310237_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

'W -17
for Visit: Z Routine 0
Referral
Date of Visit: •/®- Arrival Time: _d; ( Departure Time: County:
Farm Name: W i t f 0 4" D SO Il/ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Title:
Phone: //
Integrator: AOSAId
Certification Number:
Certification Number:
Latitude: Longitude:
Denied Access
Region:
Swine
Wean to Finish
Wean to Feeder
Design Current
Capacity P.
Wet Poultry
Layer
Non -La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Feeder to Finish
t (
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) . P,oult ,+
Layers
Design
Ga aci +
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
IBeef Brood Cow
Other
Other
Turkeys
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[—]Yes No ❑ NA ❑ NE
❑ Yes ZYN[—] NA ❑ NE
❑ Yes Er No ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ YesVNoNA
NA ❑ NE
Yes ❑ NE
Page I of 21412015 Continued

Facility Number: Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): � Z 'e
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JZ7NotE NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4fi 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
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
Z ❑ 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 ONo ❑ 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): r3QiM• viL), SMi�4i�J
13. Soil Type(s):
1�
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
VNo
❑ NA
❑ NE
acres determination? '
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesVNo❑
NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers / Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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: -g3 jDate of Ins ection: a - -
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes gNo ❑ 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 Go ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No CO] NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field - ❑ Lagoon/Storage Pond ❑ Other: _
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[—]Yes ❑ No
❑ Yes ❑ No
❑ Yes [—]No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refef to question #) Explam any YES answers•and/or any -additional, recommendations or any„other comments
Use:drawings"of.facrlity`fo better "explainsituations (uise_addrtional pages ss necessary).
5(tithe 5t< I /I- 1i-/7
o = 3-Cls
P, u ,q,s
CON
Reviewer/Inspector Name:
Phone: .7 / / -y 20C,
Reviewer/Inspector Signature:
Page 3 of 3
r
Date: (Z - / 1-(
21412015

2
Reason for Visit: Qiloutine O complaint 0FFollow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: / /` Arrival Time: -l/�� Departure Time: � County: Region:
Farm Name: �"� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: /6 163
Certification Number:
Longitude:
ri..:n"`-.
' ke-t uKi+<! Is rcs�%
3Anar3'
+ v �. .mn'M'a.�
` ' +Ml
1 1
•
{i`•t�,�y.
r inStM4 �ti i�+�4 b911
' Y{y fix" 1 1
u IY�ti
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �No[
/ NA ❑ NE
❑ Yes NA ❑ NE
Page I of 3 21412015 Continued

Facili Number: jDate of Inspection: /b
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ETNo ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 'Zc
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 25'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 �o
❑ 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
g�No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
ZfNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2TNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
Jo
❑ 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
ONo
❑ 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
�o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
6N 'o
❑ NA
❑ NE
Reauired 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 ❑Checklists ❑Design ❑Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ]]Nd/o ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili umber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Q Noo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑-go ❑ 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 fast 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 ❑-11A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[—]Yes E?I o ❑ NA ❑ NE
❑ Yes E3<�❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
❑ Yes E3<o ❑ NA ❑ NE
❑ Yes ❑' e❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional"recommendationsoranyothercomments.,N
Use drawings of facilityto better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I (a 79G /73is
Date:
' 21412014

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit�outinnee 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: . Y[J� Arrival TimeTITE—D Departure Time: tl 0 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: n 1Title:
n
Onsite Representative: d I V O I' S
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet PoultnY
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wg= to Feeder
I
INon-Layer
IDai
Calf
eeder to Finish
L(
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I) , P,oaltr,
I Layers
Design
Ca aci
I
Current
$o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Beef Feeder
lBeefBroodCow
Boars
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
[_]NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes 0
NNo''' ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: ? I 2 j Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0<0 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
)T,S
Structure 3 Structure 4
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?
Structure 5 Structure 6
❑ Yes do ❑ NA ❑ NE
❑ Yes E3<o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental eat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ONo ❑ 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 Pending ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN> 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑�No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E21<c , ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
r3No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[3-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?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
O-Ves ❑ No
❑ Yes No
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q"1`lo ❑ 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 0o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

$acili Number: Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
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:
ff No ❑ NA ❑ NE
❑NA ❑NE
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes Lj No ❑ NAB ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [—]No 0-14A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ZrNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
any,
better
Reviewer/Inspector Name: v f r
Reviewer/Inspector Signature: Y
as
❑ Yes NA ❑ NE
[—]Yes P4o❑ NA ❑ NE
❑ Yes E o ❑ NA ❑ NE
❑ Yes Ito ]NA ❑ NE NN
❑ Yes I� I�No A ❑ NE
❑ Yes oo 0 NA ❑ NE
ons or any other comments.
71 ( Gcr_­�WS
Phone: `l 0'
Date: 1 2- �r
Page 3 of 3 21412015

Type of Visit: Compliance Inspection 0 Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit: QJRoutine O Complaint 0 Follow-up 0 Referral O Emergency 0 Other 0 Denied Access
Date of Visit: LYL�! y Arrival Time: ID Departure Timer County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: 6 LI ao'
Certification Number:
Longitude:
Design Currept
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Gucrent
Pop.
Design Current
Cattle Capacity Pop.
Da' Cow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,ouI ,
Layers
Design
Ca aci
Current
P
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I
I Beef Brood Cow
Other
01 Other I I
Turkeys
Turkey Poults
Other
Dischar¢es 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 W o ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[—]Yes ❑ No
❑ Yes RTNo
[—]Yes Ea'No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facifi Number: jDateof Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )?!fNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes J2!rNo ❑ 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 y � 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 )ErNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �i' No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) t
9. Does any part of the waste management system other than the waste structures require
[:)Yes P No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes EfrNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes rdNo
❑ 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?
�t
❑ Yes No
y �
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes VrNo
❑ 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 �o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ONo
❑ 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 FrNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ;n No
❑ Yes j!fNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Faciti Number: Date of inspection: -)
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes AgNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes PNo ❑ 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes KNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes P(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 XNo
❑ 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 KNo
❑ 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 7rNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 0 No
❑ NA
❑ NE
Reviewer/Inspector Name: Phone: Le-),L-d- 6
Reviewer/Inspector Signature: �Date: f I- a
Page 3 of 3 Cj 21412011

Type of Visit: 1
4 Compliance Inspection p Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time:® Departure Time:® County: Region:
Farm Name: T Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 1 A ^�7 S AI
Certified Operator: � /— (mil 1; i'y /" l O i SG/(
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
CerTif�Otion Number:
Certification Number:
Longitude:
/ CD &D
Swine
Design Current
Capacity Pop.
Wet Poultry
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
I ILayer
Dai Cow
Wean to Feeder
I lNon-Layer
I IDai
Calf
Feeder to Finish
g
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D , + P,ouI
Layers
Design
Ca aci
Current
D Cow
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
(hher
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 V No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
'KNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 21412011 Continued

Facility Number: Date of Inspection:
Waste Coltection & Treatment
�(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
I Xl No
7❑]
[DNA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: (maw
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
17y 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
�i(�
I R No
❑ NA
❑ NE
waste management or closure plan?
7"'�
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) ���ccc
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 XI No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) l
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop
Window/ ❑ EvidenceofWind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): Ste_ DC121 i4 {� �{(l l" 1
13. Soil Type(s):
S
ao
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ 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
o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
IRrNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑' WUP ❑Checklists © Design ❑. Maps ❑ Lease Agreements ❑Other: y�
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes I xl No ❑ NA ❑ NE
0 Waste Application ❑ Weekly Freeboard .❑ Waste Analysis Q Soil Analysis ❑ Waste Trans rs Q Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield i❑ 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 2/412011 Continued

Facility Number: - '� Date of Inspection: q 1.5 /
24-Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 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. Ix
❑ 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 M No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes } / I 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?
No
❑ Yes I*No ❑ NA
I*
❑ NE
If yes, contact a regional Air Quality representative immediately.
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 allo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
,,,___,,,[[[
❑ Yes No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes J� No ❑ NA
❑ NE
Comments (refer to question f: Explain any YES answers and/orany:additional recommendations•or.any;othercom`ments:>'
Use drawings of facility to better explain situations .(use additional pages as necessary).
w• t 1 -
►�/�g-�� i /,3
�) l�� 11 J • L)
'VAC-
62A TQ0,,V
Reviewer/Inspector Name: 4MAX014 Ll A /A E S
Phone: qIG G rD
5
Reviewer/Inspector Signature: � .
Date: a lis-JI nn C
Page 3 of 3
21412011

Inspection (J Operation Review Q Structure
for Visit: q3LRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I Arrival Time 1 Departure Time: /Q" ' County: 1.�{n(Y1/V Region:
Farm Name k,CIZ/ndAf )A01S 1-6AS7(-W ).4afiA �—
Owner Name: �&)l LL I p M M. D O i S (.t N
Mailing Address:
Physical Address:
Facility Contact:
I CA-il I_(- I iq to S
Onsite Representative: ) I1Q '-n J-z5l. k
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Owner Email:
'116-o�1fi-5330[ N
Phone: 710-9i3- ci3ba (N+*)
NAN5U1LC-E /VC 0FSU17
Phone:
Integrator:
6.0[/
Certification Number:
Certification Number:
Latitude: Longitude:
Design C•unrent
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P p.o
DairyCow
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
La ers
en
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
8 No
❑ NA
❑ NE
❑ Yes
P'No
❑ NA
❑ NE
Page 1 of 21412011 Continued

FacitiNumber: ( - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
EfrNo
❑ 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
JZNo
❑ NA
-fD-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
B No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
❑' No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
PrNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
k] 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
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
I / I No
❑ NA
❑ NE
acres determination?
T
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
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 ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Tr sfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
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?
[—]Yes m No
❑ Yes n No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: jDate of Inspection: S8
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ,n No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [Z 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 12 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes O No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes f'No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. '
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Z 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 dNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �Z No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [:]Yes No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments: g ;, 1
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
0 e jU11e A a
rS—Vrdey �i ao/% _/
riN %-ecol-Ols lod 4,5'oy
Phone:
- 7936
Reviewer/Inspector Signature:
Page 3 of 3
Date:

of Visit aCompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit A Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: t } Arrival Time: � Departure Time: County: /7l/ Region:
Farm Name: Ncu
(&n(4.v VJPU I S N6l vS TO/V FOP M Owner Email:
I • \ YI / t 1/y� 9/O-a98-5S3oCri
Owner Name: w)LjLla M. �'\O i SCVV Phone: 9/D
W.
Mailing Address: qM . wt C-L.1 orn-A Vd 1�/ �GwgAjSUI LLir NC QE3c1
i
Physical Address:
Facility Contact: (� Title:
Onsite Representative:
Certified Operator: C JlL.LtAA& I"At-V_'oT$UN
Phone No:
Integrator:
Operator Certification Number: 11030
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: � V LA 10,, Longitude:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ElYes *No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes []No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
0
❑ Yes ❑ No
❑ Yes �6 No
❑ Yes 14.No
12128104
❑NA ❑NE
❑ NA ❑ NE
[I NA ❑NE
Continued

9W,ilityNumber. — oZ3� Date of Inspection
Waste Collection & Treatment
\� ",
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
El Yes ty No
JJJ❑��-No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: LA600A/
Spillway?:
Designed Freeboard (in):
1�.5
Observed Freeboard (in): R (0_
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes NO 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 VNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ;6-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
�(,
El Yes -No
❑ NA ❑ NE
maintenance/improvement?
1T
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes t No
El NA El NE
El Excessive Pending El Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, Zn, etc.) r \
❑ PAN ❑ PAN > 10% or ]O lbs []Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [I Evidence Wind Drift
El Application Outside of Area
12.
(oof
Cropb'pe(s) e&qt'�
✓� b,ejLo>b
13.
Soil type(s) 9k j felt-5 (�>1VIVCAL�
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
KNo
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
JdNo
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
V. No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
tkNo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
o
❑ NA
❑ NE
Comments (refer to question.#): Explain any YES answers and/or°any recommendations'or any other comments
W
Use drawings of facifity'to'better explain situations: (use additional "pages as necessary).;; wM g
lA_�•
-
ap9p y
Reviewer/InspectorName F—- AtA,*oq,,/ s-
Phone: gM b 32
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents ! ,(
19. Did the facility fail to have Certificate of Coverage & Permit readily available? [I Yes , No El NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes,gNo El NA El NE
the appropriate box. ElWUp El Checklists ❑ Design 0 Maps ❑ Other✓✓�✓✓ \\\\\\
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No [INA [INE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis El SoilAnalysis ❑Xaste Transfers'' ❑ tttual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections El Monthly and V Rain Inspections 0 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?
❑ Yes 1jqNo
❑ Yes No
❑ Yes 9No
❑ Yes ;� cccNo
❑ Yes Qq No
❑ Yes /❑ No
❑NA El NE
El NA El NE
❑ NA ❑ NE
❑ NA ❑ NE
El NA El NE
❑ Yes{
No
❑ NA
❑ NE
❑ Yes
ICJ No
❑ NA
❑ NE
❑ Yes
V` No
❑ NA
❑ NE
❑ Yes
KNo
❑ NA
❑ NE
❑ Yes
1VNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes to No ❑ NA ❑ NE
FWAI -IOII

Type of Visit '0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 04 Arrival Time: ` \® Departure Time: County: ! a- Af Region:
Farm Name: I— `CQMQ7 t �MU%% S VYAS7UN PA9 A Owner Email:
L t�I LU PM 1 ' 1. �TSON G to a98 `+3vOCh
Owner Name: Phone: or193-S37oCw
.� 4tb- 93-3178 C31
Mailing Address:
Physical Address:
Facility Contact: 2 Title:
OnsiteRepresentative: I_'IiLLLk �c%l SLX,
Certified Operator: Wt uj1P0 M T S�
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: JO3&'?S
Back-up Certification Number:
Latitude: no n' F__J« Longitude: I I° I I I-1
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer 1
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer 1
❑ Dairy Calf
Feeder to Finish 4/0
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
El Farrow
Layers
❑ Non -Layers
❑Beef Stocker
❑Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Turkeys
❑ Beef Brood Cow
Other
❑ Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes 4No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
9No
❑ NA
❑ NE
❑ Yes
YNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: 3i — Date of Inspection
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 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: Lf <z06JV
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes KNo ❑ 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
QNo
❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
ty 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
P.No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
XNo
❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
�[
0-No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > I0% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [I Evidence of Wind Drift El Application Outside of Area
12.
e>
Crop type(s) 7La ,J IF VIZ_ J
13.
Soil type(s) �jt� f'r�� S Z�C>XN E AUK
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
)ANo
TXNo
[I NA El NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑
yes
tANo
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
El Yes
9
[I NA [I NE
18.
Is there a lack of properly operating waste application equipment?
El Yes
XNo
❑ NA ❑ NE
@omments (refer to queshon #) �Ezplarh"�any;�YES answers andlor«any"recommendahons•or any other comments.
,LTs�drawmgsYoffacrhty to better}eaplam srtpahons�(useraddihonat;pages as)necessary)E-
lu . � �(te-�'rlFLQ6 tAot' S GOAD . •
slay Ps �.
Reviewer/Inspector Name I fnmaa s Phone: 916- '
Reviewer/Inspector Signature: Date:
Page 2 of 3 I2128104 Continued

Facility Number: — Date of Inspection / I$
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the approprrate box. Q WUP ❑ Checklists 0 Design �l���A111111
g ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. / ❑ Yes �No El NA ❑ NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis ❑ Waste Transfers El/nnual Certification
0 Rainfall El Stocking ❑ Crop Yield 0 120 Minute Inspections El Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
UNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
KNo
❑ 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
)kNo
0 NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ElNo
119 NA
❑ NE
Other Issues
�`
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
N No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
V 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 concem?
❑ Yes
)QNo
❑ 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
10, 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
�ZNo
❑ NA
❑ NE
Page 3 of 3 72128104

7 t.
Division of Water Quality
Facility Number ?j 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit &Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: ® Arrival Time: 60 Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: �ICL`� �O-T5�
Certified Operator: �� ( M . �OTSb IV
Owner Email:
Phone:
Phone No:
Integrator:
Region:
Operator Certification Number: -1 Uis
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: [�U [�' [�„ Longitude: mom, [ ---- ]„
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes KNo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
)KNo
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12128104 Continued

f_
Fac' ' - Number: 31 -a311 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: LAcgo ,x/
Spillway?:
Designed Freeboard (in):
�, S
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
4 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
Lr-,Q No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
O No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
0 No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
kNo
❑ 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)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
A No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
14No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
R No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
J No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
�UNo
❑ NA
❑ NE
Comments (refer to question t): 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):
LIYTLE FQOSIQA/ 0INC I NS►�E OF �\ �� WALL - /VFW n �1Qi`�V�rcTA71
Reviewer/Inspector Name � nh_4A A__ ja /q(E S Phone: O - }'76 }�
Reviewer/InspectorSignature: Q%I Date: 15INT
Page 2 of 3 12128104 Continued

L.
Facility Number: — 3 Date of Inspection
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 CAWMP readily available? If yes, check ❑ Yes KNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes XNo ❑ 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
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
KNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
gNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Ef No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
PjNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
4 NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
X No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
10 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
���ttt���fff
�y No
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 10 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access j
Date of Visit: jj0 Arrival Time: nn a Departure Time: SOD ounty: G Region: Cih�
%I Farm Name: AGAAn) Owner Email:
Owner Name: UJ7LLZtq-1n ,/�htSD� Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 'A?Le_ .U07-s0/J
Certified Operator: al zzz 190750/N)
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
No:
Integrator:
Operator Certification Number: /62? 63
Back-up Certification Number:
Latitude: = o ='
= Longitude: = o =' = 11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -La er
Dry Poultry
Discharges & Streamlmpacts
1. Is any discharge served from any part of the operation?
Di sch ge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
E]Dairy Cow
E]Dairy Calf
E]Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: ET
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 [l m A f-I xTP
El Yes ❑r'_�
❑ Yes
El Yes (�
f/
%
12128104 \

Facility Number: — Date of Inspection I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier. u
Spillway?: ATID
Designed Freeboard (in):
Observed Freeboard (in): 35
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.)
,�j
6. Are there structures on -site which are not properly addressed and/or managed Yes I/E No
[INA El NE
through a waste management or closure plan? 1//
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentalthreat,
notify DWQ
��
7. Do any of the structures need maintenance or improvement? El Yes
❑ NA ❑ NE
,,,..y�No
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes !�[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 Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes /No
ElNA [INE
maintenance/improvement?
11
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes I[J 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 El Evidence of Wind D 'ft ❑CApplication Outside of Are
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from hose designated in the CAWMP?
❑ Yes Y.1 No
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes /,,,��{{{ No
❑ NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes //,{.[,d(No
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
[I Yes /VJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ZNO
❑ 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):
15) 51Zs106 14
r!
'5j9.,n1, B4U S `�r�
Reviewer/Inspector Name 4 Phone: C�[
Reviewer/Inspector Signature: Date: G
12128104

Facility Number: —23 Date of Inspection
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 appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
yJ Yes
❑ No
❑ NA
❑ NE
❑ Yes
IQ No
❑ NA
❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 00No ❑ 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?
❑ Yes X,No ❑ NA El NE
El Yes EfNo ❑ NA ❑ NE
❑ Yes A_,(No ❑ NA El NE
❑ Yes YJ No ❑ NA ❑ NE
❑ Yes X4No El NA ❑ NE
❑ Yes ko ❑ NA ❑ NE
❑ Yes
�No
[I NA
El NE
El Yes
No
El NA
El NE
❑ Yes
,---yyyV
0, No
❑ NA
❑ NE
ElYes
Ld No
❑ NA
El NE
El Yes
/�No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
z FZXts0 F_w' `
rd �� oN 6ztf
21) GocA�f /��✓/� /�GffC Gt�z-� � cos..
D16ROLf_ / e&o0. <,
SOP /�uM/� �f i/f_L 44p4 pal p 4 -7,
12128104

(Type of Visit Qfcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit —0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address: _
Facility Contact: _
Onsite Representative:
Certified Operator:
Back-up Operator:
Arrival Time: 'GOB �DDeeparture Time: County:
/41 111% Owner Email:
Title:
Phone:
No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = = = Longitude: = ° =
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes P No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
91 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 ❑ 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):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or apy other comments ' LI
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I A I Phone: - / - 6 Y
Reviewer/Inspector Signature: Date: Z
Poop 7 ..! t 1 /2R/04 Continued

Facility Number: — Date of Inspection
�Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑-No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo ❑ 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
;�Tlo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P'5No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,FzrN;o
LI 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
J-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
UNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
1!3 No
❑ NA
❑ NE
Additional°Comments and/or Drawings:
a3) 4l11 oregloil' /S cn PLO' 11 h
e i �^ jCre�
Page 3 of 3 I2129104

(Type of Visit _ ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visi Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 0 Arrival Time: �.7 �� Departure Time: County:
Farm Name: 46(Q. "/:2 1—^-7 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:V Q �Rrari
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Phone:
Region:��
Phone No:
Integrator: 71W
Operator Certification Number:
Back-up Certification Number:
Latitude: [ o = ' = Longitude: = o = , = «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
H❑ Layer —_—I Non -La et. -- - __.
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes E]�No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
[--]Yes
;2rNo
❑ NA
❑ NE
12128104 Continued

Facility Numbe
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;2 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
[:]Yes oNo
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes :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 ONo
❑ 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 j'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes fI 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 P'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes PNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 2No
❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ yes
12rNo
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
;R'RIo
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
pL'2Co
❑ NA
❑ NE
�S tells
on ,S��a� FrPlc�s,
Cow >�'nue e m s Aa
(RR /G Sic 7L cti
IReviewer/Inspector Name I K -' '1 Phone:
Reviewer/Inspector Signature: < Date: Q I

Facility Number:.3 — 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 .E No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0No []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 joo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes .ENO ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
I/J Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
E:rNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
[?f o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
12NE
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
ONO
❑ 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
ONo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes2r�o
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
24O
❑ NA
❑ NE
Additional Comments and/or Drawings:
,oalea;e LS Soot It., l000�o I f( %lG
lil ac `4ee✓/ "^ 14C O�- 7"
W �f � �/i �t /jPCvt 4 /J�l �C /�B � f K aW CI C✓P S ,c-- //GC / �" /en J�
/o�GcaGLL/�
NJ AlaCam!/� r�cY�cks �j� cva3 ��c,�/�-�7L
12/18104

'Type of Visit Q'Co liance Inspection O Operation Review O lagoon Evaluation I
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number ,• • • Date of Visit
ermitted dcertified ❑ Conditionally Certified 0 Registered
Farm Name: ................ AgLLm.f.;.._.. F
Owner Name:
Mailing Address:
Facility Contact:
Title:
Onsite Representative:-_-_-_�.li.iitf _.wnl .... _............ _.......
Certified Operator: ..... _............... _...................__-.
Location of Farm:
�1 0 Time:
Q Not Operational Q Below Threshold
Date Last Operated or Above Threshold: -_--_--_.
Coun (]UPL+:r _......... ........ _ .
Phone No: 0110 2-9 a �.-.3 a 5 j ._....
........................... Phone No: ... __.--..............................
Integrator. __---_�!L719GE _------______
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =" Longitude =• =' =11
_
Desrgu
- -r
''Current_" DmgnCnrrent _ Design
Current
Swine _ Ca aci
_
Po elation. Poultry__ __Ca acit Po ulahon...CaWe _Caiaa
.
-P.o tlation -
;` ❑ Wean to Feeder
y
- ❑ Layer „❑Dairy
Feeder to Finish
❑ Non -Layer 10 Non -Dairy
Farrow to Wean
Other
❑ Farrow to Feeder
f Total DeStgo-Capspty '
Farrow to Finish
w
F
Gilts
Boars
Total SSLW �`'
,.
- .: ...-
__ L Number of Lagoons `
Solid Tv%abs
—
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Q 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 ❑No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 2/No
Waste Collection & Treatment --__//
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes QNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _._......
Freeboard (inches):j�_
12112103 Continued

Facility Number: , j Z3 Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
0 No
seepage, ern.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ yes
QNo
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
�
7.
Do any of the structures need maintenance/improvement?
❑ Yes
OrvO
8.
9.
Does any part of the waste management system other than waste structures require maintenan�mprovement?
Do any strictures lack adequate, markers with required maximum and minimum liquid level
❑ Yes
( 70
gauged
❑ Yes
o
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 o
[]Excessive Ponding []PAN ❑ Hydraulic Overload ❑ FFrozen Ground ❑ Copper and/or Zinc
12. Crop type ! (t Vvl I � (Sr) SGrS le
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes EO Ro
b) Does the facility need a wettable acre determination? ❑ Yes G1v
c) This facility is pended for a wettable acre determination? Yes p'N0
15. Does the receiving crop need improvement? ['j Y/es ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes do
Odor Issues
17. 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? /
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes � N
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt ❑Yes ❑ No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Field Copy ❑ Final Notes
S�,A6F0 rR e pct,4>
Gbr W u,P uPDA-M9 D.T rrEcut:= Tb TEc t, A Cx Es P00 KL) rtzZlE/✓T
(RALANGE A(iS 6 ALE ,C$ i&QtNG 61 /Ver tc/�7f G ew
lid 1 .
Reviewer/Inspector Name ,'
Reviewer/Inspector Signature:
Date:
12112103 Continued

Facility Number: 3 I — 2-31 Date of Inspection t--�---t
Required Records & Documents
21. have
/
Fail to Certificate of Coverage & General Permit or other Permit readily available?
[I Yes
No
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
ffN0
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
E']*�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
--))
QNo
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Ci6
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ oo
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
LINO
28.
Does facility require afollow-up visit by same agency?
❑Yes
5cU
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
o
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
Yes
❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
EaNO
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
[jib
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
IKNo
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
4 o
❑ Stocking Form ❑ Crop Yield Form []Rainfall []Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
E3 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
v � n
ddittonal Coiitmeau and/or Drawings
12112103

Type of Visit '10 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:
0 Permitted [3Certified 0 Conditionally Certified 0 Registered
Farm Name: Tke//nq �'�O"Jloxh
Owner Name: Pl e I e-L4ji bw i 1 11,9 z i/d ti
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Location of Farm:
Tittle:
Time: 13
Date Last Operated or Above Threshold: _
County J Uri lin
Phone No:
Phone No:
/�
Integrator: /� reSjoi C
Operator Certification Number:
❑ Swine ❑ Poultry []Cattle [:]Horse Latitude 0' =` 0" Longitude =' =1 = u
e�st�Design
Curent Design Current
SCa aci
Po ulation Poultry Ca aci
P,o ulation Cattle Ga achy P,o ulation❑Feeder
❑ La er
❑ Dai
Finish
20 :, ❑ Non -La er
❑ Non-Dai.
❑o Wean"'
7Boam
Other
if ,'.�❑
Feeder
❑ Finish
Ttal Design @apt'e t❑❑
Total SSLW
Number of Lagoons �=10 Subsurface Drains'-P-r-es-ein-t-110 Lagoon Area 10 Spray Field Area
Holding Ponds / So6d Traps
❑ No Li uid Waste Mana ement S stem
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 ❑ 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 ❑yNo
2. Is there evidence of past discharge from any part of the operation? El Yes 2l tvo
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 ,Lil No
Strut fture I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: /
Freeboard (inches): 310
05103101 Continued

Facility Number: / — �% Date of Inspection IYY//n/IJ�I
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes XNo
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes o
(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?
❑ YesZ'No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes XI No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes No
Waste Aoulication
10. Are there any buffers that need maintenance/improvement?
❑ Yes )ZNo
11.
Is there evidence of over application? ElExcessive Pending [IPAN [IHydraulic Overload
❑ Yes'0No
12.
Crop type M,-,--t-oda PcL4 , 6er^vd�i t�crs�-vre}.S a!l G✓u-tr..
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes _23 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes ❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes ❑ No
15.
Does the receiving crop need improvement?
Yes ❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes 7
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes _Z"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
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
,01No
Yes No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
r❑I
[I Yes .�I No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes L3"No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ jrNo
(ie/ discharge, freeboard problems, over application)
Yes
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?
ElYes Af No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes .E No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
;Gomme erfto question # Explain any1,YES annswers and/or any recommen nsyor anpo er+comments. '°:'A
Use drawings opfacilrty tblbetter eiPplam situations (use additional pages`"as necessary) "� ❑ Field Copy ❑ Final Notes
N. pv/l S)) s��a`f s �iac� iwlo the la��oofn i/ ot�i r�ow, des9,L. tale.
llleed To :ti.��bve 6er.hMai em,� e-r v,^c gPod S(mytal ar 6e-r---7O 4OvN
pv/lS Zt -f —! and la - /� . some Gj"nq ir ar web ;e vl1S l�jor ✓e q
yaoez
d s -'4 af' bef•n✓dA While So•"e /�j e re'l- '/4C-4,.
A pal y 1;---.e od /acre on 6:r,I Ies41-S .
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 172-
05103101 Continued

Facility Number: 31 2 y 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 ❑ No
❑ Yes 21 No
Cl Yes A�fNo
❑ Yes J2No
❑ Yes fTNo
❑ Yes�No
❑ Yes ❑ No
Additional Comments and/or Drawings:*�e�*,3:
F�eebocrrd records for larf hu/F QF' may. c�vtoC �!l of
T„ne f�vl�� ZoOJ, �e sire fo use Oi r,,,asle nalysis
da¢ed wl-' ;vl 60 da s Or O+joj tfC'44to+h evan4s 40 Calcvlor/e
-`he v74,o'9 ep, q/op1;neeG(G .yew
W r-fe A✓1Rl s;S Fo c---wee gdgf%l 2oO-3l— eveoMs.-Tke
J',Qf�- Z� ti�Ye rlO� bean vpd�l-�d
,,peQO1 4P u� � �b.e.�. da;1 y and afle� eA2, S /6S a�
/Need -�o use eau r�!>� 3�/�nl a!►�w4n CC off'
par-/ t l-e pv/ls per waste p/a,n i1�tr�t�/''e_
O5103101

:-�O]Divrsion of Water Quality
>`' Q Diyrsron of Soil and•Water Conservation " -
Q Other Agency. .. - .
Type of Visit _.O Compliance Inspection O Operation Review O Lagoon Evaluation - _I
Reason for Visit $XRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 23 Date of visit:
Permitted ❑ Certified ❑ Conditionally Certified Q Registered
731 e 1 ^-t4� n D tn,< o f �a r M
FarmName: ....................................................................... .....
Owner Name: N/ Q ✓''� d/ LtN r f Ntt, lij,.i O h
Facility Contact:
Title:
Time. Printed (in: 7/21/2000
Date Last Operated or Above Threshold: ..
t
County:J.)...V.. ................................
Phone No:
Phone No:
MailingAddress: ..................................................................11............................................................................. ........................................................... ..........................
OnsiteRe resentative:Lti. �!i,_.._.___O_�S'/01'l y��/6�1
P �... �. /t'..............--....................................... Integrator:...l..............'7._e.............................._......--........
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
eswlne ❑ Poultry ❑ Cattle ❑ Horse Latitude • O� �« Longitude • ��••
Design Current Design Current Design Current
wie Poultry CaaiPoulaon Capacity,`Po Population, Ca aci Po ulatio
r
Wean to Feeder ❑ Layer ❑Dairy
Feeder to Finish 2&
140 ILINon-Layer I I ILINon-Dairy
Farrow to Wean
Farrow to Feeder ❑ Other
= Farrow to Finish Total Design Capacity
ra. Gilts
Boars Total SSLW
I❑ Subsurface Drains Present
❑ No Liouid WasteManagen
Spray Field Area
Discharges & Stream Impacts -
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other ..
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ............... J................... .................................... ................................... .................................... .............................
Freeboard (inches): 31
5/00
❑ Yes/No
❑ Yes /,,-ZNo
❑ Yes )AO
❑ Yes U4110
❑ Yes XNo
❑ Yes"No
❑ Ye i"o
Structure 6
Continued on back

Facility Nuhiber. 31 — 3 Date of Inspection 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 /ZNo
seepage, etc.) //
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �dNo
(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 ho
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ YesXNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level t
elevation markings? ❑ Yes VNO
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes)�INo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ril No
12. Crop type 3er rytId eI Ee/, ^xmd -P&qt/ re .iWt.A' GI^at, h T
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes/ No
c) This facility is pended for a wettable acre determination? ❑ Yes
VNo
15. Does the receiving crop need improvement? ❑ Yes yJ No
16. Is there a lack of adequate waste application equipment? []Yes A3'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes )dNo
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 INo
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 An
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
No
❑Yes A
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes yJJNo
24. Does facility require a follow-up visit by same agency?
❑ Yes J� No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes O No
)4'6- iblatigiis;ot: deficiencies were itofed- diWipg this;visit; • You witI i ebeiye rio: WWI: • ; • ;
comes dence:aboutthis visit :::::::::::::::::::::::::::::::::::
Comments (refer to question #): Explain any YES answers and/or any recommendations or any,other rnmments`
Use drawings of facility to better explain situations:_ (use additional pages as nec essary). s
.. ..lA.
15. aO(I jl/ �� Me gGGo+'�,�^�i �D SOr� -!'23� yL�COr✓IY�12reG[gY iOhS •
Nv-�e1-,ilael sg"-e¢nfollat,rJ9vidwiceeh
4r
AI)owa k ee of .,,teore �A n So /bs, 4 /
T t '&c f l i {y qnd net orris ek re Lvel/ key f.
IReviewer/Inspector Name 510 he WOl r • igail %S _ Y r� I
Reviewer/Inspector Signature: t,.or _ _ Date �� gp10

Facility umber: 3P/ Date of Inspection Q Printed on: 7/21/2000
Odor Issues -
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ YesZd No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes
/r 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 Pi No
t
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 )YNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )YNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

D Division of Soil and Water Conserviition'-Opleratio- 'n R _evi'ew
i-
E3,Division of Soil and Water Conservation - Compliance Inspectp*on
Ckpi'vision of Water Quality, -'Compliance Inspection �
E3 Other Agency. - Operation Review
[Q,Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -LIP of DSWC review 0 Other
Facility Number i Date of Inspection
I Time of Inspection F_J�? 24 hr. (hh:mm)
[3 Permitted E3 Certified E3 Conditionally Certified E3 Registered Date Last Operated: ..........................
Farm Name: V�5 In,_ Countv: ............. ca ...........
......................................................... ........... C
OwnerName:
.........................................................
Phone No:..................................
Facility Contact:
Title:
........ Phone No:
MailingAddress : ....... : .................. .. W. �-.- ........... . ........................................................................ .........................
Onsite Representative: ... Ulf. ........ Integrator ........... AV= .........................................
Certified Operator:._. A ... L,t . . . ............ ........ . Operator Certification Number: ......... .0 .. V ....................
Location of Farm:
Latitude = 0 =1 =1 Longitude = - =1 =11
.W.V1114
L] Wean to Feeder
Feeder to Finish w
❑ Farrow to Wean
El Farrow to FeederT
f-I Farrow to Finish I
Poultry Capacity Population Cattle Capacity Population
[I Layer � 1[] Dairy I
I[] Non -Layer I I IE]Non-Dairy
l
❑ Other I I I
Total Design Capacity
Total SSLW
Number of Lagoons I 1 10 Subsurface Drai!LEE!!!2LJjE1 Lagoon Area 10 Spray Field Area
Holding Ponds / Solid Traps � ❑ No Liquid Waste Management LyS_te_M___j
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation (if yes, notify DWQ)?
Discharge originated at: [I Lagoon El Spray Field M Other
a. If discharge is observed, was the conveyance man-made'!
b. Ii'discharge is observed. did it reach: E] Surface Waters El Waters of the State
c. If discharge is observed. what is the estimated flow in gal/inin?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier:
Freeboard (inches): .............
Structure 2 Structure 3 Structure 4 Structure 5
C] Yes [gNo
❑ Yes E] No
❑ Yes E] No
❑ Yes E] No
❑ Yes 19 No
E] Yes rV4o
7'
El Yes R� No
Structure 6
1/6/99 Continued on back

Facility Number: — Date of Inspection Printed on: 7/21/2000
5. Are there any imme iate threats to the integrity of any of the structures obseked? ie/ trees, severe erosion, ❑ Yes [ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑Yes kNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over
12. Crop type
Excessive Ponding ❑ PAN ❑ Hydraulic Overload
13. Do the receiving crd�& ffer with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
fie/ WUP, checklists, design, maps, etc.)
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0' N*'Wb;tidr,is:or deficiencies were itbtii.e,d ilitripg this:visit:, Yo,it :will receive Rio: further:: •'
eorrespotideitce: about: this :visit ::.....:.......................... .
❑ Yes [RNo
❑ Yes RNo
❑ Yes KNo
❑ Yes _qNo
❑ Yes M�No
❑ Yes KNo
❑ Yes Wo
❑ Yes Mo
❑ Yes ®QVo
❑ Yes *o
❑ Yes GNo
❑ Yes 9(No
❑ Yes ;No
,Yes',❑ No
❑ Yes QR�o
❑ Yes Wo
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):
I6j.� IZECOyd, ICA-f- 1(-s vvot ! Pro wa-ver vrJa+-t_ .fit
1e Vel5 Cb1^ A_w-,-At kjusi �. l ��al\ rccoYdS .
❑ Yes 9-No
❑ Yes to
❑ Yes )!No
❑ Yes Z61\ o
Reviewer/InspectorName I, r 4—L ✓ YVI r U i C. Vt/lr I
Reviewer/Inspector Signature: �' �N . �/J^. f a � Date: lU J L 2,nm /On

Facility Number: — Date of Inspection
I `
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
XAia--,
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Eg.No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
5PNo
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
22 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
1
No
i t
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
No
3/23/99

Pacilih Number Date of Inspection
Time of Inspection 24 hr. (hh:mm)
E Permitted 0 Certified p Conditionally Certified p Registered G o[ perattona Date Last Operated:
Farm Name: TLe.1ma.Houston.F.acm.............................................................................. County: Duplin WiRO
Owner Name: Herman.Davis.................... Houston ..................................................... Phone No: 9.10,29&3727 ..........................................................
0
FacilityContact: ...............................................................................Title:............................................................... Phone No:
Mailing Address: 602.N.. 11liams.Road........................................................................ Keu3M.V. le..NC................................................... 28349 ..............
Onsite Representative: .......................................................................................................... Integrator:Priestagr1arjas .....................................................
Certified Operator: .................................................. .............................................................. Operator Certification Number:.........................................
Location of Farm:
Latitude ®•®° ©°° Longitude©, ®° ®"
Design ,, ----Current esngn . _C Tr— rent esign urrent
Swine `Capacity =Population Poultry Capacity PopulahoCaitle Capacity Population
❑ Wean to Feeder 10 Layer I ` ❑ Dairy
® ee er to FnsF ❑ Non -Layer 10 Non -Dairy
❑ Farrow to Wean — -
'' ❑ Farrow to Fee er ❑ er '
[3 Farrow to Finish _ Total Design -Capacity 2,940
p Gilts
❑ Boars Total SSLW-' 396,900
Number of Lagoons _� ❑Subsurface rams resent ❑ Lagoon Area ❑ SFray Field Area
Holdmg:Ponds / Sdhd Traps ❑ o Liquid Waste Management System " r
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes p No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes p No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway p Yes ❑ No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ...............2A...............................................................................................................................................................................................
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 Nu her: 73 37 Date of Inspection
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
p Yes
p 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
p No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
p Yes
❑ No
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
p No
11.
Is there evidence of over application? ❑ Excessive Ponding p PAN
p Yes
p No
12.
Crop type
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
p No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
p No
b) Does the facility need a wettable acre determination?
p Yes
p No
c) This facility is pended for a wettable acre determination?
[7 Yes
p No
15.
Does the receiving crop need improvement?
p Yes
p No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
p No
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?
(ie/ WUP, checklists, design, maps, etc.)
[] Yes
p No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
p Yes
p No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
p No
21.
Did the facility fail to have a actively certified operator in charge?
p Yes
p No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
p No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
p No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
p No
25.
Were any additional problems noted which cause noncompliance of the Certified A WMP?
p Yes
p No
3' No.violations-or. rleficicircfes.werewoted during.this visit. -YYour will receive no further. -. -.
... .... ...................... .......................
eoriespbudeitee about this;visit:
freeboard available. No problems detected. Good vegetative cover on dike.
Reviewer/Inspector Name ipat2ick FusselP -I Richard Moore,(DLQ)7..
Reviewer/Inspector Signature: Date:

17
13 Division of Soil and Water Conservation Operation Revrew- _ s
Division of Soil and Water Conservation Compliance Inspection r
- Division of Water Quality _ Compliance Inspection }^
[3Other Agency,- Operation keview .
W Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 Z Date of Inspection
Time of Inspection .70 24 hr. (hh:mm)
® Permitted E3 Certified E3 Conditionaliv Certified [3 Registered 0 Not O erational Date Last Operated: ..........................
Farm Name: ............. ..... ............................� �r county: ....tl..t.0............................. .......................
t.....................
Owner Name: ........:....a^1AN_.VIS....I.vu..STD..Y................................. Phone No:.......................................................................................
Facility Contact:
Title:
Phone No:
MailingAddress: . .....................................................................................................1................ ..................................................................................... .........................
Onsite Representative:..=..f M9t'1....�oN,S�'on1.�-a �qt') /7ou$erl Integrator:....!�e''++�of e............................................
........... ......................... .....J7.....�.....
Certified Operator: ...................................................
Location of Farm:
Operator Certification Number:
Latitude =•=' =•` Longitude =• 01 =11
'--Design Current.'
Swine - Capacity Population
❑ Wean to Feeder
Feeder to Finish
2 t -o
20 OG
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
.. �Ni nrber'of-Lagoons.
Holding Ponds / Solid Traps
I❑ Subsurface Drains Present JEI Lagoon Area 10 Spray Field Area
❑ 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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ........ z..I............................................................................................................................. ............................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ® No
❑ Yes JN No
[]Yes .8 No
h /a
❑ Yes 9 No
❑ Yes. 0 No
❑ Yes e3 No
[]Yes ® No
Structure 6
❑ Yes ct.NO
Continued on back
3/23/99

Facility Number: ? Date of Inspection
6., Are'there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 10 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 §4 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? jZ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes K No
Waste Application
10. Are there any buffers that need. maintenance/improvement? ❑ Yes B[No
11. Is there evidence of over application?
1 ❑ ]Excessive Ponding ❑ PAN El Yes 9fNo
12. Crop type tpofpeer'tAu t6r FIQt1,"&rwtVa(or ('64 e-e, sw,�ll l��`ortl
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes R 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 jo No
15. Does the receiving crop need improvement? Yel5P*XYes m No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
19 No
Required Records & Documents
17.
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?
fie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation; freeboard, waste analysis & soil sample reports)
1g Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IffNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
IM No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes jffNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes $K No
24. Does facility require a follow-up visit by same agency? ❑ Yes JgNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes JRNo
i viblatiotis:oi: Oflciendias were itbted� dtWi.h.9 Ns:visit: • Y64.:'Wll•receipe .YK futftr. -
:'cories orideitce:abotiEth:':':':':':....
Comments (refer to question #):. Explain anffES answers and/or -any recommendations or any other comments
-Use drawings of facility -to better explain situations: t use additional a es as necessary):
8. Oct Wes 41wA- q'rc />'1o✓Y 41 an :1 O� V e�j✓ &/
1,al ved or o4 (;zed .
K. Week -Flo. es4,gb1;sh GoeisM over -H,e e»-1;., �'4t- Owe •F,'eUs
Cl oscS-' _'o -"w road. some bQrc S&& ,"d
�Orese✓I-�l1 /'n-IIICse �;�tdr. �f�!y �;,,.te gccv�A;n� sail -fes�
+0 Melly es�abl;s% oous�al. Beck GoaS�q� �'��ld is is ypod
Reviewer/Inspector Name Name �, - „e Wall=' m q ��1` 3 � S' 3 �0= �?
Reviewer/Inspector Signature. Date: W'M7
3/23/99

------------
Facility Number: — ZV Date of Inspection
Odor Issdes
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
aYes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
49 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
lid 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
D9 No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
gNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
tRNo
Additional -Comments an or- rawings:_-
-1 XeSup"Nc kceP,'"I-`�JWeek-ll �ret(7oct�Y.� rcco'ds
kee� Z)OZ— 2 -Fo r,-15 L;pAc(4e_d e4 )er,s-1 rvion4h1 y_
3/23/99

Division of Soil and Water Conservation 0 Other Agency
Division of Water Quality
of DSWC review
Date of Inspection v� t
Facility Number
Time of Inspection ®0 24 hr. (hh:mm)
E3 Registered .Certified M iApplied for Permit 13 Permitted 10 Not O erational Date Last Operated:
Farm Name: ...
..—.1.y1f `'�...�\` 1s^'................................... County:....q.11.�t..\......... :................... .......................
OwnerName:.. •,•\_hz; i}^ .................................................................. Phone No:........1 .^......................................................
Facility Contact: .............................................................................. Title:
�t 1i
Mailing Address:.._U.Ga' `�?w .... �..1\h• .y,...��,...
OnsiteRepresentative:QL.-� � �r/
Certified Operator....... ............................................
Phone No:
Integrator:
Operator Certification Number:
Lora on f Farm•
�� 1.................. ... ham... .. .0 1...... �! .................. ............................................-....... ' ..............
..................
v-, ...._-��,...._t..;........................................ ................................ :......................
Latitude 0'=,=« Longitude ='='={I
Design Current
Design "" , Current Design ' �"Current
Swine = e
Capacity=Population
Poultry Capacity Population Cattle .' Capacity Population
❑ Wean to Feeder
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
❑ Farrow to Finish
General
1. Are there any buffers that need maintenance/improvement? El Yes No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon El Spray Field [I Other
a. If discharge is observed, was the conveyance man-made? El Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) El Yes No
c. If discharge is observed, what is the estimated Flow in gaUmin? N i_
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes ONo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes W No
4. Were there any adverse impacts to the waters of the State other than from a discharge? El Yes J4 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes VNo
• maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ONo
7/25/97

Jy )�.#
f lFacifityNumber:
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes N No
Structures (Lagoons.liolding Ponds. Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
StmSture I Structure 2 Structure 3 Structure 4
Identifier:
.......................................................................................................................................
Freeboard(ft):........ v�.........................................._.........................................................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑Yes
;qNo
Structure 5 Structure 6
...............................................................
.................................................................
❑ Yes
0 No
❑ Yes
P9 No
❑ Yes
MNo
Waste Application
14. Is there physical evidence of over application?
(If in excess ofIL MP, or runoff entering waters of the State, notify DWQ)
15. Crop type
L..... :... I .... f �........................................................................................ .............................................................
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?
O-No.violations•ordericient:ies.werenotedduringthis.visit. Nou:willreceivenoftirther.
• ctirrespQtideitce about fhis:visit:::::: � : ; • : • :: :: � � : • • ; ; :::
�r\y V-Q--A 1.
❑ Yes IX No
❑Yes UNo
❑ Yes (�(No
❑ Yes VNo
Ed Yes ❑ No
❑ Yes eVNo
❑Yes ONo
❑ Yes ($No
0 Yes ❑ No
❑Yes (fNo
❑Yes NjNo
❑ Yes to N0
as
7/25/97

l A❑DSWC Animal Feedlot Operation Review
�DWQ Animal Feedlot Operation Site Inspection
10-Routine O Complaint O Follow-up of DIVO inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number
z 4T
Time of Inspection O)IIED 24 hr. (hh:mm)
0 Registered ® Certified E `A1pplied for Permit E3 Permitted E3 Not Operational Date Last Operated: ..........................
Farm Name:._ sR_.1.ry . .....�1�..�.(.. ('9. �.. nn:ex. ........................ County:../ .. ................................
Owner Name: ............ ..4....M,t..r... .............. .................................. Phone No:..`q..�..Q..�....g.�......1..� .........................
Facility Contact:
Title:
Phone No:
g !`p.�.�.._...... _ t.....l1,.a�r...,,5,.......F...4.................N•'•4•<+n.rtnnS..V.i..�.iP.:j...i.-L.................. .Z...0... 7�.`.i...��1
Mailing Address:...... ....L,
OnsiteRepresentative: .... 1.-:.1.�...... t-M..us..{re.s^...................................... Integrator:-,--- _r7ks.1 p`-a.�._..........................................
Certified Operator;...T.%1)_'J.t,� ........ &.......... _v.S_E ........... Operator Certification Nutuber:..... l.t.D:ii..7.................
Location of Farm:
(.�tn....�.A.S..1:;.....S..i.t�.P.....
p
.....5...1.7-01.t... a.P..p.z:c.Jt..t.�nn..et/,�(p_�7-....
1.....
N^.i..1.G..... h.o.+.:..tta..... .Q..
... 1xt_'1-tnr�{....cr.h.h..
..W.l.1' '1.....
.N....�.Ll..........
Fc1. !S..t........'-..h.C.r.1..1�..
-!t.......Q.t�.....Cxf^.....{ t.......1:,0.c
..........................................................................................
Latitude 1 91 11 41 Longitude 1 *1 11
Design Current
SwineCapacity Population
❑ Wean to Feeder
® Feeder to Finish
2 el 4 r
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of Lagoons / Holding Ponds
Design Current Design, Current
Poultry Capacity Population Cattle Capacity, Population
❑ Layer 1 ❑ Dairy
❑ Non -Layer I Non -Dairy
❑ Other
Total Design Capacity 29 Ll 0
Total SSLW
Subsurface Drains Present
Area
General
1. Are there any buffers that need maintenance/improvement?
❑ Yes
KNo
2. Is any discharge observed from any part of the operation?
❑ Yes
® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed. was the conveyance man-made'
❑ Yes
® No
b. If discharge is observed, did it reach Surface Watcr? (If yes, notify DWQ)
❑ Yes
Jallo
c. If discharge is observed, what is the estimated Flow in gal/min?
t )A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
W No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
E[No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
K Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
E!LNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
RNo
7/25/97
Continued on back

Facility Number: — Z
8.
Are there lagoons or storage ponds on site which need to be properly closed? -
❑ Yes
XNo
Structures (Lagoons 11oldin0 Ponds, Flush Pits. etc.)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
IM No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure
6
Identifier: ?? ......................................
....
Freeboard(It): .......................................................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
I$No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
RNo
12.
Do any of the structures need maintenance/improvement?
❑ Yes
R. No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
® No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
KNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ... b.4lY.,nrvu..r!::vS............................................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
Id No
IT
Does the facility have a lack of adequate acreage for land application?
❑ Yes
J&No
18.
Does the receiving crop need improvement?
XYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
R No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
I[No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[&No
22.
Does record keeping need improvement?
Ind 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
IR No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
93 No
13 No.violkions or deficiencies were noted during this.visit. Noti mill receive no further
correspondence about this visit..'
5. %s^...` a .r-r- M'� `-� S / S1-v w,-` 1 � v`4 T•: •^" 3i t"�`^ _
it, WOV - o aOrYe�d'�y1 rvu S tit S� t��S•1�
t-e V w.- le Et. c-. y a� w 0.3 tom. p te...n rro w. 1.! f r c f CO Vim. s (•-L G q y -t w�-� f S �q
p 1.e a. s t s e-.%�d c.. /c.o� P n F {w��-ti,{fj1� V_,. l +, % l.e w :1l-L, s pt 0..111 FYt C1,11 cwtiJ(.
H Cal qq t�� �� I (Q U� r111, �%'$ T� ✓ W `^ O ,[ Jj�''� (,Q 1N ` ✓1^ I ✓q I p N . A [S O , v KZo. c cA i9 a-•^1 � c.t 6^ S .-+.•'1 rt.0 .d-i l:.e . F a.�d � f-.v. t.i w✓ .» �.✓S i Al a I t o ✓
Dfrr�bor oQ -rt ba inPu. 1
Cic�wtQ�10- art tb. i1jy.Y afio.t r^^ tt
b awe r w t cd 60 t..p y-" t e. 4-e<L fro fan s v . e
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ „I„ p,r,.7�-J- r an - Date:

•
Site Requires Immediate Attention:y10
Facility No.7
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIQNl SITE VISITATION RECORD
DATE:
1995
i line:
Farm Name/Owner: ly Ln'3Xti��'jQsy 41/
Mailing Address: L1 l-1'
County: 17�/P Li
Integrator. ��r Phone:
On Site Representative: ��� X/ �` Phone: 7
Physical Address/Location: ) A T F,Qrif'))
,59 1'7dl On/ e;
Type of Operation: Swine Poultry _ Cattle
Design Capacity: q1 4d Number of Animals on Site:
DENT Certification Number: ACE DEM Certification Number: ACNEW
Latitude: % Z " Longitude: Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inche t9r No Actual Freeboard: 9 Ft. -J�!_ Inches
• Was any seepage observed from the lagoon(s)? Yes N
oas any erosion observed? es r No
Is adequate land available for spray? YesorNo Is 1r crop adequate? Yes or No
Crop(s) being utilized: &��e " f�n
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin.. es r No
100 Feet from Wells? es or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes <9
If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments: Ali ale
729 /A/ D �
cc: Facility Assessment Unit Use Attachments if Needed.