 Yes -&No
c, If discharge is observed, what is the estimated now in gal/min? �A
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 J2No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes JZ-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes EfNo
Structure I Structure 2 Structure 3- Structure 4 Structure 5 Structure 6
Identifier: ......... .............................................. Z............... ..,3
....................................................................................................................................
Freeboard (inches): 33 2- 5 2•
5100 Continued on back

Facility-Ndmber: 3— j 5O1 Date of Inspection 1 3 l
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes 43'No
❑ Yes L3 No
❑ Yes fd'No
JYYes ❑ No
❑ Yes 12rNo
❑ Yes f�lo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ YesJ2rNo
12. Crop type Fe5c,e L*rs1,Wheq4,Sov6,*gn9 St�t�ti1 !ate►� C� Uefnt+�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yesl'No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Re uired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
Q yiolaiiQris;er dgfeien�ie rv�re pO" during �h4s:visit; Y60 ",,dise viye no fu4 th r
.. wrrespondenee about this visit... ...
Used ivnngs pf facility td >better explarn sittatiotm (use additional Psges^as nl
❑ Yes ❑ No
Oyes ❑ No
❑ Yes 11�10
❑ Yes ATNo
❑ Yes.'No
❑ Yes CdNo
❑ Yes ETNo
❑ Yes 4TNo
❑ Yes ONo
❑ Yes E(No
❑ Yes UrNo
f�Yes ❑ No
S. a;,r vend ►s ayt 41,e .6ac,k s►de a-/' layout, 3 einet glee 40' be
reps red . r 1
15. ��eld �� Wh�'Gt, is .rrec"e ji 4he w tie flet-% hats Wy, �,Nley�escve; -�Lt�S
Field r7ced�
S 4o be 14,11-fad # 'h �e5cv8 il �ve q 2'0 z
M.-. Band says Feld IDf-rjde_d 4o e5�4(,'stl need 4. Gon�,ge4
4a ec1'efI,sf ;,r,,ted,P1 4P v4 sv;l,rable tv;-1 ar crop ;-IOIqn end
mol ke p[ a � -Fo 5P ; -j be f ^-tva .7 s �� 2W 7- 6- e-<44A 6 r l.A o- 4ef ai°P rere ade (C �
Reviewer/Inspector Named ytCt ✓q _ j'/�Lt i 5 -- . ;# _ _ ".
Reviewer/Inspector Signature: w/!e{Ir t Date: 10/3/Ol 5/O0

Facility Number: Y) - ] SQ Date of Inspection ) O
Odor issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor 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 ONO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ONO
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 040
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 ONO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
AdditionaU Comments an orDrawings:
1 _ ✓ . $��d vGGc�S�'p�,a11x ►4etkel a pul) aln�to 4 e beeG1c
4t,,;s is 6on4rar 410 17,•-r
I Dl ,\X o h P �A -VLA � 'in -f e N W -B s 6 ttv be
gddeo to f lair 4 w4able Aces ;,�' ;, /,,,ill be Arrl;ed on .
19v ll s Zq -b Z6 , n - , -e l o< )3 slrp H l cl be e- -n4 i n a4 cd e -, ~ d + ,' eo(
in was eflwi A -Ad �wehable ael'P3 dve 4o 9onet et-v4 haY
lev
yv 1) 3 ,-, F�a tot 2 neee s 4o ra aoo n1 for" n-) f>ci44 W h.y c.4
1,zs- 4co-0096 ;T. AU' ke tha Te-s ?O Wage fla" at►7d btle�lable
NAe: Yb <;9h kla-J4c pla-,.
tv,�7)C!C24 'Vee4 4o e->�- Fi pes ',740 tet.�)eov1 -ID f,-eve-4 creLs1ez-,
2,-,c kyve►�^ wal j,
Z.S'. relol5 q q✓ld ?Bft Q`e 6er"Lfd6f h6ty in wcs4e plat%% bt4 17o4l,
` ra
are be)nl zed. /ilea'd 4' r"k'e 5vre444� Lva�
s4e l��
-Field rA t ; ce a ve in Alreeyven4.
5100

Division of Water Quality
Q Division of Soil and Water Conservation '
Q Other Agency
Type of Visit *O(Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for VisitRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 1 IS I
Date of Visit:
Permitted [3 Certified © Conditionally Certified [3 Registered
Farm Name:..........T~,.'!-�...........
Owner Name:.........-}�...p..!......
c.(r..................................................:
ld /I 0o Time: �Z Printed on: 7/21/2000
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold:
County:.. D.il,.O... ) h.........1..................
Phone No:....... ........................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress:............................................................................................................................................................ ..........................
Onsi€e Representative: .........................._.Integrator:....,M M. rWtf
.......... .... Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Poultry ❑ Cattle ❑ Horse Latitude • �4 •4 Longitude • 4 46
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish 1 1 O J ❑ Non -Layer JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-,-n Area JE1 Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream impaciti
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 'KNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes ] No
c. If discharge is observed. what is the estimated flow in gal/min? 17/A.
& 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 J'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes xNo
Structure I Structure 2 Structure ; Structure 4 Structure 5 Structure 6
Identifier: f.....................-z._...._._...._................`..3........... .... ...... .............................. ......_._........................... ........ ........... .................
Q
Freeboard (inches): .3 I z
5100 Continued on back

Facifity Ntimber: 31 — JSC% Date of Inspection / O / Qp Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
El Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes XNo
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ;WNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ;F5 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 ONo
11. Is there evidence ofoverapplication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes JZNo
12. Crop type _ i'C? SGUe�yfs�/ W rl(Za�, &l'n'IVG�o1 4�4y�MR��-�r'�i-t,h
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
OYes ❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination'?
❑ Yes ❑ No
15. Does the receiving crop need improvement'?
XYes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes J No
Required Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes �'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) XY ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis'& soil sample reports) Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ffl(No
21. Did the facility fail to have a actively certified operator in charge'? ❑ Yes sjrNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application) El Yes �'No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes dNo
r
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 8No
�: �cio violaEitoris:or deficiencies were hated-diWitig this'visit'. • Y:oit Will•reeeiye titi iruethi f
• ctirresponde' ' e. ab' k this .visit ' . ... .. .. ... • . • . • . •
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
13. e I d I I is twl ' n 44e w4-c4e F An •bvf i4 Ztas lk 4V,0 I;
:eld !D f3 �s 4eSGue ►n ran bv4_ bey—t�drr�versc�G{
wcLs apf4hr • . ere{ 13 is --re ue i►1 waS-{p1a/n {�vf
t S 4 b a !� S 0/SO r+1; X �' �' s c� ve ,-� 6 ✓ V-1 V art � � �,`� id t` + a ��l r' 64i
u1 fck wa is ►+a� l� ce'r••,g, ergs should >~ waJ-lc �r•,Y►.
IS. �'e�d .s rU �sGa t lOia l� berr+�t r� � 6tJ 4,�e .4-cld �s
Severely ovev,191'zPwn tV41. reeds. su-e ,9oQ�y s�pnd
6e-rn►•da is e.sfab),ske4 vri reC-e—nI/y --rfr;99ed gelds
Reviewer/Inspector Name �7IJ� 12 L✓RI�% �r
Reviewer/Inspector Signature: Date: 091- V 5100

Fmcility :lumber: '� f — SQ Date of Inspection p d , Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ 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 ,9No
28, Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? AYes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/orDrawings:
91 McfA 4o, G//5e he eih covQ
� n e 2 Aa.1 S � S �� s'
- � 4h 4� -eee la- des llh no�- record ob�a 'w if-
•
and Aeef 'I w4k 4hc re w►-1eb- 6 4echrt1 cu 1 SPcc�a�l'sf
t04A rrty<q s�9�, n)'iy new w�►l�-e �la� ar w�s�C �l�h �friten�nc�
7/ be Y00 "6 .
1'7. 7w4l send yl-olver q eoVo� a/'atef� 1,eGe�r-J
l*I. -Here qee TWO Sel< aF �'�eebeq�'a{ t/1GGords �Lt.;c� salow
of : i re ih -Free b oa'-d 1 e ve 1 t -Fo.-- 440
sea►'vw of ale . -T-henc at-''e 4;.4.%c �rsc►re�O�t+�c; G � (�e�w�eYt
-fhe i';O1d, Y74042 "Ook 5�0"Z" , �-�i-+.eS an� lh,xe 4 � es-
`2 4Ae
e eev oPt �1,c inn {a•-rt�5� J r►ne i� ��e �>^cfp[ ►tofe
PP
boo, ot�e 9rc 4koh 4he �,' s r orp�vlicot-�;oh-s�or.vti
--VAM-2/f. CResneGords ev,-e no1aVR:1aJ
DId, 1ec01-dS heed e obla;,iek{,30f cords
Yo ,
1� sa �' 1 sa ri, P1 e'� o a,� i -�',' e 1d j l?e e�S �p 6c T"ti.l�e �1 Cl ►2aG and
Gt n 1► .S 10 u Id be- I ,`ed a croe d rt�r -1'0 e s v
�; 1d ,sh,,t4JA be b.-omen inf6 Sy
i
,sa )'1 'e'-54s n eeA 10 Id'- kcf� w;lh o"')/-f� ZoaO
s AesG44- Wn-49 �AAt /ef ►,eeA �oybe, eY1
�a i 1 � s I w�. �1 I° �. �
1, ► zA ve, q n or�eG� G�J ►��i , rt � d A- T or,'eh' /
[ Iku?ly51;f
da4Gd lsJ/�o.
4he nex-1,'h &-dee
18
11
(>-c Wf It gee IS YID V a 1; pj Sa PJ1l% TO (OV2Y' 7LAe Y / l Y' 7 ,'o�,.s
OGGv�'r'i►'L.r lam-�+.,i@Gh �nv2� j ��p �7 vrJQ 7�pa'
be cf-� 1, h,,L
'PAN 6al,3hee!;�.
jb. 2 .-eG1r :;4`2;7 Z�ov.+t s are,s r�G� be4weeh 44,`r
Be svr'a ;41 t mS4 Ntah
5/00 25. KeJA�Gser� i r ve 5v+iel4cd A d,fFeeerll S�r�t ► �R cs^n is fJsGG� iv!
�e(d 13 ), n C—t? » ; �'� �9�f �11►�1�1 er�h , eed fo -*&. z4v
--rtGGo,^G(+ rLq �o dcs/9n ar �a�e �G�'ik''f;�FG(• *1 �O,GI �6!'1�( �� !n Ong O��Ze S�r'R f ZjPys�

Lagoon Dike Inspection Report O
Name of Farm/Facility
�o� �. f . --�
(� So
Location of Farm/Facility
C ti (� { 9 f w S_o �o ��_
1 ro �r ^ �700 ��
CG r1 P.
Owner's Name, Address C-
- -
/�� �i S o
and Telephone Number
(� C_
lv —2 4/ q
Date of Inspection
a 7 Names of Inspectors Q
P�--
Structural Height, Feet
-
�J Freeboard, Feet
�� ,? �t}�J
Lagoon Surface Area, Acres
PG 'ice Top Width, Feet
101,
+
j
Upstream Slope,xH:1 V
-
Downstream Slope,
xH: IV
Embankment Sliding?
J
LYes No �.. i c� 2
T L
o t'� p f Q �C
(Check One, Describe if Yes)
J ,
Seepage?
Yes No SSr f -
N� Ole -
(Check One, Describe if Yes)
rr,
Erosion? Yes No
(Check One, Describe if Yes) C /
i0 Q
4, S J
Condition of U _ �a e x —�f e P
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes )�- No if Yes, Depth of Overtopping, Feet
PCr � [ �rr r
Follow -Up Inspection Needed? _Yes No V ] ( -See11� S
o� i� 5��� 4.k�
Engineering Study Needed? is Yes AOL No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
l
ther C mments - C c &
-
A, 0 A J
Yes No
10 ( e N11 C, t
c e 5 h e #c',-

S
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Lagoon Dike Inspection Report
-S e- e - &_,:� je J
OAS' Names of Inspectors
�i Cr
Freeboard, Feet ` to -
{� e C Top Width, Feet -
� IDownstream Slope, xH: IV _
Yes No
Seepage? Yes
(Check One, Describe if Yes)
_ No
h 0 �
i
i 6���-
�e
A
e I
Erosion? Yes ___�/__ No
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
(r a h e t c PA i1Ns ; � � ,�,�� I �
Yes )�_ No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes X No
Is Dann Jurisdictional to the Dam Safety Law of 1967?
Other Co nt
C_ ;
%a 5l42d
5 �
; � � S (o f .
l�
S e T�
S C At e
e Q'
v Ic
)
r 4?_ j d,

cx

sw^ 741
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:l V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees) -
Did Dike Overtop?
Lagoon Dike Inspection Report
Lis C(
Names of Inspectors N A
c%C
y r r
/ Freeboard, Feet
3 Top Width, Feet
t ;f
- Downstream Slope, xH:lV - I
Yes No
Yes No &�f Cl_< V T 61ke-
_4= L6 k!l G� P
Yes No V (:' row `I 20
y C nA j G N ar6U,, j )U
Yes —)4- No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes_ No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments ! M1 1 h JT
C.rje j
iC2 e - U
• JCS i C i P.-•- �- (P C t f]O ti � Re- — � e � S44
4� a-y [ J e � I­rCroc✓ D -tiI /'I �, dr�

ol.�
���i
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r
L1
1 Division of Soil and` Water Conservation ' 0 eration Review =:'
,13 Division of Soil and Water Conservabotu' eCompiisnce Inspecfiotn
TDtvtsiion of Water Quality 'Compliance Inspection Y
_. •Other Agency;- Operation Review a
s,
F.
Routine Q Complaint Q Follow-up of DWQ inspection 0 Follow -tip of DSWC review Q Other
Facility Number Date of Inspection t-� Time of Inspection 24 hr. (hh:mm)
Permitted ©Certirie[d�� 0 Con1diitionaliv Certified [3Registered [j Not O erational Date Last Operated: ...
,.......... Farm Name: ................................................... County: _.........{'1.
Owner Name: ..........................---....... Phone No:
Facility Contact:........................................................ . . .Title:.................---_.. .. Phone No:.........--.--..---.-....
Nlailing Address:
+•I e (
Onsite Representative: W1>>�' ... ............................................................ Integrator: ............
.........p....
....................................................
Certified Operator : ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
r...... ......... ............................................................... ....... ................
....._............................................................................................................................................... -
Latitude C�` Longitude • �� �'°
Design Current Design Current Design Current
Poult Swine Capacity Population', �..�. �_ ._ ..�".capacity Population Cattle Capacity 06pula '
❑ Wean to Feeder
Feeder to Finish
6
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
e „, ` Nutmber of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
Holdtn Ponds/Soli
d Traps E:=_ = ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes XNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance than -made'! ❑ Yes ❑ No
h. 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 tH�No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes '�ZNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes O 'wo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): ............. ...................a ..
..................................................................................... ...
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes UNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: 3 — j hate of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application -
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over applktion? 0 Excessive Ponding ❑ PAN
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21- Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: {o vioiaiicjns:or ilefeiencies erg Hated dur g #his:visit' ;Yoi� will receive Rio 1`ui-thetr
corresporide'*e. ah"'f this visit.... .
Use:drawtngs of facilsty to*etter:ezpla[asituatrons (use additional -pages as necesiary)
r
O\ 4--t6(3cN .
❑ Yes 9No
❑ Yes KNo
❑ Yes gNo
[-]Yes WNo
❑ Yes ONo
❑ Yes [ (No
❑ Yes ONo
❑ Yes )q No
❑ Yes ❑ No
Oyes ❑ No
❑ Yes ZNo
❑ Yes VNo
XYes ❑ No
❑ Yes tyNo
Oyes ❑ No
❑ Yes tgNo
❑ Yes P�No
❑ Yes WNo
❑ Yes No
❑ Yes No
❑ Yes C�No
Reviewer/Inspector Name FIE) :"
Reviewer/Inspector Signature: Date:
3123/99

Facility IVumber:3 — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below [:]Yes gNo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Wo
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 O(No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes A` No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes No
tiona . omments an or rawEngs:-- = _
�a
w
3/23/99

❑ DSWC Animal Feedlot Operation Review
'':�•aisa- F 'i 'cx- k
Y DWQ Animal Feedlot Operation Site Inspection
lO Routine O Complaint O Follow-up of D\'4Q insEection O Follow-up cif DSWC review ® Other Pjj6uj Cv,,, Ps,.iG
Date of InspectionF-I �$
Facility Number t I Time of Inspection 0'�13 24 hr. (hh:mm)
J3 Registered 10 Certified 10 Applied for Permit (3 Permitted [3 Not Operational I Date Last Operated
FarmName:....... Jotl�. ........P h).......................................................................................... County:....1 [l!-................................ ....... .......................
Owner Name: ....... OU�...C,�. ............. ...... .... Phone No:..�lo.�..�L.' T�..
Facility Contact: ..... �0......9=.1)........................................... Title :........... Q.it►7e .................... ..... Phone No:...................
Mailing Address: ....... %s........ S.eu`i �....N�.................................................................. ..........................:.��........
Onsite Representative:.... -tin...... ............................................ Integrator: ......
[JY.......-........... .........-............................-
Certified Operator :.................................................. ................•--..................................... Operator Certification Number........... . . . .........
Location of Farm:
...,ai,.....f-eta,...... 0....... .m:.i� ...v►e�.. a...... ...�5.2 ...:. u .....c .tar...... ;..Doh:n......Ga:.....tu.tu........P.n:........
..
.....-1..=. ..--..-. N�l, ..... .1 S.Ir....� �. ...A.........................................................................................................................................................................................
Latitude Longitude 0• �' �"
Design
Swine
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Population
Design _ Current Design 1 '' Current
.Poultry . Capacity Population Cattle Capacity„., Population .
❑ Layer ❑ Dairy
❑ Non -Layer ❑Non -Dairy
❑ Other
Total Design Capacity p
Total SSLW
Number of Lagoons / Holding Ponds ILI Subsurface Drains Present JrO Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
General
1.
Are there any buffers that need maintenance/improvement?
❑ Yes
fig No
2.
Is any discharge observed from any part of the operation?
❑ Yes
G No
Discharne originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
18 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in g,alilmin?
JV
d. Does discharge bypass a lagoon system? (If yes, notify DWO.)
❑ Yes
® No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
00 No
4.
Were there any adverse impacts to the waters of the State other than from a discharge'?
❑ Yes
191 No
5.
Does any part of the waste management system (other than lagoons/holding ponds) require
El Yes
® No
maintenance/improvement?
6.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
7/25/97 Continued on back

f
Facility Number: 31
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
P3 No
Structures (La oons,11olding Ponds, Flush Pits, etc.)
9. is storage capacity (freeboard plus storm storage) less than adequate?
Yes
❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: I L 3
Freeboard(ft): LS .z..........................Z.............................. ..................... ....................................
............................................
....................................
10. Is seepage observed from any of the structures?
29 Yes
❑ No
It. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
JO 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
V3 No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type J fte v!-:....................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18. Does the receiving crop need improvement?
❑ Yes
® No
19. Is there a lack of available waste application equipment?
❑ Yes
55 No
20. Does facility require a follow-up visit by same agency?
f4 Yes
❑ No
21, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22. Does record keeping need improvement?
Yes
❑ No
For Certified- or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
Lm No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P No
25. Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
50 No
O-No.viailations°or deficiencies'were ntited-during this;visit. Y6u'W'ifl i&e' i've-ito-ftirther-:
et &r 506ndehce. atioid this'visit::
`- LayOK Ak i sl.ov(J be I bw
I4• N&%ti`p6 1c,ofa, -ic-tt dr\
12 ze
i n 1 �Y�e�
G 4, r Vir`tJ IV o`t Prfavwv� i r, G rv� ro,%<16,e 4W ��yv� mArwur,
OfOA *z. 7S&vAt -,, Wcrt-- `h Vu►-. A pn4c-%:otUl ea, zntgr -,hwij
3 spa) I,..-e.c Ujd 'j � m�� &M skoO be Wc�C.NO wt*
�z. has c s Gtv►��SIS S�is�f 6e UpdkW. 5 r rc[oY�
Reviewer/Inspector Name
��Oold be- N-f 61 RIB
7/25/97
Reviewer/Inspector Signature:
Date:

Facility Number: _ 1..... — Date of [inspection:
Additional Corrirnents ifn&or. Drawings K
mQ. ��.� N f � S � ri.a v� 4Lc�.c-k f s7 �;, `�. f � t►....� ft PP rvio/',.r-
4/30/97

[j Division of Sod aad Water'Conse'rvahon Operation Review X
.; iyisron of Sod and Water Conservation : Compliance Inspection 'r
Division of Water Quality Compliance Inspection t
�.
=� Other Agency Opeiaaon Review_
fc
..C„
Q Routine Q Complaint O Follow-up of DWQ inspection Q Follow -tip of DSWC review:Other
Facility Number r Date of Inspection
Time of Inspection 24 hr. (hh:mm)
0 Permitted Certified ❑ Conditionally Certified © Registered [] Not O erational;�te Last Operated:
FaunName: ......! .�-................................................... County:............/....:.........................................
OwnerName:.......................................Q ..... ........ Phone No:."............"..............."
FacilitvContact: ................"..."...........................:............................. Title:....."........................................................... Phone No; ...................................................
MailingAddress : ..........................:......... ...................'.. ..,.......................
........................................................................................................................
Onsite Representative:........................................................................................................... Integrator: ....... l...l...!Ff...........................................................
Certified Operator : ................................................... ............... .............................................. Operator Certification Number:..........................................
Location of Farm:
�i
Latitude ���` �" Longitude �• �� ���
' Design Current Design Current Design Current
Swine Capacity Population '.Poiilfry Capacity Population Cattle ' Capacity Population
Wean to Feeder ❑ Layer ❑Dairy
> ❑ Feeder to Finish ❑ Non -Layer : ❑ Non -Dairy
[] Farrow to Wean r
❑ Farrow to Feeder ❑ Other A
In Farrow to Finish Total"Des><gn Capacity.
❑ Gilts,
❑Boars Totat SSLW
Number of:Lagoons : ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding.Ponds / Solid Traps ❑ No Liquid Waste Management ,System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon t❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance inan-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: r /! /i % I/
Freeboard(inches): ...... [........................... ......I ..................... .........�-...... .............. ................................... ................................... .................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
3/23/99 Continued on back

31-16
Facility Number: Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8_ Does any pan of the waste management system other than waste structures require maintenarice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
`' rite ppllcatlon
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
❑ No
❑ Yes
❑ Yes
❑ No
❑ Yes
❑ No
XYes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
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?
Re aired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0: No yiol..s....a . mere rii ......rt. t.•. wll-f&6ye iio furthrg t
Torres 6fiden 'abiluln this "Visit.' -'-
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 ❑ No
e_wd/Conii�r
recommendations or_:anyherp,nYncomments. .
-! _
agesanrof cilitobtterxplansituation(useaddinalpise-drawinl
r,7,1
IS ref ]awrs� G alike wall vim, Jain / i tt°rC
i oh � 5 `' � ��arvt* • �GY�t' Yr�15 21'� r� ,rr u�u � a�n
1�
1 doww u�-fi l �i' u.a� !r ✓�� Tyra r��r �rC� cl a /eras /-' AS .
ul� �i'v�l /Y� r}� 1' `�L rrsrds ! 7 « act�rd, � fowl �1►t�� • �t.cr
�e hairaC . Pw la don #Z ►L �►n 4; ► Witt
itt
,i
rvta,rlcp reads a-t- le n.<-� 21o�� Off' aV4 1 ahl,r -9-te bBard . &&-e "x'-zr �l Y�—ti�tr�� �
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
in n/1 . /. 1_ \
` t.), I W_ : av-� e7.'e - n ffmC- ('9101.115- 7 {` fah l.. Z't GGD I l[-�,rter t / tc Yt
99

r
4 560" Lagoon Dike Inspection Report
Name of Farm/Facility BJd u�
Location of Farm/Facility k( 14,
Owner's Naive, Address CLCJ.� � go S P _L' %��y S 0
and Telephone Number 1� c , f� a s�
Date of Inspection
O � 19:F
Names of Inspectors
Hc- V ,' C
Structural Height, Feet
Freeboard, Feet
lj �' ,L f (}4J
;,l
Lagoon Surface Area, Acres
fG ke
Top Width, Feet
Upstream S1ope,xH: I V
rf
. {
! f
Downstream Slope, xH:1 V
Embankment Sliding?
Yes No
�.• i c� 2
d eS p� C F� Ec
(Check One, Describe if Yes)
l
Seepage?
Yes No
SSr b�C_ —
Nv
(Check One, Describe if Yes)
Erosion? Yes No _ 5�� 2 S
- L
(Check One, Describe if Yes) s
Condition of jQl- Cy Lee —
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes >C No If Yes, Depth Hof Overtopping, Feet
Follow -Up Inspection Needed? Yes No V e { ! S c P ; S (` `S
o�
Engineering Study Needed? _IX, Yes _AOL No
Is Dam Jurisdictional to the Dam Safety /Law of 1967?
ther C mments i- e— C, ( C- I)r �- u e
(0Q her r
Yes No
�12 'ASc�e _W
Ge Nec t /6(-,/ �o1,-- t &ram
/\1 c e 15 v e #r,--

/5 51-7

S
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Lagoon Dike Inspection Report
Follow -Up Inspection Needed?
Engineering Study Needed?
i
6dbyNames of Inspectors __ � N�0
:L V i C
1 Freeboard, Feet to r
loe
Top Width, Feet
i
✓ Downstream Slope, xH: IV -
Yes n No
Yes �� Na
Yes L No
J
�NC eot )ESN C ,,,✓��I
Yes No If Yes, Depth of Overtopping, Feet
Yes _k No
Yes X No
Is Darn. Jurisdictional to the Dam Safety Law -of 1967? Yes No
Other Co nt
Qr, q L_ q e- e �e if e - �e
C- S �C P C 'L (4 5`,gj D r e 't" (1� Cif! ),D"/ pij
� r` �► J` C'
1 n 5 { S f Opf S A J o t2 A o u, n S,4I - ! a o , •�

r
Mm

{ a 5a'n1 Lagoon Dike Inspection Report
r
Name of Farm/Facility
Location of Farm/Facility P -r e_
Owner's Name, Address_
and Telephone Number
Inspection
Names Inspectors�(%lV
Date of
of
hr
Structural Heigh Feet
b t,
r
� / � �
Freeboard, Feet
r�
� c� -
Lagoon Surface Area, Acres
1
Top Width, Feet
Upstream Slope,xH:1V
e
-
r f
Downstream Slope, xH:1V - 1
Embankment Sliding?
Yes /` No
(Check One, Describe if Yes)
Seepage?
Yes No
GIP
(Check One, Describe if Yes)
j
Erosion?
Yes No
V <2 r Q t-J
(Check One, Describe if Yes)
Condition of
if 1( 0
Q. v ,� J i U
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes _� No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes_ No
Engineering Study Needed? Yes 7� No
Is Dam Jurisdictional to the Dam Safety Law of 1967?
-Yes
Other Comments
`No
r f
46
C Re 4�
���se- reC-roe✓ /}o,tii �1 d�

/101
I

Routine Q Complaint O Follow-uE of DWQ inspection O Follow-up of DSWC review O Other
Facility Number
Farm Status::...l�L!� ..._ _.... _ ....
Total Time (in hours) Spent onRevie►v
or Inspection (includes travel and processing)
Farm Name; .. r(e41Cht`� Z �'3 County:....DV.11M....... -•.................................
Owner dame:In _..... Pliorte \To:._L9jk)..ZS
47`�•... --- .............. .. .......__.
Mailing Address:. w' . Kc ` L ` .. - - !^ �lli .......... via._. _.... _........—......_...._
OnsiteRepresentative: _hau .. _----- integrator: !V`
-1 - - ------------- . ....... . ...
Certified Operator: _. C'k.UA_..A . ..... Operator Certification Number: 1-k-7 31Z_
Location of Farm:
Latitude Longitude
❑ Not U erational Date Last Operated:
rype of Operation and Design Capacity
Swine ? Poulhy Caile Numfier,
GNuuber�
.f-�umer
r ..x - ..
❑ Wean to Feeder
Laver ❑ Dairy
Feeder to Finish
6 �h� ❑Non -Layer ❑ BeefF 3`
mot,
Farrow to Wean
-�.._.4
Farrow to Feeder
Farrow to Finish
❑Other Type of Livestock f `
a
a r'`' }.
LxY -
Nhmber_of La oohs /�aldm Ponds Subsurface Drains �❑ S ac ra Present
-� ❑ Lagoon Area ❑ Spray Field Area
General
1. Are there any buffers that need maintenance/improvement? ❑ -Yes -®NO.
2. Is any discharge observed from any part of the operation? ❑ Yes No
& If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gallmin? 1j
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes No
Is there evidence of past discharge from any part of the operation? ❑ Yes No
4. Was there any adverse impacts to the wate-rs of the State other than from a discharge? ❑ Yes No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
maintenance/improvement?
Continued on rack

6. Is facility not in compliance with any applicable setback criteria?
7. Did [he facility fail to have a certified operator in responsible charge (if inspection after 1/1/97)?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaLoons and/or Holding Ponds)
9. Is structural freeboard less than adequate?
Freeboard 0* Lagoon 1 Lagoon 2 Lagoon 3
_ _ ..._ .....-. 3s....
❑ Yes [DNo
❑ Yes 91 No
❑ Yes R 1�To
❑ Yes PO No
Lagoon 4
10. Is seepage observed from any of the structures? ❑ Yes IXNl o
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/unprovement? 14 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 adquate markers to identify start and stop pumping levels? ❑ Yes ® No
NVastLAppLicntjun
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 tS T _ _...-- — -
16. Do the active crops differ with those designated in the Animal Waste Management Plan?
17. Does the facility have a lack of adequate acreage for land application? -
18. Does the cover crop need improverrient?
19. Is there a lack of available irrigation equipment?
For Certified Pacllities Only. .
20. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
21. Does the facility fail to comply with the Animal. Waste Management Plan in any way?
22. Does record keeping need improvement?
23. Does facility require a follow-up visit by same agency?
24. Did Reviewer/Inspector fail to discuss review/inspection with owner or operator in charge?
S. V7j-X (eak,n) kjdra in rW -0,5 Be cAvtful o-� �6ctmt& of .atwr. tkv►np-r .
lz. La. 60n +-9�tls 51 �} be n�owe�} alr. iajon5 Z + 3.
� . l-o.VoeE 4LL (t, �A �V ft' WkGIN LOCOA JJQS pVyA
rj
❑ Yes .® No
❑ Yes ® No
❑ Yes P No
❑ Yes [)} No :
❑ Yes [A No
- ❑ Yes
[N No
❑ Yes
[A No
- — ^ ® Yes
❑ No
❑ Yes
No
® Yes
IR No
Reviewer/Inspector Name-
Reviwer/Inspector Signature: Date: (414 If-7 .
Division of Water Quality, Water Quality Section, Facility Assessment Unit 11/14/96

IV Routine Q Complaint Q Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number Time of Inspection I 10'=24hr.(hh:mm)
Total Time (in fraction of hours
Farm Status- [I Registered [I Applied for Permit (ex:1.25 for I hr 15 ruin)) Spent on Review
M Certified ❑ Permitted I or Inspect -ion includes travel andprocessing)
❑ Not Operational Date Last Operated:.... _ .._ _...._ _.... _ ........... ..........
i........ ...... ....._...._ ....... ..... .........
Farm Name:........ _0QLV, �hSL.. S!:17�... �.� .. _..... _.. _...... County: .. fiC .. »»..... ...._...... _..., ....... ....
Land Owner Name:.._. _.... _...._ .... _ . _...... .... ........... Phone No: �b���`�—..Z"f
Facility Conctact:... .iIQ .... ....... .... Title: _..O�,hR,r..rr���_..._��.... Phone No:...���Q�. Z'.:.t; ��7L
Mailing Address: ...gl���_ N.� .. Sid ...._ .... .......... ........... ..... �C4! Ll.[I e . f.. .... _ -4`%4 �....... _...._...............
Onsite Representative:..... ---- _. - ......_....... Integrator:
Certified Operator:...........111[ iXlYl l.......AX110./O..l1f l...f�...Operator Certification Number:... U
Location of Farm:
Latitude O�D•=, " Longitude • ®s ®��
Type of Operation and Design Capacity
M14>' � ; w` u D s gn Cirren Desig: �Curre t � D ign Curren#
S ne� �,Ca aci Po ulahon poultry ;Ca i6 * 6126au
❑ Wean to Feeder I❑ Layer g
®Feeder toNon-Layer
Finish ❑ ❑ Non Da
Farrow to Wean ! • �. 5
Farrow to Feeder` TOtai De51gIICapacltyQ
AQ Farrow to Finish El :..
❑ OtherW.
f y
Number of Lagoons:/ Holding P Uw AE]
gu Subsurface Drains Present
r ❑ Lagoon Area Spray Field Area u ,
�jEneral -
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 obsen�ed, 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
4/30/97 maintenance/improvement?
❑ Yes 0 No
❑ Yes M No
❑ Yes [� No
❑ Yes
No
tj
❑ Yes
No
❑ Yes
No
❑ Yes No
❑ Yes No
Continued on back

7-1 Facility Number:.._ ......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ® No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 19 No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes [1 No
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes R No
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
3.S
10. Is seepage observed from any of the structures? ❑ Yes [A 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?
Pi Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoffenteringwaters of the State, noti`fy-DWQ)
15.
Crop type ......... ... .iLh�4lSl....... ...... ......................... ........... i�lrtif'k........ ............ ............. ...... ......... ............. ...
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
❑ Yes
® No
19.
Is there a lack of available waste application equipment?
❑ Yes
P No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
Qj No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
For
Certified Facilities Qnly
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
RNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
24.
Does record keeping need improvement?
®Yes
❑ No
Reviewer/Inspector Name
A '_*
Reviewer/Inspector Signature:
Date: 6/9/Lj
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4130/97

DSWC Feedlot Review��
Animal Operation
-
� �`
� DWQ�Anlmal Feedlot Operation S1te�inspection
� ,� E
Routine OComplaint 017ollow-u2 of DW2 inspection O Follow-u of DSWC review Q Other
Date of Inspection I t 14
Facility Number
Time of Inspection D 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
M Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: _,...�zlB�....1�£221� ... yyQ��LC.Yx�............................................... County:. lliN.... ........ _....................... -......_ .....
Land Owner Name:�... _... _ Phone No: ( .ION Z-�' 1. -24-14-_-..._....
FacHity Conetact:... 4V�, pi1 ..... ..... - . Title: _...QUn?!r Phone No: ��� �� .�� �.
Mailing Address: -_..�5._!..1�.......... ..... -- ...... _.:.._......_ ...........kALe.� .... ..........
..�Gri... ..... _ .....
Onsite Representative: _bM..L....,tAl�`` Mke . > ......-_.... ........... _..... Integrator:..._.A. U......
._.....
.................
-.....................
I, �p ....&�t1Z.... Operator Certification Number: -.- lJo Certified Operator: .Y�I.tI.11(1�Q...........!jQ 4A)MM-11-1:p ,�.�:.................
Location of Farm:
.. S ...... '3 ...Cz...... N G.-` ^t... a ..... .. - ...... �fr tn..... iS...
�Ra..... D.,..
.e _.R. ................,...... -........ --..... �...... _ ....� __............._ .... a
Latitude �•�� �u Longitude
Type of Operation and Design Capacity
f
w Design Current �`, r DesigCu
n rrent, Design
�Cirnrent
Swine .,Pool... n Cattle .
Pu ulation_ a hy� Ca acrty Po ulation,,E �_Ca aci Fo ulai�ou��
El Wean to Feeder I❑ Layer F ' ❑ Dairy I
❑ Feeder to Finish ❑ Non La er ❑Non Da
Farrow to Wean
€<
Farrow to Feeder Total Design Capacity xWE
d
Farrow to Finish
tit al SSLW
' ❑ Other s
Number of LagoonsT! Haldmg PondsZ i ❑ Subsurface Drains Present
IN
❑ Lagoon Area10 Spray Field Area
a
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?
❑ Yes (9 No
❑ Yes P5 No
❑ Yes i M No
❑ Yes[M No
W
❑ Yes JRNo
❑ Yes §1 No
❑ Yes 19No
5. Does any part of the waste management system (other than lagoonsiholding ponds) require
4/30/97 maintenance/improvement?
❑ Yes [P No
Continued on back

Facility Number:.3
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ®No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures fl.agoQu.5 and/or Holding .PonUs
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
1 I. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes Cd No
❑ Yes 0 No
❑ Yes 09 No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste_ Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .............. 5.... _ .... _ .... _.....__..ltif.�,...._....._ ....__.._..... __......
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For Certified Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
tie- �'�a kAl k skoj be Y"OLJ4 .
z4. L. %d it%>. moot. �6m wkid,
❑ Yes W No
❑ Yes ;& No
IR Yes ❑ No
❑ Yes 0 No
❑ Yes [A No
❑ Yes &No
❑ Yes 19 No
❑ Yes 19 No
❑ Yes PLNo
❑ Yes IS No
❑ Yes 01 No
❑ Yes EA No
❑ Yes JR No
Yes V No
cc. Division of water guaury, crater vluattry section, Cactttty Assessment Unit 4/3U/97

JOA Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection _ f
l(,
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
IN Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: -_..:....._..... ._..... ......... .................. ............... ...... ............... ........ _...............
Farm Name: ..,.b�&n 1IaY.!YCounty:. . �1 11.._. .... ..... �.....__.
Land Owner Name:........... ....LZL7?�t!_..........._..... . ... ............_....... Phone No:... (.1 . - .,4,
Facility Conctaet:... _..5?N ... .......... .... Title: _..Y.... _ Phone No: ..� �II� 21:.. ��.
Mailing Address:..... 5.. NG.?.._...... _.... .1.... _....._.........._.....
Onsite Representative:..... o s ... .. 1±13C1,i �..... +... ......... ........... ._......
Certified Operator:....._.{,�i�lY� S�Q(�r+ta .C�....1...........
Location of Farm:
Integrator:........ _ . .. .... ................. _........ ..... _.
Operator Certification Number: ....(1Uz. .................."
Latitude • 4 Longitude • 4 u u
Type of Operation and Design Capacity /r
_ - �Cn
rrentE F Design C great - Design *Current Des n
;
Swine. r.• Ca ace Po" ulation�'�aultry Ga aciPo ulatEone ._..Ca ace'*Po ulation
i ❑ Dairy
❑ Non-
EEi
F w to Wean h'Ew 1.1-1
Farrow to Feeder Total Design Cap4cklut
El Farrow to Finish; q
Other, rw .
u
U Numberof Lagoon Haling#Ponds ❑ Subsurface Dra ns Present
10 Lagoon Area ❑ Spray Field Area
Wean to
❑ Feeder ,�❑ La
El Feeder to Finish �„'. ❑Non -La er
ene al
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?,
Discharge originated at: ❑Lagoon ❑Spray field [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 gaUinin?
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?
❑ Yes W No
❑ Yes 0 No
❑ Yes 09 No
❑ Yes ®No
N jA�
❑ Yes [P No
❑ Yes �Q No
❑ Yes � No
5. Does any part of the waste management system (other than lagoons/bolding ponds) require
4/30/97 maintenance/improvement?
Yes ❑ No
Continued on back
ene al
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?,
Discharge originated at: ❑Lagoon ❑Spray field [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 gaUinin?
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?
❑ Yes W No
❑ Yes 0 No
❑ Yes 09 No
❑ Yes ®No
N jA�
❑ Yes [P No
❑ Yes �Q No
❑ Yes � No
5. Does any part of the waste management system (other than lagoons/bolding ponds) require
4/30/97 maintenance/improvement?
Yes ❑ No
Continued on back

Facility Number: ..31.......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons andlpr Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
' ....... ....... ...I ... ......... _
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes W No
❑ Yes [% No
❑ Yes MNo
❑ Yes [�j No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste AVRlication
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWG } L
15. Crop type �Q4io S ..__..... _ .................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Ur Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste.Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24, Does record keeping need improvement?
3 �tx �zns h��r� �r, rrreic� #S, �e cur'c
2A LaVlascon QV -On' w1m&' ux" �uty. j
❑ Yes 13 No
❑ Yes R No
❑ Yes ® No
❑ Yes PS No
❑ Yes (P No
❑ Yes ® No
❑ Yes J& No
❑ Yes No
❑ Yes [ No
❑ Yes No
❑ Yes No
❑ Yes 12 No
❑ Yes C] No
14 Yes ❑ No
UrrI(XVM �qe .
Reviewer/Inspector Name
. _
Reviewer/Inspector Signature:
Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attenti n:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE: , 1995 .341
31.
- S�
Farm Na
Mailing
` County:
Integrator: v Phone:
49.
On Site Representative: Phone:
Physical Address/Location: t •Aj. sk l
Type of Operation: Swine V Poultry Cattle
Design .Capacity: -rOp. Number of Animals on Site: ^
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: _' Longitude:�'' 1L" 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: 4--Ft. Inches
Was any seepage observed from the lagoon(s)? Yes No as any erosion observed? Yes r N
_ Is adequate land available for spray?6Ye$)r No Is a cover cr p adequate? Yes or No.��
Crop(s) being utilized:r'�aCtJ��O,e'JRS
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings? es r No -
100 Feet from Wells? es 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 r No If Yes, Please Explain.
-- - Does the facility maintain adequate waste management records (volumes of manure, land.appiied,
spray irrigated on specific acreage with cover crop)? Yes or No
nal Comments: 4�/ arrrG Owl GL
o
7-__L:LA zrVZ;W � eL Z,
L Gvt. n4 ,
Inspector Name S iplatureJ
cc: Facility Assessment Unit Use Attachments if Needed.