310271_INSPECTIONS_20171231

NO H CAROLIN 'Am
Department of Environmental Qual

for Visit: C�Routine O Complaint O Follow-up O Referral
Other O Denied Access
Date of Visit: Arrival Time: O Departure Time: ® County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: D o 1 Lp co C Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Swine
Wean to Finish
Wean to Feeder
Design
Capacity
Gunrent
Pop.
Wet Poultry
Layer
Non -Layer
Design
Capacity
Current
Pop.
Design Current
Gattie Capacity Pop.
Da' Cow
Da' Calf
eeder to Finish
OQ
3 ZLn
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D P,oult ,
Layers
Design
Ca aci
Current
P,o ,
Dry.Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
I
Pullets
I
lBeef Brood Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 gNo ❑ NA ❑ NE
Page I of 3
21412015 Continued

Facility Number: - 2 7.1 Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes DINo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental th eat, 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 Io ❑ 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 ZrNo ❑ 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 ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
��_N"""o��/
❑ Yes ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ;Nq� ❑ 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 N9 ❑ NA
�[
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes NNo ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers . ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections/❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 21420I5 Continued

Facili Number - -Z Date of Inspection: S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No - ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
Yes
No ❑ NA❑
NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No ❑']VAB❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
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
ETNo ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
gjNo ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
LJ 1Vo ❑ NA
❑ NE
Reviewer/Inspector Signature: r� / ��/Y Date:
Page 3 of 3 214 015

Type of Visit: 0compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: J24outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:
J L. 3 Arrival Time: _
. Departure Time:
County: J �7 Region: "a
�"�'
Farm Name:
4t {y 5-Owner
Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: a! 4 /In (* 1 - e
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone:
Integrator•
Certification Number: 140
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Wet PoultnY
Layer
Non -Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
Da Calf
feeder to Finish
3
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D . + P,oultr.
Layers
Design
Ga acit +
Current
P,o ,
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
01 Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [� No ❑ NA ❑ NE
❑ Yes [a No
[:]Yes No
[—]Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3
21412014 Continued

Facility Number:.. Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �/ o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes o ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
[2,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
R 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 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
L' No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
a No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
P'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
J2 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
U No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0 No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
2TNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[:]No
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: [Date of Inspection: ?
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes QNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes P3' No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes P}No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes Tr No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes [a No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes E� No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
❑ No
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
VNo
❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or anyradditlonal recommendations or. any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
W�y�
I -A
i. o/
(''/3e//y 6 -'? V 0. )
iJ r3 3 t a)
0
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Fq r/1,11- J- rt c401e s" /c e1C'�q4%7&If
Phone:l/
Date: I1 3
11412014

Date of Visit: jeL. Arrival Time: Departure Time: County: /ram Region: cN%�
Farm Name.: L' L /j?7 / -m Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: an Zcca
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator: In /,o
Certification Number:
Certification Number:
Longitude:
Design Current
apacity Pop.ltry
to Finish
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dai Cow
to Feeder
Non -La er
Dai Calf
er to Finish
w to Wean
rBoars
Ek . P,oul
La ers
Design
Ga aci +
Current
P,o .
Dai Heifer
D Cow
w to Feeder
to Finish
Non-Dairyw
Beef Stocker
Non -La ers
Beef Feeder
Pullets
I Beef Brood Cow
Other
01 Other I IOther
Turke s
Turke Poults
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 3 No ❑ NA ❑ NE
❑ Yes 4 No ❑ NA ❑ NE
❑ Yes P No ❑ NA ❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Page I of 21412011 Continued

Facility Number: Date of Inspection:IZ-11-7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes !LJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier: $2.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesZ 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,M No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes in 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 Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes p No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes )Z No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 6 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,E] No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
ep
17. Does the facility lack adequate acreage for land application?
❑ Yes 2] No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No
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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes f ] No
❑ Yes 2 ] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: 21 - a Date of Inspection: „
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
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?
Otherlssues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes ;D No ❑ NA ❑ NE
❑ Yes F3 No ❑ NA ❑ NE
❑ Yes g No ❑ NA ❑ NE
❑ Yes Z] No ❑ NA ❑ NE
❑ Yes,[^] No
❑ Yes JZ No
❑ Yes No
❑ Yes ,❑ No
❑ Yes eNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature: Date: IZ l9//,3
Page 3 of 3 21412011

Type of Visit: I&Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: A fit® Departure Time: County, uN Region:
Farm Name: CSY_ F4f vkS 4 h-4 A `FYaQ.MS Owner Email:
Owner Name: '(]6N Lq caa Phone: q IO-3&cSr�/�57�
Mailing Address: JqL/ �nNCGM63F CW /r t7u�V1 VL,/(�E,/j(C 9 60S
e
Physical Address:
Facility Contact:
Title:
Phone:
OnsiteRepresentative: �// LAIC Integrator:
CertifiedO Operator: �Kt4L1� G. LAeor_ —/a I�/j��—
p Certification Number:
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
11,111,11tDesign
Swine
Wean to Finish
CurrentIII
Capacity O.P.P
WetPoultry -
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
L
D . P,oult . C>a aci P,o
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
El Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes N No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Pagel of 21412011 Continued

Facili Number: Date of Inspection: /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes No
Structure 1
Structure 2 Structure 3 Structure 4
Identifier:
O(,
Spillway?:
Designed Freeboard (in):
9'' • S
�4 • S
Observed Freeboard (in):
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?
❑NA ❑NE
❑NA ❑NE
Structure 5 Structure 6
❑ Yes IXI No ❑ NA ❑ NE
❑ Yes 0 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) �[
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
��y[[[
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE -
❑ Excessive Pending ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn,etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): �> 12- ) C
A /
13. Soil Type(s): �}} e E`$tw(� 1 t A 2 U A/ / VOQ FoUC
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP QChecklists ❑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 0 Waste Analysis Soil Analysis
Q Vj�Sste Trans
rs Q Weather Code
0
Rainfall []Stocking 0 Crop Yield Q 120 Minute Inspections Q Monthly and 1" Rainfall Inspectionnss
❑ Sludge Survey
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes I�.Nt,
No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes YYYIxI""""'
No ❑ NA ❑ NE
Page 2 of 3
�j
21412011 Condnued

FacilityNumber: / - Date of Inspection: q /J /
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
p
XI No ❑ NA ❑ NE
the appropriate box(es) below.
7�
❑ Failure to complete annual sludge survey [-]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
No ❑ 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?
!!!""""'fff
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
10 No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
ylal�a �• I I .a
q/la//I 9
3110//) 9.0
n
C4L'I3 Ai�cY�
Reviewer/Inspector Name: MA IVC41 -
Phone: Ilo'-i/(c F3d 7
Reviewer/Inspector Signature:
Date: q/',61ig
Page 3 of 3
21412011

3—V Division of Water Quality
Facility Number a I Division of Soil and Water Conservation /
0 Other Agency ✓
Type of Visit �4 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: \ /[ I Arrival Time: �/ �./®�I Departure Time: County: U Al Region:
Farm Name: CJK FA/(LM5 �}^ I'q Y t '1-m (fig Owner Email:
Owner l 4
Owner Name: �nOi�/ ((�,pxcaa / �/� /� Phone: 16_3�yS /O
Mailing Address: J Ll 1,7t t/v1C0M(iN t- �N / t� `CLAX % 0L.I 0 �'j
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 1`��i�[ _iF'��� Integrator: .yam
Certified Operator: �oNA C D L AGOG erator Certification Number: )(D 14
Back-up Operator:
Location of Farm:
Swine
Other
❑ Other
Back-up Certification Number:
Latitude: =0 =' = Longitude: =o =, ="
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer I i
I❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I. 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)
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Ij(1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
ElNA
ElNE
ElYes
No
A
❑ NA
❑ NE
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?
a. If yes, is waste level into the structural freeboard?
Structure I Stru�(ttre 2 Structure 3 Structure 4
Identifier: a
Spillway?:
Designed Freeboard (in): 1q. S
Observed Freeboard (in): T�;� oC
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes )(No [I NA ❑ NE
❑ Yes TTTTTT❑"''''No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
�/ No
El NA
❑ NE
El Yes
IXI No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 111 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 El Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) ZeQ.6# D ( (L W )
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ yes p No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes V No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes /&LNo ❑ 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 additionahpages as necessary)')
s..t. ... ...:... .:., r
Reviewer/Inspector Name F ArA(�a/I104 C—;4Q YC_5.
Phone:
Reviewer/Inspector Signature: �►tfY�.tryLtD�
Date:
Page 2 of 3 12128104 Continued

Facility Number: '3 —al Date of Inspection
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box. El WUP 0 Checklists 0 Design El Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
No
❑ NA
El NE
'"�
Waste Application 0 Weekly Freeboard Waste Analysis Soil Analysis 0 yoaste Transfers ❑ ual Certification
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections 0 Monthly and l" Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
1/..I No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
p�I No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
1!!SJ�No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N%,No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
) No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes]
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
`�l ►s//v 1.3 �. a
CAUg�_DoVV DcA E Pr 1
Page 3 of 3 12128104

Type of Visit i0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: 3 �S /� Arrival Time: `/0 Departure Time: County: ��ya� Region:
Farm Name: C S K �:QQ M S * j(* M F; (MS Owner Email:
Owner Name: %DON (-r,C.or,— Phone: [phone]'S9y
Mailing Address: 194 KUIVCtSMRr= � t'Mat/N/ QU� /UC a83(9S
Physical Address:
Facility Contact: Title:
/
Onsite Representative: `—a ca a
Certified Operator: �RLA C • Lo.Cor_
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number: 314
Back-up Certification Number:
Latitude: o = ' = Longitude: = o = ,
Design Curren[ Design @u ent
�Destgn Current
'Swine
Capacity.Populattop ? ,Wet Poultry Capacity P p lahiin�Cattle IF Capacityy opulahoa
..
❑ Wean to Fmish7
r-
❑ Layer
' ❑ Dairy Cow .
❑ Wean to Feeder
1
10 Non -Layer
1
❑ Dairy Calf
Feeder to Finish
y(o00 ��� '� �,
. ❑ Dairy Heifer
... ❑ Farrow to Wean
Dry,Pbultry `..�,,,'""'^""". ❑ D Cow
.,,,,,,,"
❑ Farrow to Feeder '``"' " '°"""'
❑ Non -Dairy
❑ Farrow to Finish❑Beef
'=
❑ Layers�.
Non-LayersEl
�;❑
Stocker
❑Gilts
Beef Feeder
_ ❑ Boars
---
El Pullets
❑ Turke s
❑Beef Brood Cowl
,..Other, .. ❑ Turkey Poults
❑ Other
, ❑Other
Number of 11 U ures:
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 IiSI No El NA El NE
❑ Yes //❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
lal No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection !O
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ANo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 St re 2 Structure 3 Structure 4
U4
Structure 5
Structure 6
Identifier.
Spillway?:
Q
Designed Freeboard (in): % (. S %^^9. S
Observed Freeboard (in): 9 t-I oC 5
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
ElNA
[INE
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 _KNo ❑ NA ❑ NE
8. Do any of the smctures lack adequate markers as required by the permit? ❑ Yes KNo ❑ 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 9 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes �TNo ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes P�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) R '(Lb) �3 E (Z ( C� S 6
13. Soil type(s) (nO.A V6'[q3tAq6 YMA ILU! lIV
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 VNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes No [I NA
El NE
17. Does the facility lack adequate acreage for land application?
,�
El Yes ;g„1 No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o ❑ NA
❑ NE
Comments,(refer to,questimt #): Explain any, YES anw se s and/or any rm ecomendations or an otherrcomments "
Usetdrawm s of faciti to better ex lam sttaafions pseaddrtional. "a es as`necessa"
_. g tY• P ( P g ry) ;`w
319/!o a.ti �.y
Reviewer/InspectorName r�mQ1efj(J CLta�NE�"-
Phone:
Reviewer/Inspector Signature:(
Date: 0425JAa
12128104 Continued

Facility Number: — Date of Inspection /O
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 161 No ❑ NA ❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
P{No
❑ NA
❑ NE
the appropriate box. 0 WUp ❑ Checklists ❑ Design
g El El
, l
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
A No
❑ NA
❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis 0 Waste Transfers ❑ Knual Certification
/[3
0 Rainfall ❑ Stocking El Crop Yield 0 120 Minute Inspections El Monthly and 1"
Rain Inspections
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
KNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain minbreakers on irrigation equipment?
El Yes
A
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ANo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
XYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
KNo
❑ 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
JKNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
KNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NNo
❑ NA
❑
NE
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12128104

Type of Visit & Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: a9 Arrival Time: Departure Time: County: Region:
2MS\
Farm Name: G�4�FA + ',A'Nk �_ —M-S Owner Email:
Owner Name: 1-,�OnII1�l ( o e— ,A,� /�� Phone: C)19 —bsE — e�9(30
Mailing Address: � �l L1 ?_ AU iO3fn 9 r LV MCK t/t/Y V L_E N
Physical Address:
Facility Contact: _
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
u L0.C�a_
Title:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: =o[=, Longitude: =°=I
Design Current
Design Current
Design Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle
Capacity Population
❑ Wean to Finish
10 Layer I
❑ Dairy Cow
❑ Wean to Feeder
JLJ Non -Layer I I
Dairy Calf
Feeder to Finish
Ci
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑
❑ Non -Dairy
❑ Farrowtoto Finish
El Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Turkeys
❑Beef Brood Co
Other
❑ Turkey Pouets
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ICI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
No
❑ NA
❑ NE
❑ Yes
f+�1tj No
❑ NA
❑ NE
Page I of 3 12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
�(
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
X No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: of
Spillway?:
p
Designed Freeboard (in): 5 / .5 fin(-
dObserved Freeboard (in): _ S
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
16 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
4No ❑ 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
yrrrry No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
,,\{
No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift [I Application Outside of Area
IJ 12. Croptype(s) TER ��1� Ee—LN�
13.
Soiltype(s) QR.Q.r 6C-13uQj9, MA N
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
I�No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
q No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
,e! No
❑ NA
❑ NE
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
fiallo
❑ NA
❑ NE
i09 01C CAM S /VOT 0Q7 bF-T - CACp ZI (VIS 01 C, gC7►Ur—
Reviewer/InspectorName ��mANs�q L7VS Phone:
Reviewer/Inspector Signature:
Page 2 of 3
Date:

Facility Number: — Date of Inspection Qz5m]
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Desi gn ❑Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
ANo
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard ❑ Waste Analysis 0 Soil Analysis ❑ Waste Transfers ❑ )rnual Certification
0 Rainfall ❑ Stocking ❑ Crop Yield El 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections El
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JdNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
10 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
)].No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ANo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
Z No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
A 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
16 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
;&No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
4NO
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
*o
❑ NA
❑ NE
Page 3 of 3 12128104

I/'�1 ® Division of Water Quality /
Facility Number 3 d I 0 Division of Soil and Water Conservation ./
Other Agency 11
(Type of Visit .Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit $_Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: PD-5—A-1Arrival Time:F_Q_."_/5D Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator: _
Location of Farm:
Swine
Other
❑ Other
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: = U = . = « Longitude: = o = , =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
h❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes %No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
allo
❑ NA
❑ NE
❑ Yes
O�No
❑ NA
❑ NE
12128104 Continued

Facility Number: 3 1 — aP j 1 Date of Inspection /5 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: (.ACOQ/Y I LACWHOL
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): rpi 3 S
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 EXNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes V�No ❑ NA ❑ NE
❑ Yes o No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes MLnkNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes M 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 LM El NA [I NE
maintenance or improvement? c�No
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes QY No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ORNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drill ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
4 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
1� No
❑ NA
❑ NE
Comments (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):
Q0, Ge-r CO(?':�,oF F14Y 70 law
A•tT,V. AmaND,4 CzA/NES
qjo- 3s0- 9WV
Reviewer/InspectorName AfnANDR 6 ln/ Phone: to
Reviewer/Inspector Signature: _ Date: rj O
12128104 Continued

Facility Number: ?� —��� Date of Inspection f $ 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ZNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [9 Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists W Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes W No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
%No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Pq No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes®
No
❑ NA
El NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
���c\1111
tqr No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes\
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ 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
R No
'❑ NA
❑ NE
12128104

0 Division of Water Quality
Facility Number � i Z � �� 0 Division of Soil and Water Conservation
—_ Q Other Agency'
IType of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:T_
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: ,^3 •.�/,Departure Time: i2 County:
fLKM6 A*) kg1�2_61n_5 Owner Email:
Facility Contact: Title:
n/�®N L/
OnsiteRepresentative: /`�/A I�OF_
Certified Operator: "0 O/y "+ eDE
Back-up Operator:
Location of Farm:
Latitude:
Phone:
La Region: aK�
Phone No:
Integrator: _U/low CaKOeJ.J
Operator Certification Number:
Back-up Certification Number:
0 Longitude: F-100
Design Current Design- Current
Swine - Capacity PopulationWet'Poultry Capacity Population
--
❑ Wean to Finish I I ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
® Feeder to Finish 00
[] Farrow to Wean
Dry Poultry
Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design
Cattle Capacity 1
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:, C
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
n
❑ Ye:/No ❑ NA ❑ NE
❑ Yes
[--]No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
7 /28/04 Continued

Facility Number: —Z Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes yJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes /❑ No ❑ NA ❑ NE
S ructure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: clik f �J� ?_
Spillway?: /�'o NA
Designed Freeboard (in): N S /Lj,5,
Observed Freeboard (in): _1 ,--So
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) /rrd
6. Are there structures on -site which are not properly addressed and/or managed El Yes y� No El 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?
A Yes
❑ No ❑ NA ❑ NE
8.
Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
�No [I 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 ElNE
maintenance or improvement?
/
Waste Application
10.
Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
,(�
iYJ No ❑ NA ❑ NE
maintenance/improvement?
/�
11.
Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
'ONo ❑ NA El NE
El Excessive Ponding ❑ Hydraulic Overload El Frozen Ground El 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 ElEvidenceof Wind Drift Application Outside
of Area
12.
\❑
Crop type(s) `UERir)c% A Z RA F_ I
ll
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
CNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes [3 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes t!J No ❑ NA ❑ NE
17. Does the facilitylack adequate acreage for land application? /
q g pp El No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes VNo ❑ NA ❑ NE
IComments (refer to question #): Explain any YES answers and/or any recommendations or any other comm ents.t' I
Use drawings of facility to better explain situations. (use additional pages as necessary):.
�� f^�n�GF7�rQra�✓ /V<c�s /��inP�lo�c�f.>J7' �i/cou.�.o L�tz'.00�'y�,
,r I�5%�`i C/Q2�5 -Li✓ iG�-C6S.
Aw,
IReviewer/Inspector Name I / ' I Phone:
Reviewer/Inspector Signature: Date: �o
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents ((
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ yes ILJ No ❑ NA El NE
the appropriate box. ❑ WIN El Checklists ElDesig
n ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )� No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
El Yes )Z(
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
F,
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
'PNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[XNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
PNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ANo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
�/
L4 No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
,,T---���{{{
t/� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
[�No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�D �F=-
D !� � �� �z�✓c_ L.� d,Q0�,2.
If
/S
J
Page 3 of 3 12/2&04

Division of Water Quality
Facility Number I Z Division of Soil and Water Conservation
— —
_ 0 Other Agency
Type of Visit to Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit (a Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
-Date of Visit: //�).�{� Arrival Time: Departure Time: `!5� ounty: A_)Al&OAI Region:
Farm Name:/ K FAemm 6 40 Owner Email;
Owner Name: a V Z A 64 Phone:
Mailing Address:
Physical Address:
Facility Contact: %/%J Title:
� 6 Onsite Representative: A14—
Certified Operator:
Back-up Operator:
Location of Farm:
Design..
Swine Capacity
Phone No:
Integrator:G(?OiC� /�iofJcd J
Operator Certification Number:
Back-up Certification Number:
Latitude: Mo �� M Longitude: F_
Design Current
Wet Poultry Capacitv Population Cattle
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Calf
Number of Structu
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
o=' ="
❑ Yes PINo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
FINE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

Facility Number: 13— Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stone storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: i'.•//T•K l_ Z
Spillway?: N0 �O
❑ Yes �TNo
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Designed Freeboard (in): 1q. 5_
Observed Freeboard (in): 25- 2 6
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
oNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
VNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
r r No
[INA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
ElYes
,.
l[I No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
10
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
P 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
„
t
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ Yes
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
XNo
❑ NA
❑ NE
VNo
❑ NA
❑ NE
[r No
❑ NA
❑ NE
�No
❑ NA
El
XNo
❑ 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):
�� /%6P �CF�,9-�roi✓
�Q/Fz��s)zn/ti'Oe /lou.✓.o
L��4G 1
21Y:5Orc Sg1nPGz.✓�
�GQu2,gfd /Ns✓afiGcy
Alp Si�iyl�US /7/ fir/ 1�
?e05
_
lIfCORQ o� F ©✓
_
7 U,
Reviewer/InspectorName
l
n
Phone:
Reviewer/Inspector Signature:
Date:
Page 2 of 3 12125I04 Conanuea

Facility Number: — Date of Inspection 3 3
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ElWUP ElChecklists ElDesign ElMaps ElOther 1TT���
21. Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis VfSoil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and N Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
[I NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Elw Yes
rrP No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
XNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ILI No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[ZNo
❑ NA
❑ NE
Page 3 of 3 12128104

Division of Water Quality
0
Facility Number 3 2fl Division of Soil and Water Conservation -
-- -- '--.- 0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 91Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: L(
Farm Name:
Owner Name: _.
Mailing Address:
Physical Address:
Arrival Time: to / Departure Time: County:
-� t1W6A,4,l�[ '3 Owner Email:
Facility Contact: / Title:
Onsite Representative: !�
Certified Operator: �A,af L
Back-up Operator:
Location of Farm:
Phone:
Region:
Phone No:
Integrator: Z(r.�A C �
Operator Certification Number:
Back-up Certification Number:
Latitude: F7] oF--]' F__] Longitude: F 1 o n n 11
Design Current Design Current
Desisj gn Current
,-,Swine - -
Capacity Population. Wet Poultry Capacity Population
'Cattle =Capacity
`IZopulahon'
'
❑
Wean to Finish
❑ Layer
❑Dai Cow
t.„
Wean to Feeder
JLJ Non -Layer
I
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
'.; ❑ Farrow to Wean
11Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
El Non -Dairy
'. El Farrow to Finish
❑ ers
La
�
i, El Beef Stocker
EJ
�;- ❑ Gilts
❑ Non -Layers
❑Beef Feeder
ElBoars
❑ Pullets
❑ Beef Brood Co
-
-- -- ❑Turkeys
- -
- -
' Other
❑Turkey Points
❑ Other
❑ Other
Number of Structures
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
0
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ,I!J No []NA ❑ NE
❑ YesXNo ❑ NA ❑ NE
12128104 Continued

Facility Number. — g Date of Inspection /
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I
Identifier: —— F—
Spillway?: / w
Designed Freeboard (in):
Observed Freeboard (in): 3 W
❑ Yes ,mil No
❑ Yes El No
Structure 5
El NA ❑NE
❑NA El NE
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes O/No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,,/
6. Are there structures on -site which are not properly addressed and/or managed El Yes VJ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Cl Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[-]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Croptype(s) �D (if///��jA9 .�y��.�;! �F�2AlUlJA � �T v �• �OtJ
13. Soil type(s) Q. 1/pJ
,,,{{{
14. Do the receiving crops differ from those designated in the CAWMP? J[3 Yes ❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? /❑ Yes V(No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA ❑ NE
gNo ❑ NA ❑ NE
YJ{{No El NA ❑NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to betterexplain situations. (use additional pages as necessary)
T uus st g �µ i7
�OJ�s� � • ,/,tJcP
G-RA�� �j�Q GFlUm
p/�p
�s/ A
p w c
E/e �l-i— (DA.
'PS fip e 'P. 1 ,14
Reviewer/Inspector Name I t% . �, Phone: / 69" (!'
Reviewer/Inspector Signature: Dl/$� / Date: O Alp
Page 2 of 3

Facility Number: —Z47q Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes XNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No El NA [I NE
the appropriate box. ElWUP El Checklists El Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. PYes ❑ 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
V(No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
,,,--❑,,,rrrNo
L,p No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
YNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
ANA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
(i1%T� Ri�Co�Z05,
❑ Yes
/90 to
ElNA
❑ NE
❑ Yes
J[J No
❑ NA
❑ NE
❑ Yes
OlNo
❑ NA
❑ NE
❑ Yes
)ZNo
❑ NA
❑ NE
❑ Yes
L� No
El NA
El NE
El Yes
/U�No
❑ NA
❑ NE
,�Z ,)� r 5,-
Page 3 of 3 12128104

Type of Visit JO Compliance Inspection U Operation Review U Structure Evaluation U Technical Assistance
Reason for Visit XRoutine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ;00 Departure Time:
Farm Name: /ARJih5 Y&O kR M &42015 Own
Owner Name: r"✓ LAPh
Mailing Address:
Physical Address:
Facility Contact: / Title:
OnsiteRepresentative: Z'191V G466—
County: W&Z Region:1aMO
er Email:
one:
Integrator:
Phone No:
i
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: = U = ' = Longitude: Q o = ,
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dai Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures: ©'
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes jo No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 4A No ❑ NA ❑ NE
❑ Yes )z No ❑ NA ❑ NE
12128104 Continued

Facility Number. — Date of InspectionIY/ w[QI
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: /:g/a L_ Lti
Spillway?: /UD kb
Designed Freeboard (in):
Observed Freeboard (in): Z_
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 IGI No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ID No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Y No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement? rrr���ttt
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Wjndow ❑ Evidence of Wind Drifi ❑ application Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
O No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
P No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination%❑ Yes
P No
❑ NA
❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
O No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
zNo
❑ NA
❑ NE
t! 4a oo o.
�) Qum/Ek WV XFS,e4oep &IkE � No t�tc aarws, ��+�s Gye vss
&1As' 6'fa'"e v,+-r
Reviewer/Inspector Name , Phone: /U- 3YS XR7 21l.
Reviewer/Inspector Signature: Date: O

Facility Number: —L Date of Inspection 17/7NFJS I
_Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No 1-1NA ❑ NE
the appropirate box. ElWUP ElChecklists ElDesign ElMaps ElOther 91
21. Does record keeping need improvement? If yes, check the appropriate box below. Oyes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking to Crop Yield A 120 Minute Inspections ❑ Monthly and V Rain Inspections O Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
P No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
V No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit'?
❑ Yes
O No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
JZNo
❑ NA
EI NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes
❑ No
❑ NA 0 NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes'ANo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
/rrryyy
30. At the time of the inspection did the facility pose an odor or air quality concern?
El Yes
yu No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
,,,---...,,,///
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
Lp No
/
❑ NA
[I NE
33. Does facility require a follow-up visit by same agency?
El Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: -
1a) A449 % ✓Z7a9c F2 40 -41 d;fx_ 5�hc�zo ;
��Coao
WE4? 2
119o�2FZ� �Qe-2 Foy,►-� 7 �s�,
F; ��kA.JF�Ec�Js �,o,EAn6A T 8� � G� �Jf%AePF_,
12/28104

(Type of Visit _Mompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 9'Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number r,3 1 Date of Visit: 0 Time: S 3a
10 Not Operational Q Below Threshold
Permitted Certified 0 Conditionally Certtiffied( 13 Regiistered Date Last Operated
�or Above Threshold: ..... _.__.
Farm Name: /..... 1,n,.a..K.... ..... .... .1!..!..._C�Q.... .__fyL� ............... County: ......
s.l�! __.........____._.._._._
Owner Name:
Mailing Address:
Facility Contact:
Title:
Phone No:
Onsite Representative: __- --- y.,AP&...... - Integrator.
Certified Operator: ._.................................... ...
Location of Farm:
Phone No:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =• =' =11 Longitude =• =, =.
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
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 gaUmin?
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
§Erin` e I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ...__._._.......�--..._.. _---._Z e _ ..__._._..........___.._. __._
Freeboard (inches): o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ Yes VNo❑ Yes [ 0
Structure 6
12112103 Continued

FacilityNumber: g � — aj % Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed?bserved? (ie/ trees, severe erosion, ❑ Yes :/0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ yes
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? es ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelmprovement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes rXNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes �'ivo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type eFtmm (r. SAI O
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes
14. a) Does the facility lack adequate acreage for land application? ❑ Yes VN
b) Does the facility need a wettable acre determination? ❑ Yes
c) This facility is pended for a wettable acre determination? ❑Yes
15.
Does the receiving crop need improvement?
❑ Yes
[INo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
No
Odor Issues
17.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
❑ yes
o
liquid level of lagoon or storage pond with no agitation?
18.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
19.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
o
roads, building structure, and/or public property)
20.
At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes
No
Air Quality representative immediately.
Field Copy ❑ Final Notes
%.)CV
�i� t�J62 Ja �3.lCE WAc_(,S D� (j�orH {.A(,ao 05 NCFDS jeftoUb
C-n�lE Slvlr�l,t� Trc�E t v1,TEa� Ix wA�s a� G�1L1
GAtsP>R� � �t umGE 1��E wl o n:W'AA1 01J ?Wyz-�
i&C,e S l C � SWAff,
Reviewer/Inspector Name x
Reviewer/Inspector Signature:
Date:
1u1z"Mi Continued

Facility Number:.3 — Date of Inspection y/ 13�oy
Required Records & Documents /
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes o�
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes [�N/
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes lE No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) /Yes❑
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ■/K
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
33. Did the facility fail to conduct an annual sludge survey? ❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes
ms ❑ N�
35. Does record keeping for NPDES required forneed improvement? If yes, check the appropriate box below. ❑ Yes 6— 0
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall []Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit P Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit o Routine o Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
E3Permitted 0 Certified D Condi ' natty Certified Q Registered
Farm Name: m./ /Y) S
Owner Name: vV�fe' zz
Mailing Address:
Time: 17T_)J
Date Last Operas d or Above Threshold: _
County:PL�/�
Phone No:
Facility Contact: Title: Phone No:
Onsite Representative:
p �4-66 Integrator•
Certified Operator:
Location of Farm:
Operator Certification Number:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude =a =, 0` Longitude =* =, 0`
Design` -
Swine ,Ca aci
Currr t
Population
Design
P,.oult_ry Ga acif
1Cud�ent'
P,o ulation
` - '� Design Current
Ca_ltl_e Ca aci P,o ulation
❑ Wean to Feeder
- ❑ La er
❑Dai
Feeder to Finish.
❑Non -La er
❑Non-Dai
Farrow to Wean.f:raa,xusa
❑ Farrow to Feeder
❑ Other
Total Design Capacity
Total SSLW
❑ Farrow to Finish
❑ Gilts
❑ Boars
Number of La oons © ❑ Subsurface Drains Present ❑ lagoon Area 10 Spray Field Area
00001 Holdin Ponds / Solid Tra s
g P ❑ No Li uid Waste Mana ement S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes Pq 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 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes O No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
SIntcture 1 Structure 2 Stmcmre 3 Structure 4 Structure 5 Structure 6
Identifier: 6)1</_
Freeboard (inches): 94
O5103101 Continued

Facility Number: -2 Date of Inspection
5.
Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
('
O No
seepage, etc.)
6.
Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
❑ Yes
No
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement?
❑ Yes
No
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
No
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Aonlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
Pd[•Io
11.
12.
Is there evidence of over applicatio ? ❑]Excessive Poonding PAN ❑ H draulic Overload` Yes
Crop type �
>j�`]"I/No
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CXWMP)?
❑ Yes
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
,,,....Q,,,..................,,,,,,�//////No
No
b) Does the facility need a wettable acre determination?
❑ Yes
No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
XNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
VJ No
Required
Records & Documents
/,,.,.,(
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ILl No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
/�
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ANo
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
.ko
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
1[I No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
�fNo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
?cF +k ,� S-, ,.,;�.'': �v 3#' .i. -aR .Ss r #'� d'( va.' 3 '.. Yti.'at, x v
omments (refer to question Explain any YES answeis,==and/or anq'recommendations or. y of er comments'-� . `�'
drawings of facili; to betteq eiiplam situations (use addibonahpages as necessary)
(Use
,..,,�.,g❑Final Notes` FM
n�T,�Da �Q ��oGrgT FFpS AID ®ovy �GF_T' ?1rolj F �/
SAPG�nI�- ,lll>D ��e�o fir— C.�Y �� G�coo� • C'owrz.��.�- lv®�K�.t��
0� lIFGF9A-�.�t/� C'o✓Ez D� ��2F �-�FA-S (/hq��..�y G�ar�
Reviewer/Inspector Name 1
Reviewer/Inspector Signature: Date: /
05103101 V - 1 --
Continued

Facility Number: — Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or. Drawings:
` ..o�JCF
6Ck-Gk Chi✓ ��.P�i zo„l5v
%
6
O5103101

Division of Water Quality _--
. Q tvtston of Soil and Water Conservation
Q Other Agency -
Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification O Other .) ❑ Denied Access
Facility Number Date. of Visit: Ti.,: I X. Printed on: 10/26/2000
Q Not Operational Q Below Threshold
Permitted E3 Ce •tied Conditionally Certified I] Registered Date Last Operated Above Threshold: ....
Farm Name: �IC� Countv-.. ... ;Y. 1_!�c..........................
............v..1..................4'...1<.".....o� .<... ................. ......... k I.' �r�.:........
OwnerName: ......Q..:...f................................../......................................................... Phone No:.......................................................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:
Mailing Address: ..:..,�......... ....................... ...............................................
.....................................
e:�l......................Inte rator:.........YY............................................... Onsite Representative...................j! _................... ,
Certified Operator:
Location of Farm:
Operator Certification Number ...........................................
Swine []Poultry []Cattle []Horse Latitude Longitude
Design Current
Swine Canacitv Ponulation
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Po uI tion Cattle Capacity Population
❑ Laycr ❑Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons iLJ Nuosunace uratns rresent JU uagoon Area lu np
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. II' 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 now 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 Slr ctu<re 2 Structure 3 Structure 4 Structure 5
Identifier: .............. ..........-�.... p��l ....
Freeboard (inches): #�
5100
El Yes $No
❑ Yes ❑ No
❑Yes a❑No
• ram'
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes KNo
Structure 6
Continued on back

Facility Nurrtper: — Date of Inspection -� � Printed on:
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management m
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?
1 /9/2001
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
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
12. Crop type
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes N0
❑ Yes 4 No
❑ Yes 6 No
❑ Yes C'No
❑ Yes 0 No
❑ Yes j8fNo
❑ Yes &0
13.
Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14.
a) Does the facility lack adequate acreage for land application?
❑ YesINONo
b) Does the facility need a wettable acre determination?
❑ Yesc)
This facility is pended for a wettable acre determination?
❑ Yes
15.
Does the receiving crop need improvement?
❑ Yes
k,,o
ty No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
qNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
01No
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
o
19.
Does record keeping need improvement? fie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
�eNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
15tNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Eg No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
discharge, freeboard
(ie/ problems, over application)
❑ Yes
tdNo
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
E�No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONo
�VQ vi91 (itjris:oi• tleCcie;ncibg wgre poted O(Witig ihis;vjsjt; You wit!•;ecgiye riti fug th$r • ; • ; -
::
etiries orideitceabbittithisvisit:............ : : . : . :•;•;•:-; ;•;•;-;-;•;
Reviewer/Inspector Name
Reviewer/InspectorSignature: /�Jni,r ��Y/J/Y%4 1 Date: — S_L/ 2/6/ 5100

Facility Number: — o'%' Date of Inspection '%t /� //� j Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes N0
liquid level of lagoon or storage pond with no agitation? ....11ll.... """"
27. Are there any dead animals not disposed of properly within 24 hours? El Yes to
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 0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or '
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes /l�\�/ 0
32. Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover? ❑ Yes IRI No
Additional -Comments and/orDrawings:
5/00

Kontine O Com taint O Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other -
Facility Number Date of Inspection
yyy((( Time of Inspection.' 24 hr. (hh:mm)
APermitted 0 Certified Q Conditionally Certified E3 Registered 0 Nut O crational Date Last Operated:
Farm Name: ......1 ✓..�............... ......Y.�% County:................
r�............................................ ,/ L
Owner Name:.........����,.w...................... ..l- .............................................. Phone No:./ .11i�... .J....3....—..SZ/1 1......P.
Facility Contact: ..12�rT%i........ . ............ Title:..f�1W.�� ............................... Phone No: /a).PqC.../../)..�Q�it�..0
MailingAddress:....................................................................................................................
............................................ ................... ..........................
Onsite Representative: .[..[.Cf}?........_.:_'"� Qom ............................ Integrator:.............�f'/.0�� .S
✓✓ I
n................. .
6. Certified Operator.,.,,,,, ! /(...... .........tii ,,,_.„ Operator Certification Number.,,,.,,,,_.,,._...,_,,,,,,,,,,..,.._..._
fffCCCyyy...... ......... .
Location of Farm:
Latitude 0.0` =.. Longitude =• =1 =11
Design, Current. Design -Current 'Design Current'
„_Swine 'Ca acity.;.Population Poultry Capacity Population`Cattle _ .Ca aci %Po ulatiou'-
'a. ❑ Wean to Feeder ❑ LayerI JE1Dairy
Feeder to Finish -Layer ❑Non -Dairy
<-. ❑ Farrow to Wean ,_ _...... ..-. • ..
❑ Farrow to Feeder JE1 Other I_
❑ Farrow to Finish Total Design Capaci ❑ Gilts
❑ Boars ' Total SSliW*.:
- Number of Lagoons", JE1 Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area '-
Holding Ponds /Solid Traps `� ❑ No Liquid Waste Management System
utscnarees at Ntream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If 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: q '!,
Freeboard (inches):..........,C�./...................:........11._//
...............
❑ Yes CNo
❑ Yes ❑ No
❑ Yes ❑ No
/0-
❑ Yes ❑ No
❑ Yes KNo
❑ Yes KNo
❑ Yes 0 No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Ia1 No
3/23/99 seepage, etc.) ba
Continued on back

Facility Number: — Date of Inspection
6.
Are there stmetq a on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Yes No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7.
Do any of the structures need maintenance/improvement? '
❑ Yes O�qo
8.
Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes Io.
9.
Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
,,_/
El Yes by No
l �"
Waste Application
10.
Are there any buffers that need maintenance/improvement?
❑ Yes 13440
11.
Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes JONo
1.
Crop type
13.
Do the receiving crops di er with those hesignated in [he Certified Animal Waste Management Plan (CAWMP)?
El Yes -J&o
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes KNo
b) Does the facility need a wettable acre determination?
❑ Yes ,ZI-No
c) This facility is pended for a wettable acre determination?
❑ Yes ZNo
15.
Does the receiving crop need improvement?
❑ Yes jKrNo
16.
Is there a lack of adequate waste application equipment?
❑ Yes KO
/j`�
Required Records& Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes -JELLVo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
,EYes ❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ;JNo
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 �dNo
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes KNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes 0
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
..
i.. 4iola{itit....... e.... were pgte� diH`it. this:v.. • 1 o. will ..... do further
. ctir'resporidence: about his visit: ............................ .
-i ✓L- I ` e if_ P.,. t.t ./
I Reviewer/Inspector Namej.���
L
Reviewer/InspectorSignature=emu/ /f„A�Sq Date: /

Facility Number: — Date of Inspection I XLY7
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 1�I 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 1( I 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 ONO
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 k--No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes fgNo
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes lirNo