310230_INSPECTIONS_20171231

NORTH CAROLIN .AM
Department of Environmental Quai

Reason for Visit:-EY'lEoutiine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 2 'f 5 Departure Time: © County: 1 Agion:
Farm Name: � CCCD6 y4L i Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: (� (Title:
Onsite Representative: ��4� (\ /v l
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
MU
Dign Current
Swine Caes
pacity Pop.
Wean to Finish 7e/ OP
Wet Poultry
Layer
Design
Capacity
Current
Pop.
rr
Design Cuent
Cattle CapacityP.
Dairy Cow
Wean to Feeder
I INon-Layer
I
Da' Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I)r, P,oult ,
Layers
Non -Layers
Pullets
Design
Ca aci
P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
Other
—TurkeyPoults
Turke s
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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
[—]No
❑ Yes
7No
[—]Yes
FNo
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 21412015 Continued

lFacility, Number: - Date of Ins ection:
Waste Gollection & Treatment
4 Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 0 No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen real, notify DWR
7. Do any of the structures need maintenance or improvement? [—]Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
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
N ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
y/❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
L— No NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yesallo
ElNA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 21412015 Continued

Facili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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 YNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No DrfqA ❑ 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 DINo E NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the 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 ff N❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (referrto question # Ezo.lam,any,`�YXS;answers-and/or any additional recommend ationsio�µaoy�other comments •
Use drawings'oftfacditysto better explam sitdahons,(use additibdi&pages as necessary)I
K
Reviewer/Inspector Name: d
Phone: 9? P 6 / 3�
Reviewer/Inspector Signature: 0
Date: 2 er �e-
Page 3 of 3
21412015

(Type of Visit: Q Coot�tpliance Inspection U Operation Review O Structure Evaluation V Technical Assistance
Reason for Visit::� tlJ R.00uutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: F Jbjj� Departure Time: © County: t i Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Owner Email:
Phone:
Onsite Representative: —%GQ A—j efjj rAMj i rg Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I M I
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
(y 0
Non -La er
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
DGy Poultry
La ers
Design
Ca achy
Current
Pao ,
Dry Cow
NOD -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Points
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DW R)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DW R)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
[—]NA ❑NE
NA ❑ NE
NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
21412015 Continued

Facility Number: Date of Inspection. p
Waste Collection & Treatment
�No
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑Yes
DNA
❑ 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: I N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo
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
do
D 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 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 D NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No 0 NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo D NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
dNo
D NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
dNo
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
1:2'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[l No
NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ea/No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
[D'No
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 Q 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 [n 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

Facifi Number: Date of Inspection: $ V
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes d/No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [—]Yes C31No
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ No ❑ NA ❑ NE
ZNo ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
E] No
❑ NA
❑ NE
❑ Yes
D-TYp
❑ NA
❑ NE
❑ Yes
[]-'No
❑ NA
❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2/4 2015

Reason for Visit:
Date of Visit: I?
Farm Name:
—
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
: 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Arrival Time: ® Departure Time: County: Region:
Title:
Owner Email:
Phone:
Onsite Representative: A 0 ►V `au Fes, Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
illDesign
Swine
Wean to Finish
Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
WM
Cattle Capacity Pop.
DairyCow
Wean to Feeder
b
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dt.+P,oul
Layers
Design
Ca aci
Current
P,o
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes �] o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: Dale of Ins ection: S
Waste Collection & Treatment
4. Is s!prage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure Structure 2
Identifier: A J21
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M7No
❑ 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
r/NNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environment threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑Yes
N
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dN
❑ 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
eNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZN
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
V
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
0/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E 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 o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections El 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 4o ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: -3 Date of Inspection,
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes MK ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes YNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes L2"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 2 No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
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 Io ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any,othercomments.
use drawings of facility to better'explain situations (use additional paces as necessary). .
Reviewer/Inspector Name:
Reviewer/Inspector Signatu
Page 3 of 3
6fi Lt/ Phone
re: Date:
2141206

Type of Visit: U Cog�pliance Inspection V Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit: C1J Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0.',Denied enied Access
Date of Visit: Arrival Time: ® Departure Time: County: aAa-W Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:N�1: >J�} j.) M:'-
i
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: �� 1
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
Q
Non -Layer
Dai Calf
Feeder to Finish
Farrow to Wean
D , P,oult ,
Layers
Design
Ga aci
C-urren
P,o ,
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
o
Zio
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

acili Number: - Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L R (lzrbo
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to theintegrityof 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 M 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 DWR
7. Do any of the structures need maintenance or improvement? ❑Yes VNo❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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 I .f No ❑ NA ❑ NE
maintenance or improvement? "'777"""
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ 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 Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s)
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
m No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N/o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
g io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 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 ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

acili Number: q- Date of inspection: ry ILJ
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 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
o ❑ 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?
WNc
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
zVC ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection withan on -site representative?
❑ Yes
o ❑ NA ❑ NE
INo
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.,
Use drawings of facility to better explain situations (use additional pages as necessary). ,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Reason for Visit: O'Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: F 1616Departure Time: FO 5$ County: \,QL X)J Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: J,4JA` NPk0 • A ILL. E fL
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator•
Certification Number: 1801,,
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
C•attie Capacity Pop.
DairyCow
Wean to Feeder
2
6
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Drn P,oul
Layers
Design
Ca aci
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeefBroodCow
Other
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge teach 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 WNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: U Date of Ins ection: yq
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes (3/No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No [DNA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L;Q G'00 W1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [/No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [—]Yes n 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/al threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ICJ o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E3 No ❑ 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 ❑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 E o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes 7NNo ❑ NA ❑ NE
❑ Yes
❑ Yes 5No
❑ NA ❑ NE
❑ NA ❑ NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes 'f' o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: Date of Ins ec6on: $ 12—.1 16
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ej No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JZ�No ❑ NA ❑ NE
the appropriate boxes) below
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ff No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes [�`No ❑ NA ❑ NE
❑ Yes [;t/No ❑ NA ❑ NE
[—]Yes dNo ❑ NA ❑ NE
[:]Yes [DNo ❑ NA ❑ NE
❑ Yes M No ❑ NA ❑ NE
❑ Yes [33No ❑ NA ❑ NE
❑ Yes � No ❑ NA ❑ NE
Reviewer/Inspector Signature: L12_ Date:
Page 3 of 3 21412011

Type of Visit: 99 Compliance Inspection V Operation Review O Structure Evaluation Q) Technical Assistance v
Reason for Visit: V1J Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: E 17, Arrival Timer Departure Time: County: ft�'/� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: .�' Tittle:
Onsite Representative: C3,6 li aT L4I/ / t' y,/��-t- alc
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
lzoil
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
- Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr.+ P,oult . +
Layers
Design
Ca aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes dNo ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes �;Oo
o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes U No ❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: rj Date of —inspection,
Waste collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
�Strucctture I Structure 2
5. A& d*J
3
❑ NA ❑ NE
❑ NA ❑ NE
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
[—]Yes [/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes E�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 I dNo ❑ NA ❑ NE
maintenance or improvement? "`YYY'
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes r No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EZ/No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I �o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
I��PT�
❑ 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
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes /N9 ❑ 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 o Number: 0 Date of Inspection.
24. Did�the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes t No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes o❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
0 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
0 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
[2�No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
dN
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question II): Explain any YES answers and/or any additional recommendations or any other comments.:
Use drawings of facility to better explain situations (use additional oases as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:
-73 M

Reason for Visit: p Routine p Complaint p Follow-up 0 Referral p Emergency p Other p/Denied Access
Date of Visit: Arrival Time: / jf Departure Time: County: DWLJA Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: C_)Oa/arg&) #hLL�jL
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
1)r. P.oplt .+
Layers
Design
Ca aci_
Current
P,o .
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turke s
TurkeyPuults
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 C ] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: fi7 1ED Date of —Inspection, glit
Waste`Collection & Treatment
dNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ 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
ff 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
Wo
❑ 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
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
E No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Zj No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Zo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
6
❑ NA
[3 NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
;rNo
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�`/❑
j yrvo
❑ NA
❑ NE
acres determination?
7
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
Io
❑ NA
❑ NE
Required Records & Documents
— /
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
I ht4O
[3 NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[2No
❑ NA
❑ NE
the appropriate box.
❑ WUP [I 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 ❑ 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 Number: 12, 1 Date of Inspection.,
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 0 JN ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 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 ONo ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes �] No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
— /
❑ Yes I YNo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
777���
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes El -No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes t. "o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other commentsw ''
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature,
Page 3 of 3
Phone: Ile y .73
Date: a
2/4/2011

ti
Drvtsion of Water'Qaahty
Facility Nu�3b
Division Sotl Coaservatt
mber 3 I
of and=Water on.
;,
--..-•-.„ -�,.-
O'Qther Agency
Type of Visit Qf Co I liance 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: QI/CLV Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
OnsiteRepresentative: Cibl%H-r /NZuE✓L Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = [� « Longitude:
- Destgn
Current
,. _ Destgn
w
_Current Destgn -'@urre f
Sivme Capacity
Population
Wet Poultry Cap tty Population CatileM, C pacittpulation
,.
❑
Wean to Finish
❑ Layer
I
❑ Dairy Cow
`
Wean to Feeder
6
a
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
t...,a,..,. ❑Dairy Heifer
El Farrow to Wean
Dry Poultry,
' ❑ D Cow
El Farrow to Feeder
; ❑ Non -Dairy
El Farrow to Finish'
.. El Layers
❑ Beef Stocker
El Gilts
- ❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
Other
' El Pullets
❑ Turke s
❑ Turkey Poults
. ❑ Beef Brood Cowi-'
y s k M. *.
_
❑Other
L` ❑ Other
Numbervof 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 I of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
2 Io ❑ NA
❑ NE
El Yes
LINO ❑ NA
❑ NE
12128104 Continued

Facility Number: e3 j -pZ Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes fNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 66snI
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
❑ NA
[I NE
(ie/ large trees, severe erosion, seepage, etc.)
VNo
6. Are there structures on -site which are not properly addressed and/or managed El Yes
❑ 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 thyeat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes
J No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
dNo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
LJ No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
do ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
_No ❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 His ❑ 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
El NA
Y
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑Yes
El NA
NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
L'J No ❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
VN[:1 NA
[INE
Is there a lack of properly operating waste application equipment?
El618.
Yes
< ❑ NA
❑ NE
Comments (refer to,quest ion #): Explain any YES answers and/or any recommendations or any other,'cominents
Use drawings,of facility to better explain situations. (use additionaL:paggs as -necessary):"
_
a a > ✓PnffiE P Ue 5-P— CM5 M' L— -rA/ NAR94,TV v
Reviewer/InspectorName - - Q)00,j' GA: " "." 'I Phone: Q 1,3rd I
Reviewer/Inspector Signature: Date: 1AWD
I _II

1
Facility Number: 1 —a Date of Inspection
Required Records & Documents J
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
components of the CAWMP readily available? If yes, check
Does the facility fail to ha/WI
es
ElNo
❑ NA
❑ NE
the appropriate box. UP ❑ Checklists ❑ Desi n g ❑ Maps ElOther
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ZfNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Weather Code
Rain Inspection�No
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
o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
V,
❑ NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
u1)fo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑Yes
�1]
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
�
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N
❑ 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
EZNo
❑ 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
,�,//
L2J 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
/Np '
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
7 No
❑ NA
❑ NE
Additional Comments and/or Drawings: <t -
Page 3 of 3 12128104

0
Type of Visit (/} Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: � Arrival Time: / (QO Departure Time: County: 1 Region:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: .JO/VA ll9p� AL-L"iL..
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I = Longitude: = o = ` ="
Design Curren[
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
Design
Cattle Capacity
Current
Populatiop
Wean to Finish
❑ Layer
❑Dai Cow
Wean to Feeder
7jV0
❑ Non -Layer
❑Dai Calf
❑ Feeder to Finish
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ Laers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
❑ D Cow
❑Non-Dai
❑Beef Stocker
❑Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
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 E �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NE
❑ Yes
❑ NN
❑ Yes
L� N,6
❑ NA
❑ NE
❑ Yes QNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

FacilityNumber: 31 — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure Structure 2 Structure 3 Structure 4
Identifier:
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
[]Yes M No ❑ NA ❑ NE
❑ Yes IJ 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 N El NA [I NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes V ❑ 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 u No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes [!<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > l0% 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?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
iJ No
[2/No
Ca'No
o
Wo
❑ NA ❑ NE
❑NA El NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
.1. .''^.� T ?..� 4 3h "i. "' w*G.>a3i%�a*a. 'Ya^9�.`�C'F'b'S•=yc ::.r, 'r.. ..,. ...,. .-.
fComments.(re[er toqueshon #) Y'EI lam an rYES+answers°and/or an recommendations or an other comments.
s:Use�dr`awmgs<ofafacdttyeto betteryezplam sttuahons�(use�additional pages.as necessary):_
�.. .,ems" *•�.sr �..�:oa..*1�..3;�,a:�,'s��'�4'�a�"' "'s�:+"�s.'.'�,.:•. _ ._ .� _. .-
20,) LIPPArE wUP Fo0t je►✓ 86CMPVA Fr6t-b . CALCOA%f &6Fzdy7;
Reviewer/Inspector Name �%/(� /4R/✓�(c Phone: S p
Reviewer/Inspector Signature: Date: % b
Page 2 of 3 12128104 Continued

Facility Number: - —Z, Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have gl{'components of the CAW MP readily available? If yes, check
the appropirate box. WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ es 0 No
[Zs ❑ No
❑ NA ❑ NE
❑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 InspectionVX0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑Yes
❑NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑Yes
Wo
IJ�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L���J//No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
{a NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
EdNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNo
❑ NA
[INE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[IYes
E,, o
❑ 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
ENo
❑ 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
/�.�p
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
L"J No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit (J C mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine Q Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: U Arrival Time: I ( Departure Time: County: to v Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:y�tvi
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [70 F—T 0., Longitude: �o n n
Design Current
Design Current
Design
Current
Swine Capacity Population
Wet Poultry Capacity Populafion
Cattle Capacity
Population
Wean to Finish
❑ Layer
❑ Dai Cow
Wean to Feeder
D
0
ILI Non -Layer I
Dairy Calf
❑ Feeder to Finish
❑Dai Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑Non-Dai
Farrow to Finish
El❑
La ers
❑ Non -Layers
El Beef Stocker
❑ Gilts
❑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 0 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑ N ❑ NA
❑ NE
❑ Yes
❑ Yes
la ry ElNA
❑ NE
❑ Yes
W CVO ❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facili Number: 3 — & O Date of Inspection
Wastt?Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
L?rNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
[2f/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
E�<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 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
,_,/
D No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ] 0 ]bs ❑ 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
LTNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
2 Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
JE No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NN9
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,
L✓] No
❑ NA
❑ NE
l S� U fop UN r0LL l6660t)7
ON CAWRLt_ 6Lt LEt l�ib� AS �dU (rmE 'td�
Reviewer/Inspector Name I 1 a 14- oz A)k L I Phone: I
Reviewer/inspector Signature: Date: 2
Page 2 of 3 12128104 Continued

Facility Number: — 0 Date of Inspection 7 O
Reauijed Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 7f
NNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [2No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ ❑ Maps
Design
g p El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
,_.f/
0 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
.,//❑
B No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
2J NNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZINNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ET/No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[ I No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P-T�o
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
//
❑ 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
[PNo
❑ 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
o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
AdditionalCommentsand/orDrawings:...........
Page 3 of 3 12128104

Facility Number Zjp
W Division of Water Quality
0 Division of Soil and Water Conservation
O Other Agency
Type of Visit Co pliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: I X/ Arrival Time: ® Departure Time: O County:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact '/ - / p� Title:
Onsite Representative: ✓ + q AT VefN hl ,.1 WC A
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o =' =„ Longitude: = o =' = 1
1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
110 I V-0 I I❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population:-.
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ 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

Pacility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑%o
❑ 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): S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ej`Nc
❑ 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? ElYes ,6l/to El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes FJ/ 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 Ed, o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El � ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes E?Ko ❑ 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 dNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes D'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes l( No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes [�J`No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes Wo ❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. I
Use drawings of facility to better explain situations. (use additional pages as.necessary):.
'2z 1) Of I ')EC (.G L&vJE
Reviewer/Inspector Name 1 (�)611W^qKN�t 1 Phone: (7 /7 — /.S Y
Reviewer/Inspector Signature: f�, 4U.J11 Date: 1 9//b
Page 2 of 3

[..Facility Number: Date of Inspection I d
Required Records & Documents �,!!
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [IF Yes ,o ❑ NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other �/
21. Does record keeping need improvement? If yes, check the appropriate box below. LJ Yes ❑ No ❑ NA ❑ NE
❑ Waste Applic on El Weekly Freeboard El Waste Analysis ❑ Soil Analysis El Waste Transfers ❑ Annual Certification
Elfall StoRain] ❑ 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
E No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
<o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[),No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
0Yes
❑ No
NA
[I NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
,❑
L 2/A
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
CI No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 Ne
❑ 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
<o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
®-mo
❑ 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
42NKo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[21 o
❑ NA
❑ NE
Comments and/or
12128104

2 Division of Water Quality .,
Facility Numbeir _ _ J 230 00 Division of Soil and Water Conservation ~
-- - O Other Agency Coe
Type of Visit to Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint �0 Follow up 0 Referral 0 Emergency 0 Other El Denied Access �j
Date of Visit 00 Arrival Time: i�y� Departure Time: f ,S County: LZ/t� Region: Lf/� A
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: one No:
Onsite Representative: J!>I� `,' Z9?' Integrator:
y
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ' =„ Longitude: = o = , = „
*^ `
Design Current � '
Design Current :; De_sign�EE t Guu�rr
Swine
r.
Capacity Population , Wet Poultry
Capacity Populauon.. , ;Cattle a � @a act Po ula 'on
P . ty�_
❑ Wean to Finish
I 11`101,ayer
❑ Dairy Cow
i?' Wean [o Feeder
00 ❑ Non -La er
'- ❑ Dai Calf
Ll Feeder to Finish I
Dairy Heifer
„ ❑ Farrow to Wean I
Dry Poultry
` ❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
��. ❑ Farrow to Finish
❑ Layers
. ❑ Beef Stocker
a= El Gilts
ElNon-Layers
I El Beef Feeder
[I Boars
Pullets
❑ Beef Brood Cow
-
— ❑ Turkeys
s' Other`
_ , ❑ Turkey Poults
Number of Structures*:"
i^ ❑Other
< Other
T _
--
-----
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 0 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
0
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104
Continued

Facility Number: 2 Date of Inspection
Waste Collection & Treatment ,,,......///
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes I(J 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?: o
Designed Freeboard (in):
Observed Freeboard (in): 6�7-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No
❑ NA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
,.._J
6. Are there structures on -site which are not properly addressed and/or managed ElYes VNo
❑ 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? El I,,,__�,,,((( No
ElNA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El /
No
El El 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 lQ No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ;9No ❑ 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 JX,No ❑ NA El NE
..,/
18. Is there a lack of properly operating waste application equipment? ❑ Yes IQ No ❑ NA ❑ NE
Comments (refer to question ii): 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):
Cu 4V-0 Zo Nf<.o 76"r- ';;�Cz4ev4,o oaor& 7F5>
IReviewer/Inspector Name 1 Phone: /O - 6
Reviewer/Inspector Signature: 4dV4 � Date: 3& Azk
Page 2 of 3 12128104 Continued

Facility Number: —2 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check 0Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists 4 Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ETYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis Y,
Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ElStockin G
rop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes XNo
❑ NA
❑ NE
❑ Yes EtNo
❑ NA
❑ NE
❑ Yes PNo
❑ NA
❑ NE
❑ Yes Q No
❑ NA
❑ NE
❑ Yes �ZNo
❑ NA
❑ NE
❑ Yes ❑ No
P NA
❑ NE
9Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
ScuOG� Gl% 5 Fy'6p /4111)0 //i9'
Page 3 of 3 12128104

(Type of Visit 0 Compliance Inspection 0 operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit JO Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L�/�{/�.,��, �1 Arrival Time: /�; �Departure Time: j// , y County: / A) Region:
Farm Name: C / )OAA)/ �-,V'T /A-4/gm Owner Email:
Owner Name: S[ "P�'"-9' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: �AV'6'B5y
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Latitude:
Phone No:
r
Integrator: PCf�tC�
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ 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: "e r�
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes P 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: — Z3D Date of Inspection
Waste Collection & Treatment rr��/t
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes w No El NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes /❑ No ❑ NA ❑ NE
Stru ture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier.
Spillway?:
Designed Freeboard (in): �lZ
Observed Freeboard (in): � 7
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 V�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 rLl No
❑ 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 Drill ❑ Application Outside of Area%
12. Crop type(s)
13. Soil type(s) /%v ii
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,6 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
XNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination![] Yes
P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
ONo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
VfNo
❑ NA
❑ NE
G�,��o�
��1/Z�i1��r.Co�.Gtp,
Reviewer/Inspector Name Phone: 5� ZZb
Reviewer/Inspector Signature: Date:

Facility Number. — Date of Inspection
Reauired Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? PlYes ❑ 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 appropirate box.
❑ WUP oCbecklists ❑Design El Maps El 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 ❑ 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
El NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
�Z{No
El Yes ,LI No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes A No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes VrNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ YesX No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes////❑ NOX NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes PfNo ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes No
[INA
❑ 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 yJ No
/
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA
❑ NE
Additional Comments and/or Draw-iogs: . . .. Y _..
:z ,,, . -.- .. ., fi s... a.
'
Z�) �a�lfFo /20 �'19r,�u�� z�s����� � �.�-�,�.� Dao? .�✓o
Llsf ,
"/ ,1aZ,) 7, fXZIJEO
12128104

M
of Visit oCompliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit OdRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number g Date of Visit: Time: F TT6 0
O Not Operational O Below Threshold
Permitted 13 Cfeerdffieed 0 (Coon�ditionally Certified [3 Registered Date Last Operated or Aboyve T/�treshold:........... _
Farm Name: ....._A.LSD.�y_i..._. ?iL�..Y...'..`...... T..•L'A.`_'!'fit._...._..._........._...._._ County: ... .Y'�...�!. L"i�_......_..___...._ ....._._
Owner Name:
Mailing Address:
Phone No:
Facility Contact: ............... _............... _._.............. ..... ..... ............ Title:................................... ............ _...... _.....
. ._Phone No: ........ ........ .................... ...........
Onsite Representative:.,,..jO(5._._._.&=a Integrator:.._/w—"
L�
Certified Operator: ........................................... .. ...
Location of Farm:
Operator Certification Number: .......... ...... ................ ...._.
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 7­10 Longitude =• =' ="
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ Yes
2. Is there evidence of past discharge from any part of the operation? ❑ Yes
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ........... ......... _......... _...................... _.... _...._... .................. ....... __..... ................
Freeboard (inches): M
❑ Yes
Structure 6
❑ No
IN
7No
12112103 Continued

Fgeility Number — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes W No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes o
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes N
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 No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes N
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type CaT''('' d (�Ea w oA CG) R1 oveiO iGa IATW 5VV
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
15. Does the receiving crop need improvement?
❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes [allo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes I /NLIo,,
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. 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)
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.
Comments (refer to question #) Faephtm any YFS answersand/or any recommendations -or anyaothenc�ommeuts.
Ose drawurgs of facdtty,to better exphtm stlaatioac (use addrhonal pages as necessary) ' ❑ Field'Copy ❑ Final Notes
L
fi)CQ W)UP wa"lj. uRomev 600VAt- WL-d-V-A too G),twwt✓
G0)xis Ze IvE]ED
�CCoKAS 3riJ ORd3EII(�
Reviewer/Ins ector Name
P ^ h
Reviewer/Inspector Signature: Date: 3 Oil
12112103
'Continued

Facility NumberT3T— 230 Date of Inspection
Required
Records & Documents
/
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
o
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
Noo
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
�
[;O
❑ 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
01 o
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[ 40
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
��/�
�:XNo
(ie/ discharge, freeboard problems, over application)
❑ Yes
27.
Did Reviewer/Inspector fail to discuss reviewfmspection with on -site representative?
❑ Yes
28.
Does facility require a follow-up visit by same agency?
❑ Yes
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
["Li7OB]

r 5.
Type of Visit
Reason for Visit
Compliance Inspection O Operation Review O Lagoon Evaluation
Routine O Complaint O Follow up O Emergency Notifjcation O Other ❑ Denied Access
Facility Number / Date of Visit:
�t Permitted �QCertifiedd 13 Conn iitioo-naally Certified0 Registered
/Farm Name: ' 0"e6�y
Owner Name: _ >619A �
Malting Address:
—I Time:
10 Not Operational 0 Below Threshold
Date Last Operated or Above Threshold:
County:
Phone No:
Facility Contact: Title: Phone No:
i
OnsiteRepresentative: 194'wa Integrator: �,qzz S
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry []Cattle ❑ Horse Latitude �_ ' 0` =« Longitude =o
=, 0-
Swine
Design Current
CapacityPo ulation
Design Current Design Current
Poultry Ca achy Po ulafion Cattle Ca Capacity Population
❑ La er ❑Dai
Wean to Feeder
Feeder to Finish
❑ Non -Layer ❑Non -Dairy
_ - - -_
❑ Farrow to Wean
❑ Other
❑ Farrow to Feeder
Total D¢SIgD Capacity
❑ Farrow to Finish
El Gilts
El
Total SSLW
❑ Boars
Number of Lagoons , ,.x L—�J ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
-Holding Ponds Traps.Liquid
- ❑ No Waste Management
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )dNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a.. If discharge is observed, was the conveyance man-made?
❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes �INo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes �No
Structure l Structure 2 Structure 3 Structure 4 Structure S
Structure 6
Identifier:
2
Freeboard (inches): ✓�
05103107
Continued

r
Facility Number: — CQ� Date of Inspection
5.
r /
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
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
I[J No
9.
Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level
/�
elevation markings?
❑ Yes
No
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
No
11.
Is there evidence of over application? ❑ Excessive Poonnding [IPAN ElHydraulic Overload
ElYes
No
Su
12.
Crop type (. p 7 Z L
G
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CA MP)?
❑ Yes
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
,....,lil/No
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
PrNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
//�
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
fi�No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Prr No
21.
Did the facility fail to have a actively certified operator in charge?
El Yes
yJ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
/
(ie/ discharge, freeboard problems, over application)
❑ Yes
&
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24.
Does facility require a follow-up visit by same agency?
❑ Yes
/ZNo
ANo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
"comments (refer to question #: Explain BnV,YES answers and/or anyF4eeommendations,or anyiother po menu: y ;JN�otes.'
_Use drawingsoffacilityito better,explmn situations. (usepages as=necessary)
;. Field Coov ❑ FiFA)041(E��Nr6
DTihFaDEiO/VFElo
AP?trex770IV W20-OPLU�( F02 Jefn')M
�
PULL NEEDS /oEFLr_CT IJQPrZ�A/� �t/pr7�j
'/VFUDe D-rt4FR FZF-LO ZN W Pr,57F PLAN
-� ` OL4 PL-AN (v UTZL.vZti 4
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 1 Continued

f 1.
Facility Number: 3/ —"/,F 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 at/or below ❑ Yes /No
liquid level of lagoon or storage pond with no agitation? —1
27. Are there any dead animals not disposed of properly within 24 hours? []Yes �iT No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes II 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 6c,
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes qNO
don . omments. and/orDrawings:-
q> rCor� m � D CuT ��G DFr- Dt-v MARKFe
5100

(Type of Visit (KCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number a3o Date of Visit: Time:
Q Not O erational Q Below Threshold
Permitted 0 Certified Q Conditionally Certified 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: ....
...... ...._a.............._gn.............................................................................. County:...D,`�I,\.Q(..q...........q...........
.. 04-07,.
FacilityContact: .............................................................................. Title:................................................................ Phone No:
MailingAddress: ..................................................................................................................................................................................................................................
Onsite Represqntative:.O� ............................................................................ Integrator:.._GWs
.......................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =' =«
Design Current.
Swine Cavacitv Population
Wean to Feeder
1 a`i 0
a
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design_ Current Design . Cum
Poultry Capacity. Population- Cattle Ca ^acit °Po ills
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
I Number of Lagoons m ❑ Subsurface Drains Present JOLagoonArea JOSprayFieldArea
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imnacl.S
1. Is any discharge observed from any part of the operation? ❑ Yes D(No
Discharge originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes []No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes []No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes klo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
❑ Yes kNo
Structure 5 Structure 6
Identifier: .......................
Freeboard (inches): `3 _ 1
5100
Continued on back

acility'Number: 3Ci Date of Inspection Printed on: 10/26/2000
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
KNo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
,KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
WNo
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
kNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
j(No
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload
❑ Yes
4 No
�, �es�v
12.
Crop type G'w�jft+4 K: �� 2t-cgR
13.
Z/
�.
Do the receiving crops differ with [hose designated in the Certified Animal Waste Management Plan (CAWMP)?
[I Yes
WNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
RNo
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
ONO
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
D�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
O�No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Q�No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
CR�No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
XNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ZNc,
24. Does facility require a follow-up visit by same agency?
❑ Yes
PgNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
[gNo
0`dVo•yiolati¢t. .. ileticieucies mere noted ...... this;v........... 0iYe tid furthgr ; •;
ctirrespo dence:about.thisvisit: ... .....
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):
UsF`
t{ 1 C��ca a�w Qs-d t.g t,� cv e r 2 -jz
c�rzs­es �
twt-���.p ,_:,1� t.,ut�k —a hP•P� t-t her + �.;t� t., r - _
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 5100

Facility Number: Date of Inspection I J 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 at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes N0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or I ` \\
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary, cover? ❑ Yes No
Additional _Comments and/or _Drawings, =
cc
5100

'+,•- -a Division
-t [3Division
:..;KDivision
0 Other A
rtine C>Complaint 0 Follow-up of DWQ
Facility Number ,3
0 Permitted Certf6ed 0 Conditionally Certified 0 Registered
Farm Name:
Owner Name:
Facility Contact:
Mailing Address:.........
Onsite Representative:
Certified Operator
Location of Farm:
)peration Review
-o`ropliance Inspection _
;pection
r -
W-u of DSWC review 0 Other
Date of Inspection M-10
Time of Inspection '7= 24 hr. (hh:mm)
0 Not O erational Date Last Operated: J...........................,,_._. .
.... County:.........�ty/h
Operator Certification Number:
Latitude •=` 0•1 Longitude =• =' =11
-- Design Current
' Swine <• .. Capacity Population
Wean to Feeder
IdOd
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design. Current Design Current-
; ....:: ,. __ .. ... �:...�.: _... -
'Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ILI Spray Field Area '
,Holding Ponds/ SolidTraps ❑ No Liquid Waste Management System
Discharges & Stream Impacts L Elt
,,,���y---III
Is any discharge observed from any part of the operation? - Yes No
Discharge originated ac ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?—AIA —
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes RN
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes /RNo
Waste Collection & Treatment 7�
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �r
Freeboard(inches): ........,/...�../,.........................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

Facility Number: �� — 3D Date of Inspection
Y
5.
Are there,c 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 arc not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
XNo
(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
KNo
9.
Do any stuctures lack adequate, gauged markers with required top of dike, maximum and minimum
liquid level elevation markings?
❑ Yes
VNo
Waste Application
10.
Arc there any buffers that need maintenance/improvement?
❑ Yes
X'No
11.
Is there evidence of over application? ❑ Ponding ❑ Nitrogen
❑ Yes
�No
12.
.... � ..`.............................................................................................................�.......
s
Crop type V ............
.............. .... .. .1C1./.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes [kNo
14.
Does the facility lack wettable acreage for land application? (footprint)
❑ Yes
No
15.
Does the receiving crop need improvement?
[,XYes
16.
Is there a lack of adequate waste application equipment?
❑ Yes
,,,❑]/No
No ,
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
���...111
pb 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
g� No
, \N0
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
((No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
XNo
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
KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
ANo
0' NoAtihitions or. deticiene.ies.were. noted daring iiis visit:. Y'oti will receive niT ftirther.'.'
edrrespbtidehee;tibbiXthis visif.; ; ; ; ; ; ;•;•;•;•:•;•;•; :•; ;•:•;•:•:•;•;•;•: ;•;•;•;
Comments (refer to question #): Explain any YES answers and/or anyrecommendations orany other comments
=.-
Use drawings of facility to better explain situations. (use additional pages as necessary):
/5.) LrJo✓IGG on i/st�rm� �P s �5� rP`99 -Ax.� L _ " S ti 1y
�,yJ 1cal/ �„� J;wv ,k �;cs�.,../ .,�•.�d f /JNS-f—t�.o[c�—T
w.; (it.�C/
a c . (�v i'�,,,,c•Gz 1' do
S a p>�-�rtJf- yuk c� a%a�ot- Dy 5' AI. -,L y IT tw / 14_ 6ccN.e le-114
t�OLG� H^ re e A / 64,-i II AEW 419tt r Ovr c t �a4�i�y /f AgOrA�
Reviewer/Inspector Name 6 yes y * IltA /
Reviewer/Inspector Signature: /t_1_y..�� Date:
3Br- Z4eyn __P »4�'-
1 /6/99

FactVity Number. — J
Odor Issues
Date of Inspection p 7
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation farts) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes �(No
❑ Yes 0
❑ Yes pt�o
❑ Yes I No
❑ Yes MNo
❑ Yes',8&
❑ Ycs XNo
Additional omments and/orDrawings::
%� wi (� !'%t,t-G/c. � /:�-. /�� i FfJ ✓�r,.cs�' � P �awc� vt,-P ill �v�- ; ��
D F Say��etr
3/23/99

A
13 Division of Soil and Water Conservation - Operation Review
DDivision of Soil and. Water Conservation - Compliance Inspection ,
- _ -J2rDivision of Water Quality- Compliance Inspection
Q Other Agency - Operation Review- - - -
jerRoutine Q Complaint 0 Follow-up of DWQ inspection Q Follow -tip of DSWC review Q Other
Facility Number 3 / 2 3a� Date of Inspection?
'Pine of Inspection - $' 24 hr. (hh:mm)
Permitted jzrCertited 0 Conditionally Certified ❑ Registered 0 Not O etntional Date Last Operated: -
FarmName:..........!a...Q?..`..:.....e.f:�Z............._................_........................_. County: ...........(�JL J................................................
OwnerName:........._.....................:.......................................................................................... Phone No:.. z-s._Z:....... ...... ................
Facility Contact: Title: Phone No:
MailingAddress: ...... .............................................................................................................. ..................................................................................... ..........................
r� �
Onsite Representative: ....._ . ........................................ Integrator. .....(°.�a L..S......................................
..... .... ..... ..... .................
Certified Operator: ................. ................................. ............................................................. Operator Certification Number: 5a. U.
Location of Farm:
Latitude ='=' =1 Longitude =• =' =11
Swine Capacity Population
can to Feeder
L of o
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area JEISpray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/tnin'?
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): .............. ....................
❑ Yes ' -
❑ Yes 12/No
❑ Yes ONo
❑ Yes o
❑ Yes )Z No
❑ Yes ONo
❑ Yes rlPIo
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
1/6/99 - Continued on back

• Facility Number: 3f — Zia
Date of Inspection 7 27
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or enviromnental threat, notify DWQ) 1
7. Do any of the structures need maintenance/improvement? El Yes 4! No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 2No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level !
elevation markings? []Yes �'lslo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes &No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes VrNo
12. Crop type FCrC-ta£. CXK4vl/,AIAV-/S-¢-- �-A.J,WA-L5-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes .H'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
PI'No
b) Does the facility need a wettable acre determination?
❑ Yes
�] o
c) This facility is pended for a wettable acre determination?
❑ Yes
E�No
15. Does the receiving crop need improvement?
❑ Yes
16. Is there a lack of adequate waste application equipment? ❑ Yes XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes R(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 0 No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ONo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ANo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes VNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
[]Yes ;dNo
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 XNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes PrNo
N46 , i61'atioris:or deficiencies -wer8 itgted during this:visit; Yoit will •'receive tW further
correspon.............................
ence: abouf this :visit:' : : -: -: .: -. -.
-) 54b,LID C�-CAd (0 DF$iL�S 7tIA< 1JA<L S3Lo JJ 4)" LAGnz-oJ-
�) �£cEeJ2y D�sc£9 rn/ 2y� ! r� roLi a< r ✓; rtu nlf .1 cRt1P J�P�c3f46LC
Reviewer/InspectorName " -.'(�- .1 ;J_7WC� A'i" 4°19Crl f,-'iS'7ao
Reviewer/Inspector Signature: _ zl� t,1w_ 1- , Date:
3/23/99

Facility Number: 3 � — - Date of Inspection Z�
Odor Issues
26.
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? -
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
VNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
A 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
Y1 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
tdNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
04No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
f-..0 o
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
Date of Inspection 10
Facility Number
Time of Inspection 24 hr. (hh:mm)
0 Registered 0 Certified E3 Applied for Permit 0 Permitted JE3 Not Operational Date Last Operated;,,,,,,,,,,,,,,
FarmName: .................. 1 ......g....gruffi+�..,..t....................................................... County:..... ( L1 IiN.............................................................
OwnerName: .......................... .� Urt a t ......... &.1..................................................... Phone No:......................................................................................
Facility Contact: �.l It�Rt........�nf........................... Title:................................................................ Phone No:. un)...SG.�...10.�.32 ..
Mailing Address: .........._.... M......... q!..... C 1t....5 �6i . a .......... ...... .t4&er4mi\t.tbG............................................ ..,7-?t. tar.......
OnsiteRepresentative: ............ 1......U-It................ ............ ...................................... Integrator:........... L u.IIS......................................................
Certified Operator: ..................................................
Location of Farm:
Operator Certification Number: .........................................
Latitude =• =' 0" Longitude 0' =' 0"
Design `E "Current = " Design ;,Current Design Current
Swine , _ Capacity: Population Poultry Capacity Population Cattle' "Capacity Population l'
Wean to Feeder ❑Layer
❑ Dairy
Feeder to Finish ILI Non -Layer I JLJ Non -Dairy
❑ Farrow to Wean - ..
❑ Farrow to Feeder ' ❑Other
❑ Farrow to Finish Total Design Capacity'
❑ Gilts
❑ Boars Total SSLW
Drains Present IIU Lagoon Area
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
[P No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
qNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
J� No
c. If discharge is observed, what is the estimated Flow in gal/min?
M ik
—❑
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
Yes`
LP No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
[P No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
q No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
1� No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
�g
[P No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
Im No
7/25/97

Facility Number: 3 Z�
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
[� No
Structures (LaPoons.Holdinp Ponds. Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
P9 No
Structure 1 Structure 2 Structure 3 - Structure 4
Structure 5 Structure 6
Identifier:...................................................................................................................................................................................................................
Freeboard(ft):....................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
[N No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
[]Yes
[B 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
09 No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
�{
C4No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type............�C"11................. wv2 ........o runi.,I............................ ...............................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
PNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
® No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
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
LINO
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
EP No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
R No
0• No.vi6iations or deficiencies. were noted during this.visit. You.will receiveeitti ftiriher
correspondenceab'ouffhis:visit:•; ; :: ; :: ;• •;•; ; : ; ::•:•:•':•:•:-::: ; •:-:•
I$-Cor.'1ie\ue, e4%rk -le vw Ptvt twdz �N {•e.Scve F;Cld,
u.. ;k se> .RR-z ter* 5k0\11a t �Y e�� r�W;� se"Or,. S�,-��yy t�� <6VId
be � ?,A oc�^s 1{. covrecf rC_ tAY_ For aT Pvil ctl,. cele�l6�``, VA-
h%A,ro erg �w�QhCc , [� soil ktzf 1s6,,,.t) be ��:. 4r e1e. i rfir�syitT okot zl't0A 6 ir-
A,- '�rYlw ytcO44S. e av" a '0,. 't(rw%t 'irV;CC )odor cp wo' ttwPiVA$1 fVut� S{S 51u�i�
bo i,w 1-ecork. cWmA ItSt w� licaiion n4t4 �ov tirp 4 6" o,,+J irl
aad: o+t11 la�J. C0 4 ct �s�rrr{ S�;(�I tr 4r ocs;<in"r
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: ` f jn; /,L, Date:

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
10 Routine O Complaint 0 Follow-up of DWQ inspection O Follow-up of DSWC review 0 Other i
Date of Inspection 21
Facility Number Z
Time of InspcKaion E:zn 24
13 Registered 0 Certified 0 Applied for Permit 13 Permitted 113 Not Operational I Date Last Operated: ..........................
Farm Name: ..$,..O.So.li........ &r....ft...... i.:�k:r..^..^................................................. County: .... Dy h....................................
..KU�...�.f' U
Owner Name:..........1 nlSYe L.l............................................................ Phone No:..�9.1..4...... s—
6g 560 )
Lgra 6 —. ' Bel 6�
FacilityContact: .............................................................................. Title:................................................................ Phone No:.................................... ....
Mailing Address: .AAA ......... C4. j. x. ...S..Lb�....... ................................... .a:�'�.i9, Roc'�St2.ta.�..�C...:.:.......................... . Z S R.Q..
Onsitc Representative: .... Lel/. ....�_Ys..L..............................................._..... Integrator:.._C -V..tca.1.j_._..............................................
Certified Operator:................................................................................................................. Operator Certification Number:.........................................
Location of Farm:
Q.vs... ..c W.!t&I ....c..l.. ....0...... . &.as.... ......
:.Lp..wa.......tn1,11. 1...S.[.ar..I�.11................................................................................................................................
Latitude =•=a={{ Longitude 0•=°0"
Design( -.Currents_ ,.sDesign- ;,Current, g 'Design 4Current z
Swore' Capacity Population Poultry', •Capacity, opulation;�Cattle,t „>CapacityrPopulatinn:
,rr[0]Fawucw
n to Feeder - " ❑ Layer ❑Dairy er to Finish ❑Non -Layer `. ❑ Non-Dairyow to Wean _ ;> .,- m to FeederOtherow to Finisn',Total Design Capacity,
srs Total SSLV1
�., �, 4. ❑ Drains teArea ❑S:jpray Fie1d A Number of Lagoous/Flolding.Ponds W Management SysNo Liquid mv
,.
General
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
-d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than laeoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes Wo
❑ Yes 2 No
❑ Yes ffNo
❑ Yes El No
❑ Yes 0 No
❑ Yes R No
❑ Yes 14 No
❑Yes )ENO
❑ Yes 0 No
❑ Yes PR.No
Continued on back

Facility Number: :j
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaQoons.11olding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft):
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?
Waste ADDlication
❑Yes KNo
❑ Yes
® No
Structure 5 Structure 6
................................................................
.................................................................
❑ Yes
kNo
❑ Yes
$No
❑ Yes
RNo
❑ Yes RNo
14. Is there physical evidence of over application? ❑ Yes RNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ...1n?3. .`�4<..r......tt_.r�l.:stu............................................................ .... Q,S..r.v.1`.......................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes RNo
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 whicb cause noncompliance of the Permit?
No.violationt -or deficiencies. were noted during this.visit. You4iH i&eive nafurther.
....................... ..
Orrespplidehce about this:visit:•:: ;
IS. Wtrl'- o,.. cq.rvtcj
22, C4 l c� to l e Qv{
ye.r .%cl wt; ,'f
volowJ2P- ,SfAt.ieq t
b OL we ¢ �a v
S r L -e .
❑ Yes P(NO
® Yes ❑ No
❑ Yes C&No
❑ Yes Ly N0
❑ Yes JXNo
&jYes ❑ No
❑ Yes ER No
❑ Yes RNo
IEly=':�
iU .,,,, f ; (.A -e- ;- l9 9� ,
�►�
�� p
7/25/97
Reviewer/Inspector Name
Rei,iewerQnspectorSignature: r. _,.J, 0,„1---%n. {A,_Qw' Date:

Site Requires Immediate Attention:
Facility No.3 I _
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: c-3 1995
Time: c5
Farm
Mau
Count
Integr
On Si
Physic
Type
DesignCapacity: P aci
tY: �..i��7 Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ° _�' Longitude: ?T7 ° '2X' _Z_y_" 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)oor No Actual Freeboard: -,2--Ft. _a— Inches
• Was any seepage observed from the lagoon(s)? Yes o
r(KO7 Was any erosion observed? Yes or 6
Is adequate land available for spray? or No Is the cover crop adequate? or No -
Crop(s) being utilized: �pao-a!�/ Q r Q t ti 1 e
J
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwelling/s,' or No
100 Feet from Wells? 63§ or No
1\
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes No 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
Additional Comments:
Inspector
cc: Facility Assessment Unit
A4Z�_
Signature
Use Attachments if Needed.