310211_INSPECTIONS_20171231

NUHIHCAROLINA .M
Department of Environmental Qual

Review U Structure Evaluation U Technical A
on O Referral O Emergency O Other O
Date of Visit: 7 SO I Arrival Time: 0 : Departure Time: County: PjJ,O 11,1 Region: (`V
Farm Name: AW
" �6 Owner Email: T
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: V 1)14'hw 0 11.W
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: (b I/ I
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.rIiNon-Layer
Poultry
[Layer
Design
Capacity
Current
Pop.
0
Design Current
Cattle Capacity Pop.
Dairy
Wean to Feeder
t7O
Feeder to Finish
r
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Desigu Current
1) . P,oult . Ca acit P,o
La ers
erGilts
Non -La ers
rBoars
Pullets
Cow
Other
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
/No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[]Yes
[-]No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[:]No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes�o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

cili Number: 51 - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes
L�(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):
_E
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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ,,�,,//'' o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes i i( No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)T.,
9. Does any part of the waste management system other than the waste structures require ❑ Yes I YNo ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 12r<o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �lo ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP []Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑ YesoNo
❑ NA
❑ NE
❑ Yes�oNo
❑ NA
❑ NE
❑ Yes�No
❑ NA
❑ NE
❑ Yes E5No ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes 0No ❑ NA ❑ NE
❑ Yes On ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes eo ❑ 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 �No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[FaciU6 Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ZINO ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes �� ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes '[a -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No _C],WA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
se'driwiugs of facility `to better explain situations (use additional`pages as'necessary).
❑ Yes
j—].?Co
❑ NA
❑ NE
❑ Yes
;2"�o
❑ NA
❑ NE
❑ Yes
. fNo
❑ NA
❑ NE
❑ Yes
'2rl�o
❑ NA
❑ NE
❑ Yes eNo ❑ NA ❑ NE
❑ Yes Ej'�No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
M,f,ct/'e- �-IX 1. i`ft Sk'�C Ij4 l..-S O'_� G�t?%A� �VP(,✓�C/V�/
CT ( Ka -7- _5_9
c",`",�
Ct , 4-
P, C Ik/-cs �a k-< r\ Ar,,. �;p 5p«
�a^P 4QQ1,caf.o,, l�tn 30 �a�f•
P
Reviewer/Inspector Name:
11 VC3 L't
Reviewer/Inspector Signature:
Page 3 of 3
hone: f tb?�Q �3� I—
Date:
2/4/20I5

Reason for Visit: it) Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: /0 ZO Arrival Time: Departure Time: ® County: Q)J[-k Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
i
OnsiteRepresentative: 000A-44AP MSLLZ(L,
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: IB6013
Certification Number:
Longitude:
-
rCE
3
�
t;N, `ig'�✓i`:4 4v°4T`t.
}+M1K
:.. ■-_-_
per.
\ •
-�
Re MR. on uly
■�--
,e`:
0
;�
"Mi. 1YM.��4T4FdyF;y[o,^F'/'�-T^mY�
O 3,r -k .�WMmv va�..■�--
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 E/o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0/o
❑ Yes u1 0
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: Date of inspection: /O 1124
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Q0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): fig_
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 [?fNo ❑ 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
,ptl threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ErNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes jNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 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
� �Io
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
/U1 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
NNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[DNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
&No
❑ NA
❑ NE
Required Records & Documents
No
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[�
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
dNo
❑ 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 o ❑ 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

Facie Number: A I - Date of Inspection:
24• Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2f No
25. js the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [3/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:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ,—, ,N,/o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes I Vivo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 17<0 ❑ 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 QX/o
❑ Yes No
❑ Yes OrNo
❑ Yes ❑ No
❑ Yes
❑ Yes rNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
Phone:010 1 q / i —93
Date:

Reason for Visit:�Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Arrival Time: ^® Departure Time: County: gyp( nJ Region:
Date of Visit: P-61.
Farm Name:
—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: Sot' AT" ru.J Msk Lisa Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I I b9
17)
Certification Number:
Longitude:
Design Current
Capacity Pop.
Finish
Wet Pointry
Layer
Desigtt
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
airy Cow
Feeder
?
Non -La er
Da' Calf
Finish
Wean
rpFarrow
D , r PRoul .oFinish La ers
Design
Current
Da' Heifer
D Cow
Beef Stocker
Feeder
Non -La ers
Beef Feeder
I
Pullets
Beef Brood Cow
Other
Other I
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 /No ❑ NA ❑ NE
[:]Yes ❑ No
❑ Yes [:]No
❑ Yes ❑ I)0
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412014 Continued

Facitily Number: - (- Date of Ins ection: 'i p t I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes E No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2
LA (rep-+✓
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 environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes �/ I 0 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes m 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 EdNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 124 ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 o
❑ 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
ZNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
U/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
do
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 dNo ❑ 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 ElSludge 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 21412014 Continued

Facili Number: 42- Date of Inspection: ID14
24. Did the facility fail to calibrate waste application equipment as required by the permit? [—]Yes Z'No
25. 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:
❑NA ❑NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes LA No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EdNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes (Z/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
[�/No
N�o
o
❑ NA ❑ NE
❑NA ONE
❑ NA ❑ NE
IComments.(reter to question if): Explain any YEN answers and/or any'additional recommendations or any other comments. I
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signatm
Page 3 of 3
Date:

Reason for Visit:
Date of Visit: F9
Farm Name:
—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
O Complaint O Follow-up O Referral 0 Emergency 0 Other O Denied Access
Arrival Time: p Departure Time: IS County: I , Region:
Title:
Onsite Representative: :IJOATHAN (v 1y uJM_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 19 6 9 3
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity Pop,
11,11111 1111
Wet Poultry
JLayer
Design
Capacity
I
urrent
Pop.
Design Current
Cattle C+apacity Pop.
i Cow
Wean to Feeder
3UO 2 66o
Non -La er
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oultr.
Design
Ga _achy
Current
P,o P.
iry Heifer
Cow
n-Dairy
125SLOckor
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
it5eeti3roodCow
Othe
01 Other
I
Turkeys
ITurkeyPoults
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 7 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes �No ❑ NA ❑ NE
❑ Yes /dNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facile Number: l - ll Date of Inspection: I O 4
Waste Collection & Treatment
4$js 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: L A(W60
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 25
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 7[ f 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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes dNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [2No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes UfNo ❑ 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): l
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
M No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
6/No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E>No
❑ NA
❑ NE
acres determination?
/
17. Does the facility lack adequate acreage for land application?
❑ Yes
2 `I
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
dNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
dNo
❑ NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes <o ❑ 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 dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes dNo ❑ NA - ❑ NE
Page 2 of 3 21412014 Continued

FaeitiNumber: Date of Ius ection:
24..Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2� o ❑ NA ❑ NE
t
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [:]Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [( No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 3 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
ONo
❑ 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
U io
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
D N
❑ 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
To
❑ NA
❑ NE
Comments (refer to question #): Explain any, YES answers and/or any additional recommendations or -any other-comments.."z.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
J �u>J
2N LL'L.
Phone V � 1 G - Kq!
Date: I iJ 4
2/4/2 b14

Type of Visit: O'Co Hance Inspection U Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: F4216 Arrival Time: Departure Time: County: D,pilij Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: t w)gi[jj11d M_T(bt/ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: W3 &� &
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
11.06
1
INon-Layer I I
Dairy Calf
Feeder to Finish
Farrow to Wean
Design Current
D . P,oul Ga aci P,o ,
Layers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ YesEl
❑ Yes
❑ Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 21412011 Continued

a
IFacUity Number: Date of Inspection. It
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0'/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: (-A &arwJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): aC
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 E21 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 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ 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 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): i
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
E/
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑
Nn
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[:3Yes
LJ 'Vu
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
do
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Required Records & Documents
NNo
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
,2
I yNo
❑ NA
[3 NE
the appropriate box.
T
❑ 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❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[Facility Number: Date of -Inspection: 11 13
Did the facility fail to calibrate waste application equipment as required by the permit.
❑ Yes
❑ NA ❑ NE
oe24.
(o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
12<0 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O N ❑ 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
E2<o ❑ 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
E34o ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
040 ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Er"N; ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ;2 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).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:
g1t)A94 -

Il ype or visit: U Compliance Inspection V Operation Review U Structure Evaluation (-)Technical Assistance I
Reason for Visit: tC1J Routine 0 Complaint Q Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: J bFL'T: / Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
OnsiteRepresentative: 6oNCT4ikJ ✓AzuL rl_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: IM3
Certification Number:
Longitude:
Swine
Wean to Finish
Design C•ucrent
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
140
Non -La er
Da' Calf
Feeder to Finish
Farrow to Wean
I) , P,oul
Layers
Ga aci
en
P,o
Da' Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
lBeefBroodCow
Other
Other
Turkeys
Turkey Poults
Other
0
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 1�No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes F&o
❑ Yes YNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facilj ty Number: Date of Inspection:
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 1
Identifier: {At6Fftd
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): 31
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes E5 No ❑ NA ❑ NE
[—]Yes J[/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes dNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Vo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes E�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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
❑ Yes 0 No
[—]Yes [yNo
❑ Yes [;No
❑ Yes ['No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes [�No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes No ❑ NA ❑ NE
❑ 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 u1 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [�No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili ty Number: 31 -241 Date of —Inspection. It. t 1'1✓
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25.18 the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
[3No
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
CNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: /
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes LJ o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ 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). <*'.
5/101wLL, IltkGS IJEEO P�- LIC-0 6r(' DZCE PALL_
Reviewer/Inspector Name: V O Hd A 13 (ja- . Phone: C110) 716 "-l30 f
Reviewer/Inspector Signature:. 44,,,a.C/l{' Date:
Page 3 of 3 21412011

Reason for Visit: p Routine Q Complaint O Follow-up O Referral O Emergency O Other C) Denied Access
Date of Visit: Arrival Time: Departure Time: 9 d County: Dilell/v Region:
Farm
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative: J0NA p0 f4aLr,_f_
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da Cow
Wean to Feeder
$?60
DDT
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oulh,+
Layers
Design
Ca aci
Current
Pao ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 [j o ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes V ❑ NA ❑ NE
❑ Yes d ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: Date of Inspection, Ib 2,v ll
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure I Structure 2
Identifier: LA (Vopoj
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 L
No ❑ NA ❑ NE
❑No ❑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 [i] No ❑ NA ❑ NE
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 ❑ 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 0 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?
Eo
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes dNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes D/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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 Z7�to ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: S1 - 2111 Date of Inspection,
24')Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes VNo
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
❑ NA ❑ NE
❑ NA ❑ NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Ej No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 6/No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewerlinspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes C3"No ❑ NA ❑ NE
[—]Yes WNNo ❑ NA ❑ NE
❑ Yes [,] No ❑ NA ❑ NE
❑ Yes WNNo ❑ NA ❑ NE
[]Yes [�No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
(Comments (refer to question ti): Explain any YES answers and/or any additional recommendations or any other -comments ;a k +� "w,l
Use drawings of facility to better exolain situations (use additional oases as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
JOAO rA"(N C'L Phone: 910 q g
�) D Date: I p 2 0
2/4 011

Division of Water Quality.
O Dtvtsiou of Sod and Water Conservati
Type of VisitCoorliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit G Routine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Is iti 10 Arrival Time: Departure Time: County: DUPLZ4 Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: G-OWAiitAOS fY)X_LuC(L
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =u =` =" Longitude: [�o "
.
-
Design
� =✓s s � .,�` ,ram .a a,,*�N.w�
Current % Destgnrr Current��
Destgn
Current
�Swme
;Capacity
Populatioq-°. Wet Poultry -'^Capacity Populatioq. {Caitle
C pac ty
Population
❑Wean to Finish
z ❑ La er I
❑
Dairy Cow
Wean to Feeder
3200
1 280U
f ❑ Non -Layer -
e ❑
Dairy Calf
El Feeder to Finish
Iy;:^
�'#ter, '❑ Dairy Heifer
3 ❑Farrow to Wean>
❑ Dry
❑Farrow to Feeder
`' Non-Dairy
❑ Farrow to Finish
I
„� ❑ Layers ❑ Beef Stocker
ElGilts
I
=; ❑Non -La ers
❑Beef Feeder
rvr ❑ BoarsElPullets
"
❑ Beef Brood Cowl
❑ Turke
s
❑Turke Points
0kr
; ❑ Other Number of Structures
3,m
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes U✓ No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
El No El NA
❑NE
❑Yes
❑ Yes
❑ NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: — a l Date of Inspection to Z D
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2 No
❑ NA. ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: IA Cam*
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ZS
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
E4
❑ 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?
u/
•T es
❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
d o
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E�No
❑ NA ❑ NE
maintenance or improvement?
Waste Anolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
����
L3`No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
ElG,Yes
.//
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?
❑ Yes
[� No
El NA El NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
EJ/No [INA ❑ NE
17. Does the facility lack adequate acreage for land application?
ElD Yes
No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA ❑ NE
Comments (refer to question #): -Explain any YES answers and/or auy recommendatious:oi any other comments
Use drawings of facility to.tietter explain sitdations:'(use additionali.pages,as,necessarv)e
..
7,,' &EA ofr -I'm
SA40cZAJ&,5 d XA71C-r2O.t: 6[r �S(tf li✓i4t-t--
a
Reviewer/InspectorName
fo C(,:. Phone:
Reviewer/Inspector Signature:
Date: 6
Page 2 of 3 1 12128104 Continued

Facility Number: — Date of Inspection 0 a
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 ONo ❑ NA ❑ NE
❑ Yes Ld No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
/❑
ICJ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
5�/�(�°
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
-Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
—L�'J �No
E—Ko
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�.k<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[21/No
❑ NA
❑ NE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
No
❑ NA
❑ NE .
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
�ILI
�j No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
Wo
❑ 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
-- //
LI'N'o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
E�/No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
o
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit (3JCo fiance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit loutine O Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 4 It o Arrival Time: (Ott Departure Time: County:'OUPLloO Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: Qc iJ AT14R9-J Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [70 F- [7" Longitude: non n
Design
Current Design Current
Design Current
Swine
Capacity
Population Wet Poultry Capacity Population
❑ La er I
Cattle
Capacity Population
❑ Wean to Finish
❑ Dairy Cow
Wean to Feeder31,.00
240t, ILJ Non -Layer I I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Gilts
❑ Non -Layers
El Pullets
❑ Turkeys
❑Beef Feeder
❑ Beef Brood Co
❑ Boars
Other
❑ Turkey Poults
❑ Other
❑ 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 LINo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
El NA
[I NE
❑ Yes ❑
❑ Yes No
El NA
El NE
❑ Yes IJ No
❑ NA
❑ NE
12128104 Continued

IN
FacilityNumber. 3 — Z) ( Date of Inspection l�
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EdNo ❑ 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: L.P'CrccVtW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 3No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes n No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes L'J No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ON ❑ 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 E3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes LJ No [-INA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below., ❑ Yes u No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
,E] No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
[;Io
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
[5'1 Io
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes Nj ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
c'NT_VuUr. Lwc-cr CdArrA.ol_ muctd rhis- 4V60 Row` *12.Ev7'0S tE
IReviewer/Inspector Name I mat-IAJ {_AAAI&L L 1 Phone:
Reviewer/Inspector Signature: Date: ' r 6
Page 2 of 3 12128104 Continued

Facility Number: 'j — Date of Inspection 9 tr o
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
El NE
�No
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
CQ No
❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�dNo
❑ 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 InspectioZNo
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[I Yes
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ICI
El NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ElNA
[INE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
[I NA
❑ NE
26.
Did the facility fait to have an actively certified operator in charge?
El Yes
LJNp
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
L! No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
�//
I�I No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
U440
❑ NA
❑ NE
30.
and report the mortality rates that were higher than normal?
At the time of the inspection did the facility an odor or air concern?
1
pose quality
El Yes
E N
[I NA
[I 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
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/No
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
1Q No
❑ NA
❑ NE
12128104

Type of Visit QrC,00 pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit l'J Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p Arrival Time: Qd Departure Time: County: _9fJptrtj Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: F o[7, M Longitude: n o n' n
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
E Wean to Feeder
137,40 1,dW6
JLJ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Co
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
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 VI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
El No
El Yes
�N
❑NA
❑NE
El Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — ZI I Date of Inspection 7 e
Wgiste Collection & Treatment
14. 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
Identifier: (A6,o6A)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31
❑ Yes I21/No ❑ NA ❑ NE
❑ Yes _ ❑ No ❑ NA ❑ NE
Structure 2 Structure 3 Structure 4 Structure 5
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
Structure 6
No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental notify DWQ
7. Do any of the structures need maintenance or improvement? d Yes 2_5 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes I'_I No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,.//
9. Does any part of the waste management system other than the waste structures require ❑ Yes II No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IJ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes .CJ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? El"Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
IS,) FraDS SfCl.c. NELD Ar"-rl:dni
A,Je ALso
❑ Yes
&-oslt _ ► & W (J'
❑ NA ❑ NE
❑ NA ❑ NE
El NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
IReviewer/Inspector Name - p" L ( Phone:
Reviewer/Inspector Signature: Date: 9� y �o r
Page 2 of 3 12/28/04 Continued

Facility Number: — Date of Inspection
Rettuired Records & Documents
1— 1
11,9. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes Eu No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes td No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UrNo ❑ 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 dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Cj No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ElNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑Yes IN
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
L2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
dNo
❑ 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
U 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
O/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
ffNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
M No
❑ NA
❑ NE
Additional Comments and/or Drawingsi'
Page 3 of 3 1228104
Page 3 of 3 1228104

rq 0 Division of Water Quality
FaCIGty Number I 'J� u 0 Division of Soil and Water Conservation
0 Other Agency
11
Type of Visit cotnpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: , + Arrival Time: Departure Time: County: t�v Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
� ,,,
OnsiteRepresentative: JA' A f�t1--Ll�'l. Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: o
Latitude:
Swine
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
3 I I ❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude: F-1 o = ' = „
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non-Daity
❑ 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 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes E� El NA El NE
ElYes No ❑ NA ❑ NE
12128104 Continued

• - Facility Number: —
Date of Inspection /r d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
/Structure 1 Structure 2 Structure 3 Structure 4
Identifier: Lii(fd6k)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): (,
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes Id No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ENo ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t7heat, 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? El YesWo ❑ 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 1-11Yeso ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Wo ❑ NA ❑ NE
maintenance/improvement? .,//
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes C No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
s
Yes
fI�o
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
Yes
[�]�p�J(` o
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre detertnination?❑ Yes
[J'NO
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
[allo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
0 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):
!S> FiELtI FoR- 14,AX, �LF/%lr� �OpK6fI, /(/a /9�/l
•
Reviewer/Jnspector Name 3
A?AlAA- Phone•
Reviewer/Inspector Signature: Date- /
/ 12128104 Confinued

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

t. —� Division of Water Quality /
.. �F:rcth Number � 0 Division of Soil and Water Conservation iV/
0 Other Agency
Type of Visit /0-compliance Inspection 0 Operation Review 0 Structure Evaluation
Reason for Visit Routine O Complaint On Follow up O Referral 0 Emergency
Date of Visit: Q Arrival Time: Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: b' e N O K. %%�� H/"�//—
61
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
0 Technical Assistance
0 Other ❑ Denied Access
Region:
Phone No:
Integrator: 601l1'.SA-c
Operator Certification Number:
Back-up Certification Number:
Latitude: = U = ' = Longitude: = o = , = «
Design 'Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish I
�^- i ❑ Layer
Wean to Feeder �.)D 1[ ❑ Non -Layer
�J Farrow to Feeder
❑ Farrow to Finish
Other
❑ Other
Dry Poultry
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?
Design Current
Cattle. Capacity Population`
❑ Dairy Cow
❑ Dairy Calf
I
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures`.
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
7
• Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments f fra
Use drawings of facility to better explain situations. (use additional pages as necessary):
IReviewer/Inspector Name I AL �4jf/ Phone: G I
Reviewer/Inspector Signature: Date: a 06
Peon 7 of 7 12 R/04 Continued

Facility Number: 3 —,2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
❑ No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No ❑ NA
❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design
g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
lyes
❑ No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking [Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
litional Comments and/or
) (U
�. 17
Q�O(o
alo ,r
45yoy/an/5 T
Tim
//,(, 'pa 4 `eo' 5 / <-
N t(I!/ olCte✓/ek Y
Page 3 of 3 12128104

Dis�sion of Water Quality
Facility Number = a I I �' Division of Soil and y ateConservation
0' Other Agency
Type of Visit Zompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C1d Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Arrival Time: $ 4 S Departure Time:
I Doh County: Quor&A Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: CSkJo I<-ENNt:O)�
Certified Operator: K-_r_t )e Curt..,JEGA`e
Back-up Operator:
Location of Farm:
Latitude:
n°
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
L-1„ Longitude: r]°r�
"Wea!
Design
C p ctty
zfi
t �'
/3urrentF:e
Populahon
xr ,
, st
'tWet pultryA'�Cap
- %
Design
cny
i
Current`'
Pop 1 ttoo
ri
`Gattl`
.,,,. .
; ° 't'"Design�.- Curieot
C�a�p city Population
® Wean [o Feeder
$'tAo
rao
❑ Layer
❑ Non -Layer
�`S�P,oulmu�y«m'
"A`
❑
❑
DairyCow
DairyCalf
Feeder to Finish
❑
❑
❑
DairyHeifer
❑ Farrow to Wean
D Cow
❑ Farrow to Feeder
Non -Dairy
" ❑ Layers
❑ Farrow to Finish
❑
Beef Stocket
❑ Gilts
Non -Layers
1. ❑
Beef Feeder
❑ Boars
❑Pullets
❑
Beef Brood Co
❑ Turke s
Other
�"
p
'�3€`t.'�
Number o f Structure's:
x
❑ Turke Points
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes LI No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
L/I NN ❑ NA
El NE
❑ Yes
LJ No ElNA
❑ NE
12128104 Continued

Fd¢il)ty Number: '�) — t
Date of Inspection 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: t.^6 oa 01
Spillway?:
Designed Freeboard (in): ( 1:1
Observed Freeboard (in): (4Z
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 dNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes 6No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? El LI No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes �CNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,(/
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑Yes dX0 ❑ NA ❑ NE
maintenance/improvement? /
1 L Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes C No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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. Croptype(s) (rc2MvVA C 1-L) SC-0
13. Soil type(s) A r,-a,-? t w_,L.E
�(
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? Z'Yes El No
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'! El Yes EETN�Q
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes Ly N
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? El No
❑ NA ❑ NE
Com nentss(r,efer,to questton H) Explain any YESvanswersfand/of y recom' m° e d honss , any oth �commenis
�r
1 �uT F a ca't Yt-ft
IIse drawings facthty to)better (pse
of explain situations addthonal pagestasnec'essary):
nSPcr,
I5.) 3nsay�s�� t1AS lt>tnJ IJEY PLEASC (,—X'ALIL dAl r4�=S A",
pjEt LXNA4� APPL-MCNTr_ieJ C l.? Tort CACH CiElo)
Reviewer/Inspector Name I .:10i4tj t AR�IJ(—L Lam/ '� Phone�ytb) �5S— �t 071 x ?03
Reviewer/Inspector Signature: AA. y6A,-- ,/ Date: 3lgl aS
Continued

Facility Number: Date of Inspection $ oS
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other ,_,(/
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes NJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? fie/ 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 jNo ElNA ElNE
El1
Yes LI No ❑ NA ❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
dNo
❑ A
❑ NE
ElYes
[--]No
�A
❑ NE
El Yes
❑ No
L�J NA
❑ NE
❑ Yes
&No
❑ NA
❑ NE
❑ Yes ❑ No ENA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes LINo ❑ NA ❑ NE
❑ Yes �No El NA El NE
El Yes Uo El NA ❑ NE
El Yes LJ NfN❑ NA ❑ NE
ElYes L] No ❑ NA ❑ NE
12128104

of visit f Gompiiance Inspection O Operation Review O lagoon Evaluation
Reason for Visit A Routine O Complaint O Follow up---Ottt Emergency Notification O Other
Facility Number Date of Visit: 5 / O Time: 3 ;y
JO Not Operational O Beli
0 Permitted 13 Certified ❑ Conditionally Certified 0 Registered
FarmName: ........../5�..... /_._ , .... G....,.--------- ..... ..........................
Owner Name:�T(cEn.L��1L.C4..... ....... —_--.............................
Mailing Address: ..............................................................
❑ Denied Access
Date Last Operated or Above Threshold:..
County: _rf9�,ln.___.._-------------
Phone No:
FacilityContact:.._._._._._..._..............._..._...._.._..._.___._._.. Title: ....... _— ........ ....................... _.... Phone No: ....... ___....._..........
Onsite Representa�iveJ([J2f.Cr_�,FC�EL[..../.EfL���_.. Integrator: _(Q�P t'C2..... _... ___._.__...........
Certified Operator:_..--•--_._...._.........._._._..__..
Location of Farm:
Operator Certification Number:
JErswine ❑ Poultry ❑ Cattle ❑ Horse Latitude O• =' =11 Longitude =• =' =11
- - Cprren
Dest 4 Current A' Design Giirrent 3 ¢ Destgri t
Swme.- Ca an
'Po tilation' Poultry _ _ Ca'aa
,.Po`vlation :`Cattle " .-Ca aci ..Po""Mahon ,:
ean to Feeder
❑ Layer
❑ Dairy
Feeder to Finish
`_
❑ Non -Layer
❑ Non -Dairy
Farrow to Wean
Other
Farrow to Feeder
55
Total DtstgftCagactty r4 3; 2 O p
Farrow to Finish
Gilts
Boars
Total SSLW-::
G O
`r
Number of Lagoons
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 man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
12112103
_..._.1......... ....
R
❑ Yes AJ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
[]Yes �Io
[]Yes Io
❑ Yes 0<0
Structure 6
Continued

Facility Piumber: 3� —a� Date of Inspection !3 O
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
ZNo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
W No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenancelimprovement?
❑ Yes
JA No
8.
Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
[ No
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
P'No
elevation markings?
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
ONO
11.
Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
XNo
❑ Excessive Ponding ❑ PAN Overload ❑ Frozen Ground ❑ C and/or ' c
12.
f�per
P/�H,ydTulic
Crop type L(� 11—J—� s/ GC � (/f/,E
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan ( AWMP)?
❑ Yes'VNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
P(No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
XYes
❑ No
16,
Is there a lack of adequate waste application equipment?
❑ Yes
'ONO
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ONO
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes VNo
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VNo
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes &No
Air Quality representative immediately.
Field Copy ❑ Final Notes
/5) zl"&W04 L'.� F 3 /✓EPOS mP.eodfm��) i, F��o
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
I2112103 Continued

Facility Umber::`; f —alb Date of Inspection L5 & oYl
Required Records & Documents
21. Fail have Certificate Coverage & General Permit Permit
No
to of or other readily available?
❑ Yes ;2
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 Rto
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes XNo
❑ 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 2 No
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 ONO
(ie/ discharge, freeboard problems, over application)
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes f2'f10
28.
Does facility require a follow-up visit by same agency?
❑ Yes ZINO
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ZNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes R!(No
31.
If selected, did the facility fail to install and maintain minbreakers 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 ❑ No
❑ Stocking Form ❑ Crop Yield Form []Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit to Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit PRoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: /o D Time: / 0
U Permitted 13Ce 'tied 0 C(o�aditionaally Certified 0 Registered
Farm Name: L75 r ` 7 Ime,
Owner Name: 7Z5
Mailing Address:
Facility Contact: //�� ��-- �/`LTnitle:
Onsite Representative: Vwr rTrcl zt
t
Certified Operator:
Location of Farm:
Date Last Operated Aboo�ve Threshold: _
County: ll Glr zl /:;/
Phone No:
Phone No:
Integrator: �TOGDS�
Operator Certification Number:
r/t� rn�i6.d. 1 Io1 1, lu r.. .. A.. 1 I* 1,1 lu
' Design
S 'ne ,Ca aci
Current w i '� "Design ; Current
P,o ulatioo P�oult Ca aci Papule�ho
Design Current
Cattle, : Ca aci P,o ulation
Vj Wean to Feeder
�; ❑ Layer
❑Dai
Lj Feeder to Finish
i, ❑ Non -Layer ❑Non-Dai
ILseALa KIMI E
❑ Other
Total Design C+apacity
Total SSLW
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds /Solid Traps ❑ No Li uid Waste Management System
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes/No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑,,,No
❑ Yes
,,,��///
LQ No
❑ Yes
I ANo
❑ Yes
T)2T'No
Structure 6
Continued

Facility Number: -Z/ Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
I(J No
seepage, etc.)
/
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
,�,/
1�,� No
/
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
//No
LjN0
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
El Yes
No
�
Waste Application
10.
Are there any buffers that need maintenance/improvement?
Yes
yZ No
11.
is there evidence of over application?/ Excessive Ponding PAN ❑ Hy Ic Overload
p❑
Yes
❑ No
12.
Crop type .�(� -^I �A`i!`(� LL .��i�-�L � F__� 6 U, �
13.
Do the receiving crops differ with those designated In the Certified Animal Waste Managem t Plan (CAWMP).
❑ Yes
14.
a) Does the facility lack adequate acreage for land application?
El Yes
-,/No
trd�NNo
b) Does the facility need a wettable acre determination?
❑ Yes
/� o
c) This facility is pended for a wettable acre determination?
❑Yes
1/L,I/No
15.
Does the receiving crop need improvement?
1
y� Yes
[I No
16.
Is there a lack of adequate waste application equipment?
/❑ Yes
VJ No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
Y�No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
El Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
�fNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
—No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
VNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
iCom°ments (refer to question #) Explain any YES answers and/or any recommendations oT s°uy o; ei')commeiits
Use drawrngsof facility totbetter explamsrtuations (use additional pages as necessary) o +�
ty,, t)#. Field Coov ❑ Final Notes
,tt, ,a ,
,A!5
11 0UF1?1WPtZCA7rGN 01= ` N FrELp 22 z0rQE5 f 8/�Aob
fin. O�FRAPP�zcA zoa �A-{ ACE gFFn1 N010ZbEp 00(14 7MF2
IB
KFCORI� KF FQZf�G-. I ��l�� �gt7E g F 6t� �JO(�F Nr c-u5zoo PEE rG7
AE PjEzCJFF� OPENK-702Sr �l�Ct{ G�GJ� UJ4 5 QJLy
Reviewer/Inspector Name •
Reviewer/Inspector Signature: Date: 0
05103101 1 1 Continued

v
Facility No Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below
❑ Yes
PdNo
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
YINo
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
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
,,,��///No
//yam No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
/❑ No
Additional Comments and/or Drawings: a a
15) REeEZ�� �� CRoP ���r�uP�,\ j�CEEDS -� ri�PRaJF.MF
/yR_ES-1S OF ,FA(`} �J �lJi J-�1D^\ /%Po9�o2M�y
t V �FT 1 'S SL S f AIv CF R26 r,
�DI1(.Z��L� ll,Pr7ER.
RBI TFF�t�- EL SF ,G5 1IJ
DROP-R. DW O r R Zs
05103101

(Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other El Denied Access
Facility Number
Date of Visit:
j_ s /
�rmitted 13 Certified 13 Conditionally Certified 0 Registered
FarmName: ........ L...(.. .. ....�.. ... "........................................................
.....
Owner Name: ........ _,,,„�.�/�!l=..
Facility Contact:
Title:
Time:
Operational 0 Below
Date Last Operated or Above Threshold: .........................
Count
y: Q%.,,ryr. AnL................................
Phone No:
Phone No:
MailingAddress: .................................................................................................................................................................... . ............ ..........................
...............
Onsite Representative:... .?.Y:c3„ '... ,�.. .� ...,� �.. Integrator :................ .Gi.r �_,�Jz,-,�......
��,,
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
krSwlne []Poultry []Cattle ❑ Horse Latitude Longitude �• �' �"
Snine
Current
Population
Wean to Feeder
I izee
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design' `:
Poultry Caiaci Po ulatiou Cattle Ca aci
❑ Layer EO Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other . .
Total Design Capacity
Total-SSLW C
Number of Lagoons JE1 Subsurface Drains Present ❑ I-agoun Area JEISpray Freld Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts ,
1. Is any discharge observed from any part of the operation? y�l�rr
❑ Yes to
Discharge originated at ❑ Lagoon ❑ Spray Field [I 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? —'y'
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 o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway Cl Yes O\No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..........—VT.._,...............................................................................................................................................................
Freeboard (inches): ,
5100 Continued on back

Facility Number: 3: -- L u Date of Inspection �J Printed on: 1/9/2001
. —ems
5. Are there any immediate threats to the integrity of any of the structures ohs Zed? (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 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 RNo
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 E(No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 5�10
12. Crop type g 14 , SGr
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
1 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
o
b) Does the facility need a wettable acre determination?
❑ Yes
;0
c) This facility is pended for a wettable acre determination?
❑ Yes
S No
15. Does the receiving crop need improvement?
❑ Yes
RNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
�fNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes KNo
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 KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes qN0
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 5fNo
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 P�No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes •�rNo
24. Does facility require a follow-up visit by same agency?
❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes No
"(�iQYiolatiptis;o dQfjciencieswire)IgCea-dot`ih tjtjs;vjsjt; Yogwill•ieceipt gtZtpitjtgr•;•:
. - . - cori•es orideii :e: about this :visit : . ::::::................ ::::::::: :
Continents (refer to question #): Explain anyYFS answers and/or any recommendations or any other comments Fw
Use drawings of facility to better explain sitatatioas: (use additiopal:pages as necessary):: =�
part G� �L c2// wa �l GutUi. �icrt�+'j�crL ,
f�cnv.� 1cesP�nQ �oots 5 � r
`J d
P
Reviewer/Inspector Name d �.
Reviewer/Inspector Signature: -fI/PA ,%,�%6pt.C.._. Date: „? ^ t IPI 5100

Facility Number: — �/ Date of Inspection / p Printed on: 1/9/2001
Odor Issues ���,,,......///
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes y� 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 KNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes qNo
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 m 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 "Itzo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Woo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Ofio
5100

_ V
Division of Water Quality -
O Division of Soil and Water Conservation'
O Other Agency
Type of Visit t ``Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit t -}g,Routine O Complaint Wollow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: — RS D Time: �/ 3: Printed on: 10/26/2000
Facility Number Z
O Not O erational O Below Threshold
0 Permitted .Certified 17 Conditionally Certified 0 Registered Date Last Operated or Above Threshold . ........ ........
Farm Name: ........._f i.. 'S_�.._ .�T County:........,. IF
;... ......................
OwnerName: ................................................... ........................................................................ Phone No:.......................................................................................
FacilityContact: ....... f..:.].?::Dl..� .................Title:... .................................. Phone No:...................................................
MailingAddress: .................................... ................................................................................ ........................................... ........................8............................ ...
OnsiteRepresentative: ....,._Y ....... Integrator: ..............1DI�C .
� �.�..............L'�1�.-�h��............................ 1, ..............s_b�......... ,...l..l...
Certified Operator:...._. ., Y Ak...................A.: Operator Certification Number: .... %I,e..,��Q,.� U
..................
Location of Farm:
lyswine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =` =" Longitude =• 0' ="
Design Current
3w9ne Capacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Design Current
Poultry _ Capacity Po mlation
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present
Holding Ponds / Solid Traps ❑ No Liquid Waste Managen
Discharges & Stream ImpacLS
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 Ilow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Field Area
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
.Ax,
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
identifier: .........................................................................................................................
❑ Yes []No
Structure 5 Structure 6
Freeboard (inches):
5100 Continued on back

Facility Npmber: — 7j Date of Inspection Printed on: 10/26/2000
5.
Are there any immediate threats to the integrity of any of the structures obse ed? 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
❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
❑ No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
❑ No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
❑tt No
11.
Is there evidence of over application? ❑ Excessive Pending El PAN [I Hydraulic Overload
❑ Yes
ANo
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment'?
❑ Yes
❑ No
Required Records & Documents
IT
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ❑ No
. ' .. yiol.. 0 .s.o..... a ... were itbted• during this:visit: You will-i•eegiye 0 fui•thgr
cories otidence. abouE 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)
D ��OW tc rGl/ t L W l[Nn i rt Lav�S` . =yJ, cviitsv— b W Q C
a-)1-PO�� t� �a5 rD u.w[p� rtCm�s C`i�1.t2 L fws5:61
br"r l; Cfi7� le"a Pa j �S, MT . �rt� 1 Tf ' t �c
1 ! i V W� /
`C C-Caok p tW 1 �0 5 tit t �`%
v,�vv retw�t 1 �L�t�`� '(lac- �rocr�) ►t7a5�,YW� YtcPraln
1eV_ ,'77 1 +. Yl'� 3.ork » co.Klot
Reviewer/Inspector Name
Reviewer/Inspector Signature: r'� ,,,_a - _ Date: 6,5- D I 5/oo

Facility Number: J7 — y / Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor 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
AdditionaLComments:an or,Drawings: - - - -- - :- -
3 dAl5 tom- 5 1 �V OVNA- z
rcLt -i-
( V-re-n
w I'7l1-1 . as '7/1-i1,0e,
-7/,;-1
1:5 VC-ccu-k- VO 1
��1°►laq C
i — 9-�
5100

a,
01,vf Water Quality ion o
Q Division of it and Water Conservation
Fs-f-
of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other
Facility Number e Date orvisit:
E3 Permitted kCertified E3 Conditionally jCe�rtified 0 Registered
Farm Name: .........._.-i j....._libt_-..........._.Y..�_S_`,..........(.................................
OwnerName :.......... ...., n. _ ....... ..............I.�...'.r.P...l.<..k.............................
Facility Contact:
Title:
❑ Denied Access
Printed on: 7/21/2000
10 Not Operational O Below Threshold
Date Last Operated or Above Threshold: /.........................
Counh^ ........"Y'.'<z�s.�....................`.�!................
Phone No:
Phone No:
MailingAddress: .......................................... .................................... .
Onsite Representative. _.�_.,c.�... .1_4.t...(c ._.. ", .�:�.,..:.,.._ Integrator: ,.,,,_, ".. _(�..� ,('C.,,S,� l�....._ _ L.
Certified Operator: ...................._.........._...................._...............,._......_..........................., Operator Certification Number:.......................................... 1
Location of Farm:
ib Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =1 =u Longitude =• =1 =1'
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Po ulafion Cattle Capacity Population
Wean to Feeder ❑ La
o yer ❑ Dairy
❑ Feeder to Finish JE1 Non -Layer I JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lag,.nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
%No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑Yes
❑ No
b. If discharge is observed, did it reach Water of the Stale? (If yes, notify DWQ)
❑Yes
❑ No
c. If discharge is observed. what is the estimated flow in galhnfdl
-.N
---
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
qNo -
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
Erlo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
WTIo
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ............. �.V.. �.......... .............................. .........
Freeboard (inches): "
5/00
Continued
on back

Facili[ Number: —'L' Date of Inspection 0CV Printed on: 7/21/2000
5. Are there any immelliate threats to the integrity of any of the structures obse edPel trees, severe erosion, El Yes ANo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
Imes
❑ No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
Wo
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? -
❑ Yes
dNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
jR No
11.
Is there evidence of over applicati� ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
, \No
12.
Crop type 1nlJlJ1 l
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.)
❑ Yes %No
❑ Yes ZNo.
❑ Yes [(No
❑ Yes )rNo
❑ Yes �rT'N0 .
❑ Yes <No
❑ YesNo
❑ Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? _ . ❑ Yes
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
fie/ 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?
�' id iltitiso8efciences *C-re:p.o.e..d.u.ri.ng.O..is.:v.i.it.'-.Y.o.uwttebeo fuhefdyoao:r d std
cirrespotidence aboitthis:visit:............... .
1?
❑ Yes KNo
❑ Yes 2J No
9Yes ❑ No
10yes El No
-omments (refer to question fi): Explain any YES answers and/or any recommendations or any.other comments.
Jse\drawings of facility to better explain situations. (use addition 1 pages as necessary): <
7• I �%, , ,n 010 0 v�AA v- 1 Iu 11n tit t� � � �1
�rr1� Gig:Lt wf ..s
-. n n n . — A .1 r 1 /7�._ `J,
I'{
Reviewer/Inspector Name C ,
Reviewer/Iuspector Signatupe�' ..�n/�„� % e� _ Date:
5100

h Facilily Number: ?>' —yl Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes KNo-
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes DAlo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
C!FNo
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
B-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
[JNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
10 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
WO
_AddifionallComments or.Drawings:
Cw� -i-i . S �a C �- �v np i cs✓��
v�4-
�' -4A 'e;
(�N va -
I..
y.," v`� +- 4-t f -

.; [3 Division of Soil and Water -Operation Review
- - _. - -
�Division of Soil and Water Conservation - Compliance Inspection
Division of Water Quality:- Compliance Inspection
'- - 0 Other Agency - Operation Review - -
Routine
of
Facility Number. I
of
Date oflnspection
Time, of Inspection
Permitted qCertified
p[3 Conditionally Certified 0 Registered C
Farm Name: .......1...`...;5....,\\5..
_
...._ ..... .................................................
OwnerName:. .........................................................................................................
Facility Contact:
Title:
County:
Phone No:
24 hr. (hh:mm)
Last Operated:
I'll,
Phone No:
MailingAddress: .............../...........................................................................................................................................................1............................... .........................,
Onsite Representative: .... 1,.f).^.:: :`.......................................................................... Inte-rator:..._ � 1�
1�
................................................................
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number:
Latitude Longitude �• �° �"
Swine Capacity Population
Wean to Feeder
31JLGo
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons
Holding Ponds / Solid Traps 0
Poultry Capacity Population Cattle Capacity Population
❑ Layer I ❑ Dairy —�
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW I
Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
No Liquid Waste Management System
Discharges & Stream Inmac
I. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated in: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
h. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
Freeboard (inches): ........... a�..............
Structure 2 Structue 3 Structure 4 . Structure 5
❑ Yes
X No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
MlnLNo
❑ Yes
O(No
❑ Yes
1KNo
Structure 6
1/6/99 Continued on back

Facility Number: '3 1 — .\\ I Date of Inspection �J
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes W 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 )jrNo
9.
Do any strictures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
1�6o
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
'SfNo
11.
Is there evidence ❑ Ponding ❑``Nitrogen
❑ Yes
„E 'No
12.
-of,over application?
Crop ✓c':`-i�
type ._ ....9✓cj ......I......:r—_\\....q�,�ti.-•.......................................................................................................................
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14.
Does the facility lack wettable acreage for land application'? (footprint)
❑ Yes
VNo
15.
Does the receiving crop need improvement?
❑ Yes
M No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
gNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
JKNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) -
❑ Yes
�(No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
VNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
NYNo
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
&fNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
�j
(ie/ discharge, freeboard problems, over application)
❑ Yes
ey 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
)ZNo
qq,!N,O.vltuatiotls-or UeticlenGeS .W.ere noted attring tuls'visit..'Y'ou W W .receive no Iurtner .' .' .
adrrespotidehce;abbitt;this;visit.;
1 /6/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspection
Facility Number `oL
__ Time of Inspection ®� 24 he (hh:mm)
Registered Certified [3 Applied for Permit M Permitted [3 Not Operational DateLastOperated: ..........................
,C \\
Farm Name: ..._�....�:5.....�..:vS1...........................................................................
County:..........r.....................................................................
Owner Name:....._��\Q— �� ce Phone No: _C� 1 S6�" � 3�
........ .....................
Facility Contact:
Title:
114adtng Address: ..... ...7= ... :".Ivu ...................
Onsite Representative: .... 4�.1....................................................................... Integrator:
Certified Operator: ..................................................
Phone No:
Operator Certification Number;
Locatio of F
LAIN
.......G.....L.`...>_..Q.f..,� .... .... .....yr .. 1-+..�.... �. ....... .....: ...._._KX2....�1....... ......................................
Latitude LI• "I L__j'4 Longitude L_I• 1 11
.Design ` Current `.
, - Design "Current - `Design '.Current "
. Somme ,g, ,-.:Capacity
Population
, _..
Poultry. Capacity Population : ' Cattle' -, Capacity Population
Wean to Feeder
V G
_
❑ Layer
I
Dairy
-'
❑Feeder to Finish
❑ Non -Layer,'. ❑Non -Dairy
[]Farrow to Wean
_
❑ Farrow to Feeder
❑ Other
,
-Total Design Capacity
❑ Farrow to Finish
❑ Gilts
❑Boars
Total SSLW
':Number of Lagoons / Holding Ponds
❑Subsurface Drains Present ❑Lagoon Area ❑Spray Fiel721 d Area
;,
3,''
❑ No Liquid Waste Management System
.�.a
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes P$ No
2. Is any discharge observed from any part of the operation? ❑ Yes ff No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ONo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ \Y*'e Of No
c. If discharge is observed, what is the estimated flow in gal/min? l A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ONo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes Uf No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
gNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25/97

Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons.Holdine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure l
Identifier:
................ ................
Freeboard (ft): ......., 2 :. ...............
Structure 2 Structure 3 Structure 4
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?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes M(No
❑ Yes
,M No
Structure 5 Structure 6
................................................................
.................................................................
❑ Yes
No
❑ Yes
($ No
D�Yes
❑ No
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type .... ....�.'r......f..... CA......................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violatioitsoc deficiencies. were noted dtiring this:visit: YodViiH receive h6ltiriher
..........
correspondence ahout (his:visit
❑ Yes O(No
❑ Yes '154f No
❑ Yes ONo
❑ Yes RNo
aYes ❑ No
❑ Yes P(No
❑ Yes (!,No
❑Yes KNo
❑ Yes t9 No
❑Yes VNo
❑ Yes 4 No
❑ Yes P No
Via)
7/25/97
Reviewer/InspectorName ;.
Reviewer/InspectorSignature: ) C K%� "Z�__ ,Date: kQ, a

❑DSWC Animal Feedlot Operation Review
n �
DWQ Animal Feedlot Operation Site Inspection
Facility Number
21
0 Registered 10 Certified E3 Applied for Permit 13 Permitted
of DSWC review O Other
Date of Inspection
Time of Inspection
24 hr. (hh:mm)
Not Operational I Date Last Operated:
r7t— .............. County:......... iin............................................................
Farm Name:.......�et�gS.....!5�../_'��L........te.+:m.................................................. li1/�..�
Owner Name:......tf1>..._`.:vr.lAS.....
' ............................. 0( ........................... I'hune \o:...CND.Q....:..:q,!g............................................
Facility Contact: ...... . 1...... 9MV................................. Title: ........ pls)YLX...................................... Phone No:... ............
MailingAddress: .......gluo...... M.vA........ O.J. Y.1............................................... ...... 'k.U6.,u..on......... )...CJG................................. ....Asti{.........
Onsite Representative: ..... S.X�NALY.._ ML.............................................................. Integrator: .... 6.41........ C16r1.......... .....................
Certified Operator: .................................................. ..................................................... ........ Operator Certification Number:...... f.Z1.Z�..........
Location of Farm:
rahIt.....Nw..... 103.. tam.... KwIl e.....M ..Xiler.. n..... AI'.... e-........trx\--. o...... l... ll.I... Aar* .......Fare,:..
C5...._.....1-- 3ty5..... o.M., .....PIL�er Cn..Q ....hnr. ncG f...._WC......&
Latitude = •E s a6 Longitude ©•®` 65 "
Swine - Capacity Population
Wean to Feeder
jay
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons / Holding Ponds
Poultry Capacity Population Cattle Capacity Popula
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity Z�
Total SSLW
Subsurface Drains Present JJU Lagoon Area 1U Spray Field Area
No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
R No
2. is any discharge observed from any part of the operation?
❑ Yes
M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? .
❑ Yes
JR No
b. If discharge is observed, did it reach Surface Witter? (If yes, notify DWQ)
❑ Yes
No
c. if discharge is observed, what is the estimated Flow in gaUmi0
Ki
d. Does discharge bypass a lagoon system? (If ties, notify DWQ)
❑ Yes
M No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
gI No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
Cl Yes
19 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
ffNo
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
i9No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
C9 No
7/25/97
Continued on back

Facility' umber: 31—Ztl
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes ® No
Structures (LaEoons,Iioldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes RfNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...................................................................................................................................................................................................................
Freeboard(11):......... .....................................................................................................................................................................................................
10. Is seepage observed from any of the structures? ❑ Yes ®'No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12.
Do any of the structures need maintenance/improvement?
{,Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
10 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
K.No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ........... C#.C_!& s..... 4.Y.mV.r�A............................................. ............... .... :!"l... .5[c it.................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
[]Yes
XNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
XNo
18.
Does the receiving crop need improvement?
KYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
1�LNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
r?�rVo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
1$tNo
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
CgNo
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
C9 No
PIL Noxiolations or deficiencies. were noted during this.visit. Youmill receive no further
.... ........ ........ . ... .. . ...... . ...... . ..
correspondence about this visit:: .
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7/25/97
Reviewer/inspector Name j
Reviewer/Inspector Signature: /SA,. G—, , 411 Date:

Site Requires Immediate Attention:
Facility No. 9L
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995
Time: 13 ify
c
Farm Name/Owner: 5
k Q C j
Mailing Address: t(a o /V -
14
County: i
Integrator.
Phone: 9 — 37 3 o
On Site Representative: . h ti
%j�ozh C Phone: 6
Physical Address/Location: niC 111
Ul
-ru 1 1 ✓1 c Sz i
Type of Operation: Swine `�
Poultry _ Cattle
Design Capacity: /uLkeie�
Number of Animals on Site: o 0
DEM Certification Number: ACE
DEM Certification Number: ACNEW
Latitude: 3S ° O'f ay "
Longitude: CQ D S 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) or No Actual Freeboard: Ft. b Inches
Was any seepage observed from the lagoon(s)? Yes o �Fo Was any erosion observed? Yes
Is adequate land available for spray? 6 or No Is the cover crop adequate? Yes or No
Crop(s) being utilized:
•
Does the facility meet SCS minimum setback criteria? 200 Feet from
or No
100 Feet from Wells? �Se 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 od If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: (s a 1A )/ &w n d -
-I . cp_E&5u`
Inspector Name
Signature
cc: Facility Assessment Unit
Use Attachments if Needed.