310251_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

(Reason for Visit:
.�_�0Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: i yia . Arrival Time: Departure Timer County:, Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: DNA t Mry N iLA cr,_ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 26 01,01,
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
I
Wet Poultry
iLayer
Design
Capacity
I IDai
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I
INon-Layer
Dai Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
',?WO
D . $oult ,
Layers
Design
Ca acit
Current
Pao ,
Dai Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeef Brood Cow
Other —TurkeyPouets
Other
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
dNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
VNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: -;jl;l 16
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Strucctturre_I Structure 2
lY
Structure 3 Structure 4 Structure 5
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?
E2�`No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
[-]Yes Z] No ❑ NA ❑ NE
❑ Yes [21/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes d o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes WNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [:2/No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑ Yes
[�] o
❑ NA
❑ NE
❑ Yes
][ N
❑ NA
❑ NE
❑ Yes
[No,
❑ NA
❑ NE
❑ Yes
o
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes UNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ ❑ 120 Minute Inspections Monthly and I" Rainfall Inspections El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yeso ❑ 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

Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check El Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes ❑ NA ❑ NE
r5
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 0o ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary). ,
_2 vl oQR:wWti
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 'X -Ne
Date: 1 (6
21412015

(Type of Visit: (D C pliance Inspection V Operation Review V Structure Evaluation L) Iectinicat Assistance
Reason for Visit:: Rloutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other ' 0 Denied Access
Date of Visit: F 5 rr� Arrival Time: Departure Time: County: 5_ u Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
i
OnsiteRepresentative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
Dai Cow
Wean to Feeder
Non -Layer
Da' Calf
X Feeder to Finish
0
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
I)r, P,oul.
Ca a
Non-Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
113cef Brood Cow
Turkeys
Other
TurkeyPoults
01 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 ffNo
❑ Yes []No
❑ Yes [:]No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes �j ❑ NA ❑ NE
❑ Y`o ❑ NA ❑ NE
Page I of 3
21412014 Continued

Facility Number: - Date of Inspection: 9, 111(is
Waste -Collection & Treatment
.4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1
Identifier:
LA&66
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4 Structure 5
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?
[2/No ❑ NA ❑ NE
❑ No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes [2�/No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen 1 threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes 20 ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s): /
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Wo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[1�No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
�o
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: Date of Ins ection: 4 t
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yesz No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Y3"No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[-]Yes
No
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0o
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
O/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
N
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑Yes
❑ Yes
a
❑ NA
❑ NA
❑ NE
❑ NE
ReviewerQnspectorSignature: F'�/b. Date: I-1
Page 3 of 3 21412015

Reason for Visit: (0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:/--' Arrival Time: E2= Departure Time: ® County: 0I.PtIRegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: U 60 Ap! MIS, (Cyr
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 0
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
I iLayer
Design
Capacity
IDa'
Current
Pop.
Design Current
Cattle Capacity Pop.
Cow
Wean to Feeder
I JNon-Layer
IDai
Calf
Feeder to Finish
i
D ' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Di. P.oultr.
La ers
Non -La ers
Design
Ga acit,r
Current
P,o ,
D Cow
Non -Da
Beef Stocker
Beef Feeder
NJ I Boars
Pullets
Beef Brood Cow
Other
NJ Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes n NNo ❑ NA ❑ NE
[-]Yes ❑ No
❑ Yes ❑ No
[—]Yes ❑ No
❑ Yes / o
❑ Yes / o
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
Page I of 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4.Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Structure 1 Structure 2
Identifier: C.A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
TS
[V(No
❑ NA
❑ No
❑ NA
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
FYes FNo❑ NA
❑ Yes 0 No ❑ NA
❑ NE
❑ NE
❑ NE
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes N ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
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 CNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
No
17. Does the facility lack adequate acreage for land application?
❑ Yes ❑
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes q<o
❑ 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 gNo
❑ 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 YNo ❑ 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/ El Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes I__I N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facifi Number: rX jDate of Inspection:
24. �id the facility fail to calibrate waste application equipment as required by the perms? Yes ��No
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes 6 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yesg�N0
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Yes EXNo ❑ NA ❑ NE
[:]Yes [�o ❑ NA ❑ NE
❑ Yes U No
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? [—]Yes ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑YesFNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

Reason for Visit: O Routine 0 Complaint Q Follow-up Q Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: (7Gp(�zt./ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: �OI✓lY7fiA Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: ;4 6%a
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Wet Poultry
ILayer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I
jNon-Layer
I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D�� P,oulh.
Layers
Design
Ca Tacit
C•uErent
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
lBeefBroodCow
Other
El Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes L�J ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
Pagel of 1 21412011 Continued

Facili Number: - Date of Ins ec[ion:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Io
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
`Structure
/f
Identifier: tr't(�(1O/�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ZNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
]Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat, 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
do
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,�,
I VNO
"`777"'
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
21'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
V
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
N/o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑Yes
7
❑ NA
❑ NE
Required Records & Documents
N
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 E2<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 eo
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Inspection.
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 POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
Io ❑ NA ❑ NE
No ❑ NA ❑ NE
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 Z ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Io ❑ NA ❑ NE
❑ Yes P40 ❑ NA ❑ NE
❑ Yes 2<0 ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No ❑ NA ❑ NE
❑NA ❑NE
No ❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments. I
Use drawines of facility to better explain situations (use additional oaties as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of
Phone
Date:
2/ 20I1

Type of Visit: 0 Compliance Inspection U Operation Review C) Structure Evaluation O Technical Assistance
Reason for Visit: Q1J Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Fjp4qjl2,Arrival Time: ® Departure Time: ® County: Q T Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: A7gA0 rAM'a(t;,_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: uo0%a.
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
C•unrent
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
b 6
D . P�ouI
Layers
Design
Ca aci
Current
P,o
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
jBeefBroodCow
Other
Other
Turkeys
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes 0NNo ❑ NA ❑ NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3
21412011 Continued

Facili Number: - Date of Inspection: 10 114 117-,
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: IAA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JEZ 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
jdNo
❑ 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
O/No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EKO
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
Ej 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
[2f No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E3 No
❑ NA
❑ NE
Required Records & Documents
/
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
gNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. [—]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and N Rainfall Inspection ❑ ❑ Sludge Survey
22. Did the facility fail to install and maintain a m❑ in gauge? Yes N ❑ NA NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 1.lJ '"o ❑ NA ❑ NE
Page 2 of 21412011 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
E�No
❑ NA ❑ NE
425. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
�No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
6N
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
N
❑ NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[-]Yes
[a
❑ 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
[24o
❑ 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
Io
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
O/No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
dNNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[� o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendationsbr any otheccommentsn "
Use drawings of facility to better explain situations (use additional pages as: necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (f/0 L
Date: 16 14 i/
2/4 t711

Type of Visit: Q Cory¢Hance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 4 1 Arrival Time: Departure Time: ® County: DUP L--uJ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: k._' $ N'g'T j4 jti &tZ&L . E R Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number: Zfoor);L
Certification Number:
Latitude: Longitude:
Swine
Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Feeder
]Non -Layer
DairyCalf
o Finish
',� 0 as
DairyHeifer
o Wean
pFarrow
to Feeder
to Finish
Dr, P,oulh.
La ers
Design
Ca aci
Current
Pao ,
D Cow
Non -Dairy
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes �No ❑ NA ❑ NE
❑ Yes [—]No
[—]Yes [—]No
❑ Yes I�jo
❑ Yes o
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: $ ( - Date of Ins action: Ct kerh
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard?
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
(,A 6�n d
3 o-
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?
❑ Yes
No ❑ NA ❑ NE
[:]No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [:]Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes E2rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes M No ❑ NA ❑ NE
maintenance or im rovement?
P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes dNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes Q No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes � o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes No ❑ NA ❑ NE
acres detern ination?
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 E No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes EI<No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 1,24o
❑ 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 E] 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 21412011 Continued

Facility Number: Date of Ins ection: q lII
24. DidIhe facility fail to calibrate waste application equipment as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes [7(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 ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [2�No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes dNo ❑ 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 glNo ❑ 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
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
❑ Yes
❑ Yes
[ jNo ❑ NA ❑ NE
2KNo ❑ NA ❑ NE
[�J/No ❑ NA ❑ NE
(Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.' µ
Use drawings of facility to better explain situations (use additional pages as necessary)..
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (?(Aft —731
Date: PC'
21412011

Type of Visit grCo pliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: D j Arrival Time: I r / /.�._� Departure Time: County: '➢ ' Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
i
Onsite Representative: r )J . �%i rYrILUS�'-
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o M , M Longitude: [� o =
r
Dest n Current Dest n t"Curren[
Swme Capacity Population s Wet Poultry Ca ac. Population �7;CattI' ;; ,� Ca ag�iP ul'laa 'o
_r,-- P Ty ...P .t3 P ._.
r:
❑ Wean to Finish
- ❑ Laver
❑
Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑
Dairy Calf
°';
�.. -
❑ Farrow to Wean Dry Popltry"-�'`
"
❑
Dai Heifer
m
❑D
Cow
❑ Farrow to Feeder '""R'
` ❑
Non -Da'
4
❑ Farrow to Finish ❑ Layers
❑
Beef Stocker
"
❑Gilts [t ❑ Non -Layers
# El
Beef Feeder
❑ Boars El Pullets
' ❑
Beef Brood Co
❑ Turkeys
..
": ElTurke Poults
❑ Other - ❑ Other
umbar,, Structures
EJ
#N„
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[--]No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
l
❑ NA
❑ NE
❑ Yes
��N)
L✓J No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection �
WI ste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VNo ❑ 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: i
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.) J
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 t eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o [INA ElNE
8. Do any of the stuctures lack adequate markers as required by the permit? El yes Zo ❑ 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 d o ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
15. Does the receiving crop and/or land application site need improvement? 0 Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No ❑ NA ❑ NE
j❑ o El NA El NE
No El El NE
j
o ❑NA El o❑ NA ❑ NE
Comments (equestion) P Y a anY mendahons or
Ue drain sof facility to better explain situafios(use addi6oalPasmcssaa es ry) any other commends
fa,1/(j 4L Z nJE6pEp htL tvvr kW_
Reviewer/Inspector Name �{, Phone:
d
Reviewer/Inspector Signature: Date:21
Page 2 of 3 I2128104 ' Cbminued

Facility Number: — Date of Inspection LJ•' o [
l(((iii
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑Aln p ❑Checklists ❑Design ❑ Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ 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 L�—,<0 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L�"N ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 7 ❑ 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 � NNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes � o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 2<0 ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 2No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately ,..{/
31. Did the facility fail to notify the regional office of emergency situations as required by El Yes E Nc ❑ 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 N ❑ NA [:3 NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
❑ Yes VNo
El NA ❑ NE
[I Yes❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit (D,C.,00 pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit l9 Rc utine 0 Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 19 v ( Arrival Time: Departure Time: County: "LT-P Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: U°N1aT nnN T _�fiL
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [�o [-�. M Longitude: Mo [7, r7
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
Wean to Feeder
10 Non -Layer I
❑ Dairy Calf
Feeder to Finish D q,6rUb
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
El Layers
El Beef Stocker
❑ Gilts
ElNon-Layers
❑ Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Cowl
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes LJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El No
❑ Yes
O No
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
12128104 Continued

Facility Number: j — Date of Inspection
,-Waste Collection & Treatment , (/
14. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2i 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: QA6Zffk.)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 51,
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Ed 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 E1J 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 tJ(reat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes u1 No ❑ NA ❑ NE
8. Do any of the smctures lack adequate markers as required by the permit? ❑ Yes 40 ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ,(/
9. Does any part of the waste management system other than the waste structures require ❑ yes L/J 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 L�J No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I O Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
IReviewer/Inspector Name I V u Id r 1 f-W+z CA- j Phone: /0 nc / I
Reviewer/Inspector Signature: Date: i
Page 2 of 3 r 12128104 Continued

Facility Number: -o7S Date of Inspection
l
',#Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WUP ❑ Checklists ❑ Desig
n ❑Maps ❑Other
❑ Yes Ed/No ❑ NA ❑ NE
❑ Yes E�No ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
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?
El Yes
210
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L�'�fl,Vo
[I NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑Yes
U No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�/No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[:1 No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,{/
dt 0
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑yes
l'J No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ yes
[Z 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
P�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?
❑ YesWNo
o
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
12128104

3
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: 1 4* Departure Time: County: WtltRegion: _
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: J 0404t At r ' `�'� (, �' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: o n o n n
n n n Longitude:
Design Current
�@apaci�Population
Design Current
Swine Capacity Population
Wet Poultry
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Non -Layer
❑ Dairy Cow
❑ Dairy Calf
Wean to Feeder
Feeder to Finish
airyHeifer
❑ Farrow to Wean
Dny Poultry
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
El Non -Layers
❑ Pullets
❑❑Beef
Turkeys
❑Beef Feeder
Brood Co
❑ Boars
Other
❑ Turkey Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
El NA
[I NE
[I Yes
❑N
El Yes
IJ N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number:
Date of Inspection
0 Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 / Structure 2 Structure 3 Structure 4
Identifier: A �6 N
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LIJ
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes VZN ❑ NA [3NE
❑ Yes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental [h at, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,.,/Nj ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes I,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 [3 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ,_,//
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes 7No
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ 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
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
N ❑ NA
El
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
L/J N ❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
IReviewer/Inspector Name I `j o (_.0 L I Phone: L
Reviewer/Inspector Signature: Date: b
Page 2 of 3 12128104 Continued

Facility Number: —a Date of Inspection ti J
Required
19.
Records & Documents
Did facility fail have Certificate Coverage & Permit
//
the to of readily available?
El Yes
O ❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
len No ❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [I Other
��
21.
Does record keeping need improvement? If yes, check the appropriate box below.
ElE, Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain InspectionsWeather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
�
E3 No ❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No ❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
No�❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
ElE Yes
o ❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Qo ❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
C3410 ❑ NA
[I NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E]4o ❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
EKO ❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
eNo ❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
N ❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
El
No ❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quatity
I
Facility Number 3 ( �S 1 O Division of Soil and Water Conservation _ O Other Agency ✓
IType of Visit (:5 C,(o}_�pliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance I
Reason for Visit l Koutine O Complaint o Follow up o Referral O Emergency 0 Other ❑Denied Access
Date of Visit: to Arrival Time: Il 3 O Departure Time: County: J�(iY�t S%i Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
OnsiteRepresentative: JOIVATJ4AW/ ✓✓1Z_L.t.rcr�_ Integrator•
Certified Operator:
Back-up Operator:
Location of Farm: Latitude: 0
Swine
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
LJ « Longitude: = o = , = „
Design Current Design Current.-
Capacity Population Wet Poultry Capacity Population-
❑ Layer
❑ 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?
Cattle
Design C'
Capacity .,Pop
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
I
El NA
[I NE
El Yes
L No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection t a aS a 7
.Waste Collection & Treatment 1
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
L1 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?
El Yes
d No
❑ NA
❑ NE
8. Do any of the smcmres lack adequate markers as required by the permit?
❑ Yes
ONo
❑ 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
04o'
❑ NA
❑ NE
maintenance or improvement?
Waste Application �
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes El No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes en No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
El NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rQ40
ZrNo
,�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[--] Yes
EI/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
NNoo
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
,1!J,
EJ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
SoENrTFy 1 at-t- art (Zolidoi onl s22z
Reviewer/InspectorName foNt� t�L Phone: b)796 —%348
Reviewer/Inspector Signature: Date: /a — o
12128104 Continued

Facility Number: l — 2S) Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Oxyes
ElNo
ElNA
ElNE
13 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections
❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
El
[I NA
[I NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
No
[I NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,�
LJ N
El NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
fNo
[INA
[INE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElE Yes
No
❑ NA
❑ NE
Other Issues
/
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
EJ 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
tj 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
1,� No
El NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
'NNo
L� o
❑ NA
❑ NE
Comments and/or
12128104

'Division of Water Quality
Facility Number �� 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 Routine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: -il Departure Time: County: u Glt. Region: wi
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 15etid
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number: _
Location of Farm: Latitude: = 0 = ' = « Longitude:
:Swine
❑ Wean to Finish
EJJVean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Other
Current Design Current
'opulation Wet Poultry Capacity Population Cattle i
❑ La er 10 Dairy Cow 1.
❑ Non -Layer 1 10 Dairy Calf
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
=mow
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number:3 i Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Strpcture l Structure 2 Structure 3 Structure 4
Identifier. �/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ 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 any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name I l Phone:
Reviewer/Inspector Signature: Date: GG
Page 2 of 3 12118104 Continued

Fa .ility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
i,Je P � G'a � fob lieu
a/S
Page 3 of 3 12/2&04

Division of Water Quality
I' I3T�; asi ✓;
Facility Number O Division of Soil and Water Conservation
Other Agency
Type of Visit - Co fiance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 u vC Arrival Time: / 1- S Departure Time: qS County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ///' . ,, 1, ,., Title:
Onsite Representative: 66U0 f �
Certified Operator: 14090_4-� sft.=tH
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Latitude: 0
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Region:
Longitude: 0 , = "
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑-Dairy Heifer
❑ 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 C ° ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑ me ❑ NA
❑ NE
❑ Yes
❑
o El NA
El NE
❑ Yes
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? El Yes l( No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t/p6,ouf✓
Spillway?: q
Designed Freeboard (in): 19
Observed Freeboard (in): N
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ 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) eat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,_,(/No El NA El NE
8. Do any of the smctures lack adequate markers as required by the permit? ❑ Yes LI No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) //
9. Does any part of the waste management system other than the waste structures require ❑ yes L/ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑Yes Co ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Croptype(s) ISCTI'MaDk Lr,r) S6-0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination' ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
I Reviewer/Inspector Name 1 -- —(1614 iJ
" ' L r x. r rx � Phone:010 3 -, 00 ?07 I
Reviewer/InspectorSignature: oL,,_, Date: 318 O$
12,128104

. acility Number•. — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L9 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CA WMP readily available? If yes, check ❑ Yes 2No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes IJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
EjAo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0**No
[-INA
ElNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
D'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
ElUYes
1<o
No
❑�NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
El,
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CA WMP?
ElEYes
<u
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
CTNo
❑ 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
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?
❑ Yes
trNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
I No
❑ NA
❑ NE
12128104

Facility Number Date of Visit: � Time:
10 Not Operational 0 Below Threshold
Permitted '®,Certified E3 Conditionally Certified 13Registered Date Last Operated or Above Threshold:
Farm Name: County: Dr_tn
Owner Name:
Mailing Address:
Facility Contact: // Title:
Onsite Representative: A.✓
Phone No:
Phone �No:
Integrator: �//r
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =* =` 0- Longitude =a =I =`
Design
Current Design Current Design Current
Swine Ca aci
PopWation Poultry Ca aci P,o ulation Cattle Ca aci P,o ulation
❑ Wean to Feeder
❑ La er ❑ Da'
® Feeder to Finish
I❑ Non -Layer ❑Non-Dai
❑ Farrow to Wean
- -
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design C►specify r-�
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoops
0 ❑ Subsurface Drains Present ❑ Lagoon Area JE3 Spray Field Area
holding Ponds! Solid Traps
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
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�
05103101
❑ Yes %No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes rgNo
❑Yes 1p�fNo
❑ Yes �rNo
Structure 6
Continued

Facility NumDate of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
R) No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
El Yes
W No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
®.No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
P,No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
!
elevation markings?
❑ Yes
o
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
?a No
11.
Is there evidence of over application? ❑ Excessive Pending ❑ PAN El Hydraulic
❑ Yes
SNo
12.
�Ovverlo/ad �
Crop type .fla 0 { l rn dPAj�� J/4 N leg �It/
13.
i
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
toNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
[ig-No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
I5.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
MNo
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
KNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
V,No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
®�.I,.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?
❑ Yes
ALNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
®.No
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
R1 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
5?LNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes J.No

Facility Number: — Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aVor below
❑ Yes
14 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
GSNo
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
&dNo
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.)
El Yes
g�
F No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
LNo
32.
Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover?
El Yes
,-
L No
Additional :Comments and/or Drawings:r..-
05103101

Type of Visit NJ Compliance Inspection U operation Review V Lagoon Evaluation
Reason for Visit Oa Routine O Complaint O Follow up O Emergency Notification O Cther ❑ Denied Access
Facility Number j
Date of Visit: 1/21/21101 Time: 13:00
.. m O Not Operational O Below Threal
®Permitted ® Certified E3 Conditionally Certified E] Registered Date Last Operated or Above Threshold:
Farm Name: T.bc.TUc.S.tuulb.Eatap.............. _._._........................................... _............... County: IIuplin............................ .................... ..W.IRQ........
OwnerName: Harold .................................... Smtb........................................................... Phone No: 919:50-3.7.39...........................................................
MailingAddress: ..67.7...1.CII.Esat.......................................... _........................................ RiuxkHilll...NC.......................................................... 28572 ..............
FacilityContact: ...............................................................................Title:............................................................... Phone No:....................................................
Onsite Representative: Bnent.Michel[J.Harald.Smith............................................ Integrator:.GablithemHoglArru .......................................
CertifiedOperator................................................................................................................. Operator Certification Number..........................................
Location of Farm:
East of Leon. On North side of SR 1705 approx. 1.4 miles East of Hwy 111.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 35 • 03 l 18 Longitude 77 a 47 I 18
Design
:Current
Design Currenf
Desn Curtent
Swine
Ca aa€
Po ulatioa
FouHrg
Ca aciht Po"ulatfaa Gattte
t'asac Po nlatlon
❑ Wean to Feeder
❑ Layer
❑Dairy
{.
® Feeder to Finish
2880
❑Non -Layer
❑Non -Dairy
'.
[]Farrow to Wean
..'.
❑ Farrow to Feeder
❑Other
❑Farrow to Finish
IOtRI DestgD Gapa¢iiy
2,880
.I.
❑ Gilts
❑ Boars
_:
Total SSM .;
388,800
------------
NnithergfLagoons ❑Subsurface Drains Present ❑ Lagoop Area ❑ Spray Field Area
Holding Fonds 7 So1id Traps ❑ No Liquid R sate Management System
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 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 D WQ) ❑ 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 iK No

Facility` Number- 31-251
Date of Inspection F 1121/2001
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...................................................................................................................................................................................................................
Freeboard(inches): ............... 25................ .._._._.......................... _................................. ..... .............................. .................................... ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes R No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes N No
(It any of questions 4-6was answered yes, and the actuation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes N No
8. Does any part of the waste management system other than waste structures require maintenancelmmprovement?
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 maintenanceJunprovement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Coastal Bermuda (Graze) Small Grain Overseed
❑ Yes
❑ Yes
❑ Yes
❑ Yes
N No
N No
N No
N No
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
N No
b) Does the facility need a wettable acre determination?
❑ Yes
R No
c) This facility is pended for a wettable acre determination?
❑ Yes
R No
15.
Does the receiving crop need improvement?
❑ Yes
N No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
N No
17.
Are rock outcrops present?
❑ Yes
❑ No
18.
Is there a water supply well within 250 feet of the sprayfield boundary? ❑ Unknown
❑ Yes
❑ No
❑ On -site ❑ Off -site
Required
Records & Documents
19.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
N No
20.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
N No
21.
Does record keeping need improvement? (iet irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
R No
22.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
R No
23.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
R No
24.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
R No
25.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
26.
Does facility require a follow-up visit by same agency?
❑ Yes
N No
27.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
R No
Odor Issues
28.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ Yes
N No
liquid level of lagoon or storage pond with no agitation?
29.
Are there any dead animals not disposed of properly within 24 hours?
0 Yes
N No

i
Facility Number. 31-251 Date of Inspection 1l21/2001
30. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
31. Is the land application spray system intake not located near the liquid surface of the lagoon?
32. 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.)
33. Do the animals feed storage bins fail to have appropriate cover?
34. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Printed on: 31MO01
❑ Yes 0 No
❑ Yes ®No
❑ Yes JR No
❑ Yes 10 No
❑ Yes 10 No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Reviewer/Inspector Name g
Reviewer/Inspector Signature:
Date:

Division of Water Quality _ I I
0 Division of Soil and Water Conservation
ov- - -
0 Other Agency
Type of Visit Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit g(Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: lime: EX2ZTPrinted on: 7/21/2000
Not Operational 0 Below Threshold
Permitted E3Certifiied DE3 Conditionally (Cee�rtified E3 11eeggiisterreed Date Last Operated or Above Threshold: .........................
Farm Name:.......PG.lfr............._S1/1.�/......:_�..........F•.•""•r/.1..._ ...._ Countv:.._... .. .... j,,.F/...........
Owner Name:.....L.f.v4.,................._11JX11�'.r-`-..........................,,.......... Phone No:.......................................................................................
Facility Contact:
Mailing Address:
Onsite Representa
UerttnedVperator:...................................................
Location of Farm:
Title:
61l.•-•GAY./e No:
vperawr i ertmcation Number: ..........................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =' =" Longitude =• =' =«
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Po ulation Cattle Capacitv Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
Subsurface Drains Present JJ❑ Lag-nn Area J❑ Spray Field Area
No Liquid Waste Management System
Discharges & Stream lmpacic
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 dischar_c is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ)
f
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
Susie sir I Structure 2 Structure i .......... . Structure 4 .. Structure 5
Identifier:........._.r...._...................................
Freeboard (inches):
5100
❑ Yes �(No
❑ Yes []No
❑ Yes []No
/ .I.A
❑ Yes ❑ No
❑ Yes KNo
[]Yes )QNo
❑ Yes jVNo
Structure 6
Continued on back

Facility Number. — Datc of Inspection Y Printed on: 7/21/2000
5: Are there any immediate threats to the integrity of any of the structures oOer,d'? (,e/ trees, severe erosion,
❑ Yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
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 strvetures'need maintenance/improvement?
❑ Yes
<No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
RN
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
ONO
12. Crop type
�l " /
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
�No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
b) Does the facility need a wettable acre determination?
❑ Yes
9_No
c) This facility is pended for a wettable acre determination?
❑ Yes
U�No
15. Does the receiving crop need improvement'?
XYes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
KNo
19. Does record keeping need improvement'? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
%No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
KLNo
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?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
j No
24. Does facility require a follow-up visit by same agency?
❑ Yes
�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
XNo
CVO VIOl3li0I1S,Of, 4'ricWn"tkS WeCC ilOted d*&, illg this.visit.- Yoil Wlli-I'ecelVC fi0 ftletiler, ,
:':'comes olidence:abotiCthis.vlstt;':':...:':.'.':':':':'... ':
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):
-
/u�) l/u d�'► /XiW - ivyl�rGYt'/ilBytfs --/i) �/ ZA_
/ wn5�
q -
Reviewer/Ins ector Name (,
Reviewer/Inspector Signature: Dale: /00

Facility Number: — a. Date of Inspection vv
.hdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes IXI No
liquid level of lagoon or storage pond with no agitation? 7�
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes Milo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1No
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 W�Io
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 IKNo
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes DR: o
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ' 90
3/23/99

Division of Soif and Water Conservation = Operation Review'-''
0 Division (if Soil and Water Conservation - Compliance Inspection ,
ld-jirision of Water "Quality "Compliance Inspection
r _Ej Other Agency - OperationReview
Routine O Com taint Q Follow-u of DW ins ection 0 Follow-u of DSWC review Q Other 77
Facility Number Date of Inspection 6
Time of Inspection S60 24 hr. (hh:mm)
13 Permitted %Certified [3 Conditionally Certified 0 Registered 0 Not O ¢rat
FarmName: ..._i.I ... ((.:........................................................ County:
Owner Name: ....._C, ".A.._ 1.1........................................._.......................... Phone No:
Facility Contact:
Title:
Date Last Operated:
Phone No:
Mailing Address: ......................................
ddress:.................................................................................... ............................
Onsrte Representative: ht,L,Q,r.... �"fl: }� Integrator. .,..�� �
Certified Operator: ................................................... .................................................... ........ Operator Certification Number:..........................................
Location of Farm:
Latitude =•=' =" Longitude =• =' =11
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer I I[] Dairy
❑ Non -Layer I JEI Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons I0 Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds / Solid Traps �� ❑ No Liquid Waste Management System
Discharges & Stream f rmacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ❑ Spray Field El Other
a. If discharge is observed, was the conveyance man-made?
b. If' discharge is observed. did it reach: ❑ Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts to the waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I
Identifier: Freeboard (inches): .........�b.// ................
❑ Yes O(No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [%No
❑ Yes b�No
❑ Yes K` No
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
1/6/99 Continued on back

ry, Facility Number:3 —' -s Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 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 top of dike, maximum and minimum
liquid level elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovemcnt?
11. Is there evidence of over application? ❑ Pending ❑ Nitrogen
12. Crop type
0
❑ Yes bj No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. Does the facility lack wettable acreage for land application'? (footprint)
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a certified operator in responsible 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?
u, 1Vo.vioLiations'or. denciencies -were noted uurtng Miswis1I:.'Y'ou �.Vlll.receiVe no turther .' .' .
• ' • cgrrrespotideitee' tibotit'this :visit.:. ' .:.:.:.:. . '
Comments (refer to question#): Explain any YES answers and/or any recommendations or any -other comments
Use drawings of facility to better explain situations. (use additional pages as necessary)-l'
❑ Yes �(No
X-Yes WNAI--
❑ Yes C�'No
❑ Yes �TNo
❑ Yes KNo
❑ Yes gNo
❑ Yes [<No
❑ Yes NNo
❑ Yes No
❑ Yes KNo
❑ Yes BSI No
❑ Yes VNo
❑ Yes KNo
❑ Yes ONo
❑ Yes VNo
❑ Yes XNo
[]Yes VNo
❑ Yes 9No
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 11/6/99

T a onservation ❑ Other Division of Soil and Water CAgency
Division of Water Quality
Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection
Facility Number oZ�
Time of Inspection 24 ha (hh:mm)
D Registered 17 Certified `A\ pplied for Permit 13 Permitted O Not O erationa► Date Last Operated:
Farm Name:......vz . sfv�� iY. \ v........................................................ County:...q....q_\t ` 1.............................
Owner Name:..l^ 0�4 �';v�`
......
............................................_....................................................... Phone No:....................:............................
FacilityContact: .............................................................................. Title:.......................... .......................... Phone No
....................................
Mailing Address: -o
........................................../..................
1\C 1..
�..`�..Hi\�.(..\��....._�5..1......................................................
...
Onsite Representative: Ok.�'�.r.
o.....
Q ....................
/' c ,
Integrator:.. � � L� ._
.;:�
Certified Operator;...... ............................................
Operator Certification Number :.........................................
Latitude ='=e=aa Longitude 0' 01 ="
to I
tto
v to
to
v to
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 14 No
2. Is any discharge observed from any part of the operation? ❑ Yes f (No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑Y� re �� No
1V c. If discharge is observed, what is the estimated flow in val/mm?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes FNo
3. Is there evidence of past discharge from any part of the operation? ❑ Yes O No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ONo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes V(No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes M No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes Wo
7/25/97

;;' Facility Number: 3� —� S
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaEoons.Ilolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1
Identifier 1
...................................
Freeboard (ft) ...........P�%...............
Structure 2 Structure 3
10. Is seepage observed from any of the structures?
❑ Yes t1 No
❑ Yes ® No
Structure 4 Structure 5 Structure 6
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ..7.�... I...59..{.... c-./....................................................................................................................
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?
p- No.violations or deficiencies were noted during this. visit. You "hill receive no ftirtliei• .
correspolideitce about this:visit:•:::. ;
❑ Yes [*XNo
❑ Yes Ej No
❑ Yes El No
❑ Yes 0 No
❑Yes Dallo
❑ Yes No
•Yes ❑ No
❑ Yes No
❑ Yes (gNo
❑ Yes 16 No
1.Yes ❑ No
❑ Yes 14 No
❑ Yes Ej No
❑ Yes [$No
la-�cs�-�..,,._e (( S-ta ��,t��ey��►�.tc,���� �,. a,�n�t�� v� [��.
`\1dg
A1
O
Q_ ��Ioveh2-
'�i.% � � lM�� �3'�cw/�'hy�,, � t—e ��. f'�� OC v�a+r-dU✓tt>� C y
tvRieJ
7/25/97
Reviewer/Inspector Name
Reviewer/tnspector Signature: Date:

❑ DSWC Animal Feedlot Operation Review
® DWQ Animal Feedlot Operation Site InspectionLl . .....
a
IQ Routine O Coumlaint O Follow-uD of DCVO inspection O Follow-un of DMVC review O Other 1
VWDFacility Number Date of Inspection
t 2
[ Time of Inspection ;QO 24 ha (hh:mm)
13Registered tACertified E3 Applied for Permit O Permitted JE3 Not Operational Date Last Operated: ..........................
Farm Name: G r�.............................................................
..........�[�,YL�......51'.t.t<��..r.,.�...._[7�Y.ix4..............................................._ Countv:.....l... ��.
Owner Name:...........'..:!al!!., ia.....`.....: A11Yh................................................................... Phone No: ..-F..\.....................................
Facility Contact: ......... .4WDJQ.......... Sq:U�..................... Title: ........ QWnOf..................................t......... Phone No: .LI.M...}..56.&..7.3..7 31
i\Iailittg Address: ....... 14........ �1%......GI.t7j�..._�.�.... iS�'....................................:. .........:n..ltt.(.��.(.....f^-._...................:......... .�..g°,.��.,,...
Onsite Representative:.... ,ypt!p.��...... f*M', Y._.......................................................... Integrator: .... 6-61dSK1Nu
Certified Operator: .......... 6.rota..... 5.:...._St!:H..i....................................................... Operator Certification Number :.._�..7. :�.$. . ..................
Location of Farm:
Latitude 3S • 03 ®< Longitude '11 • 0` =11
Design Current Design Current .Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder I I0 Layer 1 ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non-Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity 21 g$p
❑ Gilts
❑Boars Total SSLW 3gS gpd
Number of Lagoons I Holding Ponds JE1 Subsurface Drains Present ❑ Lagoon Area ID Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes P No
2. Is any discharge observed from any part of the operation? ❑ Yes ONo
Dischar2c originated at ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes [P No
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ) ❑ Yes P No
c. If discharge is observed, what is the estimated flow in gal/min7 NT
d. Dries 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 [3&No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [h No
5. Does any pan of the waste management system (other than lagoons/holding ponds) require _ [Rj Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes 10 No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes P No
7/25/97 Continued on back

v Facility Number: ] —'ZS'[
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LaEoons.Ilolding Ponds, Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (ft): ......... 13: 3.................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
[A No
❑ Yes
1P No
Structure 5 Structure 0
...............................................................
.................................................................
❑ Yes
P No
❑ Yes
JZ No
[XYes
[]No
❑ Yes
W No
❑ Yes
[ENO
15. Crop type .......... bu UL..............................................................................................'50411....gtPit'.L................................................ ...........................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes CXNo
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement'?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
No.violations or deficiencies were noted during this.visit. You1,01 receive no further
correspondence about this:visit:::
❑ Yes ® No
N Yes ❑ No
❑ Yes 1,,9 No
❑ Yes 1E No
❑ Yes ® No
CZ Yes [I No
❑ Yes 5 No
❑ Yes 10 No
❑ Yes ® No
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as;necessary):_
_. .
s rrtGp ot\ P;�e et�g;,� d;k4.k�t shoe) be W %->,xl1e a,nJ 1�'{tt vXodfd dX'tt4 •filled ¢
,reseedwJl.
IL, &0- Ovens or, 4,A. (c.900M hall SkOV0 de eeseeded:
Ig 8",%u4_ e,rot if\ (_db k1 to shoA be itn, Y✓eh,
LL's�f 1 mords iAovja h� Y.1i`. bj Spntly gtAI' w 1t�lOruAuber, U�1do�ct) wtsk w�olyt s
urt� ev ;rrip��JOh yvwp Sj10Jp �[ in cxr' lAJ Out"-
J 1 7/25/97
Reviewer/Inspector Name I' .r V.''<.%
Reviewer/Inspector Signature: �� �� �/n r__ Date: Q/LT�G}7

Site Requires Immediate Attention:
Facility No.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATION SITE VISITATION RECORD
DATE. Z (0 1995
Farm Name/Own
Mailing Address:
County: (A/nI/
Integrator.
On Site Representative: ---
Physical Address/Location:
Type of Operation: Swine
Design Capacity: _e­
G ppa��1W
•.• •. r1l
i
Poultry Cattle
Number of Animals on Site:
DEM Certification Number: ACE DETM Certification Number: ACNEW
Latitude: ° w—, al" Longitude -'2:2_° 14E' j03." Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon hasufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6s or No Ac al Freeboard: _J� Ft. Inches
Was any seepage observed from the laQoon(s)? Yes orWas any erosion observed? Yes or No
Is adequate land available for sprat? 'e or No IA the cover cover crop adequate Ye or No
Crop(s) being utilized:
Does the facility meet S S minimum setback criteria?
or No
100 Feet from Wells?01 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? ''Yews or0
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o If Yes, Please Explain.
Does the facility maintain adequate w to management records (volumes of manure, land applied,
spray irrigated on
F-A
cover crop)? ,VeA or No
cc: Facility Assessment Unit Use Attachments if Needed.