310267_INSPECTIONS_20171231

NOR H CAROLIN _
Department of Environmental Qual

(Type of Visit: CKom ce Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: / 7
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Arrival Time: 0 a Departure Time: (0 O County: Region:
Owner Email:
Title:
Phone:
OnsiteRepresentative: R 1 c Cu' L t_z, INl Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: / % _? Z
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.11P
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P.
Dai Cow
We -an to Feeder
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
G o +
D . P,oultr +
Layers
Design
Ca aci_ +
Current
Pao
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I lBeefBroodCow
Other
01 Other
Turkeys
Turkev Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
[—]Yes [—]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes Io ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: jt - Date of inspection:
W&ste 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?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ✓L L I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z G 2 b
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
Structure 5
NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes Io ❑ NA ❑ NE
❑ Yes ❑ ❑ 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 AIo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ffNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ErNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application �
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes L_I 1V o ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes `Io ❑ 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 ff No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes EfNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
C:rNo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ETNo ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [3 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield. ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections Slu ge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: jDate of Ins ection: r
24,.. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑NA ❑NE
❑'ISo�❑ NA ❑ NE
❑ Yes
L!1 1To
❑ NA
❑ NE
❑ Yes
❑ No
fNA
❑ NE
❑ Yes
EJ No
❑ NA
❑ NE
❑ Yes P o ❑ NA ❑ NE
❑ Yes [;J011To_❑ NA ❑ NE
❑ Yes L KO ❑ NA ❑ NE
7
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes �❑ NA ❑ NE
Reviewer/Inspector Signature: W Y ` Date: y
Page 3 of 3 214,12015

DMtR5n of Water Resources
N'acility Number - 4 7 OO Division of ry soil and Water Conseation
% Other Agency
Type of Visit Complt ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: I f I / 7 /nl Arrival Time: Departure Time: 9 2 D County: Region:
Farm Name: `may./yam'/-y�Y Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
//
OnsiteRepresentative: 1� ! I II e�--
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: 1732 f
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity P.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
k Orl
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . P,oulh,
Layers
Design
C_a act
Current
P,o P.
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I 113eef Brood Cow
Other
OtherI
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes
❑ Yes
❑ Yes PNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of
21412015 Continued
r

r
Facility Number. 7 4 - G jDate of Inspection: ! 7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes r4o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Stricture 1 Structure 2 Structure 3- Structure 4 Structure 5 Structure 6
Identifier: VL I L iL f
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E3No
❑ 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 Ea o
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes Q No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ®N
❑ 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 EfYes ❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZNo
❑ NA
❑ NE
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
ElYesVNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
!dN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
BYO
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili t umber: - 2 Date of Inspection: T 6
24r•Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes -No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [;�-No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [—]Failure to develop a 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 [3"go ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ N ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes / No ❑ NA ❑ NE
❑ Yes [!�No ❑ NA ❑ NE
] Yes No ❑ NA ❑ NE
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes
❑ Yes LJ N
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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).
r� (e'a ft., 100 J_✓.
L,/LL L01oo„ ,CYp 0-Fr o/cl P'Pf`�
SO r r/ s ^ ".^/��c � S •� . // s � ° �" ti'9 � 2 r `t L r r` So � 1�'� /�S.
,�C,r (veld 3 _yam/�y�" v-i�jd-
/J 2-1— f7r) �� 7 7 ' �// b rt L/
bqJ�/� p� �gP��r��f 3Dao 1(�� �J,�r �o
rq . h 4 < ! (.r. I{a �� �ar re cnM C'./ ,//.P1 i ac }.t ftC
Reviewer/Inspector Name: 0" , r f P+ "X
Reviewer/Inspector Signature:
Page 3 of 3
Phone: I'M 77 j( 7%y
Date: tt I&AC
21412015
A

for Visit:
Referral O Emergency O Other O Denied Access
Date of Visit: 6� Arrival Time: Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: f / Title:
Onsite Representative: 01 ��` V✓"r (// 'vl `
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry $oultr,
Layers
Design
Ca achy
Current
P,
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
TurkeyPouets
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 to ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[3-No
❑ NA
❑ NE
Page I of 3 21412015 Continued

2& PO
Facili Number: Date of Ins ection: l
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2<0j ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
39 3(0
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 2rNo ❑ 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 6No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes /No •
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes lL1 �V
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes V
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes rj No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rallo
❑ 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
El Yes No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? "yes'
check a appropriate box below. ✓ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers eather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield 20 Minute Inspections ❑Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes l❑ NA ❑ NE
i
23. If selected, did the facility fail to install and maintain rainbreakers onirrigation equipment? [:]Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

a' Facib Number: Date of inspection: `f
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
Yes ❑ No ❑ NA ❑ NE
the ropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
Yes ❑ No ❑ 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 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes;/N o ❑ NA ❑ NE
❑ 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 fNo
NA
❑ Yes❑ NA
❑ Yes❑ NA
❑ NE
❑ NE
❑ NE
Comments (refer to question ft Explain any YES.answers and/or any additional recommendations or any other comments.,
Use drawings of facility to better explain situations (use additional pages as necessary).
1t3�,ei-- f- 7,
de f ;3..eC.
le,. CJ.�_ 404/Pv��� a (• f--w`E( rccvPzT
2�. C)o (/Zo ,,(, ccfio snn ItC�`9,:j i ot..7 AA
�St�?f A} IueC'k'`fGoZc I,
2_ /w� 1, 54-
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4
IO 3900 i�-Ltf �;-elds
Reviewer/Inspector Name: Q V l & V 0 cff
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1`0116 1301
Date: C7 1'3—
21412015

Type of Visit Ptompliance Inspection Q Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Q'Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: LL
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County: DLL Region:
Facility Contact: Title:
Onsite Representative: . IG // Z9./ be—_
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
ate/ y
Operator Certification Number: 1
Back-up Certification Number:
Latitude: F70
M.F-�" Longitude: [-�o[-�' [�«
.,y ,y -:, +., ♦. M x t.. R', "a j.'µ,,, ti'+Nwkeu`- at ` 'i
Design •Current ,' DesignCurrent ,.,� ,:�, .,„��Design,,.
Swme Capacity Population, 'z „ Wet�Poultry _Capacity., Populahon ,,,}.}Cattle *. Caap„aci�tyopu`I,
a; ❑Wean to Finish i:. ❑ Laver ❑ Dai Cow
Y'i1A"
,C•orrentt
ati o
„._
❑Wean to Feeder
❑ Feeder to Finish
❑ Non -Layer
„ El Dairy Calf
Dairy Heifer
I�
�"" �D ~ Poult "` "�
`` '` "'v'"
`'
❑Farrow to Wean
❑ D Cow
❑ Non -Dairy
❑ Farrow to Feeder
❑ Farrow to Finish
�-.
t;
❑ La ers
�. ❑ Beef Stocker
;
❑ Non -La ers
❑ Gilts
�.. ❑ Beef Feeder
❑ Pullets
❑ Boars
Beef Brood Co
❑Turke s
"°4^Number.of Structures
� 4 _<.. ,
❑Turke Points
❑
Other;
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes qNo ❑ NA ❑ NE
❑ Yes
Zj No
❑ NA
❑ NE
❑ Yes
2 No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
EFNo
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
J-No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facili Number: - Date of Inspection: /6
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
allo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑'No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Structure 5
Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
[2 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[�J_No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
�ZNo
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[XNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
niNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
4� No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
lL_I No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
0 No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Ej No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: Date of Ins ection:5 711, 75c
, { �
24. Did the facility fail to calibrate waste application equipment as required by the permit? 0y. UNo ❑ NA ❑ NE
25. Is the,facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes E�J'No ❑ NA ❑ NE
-the ippropriate 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 AE� No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes 'Callo
❑ NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
�o
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
EJ-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
fNo
❑ 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
ONo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Q 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).
"/h— rrfo�A'—s
1 1 7 5 lt1 L
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
A3 o
Ct
Phone:
Date: O ly
14/2011

ly
`20DOMon MA
Quality
Facility Number ®- . Division of Soil and Water Conservation
t� Other Agency 7M71
Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: QfRoutine O Complaint O Follow-up 0 Referral O Emergency O Other 0 Denied Access
Date of Visit: 11-- Arr'ivalTime: Departure Time: t�1 County: pkh
FarmName:�Gly�,d'/� /allie — I�AJ't�^\ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: \ + r ' W r Title:
Onsite Representative: 1 t',xo.� 1 p N! � U l
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Region: WAD
Phone:
/\A.& "
Certification Number: 1 ��
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Eoultry
Layer
Design
Capacity
Current
Pop.
Design C•ucrent
Cattle Capacity Pop.
Dai Cow
Wean to Feeder
I INon-Layer
IDai
Calf
Feeder to Finish
ti
Dai Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dt. P,oult .
Layers
Design
G_a aci +
Current
Pao ,
D Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
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 LI No ❑ NA ❑ NE
❑ Yes EJ No
❑ Yes 0 No
❑ Yes [ZNo
❑ Yes [7f No
❑ Yes [Tf No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 21412011 Continued

Facili Number: -akrl jDate of Inspection: Ll
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
(ZNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
0 No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes [Z'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 7f 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 Z No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes ff No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records &Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists ❑ Design []Maps ❑ Lease Agreements
❑ Yes ffNo
❑ Yes 0 No
[—]Yes Q No
❑ Yes [allo
❑ Yes + rNo
❑ Yes [ErNo
❑ Yes Q No
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes 0 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes [ No
[:]Yes [ZrNo
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ 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 (Z No ❑ NA 0 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes [2 No NA NE
the appropriate box(es) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes [?No NA ❑ NE
❑ Yes [fNo ❑ NA ❑ NE
❑ Yes [Jf No NA NE
Yes C2"No 0 NA ONE
❑ Yes [2'No NA ❑ NE
❑ Yes [TNo ❑ NA NE
Yes ff No
Yes ffNo
Yes dNo
�NA NE
�NA NE
NA ONE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments. .
Use drawings of facility to better explain situations (use additional pages as necessarv).
�- l rtr,& U we4-e lo% -,-Y\ 7
—SPV-1111� 4:tlxs Y' �.re - S1,ope.
Reviewer/Inspector Name: __:Si/t!S+tV\ Oa\;j�
Reviewer/Inspector Signature:
Page 3 of 3
f,d'e aGc�dBh'i',_
Phone: /5'A—JCS[" apl5p
Date:
21412011

3
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit j2 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /7 / ArrivahTime: �Q eparture Time: County: Region: 6�
Farm Name: 14L$
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: �/ % Title:
Onsite Representative: / �/ �L�f�
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certi [cation Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: M o [MMMI , [M-7 Longitude:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes QNo ❑ NA ❑ NE
❑ Yes
P-N
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
P-Igo
❑ Yes
ETNNo
❑ NA
❑ NE
❑ Yes
O No
❑ NA
❑ NE
12128104 Continued

Facility Number:% — Date of Inspection
i
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [;PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ['Io ❑ NA ❑ NE
Struc. e I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Ct`lL 1Y� Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 Z G
S. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes j2 No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes �No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �Ao
❑ NA ❑ NE`
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo
❑ NA' ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any pan of the waste management system other than the waste structures require ❑ Yes /No
❑ NA ElNE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ Ko
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ]0 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
[jNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
9o
❑ 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
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[ No
❑ NA
❑ NE
Comments (refer to question #):� Explain any YES ink ens and/orxauy-recommendations or any wother� comm nix k ff _
Use drawings of facility to better explain situations. (use additional pages�as necessary) an4
2 3 VL 7 ///7�iv /. 3 l�L -7 .,,.. , 7/7 8//o ?. v
j we, /s 4eV as i/ �K.r,�/� e✓eo, �s � �fz L t /.�o� � fo � s�V,.
1
'4i ¢ ?Or Z-7 lawlr 4% Cl-re k �/ bold 1, 311& �.,,r.
l/tf �a iv L 1 �
Reviewer/Inspector Name 77,;-7 Phone: 90 - p6 -?
Reviewer/Inspector Signature: Date:
Page 2of3 46iVIAU QL/-s Fc plre, ;6 /ytcAe 'Kp 0ii iori­�; 12128104
4Cics �� nee✓ 1�r�... r rc6o d, jo� 7{ 3

Type of Visit j9Tompliance 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:U. - Arrival Time: Q, Peparture Time: County: Region: L'QU_LS(�J
Farm Name: / r��/%G i7 �y/ Z Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative:4/1.,,,��i Integrator: 112,11,4
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: =o='=„ Longitude: =o=, =„
r
Design
Curreot
DesigI 15Fff—W1111111111
esign Current
Swine Capacity
Population
Wet Poultry C>apacity Population Cattle
Capacity Population
❑ Wean to Finish
❑ Layer I
Dairy Cow
❑ Wean to Feeder
JLJ Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
El Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Non -La ers
❑ Pullets
❑ Gilts
❑ Boars
Turke
❑ s
Other
❑Turke Points
Number of Structures:
❑ Other
❑Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes .t_J No
❑ Yes
[]'No
❑ NA
❑ NE
❑ Yes
VNNo
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment J
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 PrNo ❑ NA ❑ NE
// .. Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier),/ l✓L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
0 No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
k�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�treat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
Y1J No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
VfNo
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
[]Yes
ONo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes '0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[-]PAN ❑ PAN > 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
P No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
VNo
❑ 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
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
eht * a
Commeuts',(cefer`to question;#): ,Explain any YES answ•eTs and/or any.recommendahan ons or y other cm oments
Use drawings of facility to better explain situationsr(useaddihonal pages as necessary)_', V_
cc r l-
IReviewer/Inspector Name,`��y;f��h. �. >- w Phone: -/ I
Reviewer/Inspector Signature: Date: S �O U
1 s 2 - 72 8/0 Continued

Facility Number: - " Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ['Io ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑�No El NA ❑ NE
❑ Design ❑Maps El the appropriate box. ❑ WUP ❑ Checklists //
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
21 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
PNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rairbreakers on irrigation equipment?
❑ Yes
'[2FNo
❑ 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
qNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P] No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
qNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
P"No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
PI 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
pMo
❑ 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
VNo
❑ 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
f TNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
C3'No
❑ NA
❑ NE
Additional Commentsand/or Drawings:
-
���s�/a
ales 610 �let, l h//f .
Page 3 of 3 12128104

Type of Visit f2rCoommpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
C Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑Denied Access
Date of Visit:
Farm Name: _
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: / �- n�i Departure Time: County:
Owner Email:
Phone:
Region: 4zz�
Facility Contact: jtle: Ph ne No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = o = ' = Longitude: = o =
Design Current
Design Current
Design Current
Swine Capacity Population
Wet Poultn Capacity Population
Gattle Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
ILI Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
El Farrow
Layers
ElNon-Layers
El Beef Stocker
❑Beef Feeder
❑ Gilts
El
❑ Boars
❑Beef Brood Co
❑ Turkeys
[I
Other
❑Turke Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
0
❑ o ElNA
❑ NE
❑ Yes
❑ Yes/N
[I NA
[I NE
El Yes
ld No ❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: 3 - Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )3-?No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes 2 No ❑ NA ❑ NE
Structure I Structure,2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Z'Ro ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0-NNoNo El NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes / PO
ElNA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes El NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes KNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes IRTNo ❑ 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 XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
-ffNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
EfNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
.CJ No
❑ NA
❑ NE
Comments (refer to question #): `Explain any YES answer"s and/or any recommendahoris onanv the comments,
Use`drawings of facilityations"to better explain situ(use additional pages;as necessary)w
Reviewer/inspectorName phone: I
Reviewer/inspector Signature: '). Date: ."/7V'

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes E�No [I NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 9J No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Desig
n El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ;3 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{{ El
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
[I Yes -�l_1 NNo
❑ NA
❑ NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,IJ tvo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 4E] No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ YesEj'No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes -El-No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ef!fNo ❑ NA ❑ NE
Otherlssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes O'No ❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes La 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
ONo
❑ 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
B 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
C—I
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
/No
[J No
❑ NA
❑ NE
/ /8/of
furv49�!) . /
5bL e-
12128104

fwt'
(Type of Visit O'Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Si Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L
Farm Name: _
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time: O.3 CJ Departure Time: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: = o = , = Longitude: = o =
Discharges & Stream Impacts r�
I. Is any discharge observed from any part of the operation? ❑ Yes 2l No ❑ NA ❑ NE
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
.-NO
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
12128104 Continued

Facility NumDate of Inspection I Y/OT/rI
•✓
TT
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
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: S'A -1 W 1_7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 31 j 61
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes x] No
El NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes j'No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes EFNo
❑ 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 L/I 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.
211Yes ❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground Z Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes H No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes .ENO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J:J 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): -
' reed*- c77 -Lerti
Reviewer/Inspector Name Phone: — 1,2
Reviewer/Inspector Signature: Date: Z01
12128104 Continued

''ir acility Number: . — �f 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 0 No ❑ NA ❑ NE
the appropirate box. ❑ "p ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. [I Yes .E]'No []NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or
.9:1a16 107
.;z /d 8/O '%
9//1for-
f if( h a-o&50l l k
ha,5 Z,' levels 1 &4
- Plea5e CYlSCovtd-1niit
4-hl5 -C'ie. l d
/(v / o_5 7
❑ Yes .B No ❑ NA ❑ NE
❑ Yes
❑"No
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
�INo
❑ NA
❑ NE
❑ Yes
[],No
❑ NA
❑ NE
❑ Yes
❑No
❑ NA
❑ NE
❑ Yes
ErNo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
2No
❑ NA
❑ NE
❑ Yes
Q No
❑ NA
❑ NE
_e>o Ct : 9'leVC4 of
ex ce55 oC- .30 00
ff yn el t-5 o v.
1/4e1- o n /.
WL1 G - -teoJvrpc� leve
��2Gse S 161L+' f %rt" a-r Al\ ,XZI
�o L lCii./ Ct CC DC.0 _�
12128104

IType of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit''koutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: Arrival ,9me: �-Departure Time: County: �U4L/4, Region:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
OnsiteRepresentative:/YI/"l/T,V
Certified Operator:
Back-up Operator:
Phone:
Phone Noo/•,,,.
Integrator: 7L/I�/ii%JK
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = " Longitude: = o = , ="
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes )1Qo []NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
[3NA
❑ NE
❑ Yes
❑I No
ElAL Yes
J No
❑ NA
❑ NE
❑ Yes
P15o
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection!, Q_
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: �L 7 —LIZ '
Spillway?: t t 5
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 k] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,ONo ❑ NA ❑ NE
❑ Yes PNo ❑ 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 qNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes,,j2No ❑ 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 0 No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes eNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Qrea
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes ETNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes a No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
El Yes J2No
❑ Yes I'No
❑ NA ❑ NE
❑NA ❑NE
IComments (refer to question ft 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):
e * �
Lei/es lA arpa a E have 6el� li/r�G, ?� d- Ca lei
77"/3 4k5e IPUels — C2 V3 ) cli
Reviewer/Inspector Name I g roj1,t,4 I I Phone: — IYA —(o
Reviewer/Inspector Signature: IC Date: l
12128104 Continued

Facility Number: -j j -C7% Date of Inspection
1Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes Ll-no ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
J2 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 Inspectionss
El
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
eNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes .ErNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
Z 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
ffNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes [P'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ YesJ2 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 21 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 ONo
❑ 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
[INA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes PNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
[:]Yes JD -No
❑ NA
❑ NE
Additional Comments and/or Drawings:
/3 OFF
3
t,��
w�nAr 13
a �✓ �r`� a ` c� � � `` a����� � 10.500� \rt a � ec-�.
d4eds� 1V� s �CCG �Scer✓ crf� Cc�jlbfaco0s rr aoo5'
W Ai-� oy1 — S.\ �P' t 2 ccr rcl S t rd. Q1, s %ate
n "-&3 KC Je to-W1'` YIA sace�
Page 3 of 3 12128104

�t
Type of Visit 10-coompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for VisitXeRoutine O Complaint 0 Follow up 0 Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: h71,;?E/Qn Arrival Time:
Farm Name: ,S,
Owner Name:
Mailing Address:
Physical Address:
Departure Time: County:
Facility Contact: Title:
Onsite Representative: &.449r%_/,,�el Gem'
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator: iirrlr///l
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = o = ' Longitude: = o = , = «
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 2No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
2rNO
❑ NA
❑ NE
❑ Yes
Io
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 5 d.
4.
Waste Collection & Treatment
"4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ONo
❑ 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: VL
Spillway?:
pp
Designed Freeboard (in): CAM
Observed Freeboard (in): _!70 36
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ETNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes . 0 No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ZNO
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes 8 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 S fMo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ,2rNO
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 21 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes XNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes oNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes B 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 V�j No
❑ NA
❑ NE
- 4eeds to ,je-to✓t2q
be. Suva 71-1-e-e- 111W_ ola eS
apt/a w4ll
,Some wed conlvl lue-Z /'r 4,C
/?a 71 ex neoo c/�
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: < Date:
12128104 Continued

Facility Number: �� �� Date of Inspection
Reaurred Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes L 'No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Yes ❑ No ❑ NA ❑ NE
[:]Waste Application Z Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield )�(120 Minute Inspections ❑ Monthly and V Rain Inspections ER Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes Z No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,0 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
B'No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
.0 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
J2'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Q'NO
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E2'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
O 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
�j 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
49No
,❑ NA
JZNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E�No
❑ NA
❑ NE
I) FireelooaC l 4- ('0,i11GNL ('card r"4-
Q vN' s, 4e , 'PiCO-S'a +0 l�v►n o�l���
9lo - 35�0" dLoot) Oi /Yb/ f0
NeecP 6 Uje r (cJl/i%� 9/
� f.-1s�Pc�larl s
llr� c�cco�aoi.2�5 �.y
Z ,13P S ceie r,10Slac�,5e s��ve� ca/lb�� %ik.r Fvi- aOo-%'
12128104

Type of Visit OrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit gfRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: O Time: j
Not Operational 0 Below Threshold
E3 Permitted 0 Certified [3 Conditionally Certified 0 Registered Date Last Operated or Above Threshold: _..._..__
Farm Name: /��'County:
Owner Name:
Mailing Address:
Facility Contact: ___._._._... ._............ __._.._.__...._._....__Title:..__.._._._.__._
Onsite Representative: , /!Qy_
Certified Operator:._......._._.__._._......_._..___..
Location of Farm:
Phone No:
...... ._._ _. Phone No: _.______._._�......_---......
Integrator: /_[t.al(�_.. �... ........
Operator Certification Number: ,-.__,_,__,_.._..._._......
ine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
— - -
' Desgn _- Current ,' _ Desgn Current Design
Current _
. .' __
SwicesCa aat Po elation 'Po"ult}y ,?._..Ca'
aci yPo'nlstion _,Cattle "
y Ca' aci - Po �nlation
Wean to Feeder
❑ Layer
-; ❑Dairy
_
Feeder to Finish
i
❑ Non -Layer I
I
I r ❑ Non -Dairy
Farrow to Wean
_ 's
Other
Farrow to Feeder
Total Dtstgn`Capacity
Farrow to Finish
Gilts
3
s ` 'Total SSLW.-
Boars
z-
FNumber of Lagoons
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes P io
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaVmin?
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 Io
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes �No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes fNo
Structure I �Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........VL..._1 .......11_.�. �_1_ . .._.............._..................._._................_._...._..... .................... ...... ..................... _...........
Freeboard (inches): J
12112103 Continued

zA
3
Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes 040
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes P'&o
closure plan?
(If any of questions 46 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? []Yes 04No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 21140
9. Do any smctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ;'No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes J21go
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes Q-No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop typerrYl/i�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Pr§o
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes ,ZrNo
b) Does the facility need a wettable acre determination?
❑ Yes eNo
c) This facility is pended for a wettable acre determination?
❑ Yes 2T1Io
15.
Does the receiving crop need improvement?
❑ Yes $No
16.
Is there a lack of adequate waste application equipment?
❑ Yes 0No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes ,4314o
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ST<o
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes B'No
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes e No
Air Quality representative immediately.
Field Covv ❑ Final Notes
�rra�u�a. �•-��/a�a� v/t 3 ,
.Zt3�,' 2 G,
T�'!un IUC�Q�
-16eccj.-ds
Reviewer/Inspector Name r
Reviewer/Inspector Signature:
Date:

Facility Number:3 — Date of Inspection PG
Reuuired Records & Documents
21.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes �' o
22.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes [2-No
23.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ,B'No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes Qa10
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes ,E2 No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes ®'No
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes E],No
28.
Does facility require a follow-up visit by same agency?
❑ Yes 214o
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ZNo
NPDES Permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
OTes ❑ No
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Q-No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ZNo
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes �No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes eNo
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12/l2103

— /'(0 7 C et -
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Cl Routine o Complaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Date of Visit: /� O Time: � ati.
Facility Number � %
Not Operational O Below Thresho
Permitted �Certified /DC� oJnditionally Certified 0 Registered Date Last Operated o Above Threshold: _
Farm Name: 111ixfzA Ai 11/?/ �i.✓M County: w'/'t-
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Location of Farm:
e
Title:
Phone No:
Phone No:
Integrator: I/
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ='=1 0` Longitude =' 01 =�
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes _130�o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: 11L ) U)L
Freeboard (inches): 27 Zjf
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
,D'NO
❑ Yes
ErNo
❑ Yes
:!! No
Structure 6
05103101 Continued

�• 3I � ��P�C/La
Facility Number: — •T Date of Inspection ZZ -
Z&7 r��
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes -E No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes O'tG0
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 2,90
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 0'No
9. Do any smctures lack adequate, gauged markets with required maximum and minimum liquid level
elevation markings? ❑ Yes �o
Waste ADnlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
O'lgo
11.
Is there evidence of over ❑ Excessive Ponding El PAN [I Hydraulic Overload
❑ Yes
0-No
12.
/application?
/
Crop type &10ttllA`i -A SGlt061-_Aitha.c1if S�dr ZVV.4 P/ Ahltualf
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
'I No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
ffNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
fallo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
ONo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
El -No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ErNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
[.]'S es
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
2rNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
ETNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
ErNo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0-No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
EJ-No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
2No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about'this visit.
Comments (refer -to question #): _E plain any YES anssersand/or my i4c6mniendationior any other comments.
-Use drawings of facility. to better e=plam srtaatioas. (nse addroonal pages as neeessarv) - -
- - - - - ,.._ - = _- _,- - ❑ Field Conv _ ❑ Final Notes
/4 )Uce) ivl 4eep o e6& bf -Fite �iez 600�GQ ✓ecv�i� �'t� �li� {ev�+l
retod'f f '1kQQ0M 4PA %1.% r'is1e t��ter1S.
/Njb✓t
bo4
w
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 1 - v Continued

Facility Number: —&17 Date of Inspection i fop"
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additional Comments and/or Drawings:.--
05103101
❑ Yes 0 No
❑Yes 25No
❑ Yes �ENo
❑ Yes 0 No
❑ Yes 0 No
❑ Yes 0 No
❑ Yes tU No

' - - 0 Division of Water Quality
0 Division of Soil and -Water Conservation.'-
_ , 0 Other Agency
(Type of Visit 0Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit oRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number �Date ofVisit: 3 1 OI Time: �Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
j Permitted ❑ Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ........................
2:c�.�.d Waller F'
Farm Name: ......................................................................`.s, :):....................................... Countv:....._.k�./'�
Owner Name: ............&_._G_...../41 �t;................................................. Phone No:
FacilityContact: .............................................................................. Title:................................................................ Phone No:
:Mailing Address:
Onsite Representative: 1K L�t� L./w�l e................................................. Integrator: M..V. f� � �"� S'
...........................................................................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
fidswlne ❑ Poultry
❑ Cattle ❑ Horse Latitude
Longitude =• �<
Design' Current Design
Current
Design:.' Current
Caoaeity Panulation Poultry - Cana.it.
PnontaNnn
Cattle a^e..::i:a. ii :...c .i__ -
2s"s:
Wean to Feeder
Feeder to Finish
6 t{ 4. Pj
Farrow to Wean
Farrow to Feeder
Farrow to Finish
=;
Gilts
Boars
=, Number of -Lagoons
Bolding Ponds / Solid Traps
❑ Other
Total Design.Capacity
Total SSLw
- - JKSubsurface Drains
❑ No Liquid Waste 11
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: .......... .Y_L.:'1........... ......... W. /_1
.....................................................................................................................
Freeboard (inches): 20 Z
5100
❑ Yes 5rNo
[]Yes )4No
❑ Yes KNo
h /A
❑ Yes PfNo
❑ Yes 19 No
❑Yes ONo
❑ Yes 0 No
Structure 6
Continued on back

Facility Number: 31 — 2_0 Date of Inspection 3 Zf O/ Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 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 gNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes EffNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes WNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ®'No
11. Is there evidence of over application? ❑ Excessive Pending ❑ PAN ❑ Hydraulic Overload ❑ Yes 5(No
12. Crop type 6erw,udat rCS ure` SvhalI Gr4ihr Sv..nwer /ln alr fin/ +lle >grl�lVcl
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 'KNo
14. a) Does the facility lack adequate acreage for land application? []Yes GTNo
b) Does the facility need a wettable acre determination? ❑ Yes ®"No
c) This facility is pended for a wettable acre determination? ❑ Yes ONo
15.
Does the receiving crop need improvement?
❑ Yes
JffNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
:Eg'No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
fie/ WUP, checklists, design, maps, etc.)
❑ Yes
JffNo
19.
Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ff No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
fNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
EfNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
El
�(No
fie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'.?
❑ Yes
Z] No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
'15iNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
1�10 V1013t1OI15,01`ttCtlCle,I1C�i?S were) ... ilut:itig t. i5.VISIt... ir. . I .e0h, 0 PuCthO .,.,
ctiriespotidence about his 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-_necezzsary):
Is. AP�'I `1 ►;-..e gGGo rd% 4o soil -%sl Zinc artd c6mel loa► -
are ti �h :., so.-� of e Ee14J•►?es
l,tc� �ec�f� -ges-as 4o oharrhe-A `h jowks.
19. `�crsure40 t.vse. w-u4c o~,Iz <;3-A4'Iadwi��.:. 6odAys o(- eplejiGLriiohFcr
Ca/Gu/q.}:.,%-reg4ke T1CJC-200F10e ls, wlI _. "IIc✓ sa ys Ile. has r•eelbgrot recerdl
a4 Ltir Lto&,se; 1�ave tvs-e,gtick ILm to Aor i+�s�eejoh. oveeall)reni di wellkeft.
7. getlr tde 4CS-1bl,'4 grass cover eh eroded Iayoolh Rregs.
ZS. Sowte ads toq -js 6te arplicA4io.., ar�raS have vie, b�aL, f4gft4ed w�}f,swKtllgwia
,end Pull ;sspar}e,�_zd /odc60vK&4{cde 14;-,, Need-}& 191,R-44vi0t lwves4 YJecessgry
Reviewer/Inspector Name .S-10 n rrw�e I 1 /✓�Gt-/t;�s. _- ; . _ :. ..'... `. .` 'F'` -`
Reviewer/Inspector Signature: Date: 3 ZI l 5100

Faci tty Number: 3 — Z.b Date of Inspection 3 2 O( Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below j Yes - ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes lj�rNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
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 g No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 0 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ;KNo
32. Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover? ❑ Yes ❑ No
5100

('Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit l ,C,00mpliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ya Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
P ed C 'f
Printed on: 7/2112000
Wermttt ❑njerh/1r�e�d���❑jam oomouona�llly uCertified ❑ Registered Date Last Operate Above Threshold: J]
Farm Name: ....J (...Ilf!.tNf!Y..[�.(..........LL..G!..... County : ......... .... ... lr� .../ .s.:........
Owner Name: ............ .... .L%."r^�.... L4lA. .... Phone No:.........y ......... �L�
..................... .� ........ ll... Jit..............................
Facility Contact: .... ..... .Z_4....................... ... ./'`!....fitle:...j..11A.IL.W...S..................................... Phone No:...................................................
MailingAddress: .... .............................................y....................................................................................t�.../..j........ ......................... ..........................
Onsite Representalive:........L.li'/I't'/!— .................... Integrator:............1.11ll....................................................
Certified Operator:..... z l„/ . Vz......._,o f . Operator Certification Number:.,,,,,_,.
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude = • 0` =.. Longitude =• =1 =..
Design Current
Capacity Po ulatio
Wean to Feeder
-Feederto Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Poultry CapacityPo ulation Cattle
❑ Layer ❑ Dai
[[IN n-Layer ❑ Not
❑ Other
Total Design Caps
Total.SSLW
Number of Lagoons t AGJ ❑ Subsurface Drains Present 11❑ Lag^ n Ar
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, notifv DWQ)
c. If discharge is observed, what is the estimated flow in gal/mid.'
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
�� 1r .5 `•
Identifier: ......................................................................................................................................................
Freeboard (inches): �ayyl �nppyt�
5/00
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
RNo
❑ Yes
�rNo
❑ Yes R1 No
Structure 6
Continued on back

11%citity Nlumbec — Date of Inspection P Printed on: 7/21/2000
5. Are there any imme late threats to the integrity of any of the structures obse ed? ( / trees, severe erosion,
...0 s
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
ONo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
( No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
IX No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
P No
11. Is there evidence of over appli ation; ❑ Excessive Pon ing ❑ PAN ❑ Hydraulic Overload
❑ Yes
1� No
12. Crop type ►t/(I
13. Do the receiving crops diff with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
19 No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
iq No
b) Does the facility need a wettable acre determination?
❑ Yes
IN No
c) This facility is pended for a wettable acre determination?
❑ Yes
(�f No
,rtf
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
5 No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
(VNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W UP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
[ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
[vv�l No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
* •vioratiotis:oi' deficiencies were hote# during this:visit; • Y;oit'Vj11- •ebgiye tio: fui-th$r.
correspotidefi&about.this visit. ..............
�omments (refer to. question #): Explain any YES answers and/or any recommendations or any other,coutmepts _ :.
lse"drawing z of facility" to better explain situations. (use additional pages as necessary):: _
-�
Xtma.Q I(V�atna5e� -�a r t�� l,`Z V7�v�c r ��5 5
ab
ee,,C4' Lf s
Reviewer/Inspector Name
Reviewer/Inspector Signature: E ]lf/%/»7 0 Date: /

Facility Number: Date of Inspection LT0 Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes KNo
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
Q'No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
Wo
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
4WO
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
.��y,�
Aw
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
Wo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
gYes
❑ No
Additional.Comments and/orDrawings:- - - - -
5100

0 Division of Sod and Water Conservation-- Operation Review
r e= E,Division of Soil and Water Conservation Compliance Inspection
Division of Water Quality=�Comphance Inspection x ;'
z , 0 Other Agency =OperationReview
10 Routine O Complaint O Follow-up of DWO inspection 0 Follow-uD of DSWC review a Other
Facility Number I Date of Inspection I .tom/ S 1 `t`i
l Time of Inspection 24 hr. (hh:mm)
V,Permitted 0 Certified 13 Conditionally Certified E3 Registered JE3 Not Operational Date Last Operated:
..............
!Q- 11 �
Farm Name: \\�........`\\2'. Vh County: :............��.).�
Owner Name:
Facility Contact:
Mailing Address:
Title:
Phone No:
Phone No:
Onsite Representative: L�1-rQrl.f��-1 Dfl...................................... Integrator:.......j,`,!'�✓,�
..t \Y. ................ ...... ........ .
Design
_ Swine -"Ca iacih
❑ Wean to Feeder
Weeder to Finish
❑ Farrow to Wean
':' ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
F1Boars
Current_ -,. esign_ Current_'
'ooulation Poultry ' - Capacity - ponulation . , Cattle
❑ Other -
Total Design Capacity
-Total SSLW
Number of Lagoons. ® ,;.. ❑ Subsurface Drains Present ❑Lagoon Area ❑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? - ❑ Yes No
Discharge originated at: []Lagoon ❑ Spray Field []Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water. of the State? (If yes, notify DWQ) ❑ Yes ❑ 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 *0
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes C�'No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway []Yes kNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: i� !
Freeboard(inches): .............I a �J .....................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? fie/ trees, severe erosion, ❑ Yes No
seepage, etc.)
3/23/99 Continued on back

Facilhy Number: 31 dl9 Date of Inspection
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 maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over
12. Crop type
❑ Excessive Ponding ❑ PAN
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
iVd yiolatiotis:oi: deficiencies were itgfet9• dirrifid this:visit; • Yoir :will-te- b iyt lib rurthgr
❑ Yes 0(No
❑ Yes V No
❑ Yes ('No
❑ Yes O(No
❑ Yes ,C5 No
El Yes �t No
❑ Yes ONo
❑ Yes IN No
❑ Yes JXNo
❑ Yes [YNo
❑ Yes ,�/No
❑ Yes IY No
❑ Yes 1at(No
❑ Yes gNo
❑ Yes O(No
❑ Yes CyNo
❑ Yes 9No
❑ Yes XfNo
❑ Yes VNo
❑ Yes 0 No
❑ Yes 0 No
3/23/99

Facility Number: 3 — Date of Inspection
•Odor Issues -
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below XYes ❑ 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 X No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �(No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes gNo
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 O(No
3). Do the animals feed storage bins fail to have appropriate cover? ❑ Yes " I U
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ''9Yes kNo
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
1 Facility Number Z Dale of Inspection
t Time of Inspection 24 hr.
U Registered IpCertified [3 Applied for Permit XPermifted 113 Not Operational Date Last Operated:
Farm Name: ... L!�ttrt%..... L!r........rfl.!T................................................. County: ....
/.!>..l '.h...........................................................
Owner Name: ........................_�? 4., .CTS(U...........In.aA.LC........................................ Phone No:. .......................................
FacilityContact: ................................... .......................................... Title:................................................................ Phone No:...................................................
Mailing Address:...... .....p..L.&Y'.My........
Cllq..tl...... ?_I ................. I............ .............. M1........ ���TAYet....NG....................... Z.�(.31F.r.....
Onsite Representative:......(�y�. ,....Cl+....:....1J 1W'............................................._ Integrator:........!1!.1.11q.................................._....................
Certified Operator:............................................................................................................... Operator Certification, Number;.........................................
Location of Farm:
Latitude Longitude 0• �' °°
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ;B No
❑ Yes 0 No
❑ Yes
PjNo
❑ Yes
ICJ No
❑ Yes
03 No
❑ Yes
® No
❑ Yes
® No
PYes
❑ No
❑ Yes ill No
❑ Yes 0 No
Continued on back

Facility Number:
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
IM No
Structures d,a2oons.Noldin2 Ponds- Flush Pits, etc.) '
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
.® No
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure
6
Identifier: O�� .......)1 O...........................................................................................................................
.....................................................................
Freeboard (ft):............... ....L ........... .............. .�..8.............................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑Yes
No
12.
Do any of the structures need maintenance/imptovement?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses -
an immediate public r health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
`�(,] No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ..................I_o ............... YM- L1.._.Q1Xi\.n..........s(l.YhtYWc.G4YaYl.U�................cniUh.Y1.r—Fk
f .
i\�tlk.l......._......
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
El Yes
[VNO
•
ti
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
❑ Yes
®No
19.
Is there a lack of available waste application equipment?
❑ Yes
� No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
®No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement? -
51 Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
®No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
P No
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
B No
0 No violations or deficiencies were noted during this. visit..You.svill receive no further
correspondence about this: visit.
Comments (refer to question#): Explain. any YES answers and/or any recommendations or any other comments
iise drawings of facility to better explain situations: ('use additional pages as necessary):
.x
It11.�t1,� 1rIG. taal�s of bell,
l4-500ns sl,ou(t) be. mower). /6ayv, s?o--I of, (oojL (1y45oens
6"Si14\ QU^CPr1 6(� U.. Iry'µr 01�Y. �IA\1 SrtOUI� R`t`��
C\� WWe a. 1 ti CGIC�IAt��� ShW�d
72, 1 RR 2� Fort,. Ska)13 lie d � eac.I- g�%n+ �, I' � t'AN- GJct sE
Ih5 aL . L ghe�1 I G �oon A^ `ijv SPY (e S is end i ca�t
/er���ctl mlan. �0.5{t Cvr1a�4Sis s%IDvI� �1¢ �p�0 7/25/97 _
Reviewer/Inspector Name=--
Reviewer/Inspector Signature: A,;„� ��, /1 Date: l! /t 0 �q Y

Farm Status: 9 Registered ❑ Applied for Permit
❑ Cerfitied ❑ Permitted
❑ Not Operational Date Last Operated: ... ._....
..__........_..._._._...._....___�....__.__..�...._.... _...._ ....
Farm Name: t.L i[ d LLL �.E 1 ��41R ^ .�1ZA.L14 � V f « County: �.tLlt. �_tca .._�..__.....�..........
Land Owner Name:..&nrdfir..... ...... _..... ....... Phone No:_.i..l..i�..{za$_-.5��__......_..... ..
Facility Conctact:...__....__..... _...._.... ....__...... ...... _.... �.. Title: �.._.__...�...._...._...., Phone No:
Mailing Address: .+.I.......waC..a.i.�-..f.�.....�x�._.... _
Onsite Representative: .... .y.c..d.,....),r�iA..L...& _...... _.............. ....... Integrator: _......_1.t.r...� ...
Certified Operator:.._ _ .... _ �
...__......_..............._......_......_....._...._....Y......_.. Operator Certification Number: M..,.L130.__..
Location of Farm:
Latitude 35 • ok '=" Longitude ©• =1=11
Type of Operation and Design Capacity
Swine I)esignCiirrent a D gn +Current Doi o Cdrrent
Ca act . Po Mahonz�j Poultry ,t Ca Cana lation� Cattle "; „ a aegit "Po ul h n
❑ Wean to Feeder �01-ayer ❑ Dairy
Feeder to Finish ❑ Non Layer ❑Non Da
Farrow to can
Farrow to Feeder Total Design Capac�ify �W
Farrow to Finish
O other �Totat SSLVV 31
Numberof Lagoons /Holding Ponds ®� ®Subsurface Drains Present
Area - ® Spray Field Area
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: []Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes [@ No
❑ Yes No
❑ Yes ® No
❑ Yes
® No
❑ Yes
UNo
❑ Yes
RNo
❑ Yes
ENo
Continued on back

Facility Number:.._31.._. —._7
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes E.No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ® No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
CkNo
Structures (Lagoons and/or Holding Ponds)
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
®.No
Freeboard (fl): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
.....r.. �...._. ..2.A 1 .... ....... .......... ........ .__....._._....__....
._....__._..._....._
.
10.
Is seepage observed from any of the structures?
❑ Yes
UNo
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
aYes
❑ No
12.
Do any of the structures need maintenance/improvement?
0,Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
EINo
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type b..Rd^ �ci..v== ...... ..tr1 X.i._ J.?�.E..._....._........._......__....._._....__....._._...._._....__....__......_......_
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
RYes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
)$No
18.
Does the receiving crop need improvement?
INYes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
®No
20.
Does facility require a follow-up visit by same agency?
®-Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
IR No
For
Certified Facilities Oniv
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
J&No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
KYes
❑ No
24.
Does record keeping need improvement?
® Yes
❑ No
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Reviewer/Inspector Name
Reviewer/Inspector Signature: f , _l, , ,_-' A-1 - � o V _ I„ -Dates b 12
cc: Division of Water Oualitv. Water Oualitv Section. Facility assese...,X /lalt

Facility Number:-,3_�_-. --zi.7 I Date of Inspection: ! /
Addidonal`Comments and/or Drawings:' Z
Za. VCt1
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4/30/97

JUL-14-195 SS 22 FROM DEM WATEP. QUALITY S=-_TION TO WIP.O P.02i02
Site Requires Immediate Attention:
• DIVISION OF ENVIRONMENTAL MANAGEMEFacility No.
NT
SITE VISI_3 / —�G 7
ANIMAL FEEDLOT OPERATIONS VISITATION RECORD
DATE: _2t2_`, 1995
Time:S
Farm Name/Owner. �Qr
Mailing Address: ree'�
County:
Integrator k
u Phone: � _1�261� 0 9
On Site Representative: 3 ��
Phone:
Physical Address/Location: 6
•
C , J
Type of Operation: Swine _� poultry — Cattle _
Design Capacity: (G00 k i t q it Number of Animals on Site: 16�u t l
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: o V ' l7 Longitude: % 7
-<; ), _ 5 7" Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6r or No Actual Freeboard:
ches
Was any seepage observed from the lagoon(s)? Yes or& Was any erosioserved7 Yes or No
Is adequate land available for spray? %Y s r No Is the cover crop adequate? es r No
Crop(s) being utilized: 1` ))4\h0 ✓/.ef K4. L._
Does the facility meet SCS minimum setback criteria?
200 Feet from Dwellings? nor No
100 Feet from Wells? Ye or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied
spray irrigated on specific acreage with cover cropl'� yes or No
Additional Comments: a od"5
Inspector 7
Si_ ,lure
cc: Facility Assessment Unit
Use Attachments if Needed.