310185_INSPECTIONS_20171231

NUHTH AROLIN
Department of Environmental Qual

(Type of Visit: Z( Com ' ce Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Vis_it::o�utine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: 7 o Departure Time: County: Region:
r-'T'"" Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: 13rt
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: Z D 2
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
JLayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
n to Feeder
I jNon-Layer
I
Dairy Calf
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
-too
Dr. P,oulh.
Layers
Ca acit
P,o P.
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes6 ❑ NA ❑ NE
❑ Yes g;No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: MID jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0<0 ❑ 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): 2,.f—
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Yes ❑ No ❑ NA ❑ NE
❑ Yes 1�3_50 ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t eat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes C5No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
['�lo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ro
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[
❑ 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 dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes RNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

]Facility Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ffNo C] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑,NT ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a PDA 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 0-1 o ❑ N/A -❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑'NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
EfNo ❑ 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
ONo ❑ 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
Ef No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
C1 No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA
FN
❑ NE
34. Does the facility require afollow-up visit by the same agency?
❑Yes
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawinns of facility to better explain situations (use additional'oaees as necessarv)r
Pu
ovt-L-
cn c�
f n rC c.ol
pt KG L•K ` � M-Gl5 ✓ ru SS ��ve-%, iz � dcs.�.
(f f"'3s•
, - iA 51►.) 309 Jp/ti . ^ Cm Z.
Cu It "i'0w t4,z- 2-A17
Reviewer/Inspector Name: 4/awt i • 9144
Reviewer/Inspector Signature:
Page 3 of 3
^ WVN Phone: Itolj 7-1�k
Date: (Q
21412015

(Type of Visit: QOCogipliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine O Complaint Q Follow-up Q Referral. Q Emergency Q Othee\&±(r Q, Denied Access
Date of Visit: Arrival Timer Departure Time:® County: � wRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 19Q..& ut MZ'CC IdC C.l�
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: ;1�0
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wet Poultry
Design
C>apacity
Current
Pop.
Design Current
at le Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -Layer
Dai Calf
Feeder to Finish
MLID
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oulh.
Layers
Design
C:a acit
Current
P,o ,
Dry Cow
on -Dairy
Beef Stocker
Gilts
Non -Layers
JBeef Feeder
Boars
Pullets
I
jBeefBroodCow
Other
Other
Turkeys
TurkeyPouets
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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑Yes
[—]No
❑NA
❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes gNo
o
❑ Yes o
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: 74 1 - Date of Inspection:
Waste Collection & Treatment
4ylls storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure II Structure 2
Uy2i tL"
IS
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmeotto threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [_]NA ONE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes
1No ❑ 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 O/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ 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?
dYes
❑ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
(o
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and I" Rainfall Inspections
'''/"""❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

hacility Number: _ Date of [ns ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes L_I
2131. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes I o ❑ NA ❑ NE
❑ Yes Vo ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes IJVO ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
[]N ❑NA ❑NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain. any YES answers and/or any additional recommendations or any other. comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ETC-t, C C/O (.o r.�Ck(r
2�_F1
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of 3
Date:

r
for Visit Routine 0 Complaint Q Follow-up 0 Referral 0 Emergency 0 Other Q Denied Access
Date of Visit: Arrival Timer Departure Time: /Ufa CounTy::JUP Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: &&4(-Nip fyt.T (,k LLL. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: ZZQ 7_Z
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
Layer
Design
Capacity
C•ucrent
Pop.
Design Current
Cattle C•apacJTy Pop.
airy Cow
Wean to Feeder
j$ Z
Non -La er
airy Calf
Feeder to Finish
d
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oult ,
La ers
Design
Ca act_
Current
P,o ,
D Cow
on -Dairy
Beef Stocker
Its
Non-La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Pouets
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 DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes 2]/No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ N
❑ Yes [7No
❑ Yes F No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

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

lFacift Number: - - Date of Ins ectiou:9 1 ig 1 /
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes 2�N(o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes dNo
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:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAW MP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [ <o ❑ NA ❑ NE
❑ Yes P "'o ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Flo/ ❑ NA ❑ NE
❑Yes o ❑NA ❑NE
Comments (refer to:question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
NEG1 (aC 51147Lj '3SSL W&Ad to CEC-.DC(L Q LrV VA6LM 11As
3EErJ 704o « tb rXtj Lsy, A)EC9 "-n c.ofqL4�7C/T6►0
Reviewer/Inspector Name:
Reviewer/Inspector Signatun
Page 3 of 3
Phone 10/
Date: % s
21412015

Type of Visit: C5 Corn Hance Inspection U Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: (J Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: r 4 !1111V Arrival Time: Departure Time: County: DO Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: &kt- y nd _Ca c'ck , Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: q. I 0 ZZ
Certification Number:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capaeity Pop.
Wet Poultry
I JLayer
I INon-Layer
Design
Capacity
I I
I I
Current
Pop.
Design Curreof
Cattle Capacity Pop.
ai Cow
a' Calf
Feeder to Finish
Farrow to Wean
D . P,ouI
Layers
Design
C_a aci
Current
$o ,
airy Heifer
Dry Cow
on -Dairy
I Beef Stocker
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Puults
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 0 No
❑ Yes [—]No
[:]Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ Ng ❑ NA ❑ NE
❑ Yes Ld 'V ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection. It
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JZJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6y6d
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes [No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes En "' ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [—]Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ETNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Vo ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EI�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
F3 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ NNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El20. Yes
L Q 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 U o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall InspectiSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ons No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L lXo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection. 694a jig
24. laid the facility fail to calibrate waste application equipment as required by the permit`.
❑ Yes
No
❑ NA ❑ NE
No
25. Ivthe facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
Y
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
ENo
❑ NA ❑ NE
No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes E114 ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ENo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ 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 0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes / Nc ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ,� ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #I): Explain any YES answers and/or any additional recommendations or any other comments. '
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:( / 1 d0
Date: )t
2/ /2011

Reason for Visit:
Date of Visit: C
Farm Name:
—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
0 Complaint 0 Follow-up 0 Referral
Other U Denied Access
Arrival Time: Departure Time: ® County: t Ue Region:
Title:
Owner Email:
Phone:
OnsiteRepresentative: B2.Enrt MTT(UELA'_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: &-L--
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity PP.
Wet ltry
Pou
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
]Non -Layer
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
t1OO
I)r. P,oult .
Layers
Design
Ca aci
Current
P,o ,
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non-Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes LJ '�q ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 21412011 Continued

Q
Facifity Number: Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA&Vo
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
�No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
2No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑Yes
N ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Io ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No/ ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or fO lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 Noo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ,
❑ Yes
6.4
❑ 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
Ko
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
4o
❑ 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? ElYes No/ ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: It J/13
24. Did the facility fail to calibrate waste application equipment as required by the permit?`
ElYes
/N� ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ILJ ` o ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
E31<10❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
ro ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
allo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface file drains exist at the facility? If yes, check the appropriate box below. ❑ Yes Io ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
Io ❑ NA ❑ NE
Io ❑ NA ❑ NE
ReviewerAnspector Signature: , tt. ,. // Date: J j
Page 3 of 3 /2011

Type of Visit: Q4 C`ot9ptiance Inspection V Operation Review O Structure Evaluation O'Technical Assistance
Reason for VisitC(�R�ouutiine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: R� / yl/ jLj Arrival Time:®® Departure Time:©© County: Ck4(-a Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact
Owner Email:
Phone:
Title: Phone:
OnsiteRepresentative: 1>LU-t- I' T--(CUCyAi Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design
Swine Capacity
C•urcent
Pop.
Design Current
Wet Poultry Capacity Pop.
Design Current
Cattle Capacity P.
Wean to Finish
I JI-ayer I
Dairy Cow
Wean to Feeder
I INon-Layer
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr. P,oul Ca aci P,o ,
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 Io
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ON
o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes N 11O ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: Date of Ins ection: 41LI11,,
Waite Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[-]Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): '3{�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmen I threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑Yes
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 O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ]dNo NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
C:JWs
No
Q NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
,❑]
I Xrvo
"'
NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
—TTT
I 40
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
CD4o
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
91/0
NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and N Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes t:]'No 0 NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes ❑ Io ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 31 j Date of Ins ection: d4
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
Mire appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
VLl 'V ❑ NA ❑ NE
No ❑ NA ❑ NE
❑ Yes ❑�--�'� ❑ NA ❑ NE
❑ Yes 040 ❑ NA ❑ NE
❑ Yes U "o NA ❑ NE
[:]Yes o D NA ❑ NE
[—]Yes No DNA ❑ NE
❑ Yes -EJ <o ❑ NA ❑ NE
ElYes No/ ❑ NA
❑ Yes ❑ NA
❑ Yes No ❑ NA
Comments (refer to question ft Explain any YES answers and/or any additional'recommendations or any otheccomments.
Use drawings of facility to better -explain situations (use.additional pages as necessary).,-,.'
j,> C I✓�1� /✓CEb Eli
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NE
❑ NE
❑ NE
Phone: C ld b
Date: I Z
Z/4 071

1
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Timer Departure Time: it) 5 County:�p(.,=/�) Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: O c?_ c T M-ZT cli f L'_'
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean [o Finish
Wet Poultry
I ILayer
Design
Capacity
I I
Current
Pop.
Design Current
Cattle Capacity Pop.
w
Wean to Feeder
I INon-Layer
I IDa'
Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
Farrow [o Feeder
Farrow to Finish
Design C•unrent
rpaci P,o ,
Layers
Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeefBroodCow
Other
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 ZNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes VNy❑ NA ❑ NE
❑ Yes❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
21412011 Continued

Factli Number: - Date of Ins ection: s I jo
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
L
3�Si�
3b
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 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 env' onmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? 7Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ff 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes Wo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
s
Q No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[o
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
i10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,lam
I /No
T
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
D
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[r� No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Io ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes FIXo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: $S Date of Inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [j Np
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes I� 'V
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Io ❑ 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes L.J No ❑ NA ❑ NE
❑ Yes EXNo ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑ Yes C2 o ❑ NA ❑ NE
❑ Yes [5 No ❑ NA ❑ NE
❑ Yes L3N"m ❑ NA ❑ NE
(Comments (refer to question 0): Explain any YES answers and/or any additional recommendations or any otherfcomments:.,-
Use drawings of facility to better explain situations (use additional oases as necessarv).
W k_'C� WO 0
IS.) L'MMr' r.16E.0fD
Reviewer/Inspector Name:
d
L
Phone:( 90)Nq —7300
Reviewer/Inspector Signature:
Date: S / S
Page 3 of 3 J 21412011

Faclltly Numbest, g 0 Division of Sal ands after Conservation
_ Q.,Other Agency
Type of Visit ,C,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit So Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0Other
�,, �❑ Denied Access
Date of Visit: !O Arrival Time: /
1 �V Departure Time: County: �LCLJ i,� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: QIUwr, maTtWU- Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: = o = ,
Dischar¢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 I dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
[I NA
El NE
❑ Yes
❑����,,,,////No
[I Yes
El NA
❑ NE
❑ Yes
U No
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: 3 —( F5
Date of Inspection 7
Waste Collection & Treatment
114. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): goo
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes [�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes EJZNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environgrental threat, notify DWQ
7. Do any of the structures need maintenan
ce 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
UNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Vo
❑ NA
❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
,�,//
Imo+ No
❑ NA
❑ NE
❑ Excessive Pending ❑ 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?
El Yes
/
Ed No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
ElNA
ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
11No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
N
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
,,EMI
E�J No
❑ NA
❑ NE
Reviewer/Ins ector Name : m ;
p o ' _ Phone -
Reviewer/Inspector Signature: Date:

' Facility Number: 3 J — Date of Inspection
'Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ryv ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes L�J(/No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Ch kl' ❑ D ❑ AA ❑ O h
ec s tts estgn aps t er
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
(/
ICd 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 [:1
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
CJ N-
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KmOA
NA
[INE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes❑
NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
❑ NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
,_/�`}�
LJd No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
E No
❑ NA
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�,(
IlLI o
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El 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
N
❑ 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
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
ElYes
El/No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

(Type of Visit (5 Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: / f Arrival Time: 0 0 Departure Time: County: Dihol=#J Region:
Farm Name
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: C tj V_tt2o I Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , = Longitude:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ENo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
El NA
El NE
❑ Yes
El N' o
[I.,I
Yes
No
❑ NA
❑ NE
❑ Yes
L✓J No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Date of Inspection `l t
Facility Number:
rite Collection & Treatment
4.41s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
In No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LA &wv
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 14t//
0
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
eNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
,�/
h4 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
environ ental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
CJ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [aNo ❑ 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 [I Yes LI No ❑ NA ❑ NE
maintenance or improvement?
Waste Application c�
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes C� No ❑ NA ❑ NE
maintenance/improvement? Er
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes E 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
aNO
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ErNo
❑ 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
U o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
C3 No
❑ NA
❑ NE
']J Sov.,.t rJ3..lcE Wt4t.L t..1an-IcJ Nt�oEp, PSt-tt�2kS.
r+E67 up 0WtC,0 STr C]�=,sJG_
IReviewer/Inspector Name 1 Ua 17A a t cu- Phone: � q to�
Reviewer/InspectorSignature: �,_, Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 ( — J f" Date of Inspection U 16 U
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. CJ Yes ❑ No ❑ NA ❑ NE
❑ Waste Applic ion El Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers ❑ Annual Certification
ElRainfall Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E�No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 03INo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LT No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EYNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ENo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
OXo
❑ NA
❑ NE
❑ Yes
�k&o
❑ NA
❑ NE
❑ Yes
3,fNo
❑ NA
❑ NE
❑ Yes
21 No
❑ NA
❑ NE
❑ Yes
Ej�NNo
❑ NA
❑ NE
❑ Yes
E3 No
❑ NA
❑ NE
Page 3 of 3 12128104

►r
Facility Number
0 Division of Water Quality
O Division of Soil and Water Conservation
O Other Agency
(Type of Visit Q,C[9_�pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit V Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t 08 Arrival Time: d� Departure Time: County: liU L Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address: _
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
Swine
❑Wean to Finish
❑ Wean to Feeder
Feeder to Finish
` ❑ Farrow to Wean
❑ Farrow to Feedei
;. ❑ Farrow to Finish
Other
❑ Other
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: n 0 n
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
'l o L1 o (A �k,
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pallets
❑ Turkeys
❑ Turkey Poults
❑ Other
Longitude: =0 =I
Design
Cattle Capacity P
] Dairy Cow _
] Dairy Calf L
] Dairy Heifei
] Dry Cow
Beef Stocker
Beef Feeder
Number of Structures:.;��,..
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?
SI
❑ Yes CJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ,� No El NA ❑ NE
El Yes ldNo ❑ NA ❑ NE
12128104 Continued

Facility Number: '3 — )Q Date of Inspection K n O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
C?No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: LA &0100
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
LJ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
��
13 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 environmentalitreal, 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 O No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,...,//
9. Does any part of the waste management system other than the waste structures require ❑ yes E No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes if No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Pending ❑ 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 Drill ❑ 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
LJ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
2No
❑ NA
❑ NE
No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
ENo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Wo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/InspectorName v uj4 t Phone: —
Reviewer/Inspector Signature: Date: t
12128104 Continued

i
j, Facility
Number: — Date of Inspection
v' Required Records & Documents
/
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
6No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ENo
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [:]Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
,�,//
L7 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
o
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N�o
❑ 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
/o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
o
❑ NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
EI
I11/ 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
UNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/No
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Ell
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,_,(/_
IJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
do
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑NA
❑NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
WNo
❑ NA
❑ NE
Page 3 of 3 12128104

rD
fN Division of Water Quality /
Facility Number I j n it O Division of Soil and Water Conservation V//
O Other Agency
Type of Visit 0-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit dRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: S o Arrival Time: ( D Departure Time: County: QV IJ' Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
USll,o A olio
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' = « Longitude: = U =' = u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Wean to Finish
❑ Wean to Feeder
[ZFeeder to Finish
1,7 oq 0
'LJ
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ 'Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
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)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L'J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes LI No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

$acuity Number: 31 - (SS I Date of Inspection 1 6
Waste Collection & Treatment //
4.' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes LJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: tAC=)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): SU
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
EJ 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
60 ❑ 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? Il Yes
❑ N El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El 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
L- I No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
��/
E 14o ❑ NA ❑ NE
maintenance/improvement?
�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElO 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 Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E_fNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
TNNo
❑ NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
�E
U NNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
E I N
El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
coN awvE 7AiC Wyatt, No&Aa_ Nipo-C "Toesb-L MEEbED
Reviewer/Inspector Name d �co-_- Phone. q/0 Q(, ' 3
Reviewer/Inspector Signature: Date: - IJ o
12128104 Condinued

Facility NuDate of Inspection S`
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes .El No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes Q<O ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
allo
❑ 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 ❑ eather
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
IEJ-Ko
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
{O� Noo
❑ NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
C1 Yes
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
LJ Yes
,L��'N�o
E f §u
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ET No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Noo
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
,C�J,
[3,<
❑ 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
F, 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
�
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,�,
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
Vd
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El Yes
ER'No No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

ODivision of Water Quatity
Facility Number = 0 Division of Soil and Water Conservation '.
- - 0 Other Agency
Type of Visit Q,�,(oypliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ?Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 1i eV Arrival Time: rI 3o Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: !!�� Title:
Onsite Representative:—IJ��%-r t ' STCC 41 tc l "
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
o F7, = Longitude:
Design Current Design. Current -Des
Swine Capacity Population WetPoultry Capacity. Population—Cattle.Cap
ter
Other
Region:
=. K
❑ Layer
` ❑ Dairy Cow
❑ Non -Layer
I
I
JLJ Dairy CalfL#
Dry Poultry
LI Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of Structures"
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes E- No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 2< ❑ NA El NE
❑ Yes V ❑ NA ❑ NE
12128104 Continued

Facility Number: 3 Date of Inspection 7d e4
Waste Collection & Treatment
//
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
ElYes �N
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes do
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA &Ce/J
Spillway?:
Designed Freeboard (in): 1 1. S
Observed Freeboard (in): i-9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes E No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 2(No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environm ntal 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 LI 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 a o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L11Vo El NA ❑ NE
maintenance/improvement? ll//
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El -- Yes �Io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 1016s ❑ 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) %. n S G' a Cw W
13. Soil type(s) d A RA A
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
,0
ffNNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
Gr"No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
L�7,/N,
El NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
L'] No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i.) Da>, wn Nis 6a4wc - se -AD M1 t As sn► 31— 84 r r,�JSPEc ,
:LlJ SEwo COPY of L'?DXTEn Cttof ?X' tL� wS-rH 6-"S5 C,# EfV-- c.'erf6Q.
AI,� a COe`r of 5Ta6X1J1/L,.
Reviewer/InspectorName I `7' 0 P4420iu-, I Phone:
Reviewer/Inspector Signature: Date: R.i %fit 10
Pape 2 of 12128104 Continued

Facility Number: 3 — 1 IU- Date of Inspection ob
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes ld NN ❑ NA ❑ NE
❑ Yes U/ No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No
❑ NA
❑ NE
❑ Waste Applicafon ❑ Weekly Freeboard [IWaste Analysis ElSoil Analysis ElWaste Transfers
ElAnnual Certification
❑ Rainfall Stocking [ff Crop Yield ❑ 120 Minute Inspections ❑ Monthly and P'
Rain Inspections,
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
//❑
El NA
El NE
0o
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
J�(No
El NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
2�Io
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ONo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[INA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
—0N/o
(?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
�/
I� No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
WNo
❑ 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
dNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
EfNo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access
Date of Visit: I q'f4/U71 Arrival Time:
Q�t� Departure Time: J� County;
Farm Name:" Y�� 7,71 ��` 40 /�s . �/45.4N�i Owner Email:
Owner Name: �_ L, f .eA,G�l Phone: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone No:
Onsite Representative:, &<4A t Integrator: (/4��iiG(
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Region: 4 �O
Latitude: = = = Longitude: =o =,
e
r
Design Current r ? Destgn�rCurrentat
Capacity Populahon € Wet Poultry Capacity Population Cattle
asaa n
Destgn Current
Capacity •Population
❑ Wean to Finish
❑ Wean to Feeder
10
Layer
❑Non -La et
I
I
J1❑
❑
Dairy Cow
Dairy Calf
Feeder to Finish
0-
Dout
ry Ptry
❑ La ers
❑ Non -Layers
Pullers
❑Turkeys
❑Turke Poults
❑ Other
'' = _ -� ❑Dai Heife:
f ^ - ❑ D Cow
R ❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures.
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
3,
_-... _
Other .T. :.::. _
,a. '
❑ Other
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ZNo
❑ NA
❑ NE
❑ Yes
7No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Y(No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _�1_
Spillway?: A%o
Designed Freeboard (in): 40 Z 5
Observed Freeboard (in): 3L
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
,_,(
ILI No ❑ NA [I 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
�INo ❑ 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
Y(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
&145 -PC,
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No ElNA ElNE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
QJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
T
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s) __A( f, � �,
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
Z
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
No
0
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes
No
❑ NA
❑ NEB
17.
Does the facility lack adequate acreage for land application?
❑ Yes
LLJ No
T[n
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Y�cf 1�Gcolzcs Nip T ��
/f 'e zap.
IReviewer/Inspector Name Phone: C//Q
Reviewer/Inspector Signature: , Date: Ce7l¢Jl05
Continued

. ._1
Facility Number: Date of Inspection
Required Records & Documents ,��,//
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LdNo El NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes r�No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. XYes 'ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall,)ZStocking OCrop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections
,/ El Weather Code
VJ 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 U�No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes
-_,(No
El NA
❑ NE
El Yes
No
❑ NA
❑ NE
El Yes
/yJFNo
ElNA
❑ NE
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
❑ Yes [;rNo ❑ NA ❑ NE
❑ Yes '0 No ❑ NA ❑ NE
Wditional Comments and/or Drawings: vi'
L'4�P5 04a'o
12128104

of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
for Visit JO.Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: I
3 /
Permitted 13 Certified 0 Conditionally Certified 13 Registered
Farm Name: U nn- ... a r.4.G1.'
Owner Name: J2V1 I
MailingAddress: ............................. _.............. ................ _... .._... _.....
.
Facility Contact: .._........ _._._.j_....�_._.__.............. ....... ...
1Title: ...
1.....
__....._._.
Onsite Representative: ¢�[_kt%Q �:1�1Sa._ /?_✓�:s...Mjj .M.L.
Certified Operator:
Location of Farm:
Time:
Date Last Operated or Above Threshold: -.
County:
Phone No:
_...._.._..._._...__.. Phone No:____ ----
Integrator:
Operator Certification
P�Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =' ="
Oesi Current;, _ 1)est-Cnrreat _y Des Current
Ca Po"iilatioii pool Po Cattle Y
as Y _ _Ca' ac�it niaUon alahon
Wean to Feeder
❑Layer
❑ Dairy,...
C�Feeder to Finish
� , ❑ Non -Layer [I Non -Dairy
Gther
Farrow to Wean
Farrow to Feeder
4 -ill
Total Design 010d y
`7, 0
Farrow to Finish
.x• r-- -.,
Total SSLW
U, 0 d
Gilts
Boars
r-
Number of Lagoons
6
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes PXo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes Zf4o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes EJONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes „01No,
Struyure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _..__. tr---.._.. _--------------------- --- --- ---------- ------ _..._-- _------ _. _.__...
Freeboard (inches): L-2 J
12112103 Continued

Fagi_h Numbers — /,J'j
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 46 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 maintenancefimprovement?
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN , ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12.Crop type LPEAJ Wjye,+, '!pot)S(4f{A_)5 CO776
13. Do the receiving crops differ with those designated in the Certified Animal Waste
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes YNo
❑ Yes No
❑Yes ONo
❑ Yes 0 No
Plan (CAWNP)? ❑ Yes
)� No
❑ Yes
No
❑ Yes
❑ No
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
❑ Yes R(No
❑ Yes ;2(No
❑ Yes No
❑ Yes No
❑ Yes �No
❑ Yes,,�o
Cummepts (refer to gaesbon #) Eacplam any YES answers afiWor aiiy re&n endattom'.or any other rnmmeiats -
Usetdrawtngs:of fsa7tty`to better e:rplatn sttuatiot�s. (� addrhonal,pages as necessary) :�� Field COPY ❑Final Notes �t
MW /O p�cOat�,
)"Z4
- /v 0 �, Cz o
/�%7� �dE/lA<<, �.M f7`��f-> a ,Bry (.�%-4L �t9�i✓1/%2n�0,
f'l ECD� /J S of � � NF •g T ��v/� ©� oE,et y.
1 -- = - —
Reviewer/Inspector Name _ _ _
F uwz-
Reviewer/Inspector Signature: Date:
12112103 Continued

Faci3ity Namber:,3� — �� Date of Inspection / O
Required Records & Document~
ONO
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes E(No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes O'No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 010
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes ONO
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes XNo
(id discharge, freeboard problems, over application)
❑
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ZNo
28.
Does facility require a follow-up visit by same agency?
[]Yes Fj`No
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes .�rNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
(Yes ❑ No
;
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
32.
Did the facility fail to install and maintain a rain gauge?
❑Yes No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes /No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes yNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Permitted ❑ Certified 0 Conditionally Certified
Owner Name: R. `• (T R hlp� / Phone No:
Mailing Address:
Above Threshold:
Facility Contact: Title: Phone No:
Onsite Representative: fl�:i f-rKrnj,S Integrator: ,�IwDLCS
Certified Operator: Operator Certification Number:
Location of Farm:
q Swine ❑ Poultry
❑ cattle
❑ Horse Latitude Longitude
�• �_
_
. Design..-
Current _ .;..Destgn� ; ;Current :. - ,-Design,`m Current
Swine '
:CaDacih
Population .Poultry -;Capacity 1populatton v`Cattle..
.Gapatity =Populatton _
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 galimin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: T
Freeboard (inches):
05103101
❑ Yes Ld No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ZNo
❑ Yes 3zNo
❑ Yes l,Q No
Structure 6
Confirmed

Facility Number: — Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
TTT
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 anv of the structures need maintenance/improvement?
El Yes
No
8.
Does any pan of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
(� No
9.
Do any smctures 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
11.
Is there evidenAof over application? ❑ Excessive onding ❑ PAN Hydraulic Overload
/L,p_
El Yes
,,,__�,,,///No
I[J No
12.
Crop type ��Cmis CiF A-"t K)
13.
,Q=7fr
Do the receiving crops diller with those designated/m the Certified Anima Waste Management Plan (CAWMP)?
❑ Yes
No
VNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
Y3 No
c) This facility is pended for a wettable acre detemunation?
❑ Yes
�] No
15.
Does the receiving crop need improvement?
❑ Yes
[� No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
0 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
[p No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VNo
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
rrrV
ty No
25.
Were any additional problems noted which cause noncompliance of the Certified AAW?
❑ Yes
VNo
0 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
Comments;(refer to queion #):' Explain any.,YES answersand/or anyrecommendattons ocaoy olhercomments -
Use drawing's of facility to better eirphtm situatiops. (use additional pages as necessary) —"
... --, =' Field Conv Final Notes
-
>�/' L,qb� �Po,os � � Rstr�N �'©�R�'c��y o�✓ �L
j�9�/�L6S , io8/iCco G� p5>�v %fs �joP T UHF �'r/lauJnJ Dit/
FR Sos �aP F�F�osAryA S,
Nc
Reviewer/Inspector Name - •'
-
Reviewer/Inspector Signature: Date:
O5103101 r r
Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
IAdditional Comments and/or Drawinas:< - -
19) r4
�441s
4Nn 5,
JI��PF. ��CG'1205 LOri P� �� / jl�✓D
SPCC
ODO
OSIO3101
❑ Yes ❑ No
❑ Yes o
ElYes fNO
❑ Yes VNo
❑ Yes No
❑ Yes PNo
❑ Yes ❑ No

Affivis ion of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency.
IType of Visit X Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit XRoutine ocomplaint OFollow up 0 Emergency Notification 00ther E3 Denied Access
Facility Number Date of Visit: � Time: [;= Printed on: 7/21/2000
1 - /10 Not Operational OBelow Threshold
Xpermitted[3C Certified E3 Conditionally Certified 1311egistered Date Last OperateO-
kr Above Threshold
Farm Name: ...... .... ....... ........ TA6 .......................... County: ........... ift U . ............... ..
OwnerName: ................................................. ... .... ....... * ...................... Phone No:
.............. .... ...
Facility Contact: ... �.... M. . .. . ................................ Phone No:...................................................
Mailing Address: .................................... ..............
Integrator: ... ...... .. 1"11*-1-Ickk . ..... .............
Onsite Representative: Bffink...O;� ...... .. 1� I . . .... ........
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
X'Swine ❑ Poultry [3 Cattle [3 Horse Latitude Longitude =0 =1 =-
Desi Current Design Current
Current-
urrent-
5—Cattle Capacity. Population Poultry Capacity P elation
ty,- Population
Wean
7yer Wean to Feeder [I L I0 Dairy
e to
r Finish on-Layerl 10 Non -Dairy
Farrow to
Farrow to Wean
Wean
to Feeder I[] Other
Feeder
Farrow to Finish
s
Totsd Design Capacity
Gilts
I ts
Boars Tow SSLwl
Subsurface Drains Present
-Noe&r of Lagoons 10 Lag -on Area
10 S pray Field Area
Holding Fonds/ Solid T raps 10 No Liquid Waste Management �System
Discharges & Stream Impac
1. Is any discharge observed from any part of the operation?
[]Yes P(No
Discharge originated at: El Lagoon E] Spray Field [] Other
a. If discharge is observed, was the conveyance man-made?
[I Yes [] No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
0 Yes [I No
c. II'discharge is observed, what is the estimated flow in gal/min?
":�b //
d. Does discharge bypass a lagoon system! (If yes, notify DWQ)
0 Yes El No
2. Is there evidence of past discharge from any part of the operation?
El Yes JKNO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? E] Yes KNO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [] Spillway
❑ Yes x No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......... �2(0 ............ .................................... ................................... .....
Freeboard (inches):
5100
Continued on back

Facility, Number: — Date of InspectionM11211 Printed on: 10/26/2000
5.
Are there any immediate threats to the integrity of any of the structures od? bse e(ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Yes
�J No
,
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
/
7.
Do any of the structures need maintenance/improvement?
❑ Yes
® No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
14No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence Kover application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
No
12.
Crop type i A0 J
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?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes o
❑ Yes � /No
❑ Yes O
❑ Yes No
❑ Yes 62�&''
❑ Yes
❑ YesPdo
❑ Yes 90io
❑ Yes XfNo
❑ Yes qNo
❑ Yes No
❑ Yes o
�G...-...-
ldwibl'atidiis:oi: deticiencies ivgre hbfed during tbis:visit; You will i eceiye iti iui thgt • ; ;
correspondence. abouC this .visit-' . • .. .
Comments (refer to question #)h Explain any YES answers and/or any recommendations or any other comments
Usee drawings of facility
tto�better
�explain situations. (use additional pages as necessary):-
f�kUNOL "`�f i5 ►W e,hcu.PduS. 5�1y }( �2f� /Sa% :01Q
Reviewer/Inspector Name U v e i — G'
Reviewer/Inspector Signature: A g j„ p 1w,( Date: 3 10K 10 1 5/00

Facility Number: — Date of Inspection ?j Q Printed on: 10/26/2000
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
�[
R I No
'g[
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
7�
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
XNo
5/00

Facility Number 3 / / Date of Inspection
Time of Inspection 3 ' Oo 24 hr. (hh:mm)
Permitted
Certified 13 Condition ly Certified E3 Registered Not O erational Date Last Operated: ...._._..............„_
Farm Name. ........... :......4 ..:.................. .r!.l,QJ7/.......... <�W-s ....................... County:.....................Y.SDCT�i}1...................... .... .`.: �.........
OwnerName: ...... N_6/tjo-.lu................. �/1............................................... Phone No:.......................................................................................
Facility Contact: ...:.�.1°i.K�/._:........�% ...............Title: ........... 0..G.Y(.' :�............................ Phone No:...................................................
MailingAddress: ....................................... ...........................................................g............................ .......... ..........................
Integrator: D%If
...........................
Onsite Representative:...,. CH/?/_ .............. �- _Xe
Certified Operator: ........................................................................../..................................... Operator Certification Number:..........................................
Location of Farm:
......................................................................................................................................................................................................................................................................
............................ :..................................................................................................................................................................................................................................
...........
Latitude =• =' 011 Longitude =• =' ="
• Design:' `Current. Design Current -
-Swine _ Capacity; Population Poultry Capacity Po ulation =_.,Cattle
❑ Wean to Feeder ❑ Layer - ❑ Dairy
Weeder [o Finish 10 Non -Layer I❑Non-Dail
"❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
''. ❑ Gilts
❑ Boars Total 7S.SM.
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon A
Holding Ponds / Solid Traps E:= JE1 No Liquid Waste Management System
Discharges & Stream tmpacfs
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)
ipray Field Area _
❑Yes ) No
❑ 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)
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
❑ Yes ❑ No
-Na-
❑ Yes ❑ No
❑ Yes ANo
❑ Yes [(No
❑ Yes A No
Structure 5
Identifier: /,
Freeboard(inches): ........... (�.......................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage,etcJ 14
3/23/99 Continued on back

Facility Number: — Date of Inspection
6r-.Arr
Are structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
�/
pd No
(If any of questions 4-6 was answered yes, and the situation poses an
n
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
KNo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
KNo
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
9No
11.
Is there evidence of over application? ❑ xcessive Ponding ❑ PAN
❑ Yes
j1 No
12.
Crop type G(/
, \
13.
Do the receiving crops differ with tho designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
KNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
No
b) Does the facility need a wettable acre determination?
❑ Yes
Io
c) This facility is pended for a wettable acre determination?
❑ Yes
5No
15.
Does the receiving crop need improvement?
❑ Yes
16.
Is there a lack of adequate waste application equipment?
❑ Yes
,9No
0p No
,\
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
RfNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
A,No
19.
Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports)
Eyes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Eg�'No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
JVNo
(ie/discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
la No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
X No
0' �Vo yibl'atitilis:oi ilefcieucieS were noted• dirriilg ihis:visit:-:Yoij ivill-tec¢ipe Rio: fui that
. - coriesnoridence: about this :visit: :::::::::::::::::::::::::::::::::: :
l r7'ra s I �e�ko� l��4s Guts S C,
levch .
L-
Reviewer/Insl(ector Name
Reviewer/Inspector Signature:
N. d t Date:

Facility Number: 7g— I Date of Inspection
Odor Dues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes P(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes kNo
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 ��tJ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �IYI`No
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
A:dditional Comments'an or- rawings:

e . .
® Division of Soil and Water Conservation - Operation Review I R'CMVP D
[3 Division of Soil and Water Conservation -Compliance Inspection
Division of Water Quality - Compliance Inspection DEC 2 Q a999
13 Other Agency - Operation Review
10 Routine 0 Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review ier
Facility Number 31 185 Date of Inspection 12-6-99
[Time of Inspection 11:15 24 hr. (hh:mm)
® Permitted IN Certified 13 Conditionally Certified 0 Registered Not O erational Date Last Operated; ..........................
Farm Name: Jim -Grady .aad.5tuts. ac......................................................................... County:
\YMO.........
OwnerName: 13...L.......................................... GcadY................................................ ......... Phone No:(91.Q).2.67-.4.48:1....................... .................................
FacilityContact: ow.Iler................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: F.Q.Bu&.4Zfl............................................................................................ Eais.oa..N.0 ............................................................. U3.41..............
Onsite Representative: Qwngr............................................................................................. Integrator: CaLGVa1�SF.oQ11S1.t1.C................................................
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number:
Latitude 35 • 03 55 Longitude 78 • 04 04
Design
Swine Capacity Population
❑ Wean to Feeder
® Feeder to Finish 7040
Farrow to Wean
Farrow to Feeder
Lj Farrow toFi—nIsTF
i is
Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity 7,040
Total SSLW 950,400
Number of Lagoons I� N Subsurface Drains Present
Holding Ponds / Solid Traps [-== ❑ No Liquid Waste Manager
DischarEes & 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 manrmadc?
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)
Field Area
❑ Yes N No
❑ Yes N No
❑ Yes N No
n/a
0
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(inches): ...............29..................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N No
seepage, etc.)
3/23/99 Continued on back
Printed on 12/16/99

Facility Number: 31-155 Date of Inspection
6. Are ibe.e stfuctures 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?
12-6-99
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Yes ❑ No
12. Crop type Com, Soybeans, Wheat Cotton
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?
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?
U. Nti yiolatiotis:or;deficiencies•were:noted;d'ui•ing this visit: ;You'will;receive uo ftsrttie'r-; ; •
.. corresPotidehciabouithis:visit.•.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
® Yes ❑ No
❑ Yes ® No
❑ Yes ® No
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):
11,13,19- There were no pumping records since March 99'. Mr. Grady stated he had pumped since that date, but did not know
where the records were. He stated his service person was keeping up with the records.
last waste sample was dated 11-98'.
ere was not a 99' soil sample.
19- There where no weekly freeboard levels. This farm is permitted and required to keep weekly freeboard levels.
Reviewer/Inspector Name Trent Allen
Reviewer/Inspector Signature:
Date:
on

Facility Number: 31-185 Date of Inspection F 12-6-99
Odor Issues 'z&
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
❑ No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
❑ No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
❑ No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional omments and/or Drawings:
2 1 - There is not an active certified operator for this farm according to the computer.
23- Discussed paperwork problems with Mr. Grady and gave him a chance to contact me to come back to the farm site to review the
records. I was never contacted. This farm will be referred to the Wilmington DWQ.
Printed on 12/16/99

1] Division of Soil and Water Conservation - Operation Review
13 Division of Soil and Water Conservation - Compliance Inspection
® Division of Water Quality - Compliance Inspection
13 Other Agency - Operation Review
le Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 31 185 Date of Inspection 7/29/99
Time of Inspection 15:00 24 hr. (hh:mm)
® Permitted ® Certified U Conditionally Certified 0 Registered 0 Not O erational Date Last Operated: ..........................
Farm Name: dim.Grady.and.,Saats,.Iuc......................................................................... Countv:DMplio................................................ NY[R0.... .....
OwnerName: $.l.......................................... Grady .......... ................................................ Phone No: (9.01.1.67. 4.48.1........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: r.Q.AQ&.428............................................................................................ EaiSo4..lNC.............................................................. 2&341..............
Onsite Representative: Chri5..HQUUjUtd............................................................................ Integrator: CarrQ1l:SFt7.Rf1S1t1G............................... :...............
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
Latitude 35 • FOTT F 55 11 Longitude F 78 • 04 04
Design Current
Swine Capacity Population
❑ Wean to Feeder
N Feeder to Finish
7040
7040
Farrow to Wean
Farrow to Feeder
Farrow to T ims
Gilts
Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity 7,040
Total SSLW 950,400
Number of Lagoons 1� N Subsurface Drains Present ❑ Lagoon Area IN Spray Field Area
Holding Ponds / Solid Traps == ❑ No Liquid Waste Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes N No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El Yes N No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes N 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 N No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes N No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes N No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(inches): ...............3.0...................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N No
seepage, etc.)
3/23/99 Continued on back
Printed on 12/16/99

Facility Number: 31-185 Date of Inspection
7/29/99
6.
ALe,there:kstructures 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
N No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN
❑ Yes
N No
12. Crop type Com, Soybeans, Wheat Cotton Small Grain (Wheat, Barley,
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes N No
c) This facility is pended for a wettable acre detemunation? N Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
N No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
N No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
N 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
N No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
N Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes N No
L�J' Nti violatiotis:oi Befit ieucies were;noted d'ui ing this visit: ;You; will"receive no further :I
correspotideuce aboui 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):
14c) Pended: Chris Holland to provide information in August map and irrigaiton parameters.
19) Waste samples must be collected within 60 days of applications. Pumped in March `99; last sampled Nov.'98.
cep up with weekly freeboard log as required for permitted facilities.
Reviewer/Inspector Name John N. Hunt
Reviewer/Inspector Signature:
Date:

Division of Soil and Water Conservation Operation Review, m
$ Division of Soil and Water Conservation Compliance Inspecti
_ivision of WaterQuahty-Compliance Inspection
d] Other A¢encv - OveratiomReview -
Facility Number 3(
of DSWC review O Other
Date of Inspection
Time of Inspection
BP'ermitte4oln Certified 13 Conditionally Certified [3 Registered C
FarmName: .............. \:.:.....4;.0?_Pj...................................................................
Owner Name:
Facility Contact:
Title:
Not Operat
County'
Phone No:
24 hr. (hh:mm)
IDate Last Operated:
i� d P LiNr
Phone No:
MailingAddress:.................:..........................................................
.........................................,..I.......................................................................... ........... ........................
Onsite Representative:........t!.s?LliA!!CP............................................... Integrator: .......<.1. � t-.S...........................................
Certified Operator:
Location of Farm:
Operator Certification Number: ..........................................
Latitude =•=' =• Longitude =• =' ="
-
-.
Swine
Design
Capacity tyPo
Current.
Population
,.;"_,Design, Current ';_._ ,= Design''Cniient
p-
Poultry Capacity tyPo Population Cattle Capaci-ty Population '"
❑ Layer - ❑ Dairy
❑ Non -Layer I ❑ Non -Dairy I I =
- ❑ Other
-- - Total Design"Capacity
- Total SSLW
❑ Wean to Feeder
53Feeder to Finish
p
❑ Farrow to Wean
❑ Farrow to Feeder
❑Farrow to Finish
❑ Gilts,
❑ Boars
,Number of Lagoons 0 -- Subsurface Drains Present ❑Lagoon Area ❑Spray Field Area
❑
HoldingiPonds /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 gallmin?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes �?&o
❑ Yes ;�,No
❑ Yes VNo
❑ Yes L2fNo
❑ Yes 0 No
❑ Yes 0 No
❑ Yes El No
Structure 6
Identifier:
Freeboard(inches): ...........;�5....................................................................................................................... ......................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes JJNo
seepage, etc.)
3/23/99 Continued on back

r I
Facility NumDate 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 application? ❑ Excessive Pending ❑ PAN
12. Crop type C�a2r.(�WNg4r�Soy1Q_ Cs 13_1Ar •5:6
❑ Yes ONo
❑ Yes VNo
❑ Yes XNo
❑ Yes JWNo
❑ Yes F1' o
❑ Yes �No
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
b) Does the facility need a wettable acre determination?
❑ Yes
,�INo
yJ No
c) This facility is pended for a wettable acre determination?
[ZYes
❑ No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
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?
.. iVtj•vibl'atitifis;ot 8eticienci.. •were .b6t;ed-during this visit-- Y;ou Wit4receiye Iio; fui thgr
. - : correspondence: about this :visit:::::::: ::
❑ Yes tCI N
❑ Yes Zo
❑ Yes ZNo
❑ YesP'NIo
XYes
❑ Yes Ip 1v0
❑ Yes C.KO
❑ Yes Ej'�No
❑ Yes j3'N0
❑ Yes dNo
❑ Yes 12I No
SAAkf& S /kaSi 13£-Catl-'�—c77­0 ,.Jr`r;A 60 r7Pys 4r— A?pL-
j'£Sr of tntir" L45_:V r_L-'j Fesc-_ aA2•D I-,3G *4C �EJ� �r-o-�lreM%Ir �riUw l.iTlt°�
lLf c) ft4pr:A i cN4a`S +6U-0 1D ra pQaJiDE 1J/Po _ ,a AU G4 sT MAP " {RI4. GAC"tr1 f ARAM4f cS
IReviewer/Inspector Name ,_JoldfJ• �GlVA. f": �I ��'7� //•7t�o (j/ `//o '-.- I '.T 3TS ,39-1
Reviewer/Inspector Signature. t7l. �_ r Date: % Zy I
3/23/99

Facility Number: 3 i — !s Date of Inspection
Odor Issues )I
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below*es IINo
liquid level of lagoon or storage pond with no agitation? r
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes INo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes JZNo
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 PIo
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 vo'No
31. Do the animals feed storage bins fail to.have appropriate cover? ❑ Yes �ZrNo
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ZNNo
Additional Comments and/or Drawings:a
?r) or' 1b^1 "e LV-P-i' OfzN
e Ecee bar %u zp GRq: ,! Gtrc�Ep u.P_
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
to Division of Water Quality
[W Routine 0 Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other
Facility Number
Date of Inspection
I S
Time of Inspection 24 hr. (hh:mm)
0 Registered Certified 0 Applied for Permit ® Permitted JE3 Not Operational I Date Last Operated:
FarmName: .............. ..... 6,Ad....... f ..Sottii...t..1rj.,.......................................... County: ...... Dt.Qli}-, ....................................... .......................
OwnerName: ........ _.................. .............. _Grin. ......... ........ ........ ............ .... ............... Phone No:.... j.41? ..24.7...-. �i.(...........................................
FacilityContact: .......................................... : ................................... Title:................................................................ Phone No:
MailingAddress: ...... ..t2...... UX....... .1.4....................................................................... .............. `aG.hr....A[.5........................................ ..74`341..........
Onsite Representative: ............... l `c.:............0 ` t y.................. I .............. ............. Integrator: .......... Ca- .n l. ...................................................
Certified Operator :......... .IXSSiol�i4.i1... ... ..................................... Operator Certification Number:....°21.6......................
Location of Farm:
^....1akS.....st d....a.......K.L?A...,...wt............13........................................................................................................................................................
.......................................................................................................................................................................................................................................................................... .
Latitude �® •=`" Longitude ®• 64 oq
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Drains Present
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 pan of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
le, :' ;Capacity,Population
'airy
'on-Dairy
pacity o
tSt95D, goo
agoon Area 13 Spray Field Area
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes [d No
❑ Yes l] No
❑ Yes 1P No
❑ Yes P No
❑ Yes Qj No
❑ Yes lP No
❑ Yes ® No
❑ Yes [0 No
❑ Yes [4 No

Facility Number: 3� -
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laeoons Holdin-a Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l Structure 2 Structure 3 Structure 4
Identifier:
Freeboard(ft):..............3.1.........................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes 5 No
❑ Yes [P No
Structure 5 Structure 6
❑ Yes iR No
❑ Yes Ep No
12.
Do any of the structures need maintenance/improvement?
'P 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
0 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
1� No
(If in excess of WMP`,'o'r runoff entering wafters of the State, notify DWQ)
15.
Crop type.............�311�.........LQ.C....._Vd....... S�Qt4t�.............$1YA�`....Yvek�........
!?Y _.........................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
10 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
iUNo
18.
Does the receiving crop need improvement?
❑ Yes
09 No
19.
Is there a lack of available waste application equipment?
❑ Yes
(A No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
21.
Did Reviewer/Inspector fail to discuss reviewlmspection with on -site representative?
❑ Yes
JP No
22.
Does record keeping need improvement?
[AYes
❑ 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 MNo
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes (� No
p No violattonsor deficiencies were noted during this:visit. You:wiq receive no further j
correspi)Weuce about this vtstt 1
�ts6{> to queoa��� tainpYaacers antUo�y �recommd tons or any other comments
Use dtagstaeihigbeexplatn sttuaaons(useaddtNonal pages_asnecess�ary :`
Zz. V d� 'Prruy {Y tcNr)s S`'wJlt] loc ir- � �-grrw U
1 \ YtCo�S, �da (,Jw�it
Sl�ec1 � 6� i h u C cov�s.
7/25/97
Reviewer/Inspector Name 01,
Reviewer/Inspector Signature: - / `J _ Date:

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10 Routine O Complaint O Follow-up of D\yQ inspection O Follow-up of DS WC review V Other
Date of Inspection D 9
Facility Number 1
Time of Inspection am24 hr. (hh:mm)
13 Registered 13 Certified U Applied for Permit E3 Permitted 113 Not Operational i Date Last Operated:
Farm Name: ........ ..... Eita County:...Dw....li!-.>.....................................In�.t..�l�...
4..................... p
Owner Name :.......................... _-.......... Phone No:......... _ !_Q....._Z61.......
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: .......FD..... i2.A....... .....................................................................t...... ............................... -U.3 i.I........
Onsite Representative: .... 5..e va ........ Cz.) ----}.................................................
Integrator:.......q..r..r..n.1...5..................................................
Certified Operator:................................................................................................................ Operator Certification Number .........................................
Location of Farm:
Latitude =• =° =1
1 Longitude =• =' ="
Design Current Design Current+ ,Design', Current
Swine Capacity Population Poultry Capacity,Population w,Cattle, _' Capacity Popalatiuzi
❑ Wean to Feeder I ID Layer ❑ Dairy `t
Feeder to Finish ❑Non -Layer ' ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total`De'siga Capacity,_ S�v
❑ Gilts
❑ Boars `'?.; Total SSLW LOt7
^p.
Number_ of Lagoons / Holding"Ponds^ 1 Subsurface Drains Present ❑Lagoon Area pray Field Area t<.
x _ % _, ❑ No Liquid Waste Management SystemAl
'
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 pl/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
mai ntenanceh mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes ® No
❑ Yes IN No
❑ Yes ® No
❑ Yes ® No
❑ Yes JR No
❑ Yes 19 No
❑ Yes ANO
❑Yes I[No
❑ Yes V1 No
Continued on back

f. .
Facility Number: — I
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes - KNo
Structures (La !mms.Holdine Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......... :..5 ............................................................................................................................................................................................
Freeboard(ft):.......................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
CS Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
VNo
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...G.o.f....^...................$&N4.. R-T.r:.. .....,ptk*- `:.................. ................. .......... _............................ :.....................................................
.
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
g( Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
KNo
18.
Does the receiving crop need improvement?
V•Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
®,No
20.
Does facility require a follow-up visit by same agency?
RYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ILNo
22.
Does record keeping need improvement?
❑ Yes
54 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
2§No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
KLNo
No.violati6mvr. deficiencies. were noted during this.visit. Yoiiwil} receive no further:
correspondence about this:visit:::
11�Wat4. }en.� ba*t aKoS wF�e otoSzvu'd o+ tv90�w� waL(. TFzta area3 sI^o�
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�b.CQ�rti� �oL P}o �JcwL(s iro-V cAr✓vlt f^e ve.�lP/lt also
0—,4 W LtiA- f. ?"L�� 1 c.k-o f V T Lit kk e t
'I,%+g o- S
Also, � tc�d # S O� ciaLlypP�f i +o Wo.& pCa � ope.Yuiar kai moo¢
rvw o-v. ��'P�d, tUt .U,_,zS {o�• �%t wtCyv d StvsS wtj� bill r F
t .^-gi'1 �5/�
A QC14iIt e; bn ri2.v..eL ")'III Ira .co. t X,, e,rb e_ n..v lo-.. nn.- ..tn Lk n
� NuAte
a t(r
0 f
170.
Reviewer/InspectorSignature: e,k_ _,j _ ,,,,,�f. Sf—J '41_O......_`_ 9� Date:

U14A
U
Site Requires Immediate Attentio . nQ
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: Old 9 , 1995
Time: �-f r
Farm Na
Mailing
County:
Integratc
On Site kcpmscnrauvc.
Physical Address/Location:
w)
rnone: oW t — U.7-1 t k-- c1
x L- I JUA— d i
Type of Operation: Swine Poultry _ Cattle
Design Capacity: —+0`417 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: -s ' 03 Longitude: 7 6 ° 04 ' QL-L_9 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 or No Actual Freeboard:`�( Ft. - Inches
• Was any seepage observed from the lagoon(s)? Yes or& Was any erosion observed? 'le� or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilized: J eAA _r 1 C&A'n
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes 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 or 19 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Inspector Name Signat e
cc: Facility Assessment Unit Use Attachments if Needed.