310235_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

7
Reason for Visit: ('f Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1_ Arrival Time: 70 Departure Time: jl 3 9 County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ('.'9 Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: I oo D -,) Z
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Farrow to Wean
V
Z7 O
La ers
Design
Current
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
1.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Io ❑ NA ❑ NE
[-]Yes [—]No
❑ Yes [—]No
❑ Yes
❑ Yes
❑ Yes ] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: 3 - 2 jDate of Inspection: /
Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes EJ�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 121
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
['24
❑ 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
ETNo
❑ 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
1;3-;-c
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
NNo
❑ 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
D
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PX10
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
O No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage &Permit readily available?
❑Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
E"No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo ❑ 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❑ 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

Facility Number: 11 -'Z3t' I Date of Inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Io ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes L No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No UNA ❑ 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
E�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
0 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
do
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yeso
9NO
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
�No
❑ NA
❑ NE
Reviewer/Inspector Signature:
Date:
Page 3 of 3 21412014

(Type of Visit: (0 Com ' nce Inspection C) Operation Review V Structure Evaluation U Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: t 0 Arrival Time: 0 OO Departure Time: © County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title: LL
Onsite Representative: r-P'Swo 1-4"- J
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop. 11
Wean to Finish I
Wet Poultry
JLaYeT
Design
Capacity
Current
Pop.
Design Current
Cattle - @apacity Pop.
Dai Cow
can to Feeder
I
iNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,outt .
Layers
Design
Ca >,aci_
Current
P,o -
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes , / - ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Ye sjc ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facility Number: jDate of Inspection: q S
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
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
❑ NA ❑ NE
❑ NA ❑ NE
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 2JNo ❑ NA ❑ NE
❑ Yes ❑/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environme al threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 1 ❑ 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?
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 allo ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NE
[:]Yes 0 No
❑ Yes No
❑ Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ Yes
6 No
❑ NA
❑ NE
❑ Yes
[ f No
❑ NA
❑ NE
❑WUP ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 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 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

Facility Number: - 'Z Date of Inspection: I I 20 /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ N ❑ 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 Y�5( ❑ 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 o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other: /
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments`(refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
f`0-t-Q— 5,rt, P k 1" Ci(' 5r9Le 15 coffce—+
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I (0 79 G 7-3°y
v
Date:
21412015

Type of Visit: eC Co pliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 7 /r%3%%Z}� Arrival Time: ; .M Departure Time: County: U%'l Region: Y
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: 54tAfAA
IV
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator
Certification Number: ! V 55C
Certification Number:
Latitude: 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
I JNon-Layer
I
airy Calf
)C
Feeder to Finish
Qq 40
0, Vq
airy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D�. P,oult .
Layers
Design
Ca aci
Current
P,o ,
Dry Cow
on -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeefBroodCow
Other
NJ 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 'WrNo [:]NA ❑ NE
❑ Yes ❑ No
[—]Yes [—]No
❑ Yes ❑ No
❑ Yes An No
[:]Yes [�!fNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili 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
XNo
❑ NA
❑ NE
Structure l 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
[2rNo
❑ NA
❑ NE
waste management or closure plan?
r—
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
VTNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P 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
VrNo
❑ 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?
tCC'""""'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
0 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
Vj
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
,.K
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP El Checklists ❑ Design []Maps ❑ Lease Agreements
❑ Yes No
❑ Yes J�Tj�j No
❑ Yes 6 No
❑ Yes V1 No
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZNo
El Waste Application ❑ Weekly Freeboard El Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a min gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes XrNo
❑ Yes ;6No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facilitv Number: AK WaDateDate off
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes RNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes KNo
❑ 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 A
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
������//////���,,No
❑ Yes I/I No
r
❑ 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?
T�
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 7No
❑ 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 0 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
PNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Vn No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ZfNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[No
❑ NA
❑ NE
�i f
Reviewer/Inspector Signature: �/� Date: 2 /J
Page 3 of 3 21412011

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 0 Denied Access
Date of Visit: JI Arrival Time: Departure Time: /ate County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: I Title: Phone:
OnsiteRepresentative: _ Ml. as. _Rmf-�' Integrator:
Region:
Certified Operator: S'TeQgl��V 114 HLG LA QND&LS Cek2cahoo Number: 9 I 0 SS9
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity Pop.
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Da' Calf
Feeder to Finish
4YS
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
in) P,oul..+ C_a aci P,o P.
ILayers I
Gilts `*
Non -Layers
Beef Feeder
Boars
Pullets
I
jBcefBroodCow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �NO
❑ Yes ❑ No
❑ Yes ❑ No
[—]Yes
[—]No
❑ Yes
W No
❑ Yes
I &_0
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facility Number: - 5 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: 6
Spillway?: 1
Designed Freeboard (in):
Observed Freeboard (in): " l
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 t�No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) y�
9. Does any part of the waste management system other than the waste structures require ❑ Yes 1)(I No ❑ NA ❑ NE
maintenance or improvement? 7�
Waste Application �j
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ly I No ❑ NA ❑ NE
maintenance or improvement? 7"�
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): I UA,17 6l
13. Soil Type(s): C'�Zrr{Y
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes X No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes � No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
{
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes p�t,It
rlylr
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
7V
E]WUP ❑Checklists ❑i Design QMaps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ El Waste Application a❑ Weekly Freeboard .❑' Waste Analysis .❑ Soil Analysis W*te Trans ers 0 Weather Code
❑ Rainfall ❑ Stocking .❑ Crop Yield e❑ 120 Minute Inspections . r❑ Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes X No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 4No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility N+rmber: jDate of Inspection: y
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes I XI No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 17�I No ❑ NA ❑ NE
the appropriate box(es) below. N
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 0 NA ❑ NE
Other Issues �..,(
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes lyl No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 7C
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWW? ❑ Yes b6 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any othercomments., I
Use drawings of facility to better.explain situations (use additional pages as decessary): ?
64tR-7� �E �'H
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 916
Date: ?)94/19
21412011

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: XRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: [KL/f� G L Arrival Time: ® Departure Time: County: !7 /
Farm Name: �'Ot J�� "ALAS ES �� �0 Owner Email:
Owner Name: W&S714GE FA(ZM-s %NC: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
, AM E
S C__f l M R
Integrator:
Certified Operator:
(3 1 J\/
e) (LEN I
M()Oe F—
Cer t�ti11
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Number: 9 S / O TS
Certification Number:
Longitude:
Swine
Wean to Finish
Design Gunrent
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
qO
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , P,oul
Layers
Design
Ca aci
Current
P,o ,
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Q[her
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No
[—]Yes [-]No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 21412011 Continued

Facility Number: -M Date of Inspection: WhY771
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
XNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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
f No
❑ NA
❑ NE
waste management or closure plan?
""CCC
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
V No
���"`;tt
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�No
❑ NA
❑ NE
maintenance or improvement?
' \
Waste Apnlication
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): C- "/N ✓ J (..
13. Soil Type(s): �YOL
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
`4,/I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
777"'��� No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E5 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[—]Yes
I /I No
J�
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP QChecklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
0 Waste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ W4ste Transfers Q Weather Code
Q Rainfall ❑ Stocking Q Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -Z 3 ' Date of Ins ection-
I
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ly I No ❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
j�7�1TC No ❑ NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey []Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No XNA
"''''JJJJTT
❑ 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?
El Yes
,,..,(
IY I No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
0"'�
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:
❑ Yes ;I No
❑ Yes m No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any, other comments ,.,.� ,„,.TM,.�:
Use drawings of facility to better explain situations (use additional Daees as oecessarv). a Y ,
(0•4-1
511q]/I /. (9
a)3111 1-
gtA_j,ON owe 931 a
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 91(3-'4 6=fi3A
Date: 81 /o
21412011

Ii ype or visa j0 Compliance Inspection V Operation Review V Structure Evaluation U Technical Assistance I
Reason for Visit KRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: )O O Arrival Time: Q� OV /Departure Time: County: u %J Region:
Farm Name: P-d J3rS N�&J_ I ��' gO Owner Email:
Owner Name: 1-`IL�ST I(�/F,/��Jvc. Phone: 9IQ-59a-5-4-4i
Mailing Address:Q.O • &x `43 eO WNTOAI , Nc 083�9
Physical Address:
Facility Contact: \ �� Title:
Onsite Representative: J A 01 s LA MttU Integrator:
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone No:
Operator Certification Number:
Back-up Certification Number:
EJ Longitude: = o = , = «
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 XNo ❑ NA Cl NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
,�No
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
12128104 Continued

r '[
j Fatility Number: 1 —SM Date of Inspection 30
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ;IISJ No ❑ NA [I NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Y❑l No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l AQ01y
Spillway?: n
Designed Freeboard (in):
Observed Freeboard (in): 39
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
No El NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
�/���,,,�///
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
gJ No El NA [I NE
through a waste management or closure plan?
\
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
I���Y,,,J///No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes
1�'J\ 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 Apulication
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
XNo ❑ 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 kv No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
9No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
9�f No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
16o
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
„,va' ., -
Comments (refer to question #): Explain any YES answers sd/or°anyrrecom'mendahons or any:offi'er comments s
w M.
Use drawtngsiof facility to better explain situations. (use addthonal-pages as necessary)-,
1 �
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: � Date: r7
�_.._ a _r o 12128104 Continued

M 5
1 acility Number: 31 —j Date of Inspection O�[Q
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. 0 WUP ❑ Checklists 0 Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ANo
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard © Waste Analysis 0 Soil Analysis El Vste Transfers/ ❑�nnual Certification
El Rainfall ❑ Stocking El Crop Yield 0 120 Minute Inspections El Monthly and 1"
Rain Inspections����,,//tt 0
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
Eluuuuu�r
Yes
---
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
IgNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
tK'No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
M No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE
Other
Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
{
ipSJ No
'�`
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
NzNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 L
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
t� No
ElNA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
w. m.
51s110 I , 6
1-►3ID 1.1
aGtO
OiGcA� w; Co"
Page

(Type of Visit PCompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit ,Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Mhuffl Arrival Time: ® Departure Time: County: l IV Region:
Farm Name: (h - "'nSs s 1 oase, —otl� Owner Email:
Owner Name: W E5T(-}d'E PPAM5 Akhf . Phone: Cl io— 59Q-S-4-4 1
Mailing Address: 4' . G�ox -C—Lty Top . /V C D S9 Inp
Physical Address:
Facility Contact: Title:
OnsiteRepresentativel:�Amcs ( Mr t'
(
Certified Operator: 1l �U 1 // L t t�jV % i t )O0Q-F
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 5004S
Back-up Certification Number:
Latitude: =o =, = Longitude: =o [�' = «
Design Curren[
Design Current Design Gucrent
Swine Capacity Population
Wet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
1OLayer 1 ❑ Dairy Cow
❑ Wean to FeederI
ILI Non -Layer 1
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
La
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Pullets
❑ Beef Brood Co
❑ Boars
El Turkeys
Other
❑ TurkeyPouets
❑Other
Number of Structures:
❑ 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 �(No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
ElNA
❑ NE
ElYes
No
❑ NA
❑ NE
12128104 Continued

Facility umber: 1 —a3 Date of Inspection
Waste Collection & Treatment �..//
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes L No [I NA ❑ NE
a. If yes, is waste level into the structural freeboard? [I Yes !!❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i._ACIOCVN/
Spillway?:
Designed Freeboard (in): 19. S
Observed Freeboard (in): 99
5.
Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
ElNA
❑ 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
qq No
✓
ElNA
[INE
8.
Do any of the stuctures lack adequate markers as required by the permit?
ElYes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9.
Does any part of the waste management system other than the waste structures require
❑ yes
l:YNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
V
Soil type(s) h1nQ'RXA(
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
ElNA
ElNE
15.
Does the receiving crop and/or land application site need improvement?
ElYes
& No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
Elg� Yes
,XfNo
No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
J\ No
❑ NA
❑ NE
tiGomments,(refer„�tol�queshonti#) Explain auy� YES�answe'�'d%or+any recommendations.or any other comments. 1
:I9se drawings'ofrfacil�ttyptowbetter�"eaplatn�sttuahons (use addthonallpages as necessary):. i ��i � � I'�i i
Reviewer/Inspector Name !�j ta/ $ Phone:
Reviewer/Inspector Signature: Date: -=I I301oc-i
Pape 2 of 3 12128104 Continued

Facility Number. � 1 — Date of Inspection O
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
ONo
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CA WMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. Q WUP ❑ Checklists ❑ Design 0 Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
kNo
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ �aste Transfers ❑ /nnual
Certification
❑ Rainfall ElStocking O Crop Yield ED 120 Minute Inspections 0 Monthly and V
Rain Inspectionssyyy Q
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
tip No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
yyy
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
77714���
❑ 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
D�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
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
biNo
❑ NA
❑ NE
Page 3 of 3 12128104

- (�r�C 0 Division of Water Quality V
Facility Number � � _ OC J J 0 Division of Soil and Water Conservation
—' --- - D Other Agency
Type of Visit *0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit '1 Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: n9m Arrival Time: Departure Time: County:
Farm Name:
Owner Email:
Owner Name 3- 2 (12W?L I.IERSE-1-1 Tb'57A(I Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:: .�Am6S L.AfA-tPs
Certified Operator: 1�� UI A/ V er_-a T 1 v`( a-r,
Back-up Operator:
Location of Farm:
can to Finisl
can to Feed(
eder to Fini!
Crow to Wet
trow to Feei
rrow to Fini
Its
(ars
Region:
Phone No:
Integrator:
Operator Certification Number: -1 8 90-3 5
Back-up Certification Number:
Latitude: o = I = Longitude: = o = ,
Design Current Design Current
Capacity Population Wet Poultry CapacityPopulation Cattle
❑ Layer ❑ Da Cow
❑ Non -Layer ❑ Dai Calf
C% L10 13 99-) - ❑ Da Heifer
Dry Poultry ❑ D Cow
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?
L I Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures: '
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes kNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
ElNA
ElNE
[IYes
No
❑ NA
❑ NE
12128104 Continued

C l_
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
❑ Yes D(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: i-I.'Oc�
Spillway?:
Designed Freeboard (in): �. S
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 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 WNo ❑ 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 d(No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �No ❑ NA [I NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes pi No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
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
rANo
El NA
❑NE
No
❑ NA
❑ NE
No
❑ NA
❑ NE
[XNo
❑ NA
❑ NE
1�fNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawingsof facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I pN I I Phone: 910- A (O-tfy5D
,9 Reviewer/InspectorSignature: Date: 31�aa
Page 2 of 3 12128104 Continued

Facility Number. — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
AqNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
LVNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
i.�' No
\
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
XNo
❑ 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 ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation.
b
0 Other Agency
Type of Visit O Corppliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit C�/Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 6 / t. / % Arrival Time: ® Departure Time: County:yMFUN Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
i OnsiteRepresentative: JrfA&% r 6MOA 4J
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: FT n' FT Lonr itude: n o FT n
a
Design Current
Design Current
Design,, Currbnt=-s
Swine
Capacity Population
Wet Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Finish
❑ La er ❑ Dairy Cow
❑ Wean to Feeder
I ILJ Non -Layer
❑ Dairy Calf
® Feeder to Finish
3100
❑ Dairy Heifer
El Farrow to Wean
. Dry Poultry,-
❑ D Cow
e
x= ❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
ElPullets
! ❑ Beef Brood Cow
_ _
_
I ❑ Turke s
Other
❑ Turkey Poults
❑ Other
I ❑Other
Number`of Structures;.'.
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 2rNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E3No
❑ NA
❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
12/28/04 Continued

Facility Number:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: UQ 6-arJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 y
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 2No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,&o El NA El NE
❑ Yes LJ 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 [I NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑yes No ❑ NA 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 [O No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes d ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Y Zo ❑ 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?
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
ENo
❑ NA
❑ NE
o
❑ NA
El NE
,��,
Ld o
❑ NA
[I NE
l No
❑ NA
❑ NE
WNo
❑ 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):
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:

Facility Number: 3 — % Date of Inspection b D
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Desigp ❑Maps ❑Other
❑ Yes UNo [INA [INE
❑ Yes El"No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
c
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
,Ef /
l—�d
[I NA
[I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
�NNo
[2 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
9<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ NA
❑ NE
BNo
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
LJ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LE4o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ER"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
d 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
El Yes
[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Comments and/or
12128104

0 Division of Water Quality
Facility NUmb¢r 31 :L3 S O Division of Soil and Water Conservation
O Other Agency
Type of Visit orcoompliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit eRoutine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: (b p Arrival Time: .� Departure Time: County: t�UP t Region:
Farm Name
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: � Ay , &S 1 _Arv.f3
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
to Finish
to Feeder
-to Finish
v to Wean
vto Feedei
vto Finish
Other
❑ Other
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [=o =' =" Longitude: =o =,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I 1
❑Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
OTurkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
A
Number of Structures: ,I
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
❑ No El NA
❑ NE
❑ Yes
El Yes
U' ❑ NA
❑ NE
❑ Yes
LEI No ❑ NA
❑ NE
12128104 Continued

Facility Number73 1
Date of Inspection 10
,.Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier: t Aee . ✓
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): q(o
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes /No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes dNo ❑ 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 5J NNo ❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ff No NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
L' I No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
C,--X0
El NA
El NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
D/No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
YJ� NNo
ElNA
[INE
18.
Is there a lack of properly operating waste application equipment?
ElYes
ETNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name vUH Phone: %/O `76 -73 b0
Reviewer/inspector Signature: Date: I o
12128104 Continued

Facility Number: 3 I — Date of Inspection Id
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
M<NN
El NA
❑ NE
❑ Yes
; No
❑ NA
❑ NE
❑ Yes
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
2Io ❑ NA ❑ NE
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (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?
Comments and/or
❑ Yes —D4o El NA El NE
❑ Yes EJ/No ElNA ElNE
❑ Yes LJl No ❑ NA ❑ NE
❑ Yes E34/ El NA El NE
El Yes L�I No ❑ NA ❑ NE
❑ Yes El�o ❑ NA ❑ NE
❑ Yes Vo
❑ Yes �No
❑ Yes b
❑ Yes ,_ 40
❑ Yes L�J
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
12128104

0 Division of Water Quality
Facility Number /�; �� O Division of Soil and Water Conservation _1
— - --- 0 Other Agency
Type of Visit c�o% pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: / Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: (Ji /tQai LAMA
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , = Longitude: = o = ,
Design , Current Design Current D
Swine Capacity Population Wet Poultry Capacity Population Cattle Ca
❑ Wean to Finish 110 Layer
❑ Wean to Feeder 10 Non -Layer
® Feeder to Finish YQ
Other
❑ Other
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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number ofStructures:
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 ld No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes d ❑ NA ❑ NE
❑ Yes CJ No ❑ NA ❑ NE
Page I of 12128104 Continued

Facility Number: 3 — 3
Date of Inspection
Waste Collection & Treatment
WNo
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
Identifiec IA4 dO/✓ L120
Spillway?:
Designed Freeboard (in): A. S
Observed Freeboard (in): q
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
O 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 [I�kat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Nc [I NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
,�
IdNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[I Yes
. /
ER No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
CI No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
L3 <o ❑ 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 Area
12. Crop type(s) UL 6) S " Ad -ILL C-Al
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
[?Ix° ❑ NA ElNE
LGNo ❑NA El NE
E— NNo ElNA ❑ NE
[a<o ❑ NA ❑ NE
I 0 ❑ 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):
Reviewer/Inspector Name I J J (A 11 Phone: 71U &
Reviewer/Inspector Signature: xt rriA, Date: 66
Paee 2
12128104 Continued

Facility Number: — r Date of Inspection 2, 6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ['NO ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes B No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
❑ Yes
ffNo
❑ NA
❑ NE
❑ Yes
ET/No
❑ NA
❑ NE
❑ Yes
U4o
❑ NA
❑ NE
❑ Yes
CI NNo
❑ NA
❑ NE
❑ Yes
NNo
El NA
❑ NE
El yes
�EY
LJ No
❑ NA
❑ NE
❑ Yes �o ❑ NA ❑ NE
❑ Yes RNNo ❑ NA ❑ NE
❑ Yes a'No ❑ NA ❑ NE
❑ Yes ,moo ❑ NA ❑ NE
ElYes Ll No I El NE
El Yes o ❑ l ❑ NE
Page 3 of 3 12128104

Type of Visit to Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit qf Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
/
Date of Visit: �4 / 05 Arrivval Time: r 7 Departure Time: ,� ounty: �� `t/'✓ Region: W V
Farm Name: —25/ /Zo Owner Email:
Owner Name: �.� 114 rL`' / fp / 5 H /h ne:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: '9"6�"-'
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedei
Farrow to Finish
Boars
Other
❑ Other
Title::
No:
ntegrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = , Longitude: = o = , = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
ElLayer
❑ Non -Laver
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
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: �/
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /11 No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes
❑ NA
ElNE
�ONo
ElYes 11 No
❑ NA
❑ NE
12128104
Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes/6 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?: A
Designed Freeboard (in):
Observed Freeboard (in): �t
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
ElNA ElNE
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
'0 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElIL Yes
�f
! No
❑ NA NE
❑
El Excessive Ponding El Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
/
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
VfNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
No
ElNA
El NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
r,tt
/t,/,�(No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
/ILI No
❑ NA
❑ NE
51Z,7105 SOzZ IMF Po r ow c zm� it
/lin_r A(Xkt ; 6'OeA fa�fcFo
�A
L,r E
Reviewer/inspector Name 1 I/ '(rL( ,TQN ;{ Phone: 17ZO rvt,*—
Reviewer/inspector Signature: I Zt Date: /

Facility Number, 3 —Z315 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes /� No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes m No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers/ ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain minbreakers 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 nonnal?
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 ko ❑ NA ❑ NE
❑ Yes t/J No ❑ NA ❑ NE
❑ Yes m No ❑ NA ❑ NE
❑ Yes '[]dNo ❑ NA ❑ NE
❑ Yes L q No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
VfNo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes n No ❑ NA ❑ NE
12128104

Type of Visit m Co pliance Inspection O Operation Review O lagoon Evaluation
Reason for Visit tvJ Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: % Tune: 60
Q �NotOperafional Q Below Threshold
Permitted dcertified 13 Conditionally Certified [3 Registered Date Last Operateed, oar"Above Threshold:
Farm Name: Y r _-- _�__�_ _ _ County:
Owner Name:
Mailing Address:
Phone No:
Facility Contact: Title:Phone No:
Onsite Representative: 9690y OlkaffitiT
integrator. p&F-StA___--
Certified Operator:------_ _ _ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• == 0- Longitude =• =< =H
'De stgn
':.Current ' ::.
Desgn current i== Design Ctiiient
Swine Capacity
o uhtio-_sP
PopaoCatleR'Population
Wean to Feeder
❑ Layer
Dairy
Feeder to Finish
Fi
' ❑Non -Layer
Non -Dairy
Farrow to Wean
-_
Farrow to Feeder
Other
,t
Total Ca D251gDt pSCl1:f'
Farrow to Finish
Gilts
Boars
Total SSI:W;'
+
Roldimirolikw Saw
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: __� 1_II1._.__
Freeboard (inches): ' e/
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
[3 Yes
NNoo
❑ Yes
ff l o
Structure 6
12112103 Continued

Facility Number. 3 — 23 Date of Inspection 1 7125. /A(1 1
5. Are there any immediate threats to the integrity of any of the structures observe ?(i(ie/Ytrees, 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 ❑ Yes ;�O�
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance/improvement? ❑ Yes
8. Does any part of the waste management system other than waste structures require maintenancerimprovement? ❑ Yes ; Noo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes [,�No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes 'ter""
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground "❑ Copper and/or Zinc
12. Crop type rVn1 _fT M:` a CCSIj &A-W'bA CG-) 5,0
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 04o
14. a) Does the facility lack adequate acreage for land application? ❑ Yes [� N%
b) Does the facility need a wettable acre determination? ❑ Yes QN
c) This facility is pended for a wettable acre determination? ❑ es No
15. Does the receiving crop need improvement? Yes ❑ N
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ yes 2N0
liquid level of lagoon or storage pond with no agitation? /
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes .L04l
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [I Yes BTio
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 o
Au Quality representative immediately.
�Commmts {refee,tu q�shon #)Fsplam any YES an5wasand/or aruy reoommendahons ors aay other oommmts. �'���� = _-'
wtags v%a-ay --• �P��-ems x- { P�aSct ) � .� ��
�Use.dra of to�better stmsfons.� use addtbo�"` ry ❑Field Copy ❑ Funal Notes q�
I S, � w ig
35.� Clwp- %�Etr►� oP_K--e6
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: i o
12112103 1 Continued

Facility Number. O 1 _ 13S Date of Inspection Z U
.Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes OlNo
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
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 0/025. Did the facility fail to have a actively certified operator in charge? ❑ Yes E' No
26. Fail to notify regional DWQ of emergency situations as required by General Permit? _ _
(ie/ discharge, freeboard problems, over application) ❑ Yes GN-0
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes PAO
28. Does facility require a follow-up visit by same agency? ❑ Yes Q V
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
NI MES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) Yes ❑ N4
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes C-
32. Did the facility fail m install and maintain a rain gauge? ❑ Yes �N
33. Did the facility fail m conduct an annual sludge survey? ❑ Yes [3 NN/o
34. Did the facility fail to calibrate waste application equipment? E❑ Y s [�]'No
35. Does record keeping forr ES required forms need improvement? If yes, check the appropriate box below. L es ❑ Na
❑ Stocking Form 0 Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
13 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit
12112103
12112103

Type of Visit r Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 9IRoutine O Complaint 0 Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time:
10 Not Operational Below Threshold
Permitted 13Certifiedr� 0 Conditionally Certified Q Regiipte�red ate Last Operate r Above Threshold:
Farm Name: O.R. Sbt, zzi-Ri) Zip. &Rin /1/U0 ounty: Qt-Zf
Owner Name: ®. R . b Lf Zz A QO f Phone No:
Mailing Address:
Facility Contact: Q (� Title: Phone No:
Onsite Representative: �, 1i� .T� t-T 2ZAR 0 Integrator: aEE rArn E
Certified Operator:
Location of Farm:
Operator Certification Number:
Pf Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =a 0` 0" Longitude =. =, =-
Design @urrep[ = r:Design Current n.- Design @accent
s,
Swine @a aci 'P,o illation ` P,ouit. -� @a aci P(Mula ;"q @attle iw @a aeity i` P,o ulation
❑ Wean to Feeder
❑ La er ❑ Da'
ElNon a er ❑Non -Dal
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder:
❑ Other
_ Total Design Capacity
❑ Farrow to Finish
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons
❑ Subsurface Drains Present ❑ La oon Area 10 Spray Field Area
Holding Ponds / Solid TrapsE1WFQ
No Liquid Waste Mana ement S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 2-0
05103101
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ Nu
❑ Yes ❑ No
El Yes No
❑ Yes No
❑ Yes P No
Structure 6
Continued

Facility Number: —l-�✓J Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
10
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
O No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
V No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
W No
9.
Do any strictures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
VrNo
Waste Application
10.
Are there any buffers that need maintenance/improvement? -
❑ Yes
No
11.
Is there evidence of over appiica on? ❑Excessive Ponding [I PAN ❑ Hydra llicOverloajd
❑Yes
No
12.
Croptype �,l��n/Tf!✓r✓I ✓J�Q/)1LI/)i9�Y�L`'KR'?�/
13.
Do the receiving crops diffe with those designated in the Certified Animal Waste Management Plan(C WMP)?
❑ Yes
�No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
JXNo
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
ElYes
�No
15.
Does the receiving crop need improvement?
❑ Yes
V No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
VNo
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
[Z No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
E;rNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
PNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
P No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
J3 No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
JV] No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�TNo
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
..•gam ..,.�;. ...cap amua. fuse auwuuuar pngea as neceaaaryJ ve
Field Copy Final Notes
RIEe rimy PuU-co ON'5ra SNInpa
o CaLCuu�T-F PRO P1RPcz!'F_D Lt.) Fe a, 2-CO3. 5F_e 06,tn
WQl-::777'rr1J �vQ C<<-cam 3i- 382.
Reviewer/Inspector Name" �"'` : '� '"' r
Reviewer/Inspector Signature: n,� Date: w ' -g
05103101 - Condnued

Facility number: Date of Inspection `
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes tr :No
❑ Yes IgNo
❑ Yes V40
❑ Yes [/No
❑ Yes rrr�[3 No
/yT ❑ Yes ! No
❑ Yes ❑ No
Additional Comments and/or, swings:
OC)TE. DJERP,,c) F Ff\
'e7xcIEp-r FOR 1J0-tEp %Df:rzc- aOCc t
�RoER. 1
O5103101
0

Type of Visit 'compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Routine Complaint Follow up Emergency Notification Other ❑Denied Access
Facility Number 31 s Date of Visit: 20 Time: =.30
10'Not O erational 0 Below Threshold
0 Permitted 0 Certified V0 ConditioonaTllyCertified D Registered Date Last Operated or Above Threshold:
Farm Name: O k 131 4- `4 ,' FR ^ / B,# b r rt r� County: D V41 1"N _
Owner Name: 0I ` Phone No:
Mailing Address:
Facility Contact: // Title: Phone No:
OnsiteRepresentative: ink ��iZZGI�OIT/'- integrator: Py-e3La4e
Certified Operator: Operator Certification Number:
[]Swine []Poultry []Cattle ❑ Horse Latitude 1 0 ". I Longitude =• =, =-
'Design _. Current -=Destgn Current Design _ Current
Capacity _ Ca ariPo Mahon CatlCa aCih Po`uisbopSwme.
❑ Wean to Feeder ❑Laver
❑ Da'
- _ ❑ Feeder to Finish ❑ No, -Layer ❑ Non DmTV
❑Farrow to Wean
❑ Farrow to Feeder ❑ Other I4 - 4-
❑ Farrow to Finish TOta! Design Capacity r
_. ❑ Gilts
❑ Boars _Total SSIW
r
-- Number of Lagoons F' ❑ Subsurface Drains Present 110 Lagoon Area ❑ S ray Fteld Area
- ..
Holding Ponds /I: It- Traps ; � � �,�g ❑ No Liquid Waste Management System '
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ YesIzNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes gNo
❑ Yes .L/J No
❑ Yes ONO
Structure 6
I
34
Continued

Facih'ty Number: 31 -2 35
Date of Inspection 2 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
i. Do any of the structures need maintenance/improvement?
8. Does any pan of the waste management system other than waste structures require maintenance/improvement?
9. Do anv smctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type S9,-4 4fe' AAr1VgI rL-l;'ker Ar)AL101 Ber^-t✓dA Pns'r e' Sv"'VI
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application? G m 1` n/ J,, t-t be -t pi S
b) Does the facility need a wettable acre determination? /
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes XNo
❑ Yes ZrNo
❑ Yes ONO
❑ Yes ff No
❑ Yes XNo
❑ Yes ZNo
❑ Yes N0
arh
❑ Yes ONO
❑ Yes )ZNo
❑ Yes JZNo
❑ Yes J2'No
❑ Yes )O'No
❑ Yes ONO
SM
V es 4No
❑ Yes ZNo
❑ Yes El'No
❑ Yes )ZINo
❑ Yes 2 No
❑ Yes ZNo
❑ Yes 0 No
❑ Yes Jallo
❑ Yes ZNo
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
'£omments,(refecto giiestign#):E:plam aeyYES amirersand/or sny.retommendaHopsorsnv other:eommerits. '.> - _
:Use drawings of facilitg-to better explain situations. (tiseaddrhnnal pages as neccessary) -' ❑Field Conv ❑ Final NotesE
—�
ed op,
Mom. L3�Z2Q G,S tOtG �rrgL �vv G� Ci ipfI elect btlell tipqeel.
Reviewer/Inspector Name rs
�,-1I— Ma-ik
Reviewer/Inspector Signature: Date: ZD OZ
05103101 Continued

Facility Number: 3) -2 35 Date of Inspection 2 D
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes [I No
❑ Yes XNo
❑ Yes ,QNo
❑ Yes ZNo
❑ Yes E]"No
❑ Yes ❑ No
❑ Yes ❑ No
Additional Comments and/or Drawings: _„4 -
O5103101
O5103101

I
�'bivtsron of Water, Quality , ;
K O Other A encod and -Water Conserv_ anon
x g
Type of Visit compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: S Q ( Time: I /J J Printed on: 7/21/2000
.�( Z 3.S
0 Not Operational Q Below Threshold
E3 Permitted l] Certified �0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: ..
Farm Name: ...... +j.�p.... Fei:rr'vt................................................................................ County: ,47)VP_. ..............................
Owner Name: -?I
121..r..Z2a'-� ......................... Phone No: ------------._._
..........................................................................
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative: ...... 0 t Zz a10-d
�,
................................................................................................ Integrator., ..................... A
..............................................._....-.-..-..-..-..-
Certified Operator: ................................................... ........................................................ ..... Operator Certification Number:..........................................
Location of Farm:
xrimne ❑ Poultry ❑ Cattle []Horse Latitude Longitude =• �•
Design Current Design Current Design Current
Sw1ne =;, Capacity Po tilation Poultry Capacity Po elation Cattle Capacity Po elation
Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish ❑Non -Layer ❑ Non -Dairy
Farrow to Wean
Farrow to Feeder ❑Other
Farrow to Finish Total Design Capacity
Gilts
Ki Boars Total SSLW
Lagoons ; l 1 . J❑ Subsurface Drains Present. 110 Lagoon Area 1❑ Spray Field Area I
Hatdmg Poems /Solid Traps.10 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ONo
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes /2'No
b. if discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes PI&O
c. If discharge is observed. what is the estimated flow in gal/min? t1 19
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑1
Vo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P110
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑1(Io
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes,'INo
SIruµore I Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: ....................................................................................
Freeboard (inches): 33
5100 Continued on back

Facility Number: 3 / —Z 35 Date of Inspection 5 I Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes dNo
seepage, etc.) TTTT
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes /11 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 I d No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 9No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes P�No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 'd No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes FNo
12. Crop type �taiinc/ 4,1✓tvaI,U) 4ce Anneal, ]Rer tvdq
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes PNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ YesNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes )dNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ YesXNo
///��—��—
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'PrNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yesl❑'No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes No
24.
Does facility require a follow-up visit by same agency?
❑ Yes X1J No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes/� J No
///
. QM6.l litQRS.ok- dQficie,IitltS �WCCC IIOt,@d d&ifiii this'visit. - iOu .wi �f&.OW irW futthib" . • ,
117, Ne 5- v re - 'o vse et 4_q od 60 da 4,C
apfbG64;o,, GVeki4s avi4kc T22-21s, T lies ,.,,,,vles Bvtly 6o
0i >�o know w� Is be;�gs�✓ayed 101'ia�' fo 57ray,n9.l
Reviewer/Inspector Name _ _ ��O ttCW,a�-...%'i,Ct 'r= -� ;= ,c
Reviewer/Inspector Signature: �t--�.! J' Date: /( O/ 5100

Facility Number: —2151 Date of Inspection I S/// / nl I Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'P(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes',�INo
roads, building structure, and/or public properly)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ff 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.) ❑YesNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes
//V"No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

IFacility Number 3 �3S Date of Inspection 3-2 f- ptj
�/ Time of Inspection /2 : �% 24 hr. (hh:mm)
® Permitted 0 Certified 0 Conditionally Certified [3 Registered Not O erational Date Last Operated:
FarmName: .......... 1-1!.�................. Fq..!'.Y.1.n................................................................... County:......_..ta..J!f.................................._..`'" -
.............
Owner Name:.........Q.:. �L.-..t_12Ar�................................ Phone No: /d,....zg�o
............................................................................................................
Facility Contact: .......: ��:..21a �dL....Title:...(?� .................... Phone No: V) ZyG —r2SS
.......................... ..................................................................
Mailing Address:
Onsite Representative: ..... Q/�. �-• 15 `` Z�i.fof f eS .�
1!:......................................A.:............................................... Integrator:.................................................GG................................
Certified Operator:..,,,,,,,,,,,; _L71T, ....___......_.. Operator Certification Number:....,1.q, 7 3 b
Location of Farm:
Latitude =*=1 =•{ Longitude =• 01 =11
..
Desigu- Current`
--
Design -Current - Design_ Current
-. ;Swine ` - ' Ca acit y . Po ulation
Poultry Ca Capacity Po uI 'tion_ Cattle -_
ty---..Ca--I '`'Po ulatio-
❑Layer ❑Dairy
❑Non -Layer ❑ Non -Dairy -
❑Other
Total Destgn Capacity
-
Total SSLW
0 - Number of Lagoons
- -., ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area -�
Holding Ponds /Solid Traps
- ❑ No Liquid Waste Management System''
❑ Wean [o Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow [o Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Utsenarges & Ntream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ....._33 .�
......................
❑ Yes �No
❑ Yes � No
❑ Yes No
❑ Y o
❑ Yes rNo
o
❑Yes
❑ Yes �No
Structure 6
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: 31 —a Date of Inspection 1
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
1[J No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement? -
❑ Yes
5f No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0 No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
PNo
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
%No
11.
Is there evidence of over p li ation ❑ Excessive Pending El PAN
❑ Yes
pQ No
,
' s�<
12.
Crop type
13.
��
Do the receiving crops dif er withf• those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
qNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
9 No
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
,,��.VNo
gyivo
15.
Does the receiving crop need improvement?
❑ Yes
o
16.
Is there a lack of adequate waste application equipment?
❑ Yes
Po
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
P(No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
J✓��..
fie/ WUP, checklists, design, maps, etc.)
❑ Yes
WO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�dNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
V,No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
9CNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ANo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
CdNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
9rNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P(No
. . �. . . . . . . .S. . ft . . . .,. . . .were IlOt,E'.(. f�IH`kl.. i. . . V. ... . . . . . .'Q. . . . i. . t�. .. . C. • • • .
::....
noridenceahotitithis:visit_ ........... ......
vings of facility to better eexplam situahons (use additional pages -as necessary):'
Reviewer/Inspector Name , ,,,• -` - '�/� ` ; _ ' -••• t -w
Reviewer/Inspector Signature s Date a-
3/23/99

Facility Number: 3 —.�23 Date of Inspection 3-77-p0
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below-Pla-
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ANo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ISi'I No
roads, building structure, and/or public property) - T`
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes RNo
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 VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes XrNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Ye l No
3/23/99

41
Lagoon Dike Inspection Report
Name of Farm/Facility
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream Slope,xH:1V
Embankment Sliding?
(Check One, Describe if Yes)
64-
Names of Inspectors
(� Freeboard, Feet
Z— Top Width, Feet
—21
�SsLZ-�
vZ,
Q
Downstream Slope, xH:I V
Yes --_�No
Seepage? Yes / No
(Check One, Describe if Yes)
Erosion? Yes ---go
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop? Yes —No If Yes, Depth of Overtopping, Feet
Follow -Up Inspection Needed? Yes No
Engineering Study Needed? Yes No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes
Other Comments

. E3Division ofSoil
'
El Division of Soil
-a Division of Wat
-_'[3 Other Agency
I Facility Number Z 5 I
Ion Compliance Inspection - _ -
celnspection
Follow-on of DSWC review O Other
Date of Inspection
Time of Inspection Q 9 24 hr. (hh:mm)
®Permitted E3Certified E3 Conditionally Certified 13Registered JE3 Not Operational I Date Last Operated:
Farm Name: 94 zZ el ................... County: ty:.4qqu f_7.1.�.....................................p...............
Owner Name: .............. L(...:.)C.-.........'•z................................................. Phone No: �..t!.o-.'...... ....1.1(J.. ..�_zS.............
Facility Contact:
Mailing Address:
Title:
Phone No:
Onsite Representative:......._D../fiC-<4
rr2
....4J........................................................................ Integrator:.................4.........._................................................
CertifiedOperator: ................................................... ................................................ ............ Operator Certification Number:..........................................
Location of Farm:
Latitude Longitude �• �' �"
Design Current '_ Design "Current Design Current
Swine Capacity Population .Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
Feeder to Finish
'Lq
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
❑ Other
Total Design Capacity
Total SSLW
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes JR 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 X No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?' ❑ Spillway ❑ Yes 0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Freeboard(inches): ..... 9 3 ............................................................................................................................................................................................
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: 31 - 23S Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or-'-�-�-'
closure plan? ❑ Yes H 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? I§ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes $I No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ® No
Waste ADDlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
N No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
® No
12. Crop type �� S �� S� W A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
$f No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
g No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Required Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
®,No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
-
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
j$ Yes
❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
®No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
19 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
§§ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24. Does facility require a follow-up visit by same agency?
❑ Yes
JR No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
L9 No
0' Mi yiolatitiris'oi•- deficiencies •were itot_ed- during 4bis:visit' . Y:oil will•eeeeiye no further • : :
cories orideht e:about:this visit. * :::::::::::::::::::::::::::::::::: :
Comments (refer to question #)i Explain any YES answers and/or any.recommendations or -any other comments.-.__-
Use drawings of facility to better explain situationsi(useadditional pages as necessary):; ..
-
7. Mow I q jovrt weAlls.
`
19. /Ve"
(,vet4c 6trkod4Sis
iS n--exeA,
14-<4t ant o(g4r_,4
3 /)9l`1
j,
Make
SVO't: gG�Pq/qtS
Orl TICR
"UrcAgeS
'in
'PIA n.
Reviewer/Inspector Name i- .s-7pyletAjG.���.r•=' (RtQ) 3-1-5 3'=Q`(�Q=iY7 2•l7'` "'
Reviewer/Inspector Signature: -r Date: P IcM4
3/23/99

.. Facility NumDate of InspectionT
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
® No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
g) No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
IgNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
f4No
3/23/99

0 Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
e
Date of Inspection 0 30 0.8
Facility Number 2
II Time of Iaspection 2- s 24 hr.
D Registered Wertified E3Applied for Permit 13Permitted IMNotOperational I Date Last Operated: _,,,,,,,,,,,,,,,,,,,,,,,,
{� \
Farm Name: .._81.. n:`...............r............................................................................... County:
....
.1n.4 1!.G...........
...1....../........
... .......................
Owner Name:...C.R.....�? 22ie`�............................................................................ Phone No:.......�I _e;L tb — 1? e..............................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing
Onsite
Certified Operator................................................................................................................ Operator Certification Number:.........................................
n of 'arm,
.. ...9........_Q-:�l.. ............ .............1 iA........:`r..�.........`•�•i ...... ........L................................`-4..�5....... _...... ^:.:........5..............
° .........
. .���....... �...k... \ ` ..._a?.._ _✓...1¢. T.........................................................................................................................
Latitude =• =' =" Longitude =• =, ="
Design" Current a Design Current'°a Design Cur e
Swine, �-�Capacity Population -,Poultry Capacity Population Cattle,-.-,."Capacity,Populatni
❑ Wean to Feeder ,. ❑ Layer ❑ Dairy
Feeder to Finish �5j G ❑Non -Layer ❑Non -Dairy
❑ Farrow to Wean *°
❑ Farrow to Feeder = ❑ Other y`
❑ Farrow to Finish Total Design Capacity.,.
e ❑ Gilts = "
❑Boars v Total SSLw-
Number of Lagoons / Holdrrtg Ponds ❑Subsurface Drains Present-JillLagoon Area ❑Spray Field Area Y
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
❑ Yes
15(No
2. Is any discharge observed from any part of the operation?
❑ Yes
WNo
Discharge originated at: ❑ Lagoon ❑ Spiny Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
14 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
14 No
c. If discharge is observed, what is the estimated Flow in gaVmin?
N
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
0N0
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
RNo
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
10 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
ONO
. maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
M No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
r;yNo
7/25/97

Facility Number: — 3 S
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La¢oons.HoldinQ Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier: A
.......................................................................................................................................
Freeboard(ft): ...........134;....................................................................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes (fNo
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or enviromnental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..... �1..`..:_2..�!`l�^....... f....L. .......'...............................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only.
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
LT No.violations,or deficiendes.wen noted diiring this: visit. YOn.wia'receive no further .
correspi)6deuce 44out this:visit:....:... • ....... • .
4A--\\3�.
❑ Yes _1No
❑Yes No
❑ Yes ONo
❑ Yes 1A No
❑ Yes P(No
❑ Yes MN0
❑ Yes ,rMNo C
❑ Yes No
❑ Yes 6f No
❑ Yes pM No
❑Yes 9No
0 Yes ❑ No
❑ Yes 19No
❑ Yes 4No
❑ Yes gfNo
7/25/97

DSWC Animal Feedlot Operation Review
DWQ Animal Feedlot Operation Site Inspection
JoRoutine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
q q q
Facility Number 3 L
Date
of Inspection � 24 hr. (hh:mm)
0 Registered ® Certified [3 Applied for Permit [3 Permitted IE3 Not Operational I Date Last Operated:
FarmName: .... 9-0.kt...... Ffb_t..�.................................................................................. County:... ?.v....i..r................................. W.!..�..
Owner Name: ... 6.:...................................... ..J...2. ..P...... .....M.T.Y................... Phone No: ... L.`.j.) .�..)._Z9..k.-.J.. .t�.......................
Facility Contact:
Title:
Phone No:
Mailing Address:...144Wxy ..... r I
(`.:tip _S_v.!..1 �? .......... ...............
Onsitc Representative: __Q.<..R ..,........g.L .t......�T_r............................ Integrator: ..... P. _� 5..174-3.............................................
Certified Operator ,.................................................. ..........................._................................ Operator Certification Number, .......... /. f_Z7 ..42.........
Location of Farm:
LI.»......tiaQ.d.t.....f..i.Aa.....a....._5.12.1�..1...T.....ts�..�a..rx....t...tx.a. D.<.�.......�, .t...L%A.......4 o..r... .....r................
:x.n..=..G.t !..Q.........t�7.,.T......P„1..:7..0..Q.............................................................................................................................................................. .
Latitude =• 0' =" Longitude 0. =' ="
Swine Capacity Population
❑ Wean to Feeder
M Feeder to Finish
Zq Q
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons / Holding Ponds
General
Poultry Capacity Population Cattle Capa
❑ Layer I I I ❑ Dairy
❑ Non -Layer I I ICI Non -Dairy
❑ Other
Total Design Capacity
Total SSLW F x.
` I❑ No Liquid Waste
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 gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any pan 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?
9 U
pray Field Area
9Yes JRNo
❑ Yes CRNo
❑ Yes Rj No
❑ Yes ® No
❑ Yes [No
❑ Yes No
❑ Yes Q No
❑ Yes RNo
❑ Yes Q No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
Continued on back

Facility Number: 3 — 2,
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures(Lagoons.Holdins 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(fq:......... 3.r.. 5.....................................
10. Is seepage observed from any of the structures?
I I. Is erosion, or any other threats to the integrity of any of the structures observed?
Yes WNo
❑ Yes ® No
Structure 5 Structure 6
❑ Yes ® No
❑ Yes ® No
12. Do any of the structures need maintenance/improvement? ❑ Yes ® No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes E[No
Waste .Application
14. Is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ
15. Crop type......S:n..r..,n........................... �..en'..m:.s!...(La......................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ® No
17. Does the facility have a lack of adequate acreage for land application? ❑ Yes El 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?
i�j 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
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes R No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ®.No
® No.violations or deficiencies were noted during this.visit..You.will receive no further
correspondence about this visit::
ft
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t-ir4-) r e ad
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W U r•� L°-p^'S 0,
1
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7/25/97
Reviewer/Inspector Name A -
Reviewer/Inspector Signature: q.1, „ . _ , y[v-j . U,p�.,,, Date:

Facility Number.3jL--LE-5
Division of Environmental Management
Animal Feedlot Operations Site Visitation Record
Date: ' - ���•G
Time:
General Information:
Faun Name: t7, e64 � 7n eCounty: Pam_
Ownec•Name: D. Q'• t 3 i d y • ct elD Phone No: Z2 (. / 7 <;;"
On Site Representative: ' A of Integrator: 1�w5 i � Cr6
Mailing Address: I l (P'-/ Ai. A'C
�.t�uKsv.11c Jc_ Z%3VS-
Physical Address/Location: 52 i S I (o ' v - G SrZ 1 -100.
Operation Description: (based on design characteristics)
Type of Swine No. of Animals Type of Poultry No. of Animals Type of Cattle No. of Animals
Q Sow ❑ Layer O Dairy
0 Nurse
zlyo O Non -Layer ❑ Beef
OtherType of Liverrock Number of Animals:
Number of Lagoons: t (include in the Drawings and Observations the freeboard of each lagoon)
Facility Inspection:
Lagoon
Is lagoons) freeboard less than 1 foot + 25 year 24 hour, storm storage?:
Is seepage observed from the lagoon?:
Is erosion observed?:
Is any discharge observed?
O Man-made L(NotMan-made
Cover Crop
Does the facility need more acreage for spraying?:
Does the cover crop need improvement?:
( list the crops which need improvement)
Crop type: nc 15i4.i Acreage: Zo
Setback Criteria
Is a dwelling located within 200 feet of waste applicadonl
Is a well located within 100 feet of waste application?
Is animal waste stockpiled within 100 feet of USGS Blue Line Stream?
Is animal waste land applied or spray irrigated within 25 feet of Blue Line Stream?
AOI — January 17,1996
Yes ❑ No U]
Yes ❑ No EB�-
Yes CY No ❑
Yes GY No ❑
Yes ❑ No a'
Yes ❑ No (a'
Yes ❑ No CT
Yes ❑
No Q'
Yes ❑
No El
Yes ❑
No E�

Maintenance
Does the facility maintenance need improvement? Yes ❑ No C-r
Is there evidence of past discharge from any part of the operation? Yes d No Cif'
Does record keeping need improvement? Yes C! No FR'
Did the facility fail to have a copy of the Animal Waste Management Plan on site? Yes ❑ No Gr
Explain any Yes answers: 1�0 ��v� S e TdtA.,r
lq.c-e ay_!26
ii+i.G�u„Jfll�.J�D � O..<J. i%5-G� f�io '� $ua-�c ✓ ....
Signature: Date: GJ' 2e
cc. Facility Assessment Unit Use Attachments if Needed
Drawings or Observations:
n
.COI — Januar? 17,1996

•
•
Site Requires Immediate Attention: Ale
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATI�ON/$� SMITE VISITATION RECORD
DATE. O / v/ .1995
Time:
Farm No
Mailing
County:
Integrator.
On Site Representative: _
Physical Address/Location:
Phone:
Type of Operation: Swine V Poultry _ Cattle
� Capacity: Design Ca aci l7'O 4' 7+0 C Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:Longitude: Elevation: Feet
S 0 % Circle Yes or No -77 S 3
Does the Animal Waste Lagoon have fftcient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches Yes r No Accrual Freeboard^ Ft. Inches
Was any seepage observed from the lagoon(s)? Yes oq NoJ%Was any erosion observed? Yes tN
Is adequate land available for sp ay? Yes or No Is e cover crop adequate9 es or No
n f rt�Z Crop(s) being utilized: ^ 4D A!ww Is
rn ' b _ Ll"y-
Does the facility meet SCS minimum setback criteria? 200 Feet from
100 Feet from
Ito
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 90 If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No I 1
Additional Comments: flu.&� S / 7'�/� �& 5 ( 7
/lL
Inspector Name
2
cc: Facility Assessment Unit
Use Attachments if Needed.