310280_INSPECTIONS_20171231

NUH f H UAHULiNA
Department of Environmental Qual

Type of Visit: Co ance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: j� 1j� Arrival Time: Departure Time: E0 County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: J 9 L .\ o[CA-4 rC Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
r c' z y
Swine
Wean to Finish
Design Current
Capacity Pop.
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop,
ILayer I Dairy Cow
can to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Design Current Dry Cow
D , P,oultr. C•_a aci P,o Non -Dairy
Layers Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
_
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes [3-1,to ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No ❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
[] Yes
❑ No ❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No ❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
No ❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - 'Z fi—c:, Date of inspection: 11117 714
Waste Collection & Treatment
4.Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Io ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: , 1�4� Z�}�1P -3 1 ccrl=r�,
Spillway?: ---�—
Designed Freeboard (in):
Observed Freeboard (in): l fZS_ 72
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
M 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 DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ZfNo ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
rNo❑ 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 ffNo ❑ 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 io ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes N ❑ 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
'v` ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
Efm�n ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
N ❑ 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
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 ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
�o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑Yes
WNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: -4 1 - -P r—o I Date of Inspection: ti ,- Xl
24. Did the facility fail to calibrate waste application equipment as required by the permit? / ❑ Yes ErNo ❑ 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 [3'5-A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes Zf No ❑ NA ❑ NE
❑ Yes ffNo ❑ NA ❑ NE
❑ Yes ff No 0 NA NE
❑ Yes
No
❑ NA
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
LJ 1V - ❑ NA ❑ NE
Y" ❑NA ❑NE
No ❑ NA ❑ NE
Reviewer/Inspector Signature:--r- i� ��y Date: IIZIZ4
Page 3 of 3 2/4/2015

- Ui`vision of Water Resources
Facility Number - 2¢-0 Division of Soil and Mater Conservation
� Other Age�n�cy
Fype of Visit: Com nee Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
teason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: +� / 7 [[� Arrival Time: Departure Time: _ 9 U 9-- County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: '' Iva C
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Swine
Wean to Finish
Design Current
Capacity Pop.
Design C*urrent
Wet Poultry Capacity Pop.
Layer
Cattle
DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -Layer
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
Dry Poultry Ca aci P,o
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
I
Turkeys
lTurkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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 0�O ❑ NA ❑ NE
[:]Yes ❑Tlo ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: '7 { - 2 k 0 1 jDate of Inspection:
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? es ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structurre^ 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 14' s (9 • ; 11 -
Observed Freeboard (in): 20 _1.3—
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E ❑ NA ❑ NE
waste management or closure plan? T
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 [fNo ❑ 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 0-'No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes E5No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No_
❑ NA
fNE
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
ffNE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
Ej'�E
18. Is there a lack of properly operating waste application equipment?
[:]Yes
❑ No
❑ NA
[fNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
eNE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ No
❑ NA
the appropriate box.
❑WUP El 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 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? [:]Yes [:]No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [:]Yes [:]No
❑ NA dNE
❑ Weather Code
❑ Sludge Survey
❑ NA
❑ NA [/]
Page 2 of 3 21412015 Continued

Facili Number: - Z Date of Inspection: I 6
424. 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 �rNE�
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 [319�A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes 13'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? 0 Yes ri' J 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 zfyes ❑ 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 DINE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Ye ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? Yes ❑ No ❑ NA ❑ NE
Comments (refer toque" tion.#) 1Eiplaw any,YES answers and/or,any additi hal recoiumendatipns o -a-n other comments:
Use drawn s:of Facili to bet#"er, a 'Main situations use; additional s a es as `necessa .
g tY aP ( P g ry)-
I? Lo- cf- rL ( a f �,,,,,,p �s � �- � � r4r ��- o wAe_ A d a CA 14- � f
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�l'� � � 1 /�,L � �✓ � �No V I � � t. D 9 S � }� i`� �f .o � il� r L � �... l �1 � S �, 0 5
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�4L �t reS' tyre I, c�
Reviewer/Inspector Name: (,tv C( Po 1.-L Phone:
Reviewer/Inspector Signature: �t '-^- Date: [
Page 3 of 3 21412015

Type of Visit: Ej-Com ce Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: S Departure Time: �o County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: �p 1 ��4� pact _ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
We# Poultry
La er
Design
Capacity
Current
Pop.
Cattle
Dairy Cow
Design
Capacity
Current
Pop.
Wean to Feeder
:?fSM SPA
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Farrow to Finish
©, P,oult U
La ers
Ca acity,
$o
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Co —
Other. HTurkeyPoults
Other
Turkeys
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E5No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
E3<o
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

lFablity Number: - `ZFrfa jDate of Ins ection: 3 n
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
D-No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 9* �v3,�� �o'3
Spillway?:
Designed Freeboard (in): (i • S i -5 f - S
Observed Freeboard (in): 2 4 z S Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[:� No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [TNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [ErNo ❑ 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 [jNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes El'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? [] Yes [TNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes u No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
LJ No ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesFj-'No
❑ NA
❑ NE
Required Records_ &_Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check th propriate box below. Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis oil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ t20 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: Date of inspection: C1
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 to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWN P?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
[]~15'A—
❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes E 1"O ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes ff No ❑ NA ❑ NE
❑ Yes Er I No ❑ NA
❑ Yes No NA
❑ Yes No NA
❑ NE
❑ NE
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, comments. .
Use drawings of facility to better explain situations use additional pages as necessary).,''.
g ty P � p g rJ'). ::.. ,
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Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
We-.
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Phone: ' t0 ?1 6 730f
Date: C 3 r
21412014

Type of Visit: @•Compliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: ou 'ne O Complaint O Follow-up Q Referral O Emergency O Other O Denied Access l
Date of Visit: t Arrival Time: eparture Time: County: I Region:
Farm Name: C Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: Integrator:
• T
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wean to Feeder
Design CurrenE
Wet Poultry C+apacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Non -La er I
Feeder to Finish
Design
Dr. P,oult . Ca aci $o
La ers
Ron -Layers
Pullets
Turke s
Turkey Poults
10ther
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Beef Feeder
Boars
Beef Brood Cow
Other
F-TO—th—er
I I
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes 0 No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes _0 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ,;'-] No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ..C_! No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes P No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes �Z No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Faeflity Number: Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes eNo
a. If yes, is waste level into the structural freeboard? ❑ Yes P No
Identifier:
Spillway?:
Designed Freeboard (in):
Structure I Structure 2 Structure 3 Structure 4
a /-
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?
0 NA ❑ NE
❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes '12�No ❑ NA ❑ NE
❑ Yes ❑.No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes allo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes 2,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
T
9. Does any part of the waste management system other than the waste structures require
❑ Yes �o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes [D'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
'P
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes �No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,Q No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
'LD+No
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes P} No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ENo ❑ NA ❑ NE
the appropriate box.
❑WUP [:]Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. oes record keeping need improvement? If yes, chec the appropriate bo W. Yes 0 No ❑ NA ❑ NE
Waste Application ❑ Weekly FreeboardYinte
aste Analysis oil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Inspections Monthly and I" 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 ,fNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: -A 5 1 Date of Inspection: - i.
24. Did the facility fail to calibrate waste application equipment as required by the perm t? ❑ Yes Z No ❑ NA ❑- NE
2%. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes J[a No ❑ NA ❑ NE
the appropriate box(cs) 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 ONo ❑ 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
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.
34. 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
[I Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 2]'No ❑ NA ❑ NE
❑ Yes _2 No ❑ NA ❑ NE
❑ Yes 'O"No ❑ NA ❑ NE
❑ Yes PNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes PNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes J�!rNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes J;TNo ❑ NA ❑ NE
Comments (refer to question #t7: Explain any YES answers andlor.any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
5111 l3
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
CCP% oC- sir J
f-re,.rt IDAr YOr
[.sc-S "f 4-1qi S veer
a�i y. OlimP��
Ak fflorne
lod.�
Phone: 91
Date:
2/4aoll

'Davtsion of Water Qoahty =+
FaCtllty Number+ D Division of Soil and ,Water Conserr ahon w�M
u � ��.
Q Other Agency
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: Arrival Time:jE�k�parture Time: 2 : G ounty: g If IA'-\. Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact: Title:
�'I f
Onsite Representative: /T 6 &E2��
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = { = Longitude: = ° = 4 =
u �__.-
Design Current Design- Current - a Design. _:,Curreu�t
Swine Capacity Population Wet Poult� :;.Capacity_ Papulatiou. Cattle CapacityPopu laho
❑ Wean to Finish ElLayer
Lµ'
❑ Wean to Feeder ❑ Non -Layer
❑ Feeder to Finish
❑ Farrow to Wean Dry Poultry
❑�
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
r'Other _
�❑ Other'
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number�octures r:
w.. - -. .
❑ Layers
❑ Non -Lavers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Dischmes & 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 ONo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes A!fNo
❑ NA
❑ NE
❑ Yes eNo
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facili Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ No
❑ NA
❑ NE
- a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1/ Structure 2 Structure 3 Structure 4
Identifier:
Structure 5 Structure 6
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):��
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes -No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes )?fNo
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes ;,No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [�No
❑ NA
❑ NE
maintenance or improvement?
`T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
',O'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/ fNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes O'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Eio
❑ 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 2No
❑ 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 A'r'o
❑ 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 ;),Pdo ❑ 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 21412011 Continued

[Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe it? ❑ 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 Q111ailure 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 D 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?
29. 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.
TT
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
❑ NA
❑ NE
[3 Application Field ❑ Lagoon/Storage Pond ❑ Other:
TT
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
iNo
[TT]
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss-review/inspection with an on -site representative?
❑ Yes
VNo
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[2*`No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or'any other comments ,
Use drawings of facility to better explain situations (use additional pages as necessary).
s
=° 6e sum � oZ
11117110
j. 4
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
-4,
, F re- Ldrjs 144f 50Ql.
Phone: '~!
Date: tC
2/4/2011

Division of Water Quality ::
Eactli6 Number r Conservatidb
�.
1 OtherUAgencym
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit xRoutine O Complaint 0 Follow tip O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:/jArrival Time: % . tam Departure Time: County:
Farm Name: ,Cfll�72cs1� /V61 e_.:" � . / _ _ Owner Email:
Owner Name: Phone:
Mailing Address:
r ; Physical Address:
' Facility Contact: Title:
A
'-�`����rOnsite Representativer� �� /1 lC�riler�.
oCertified Operator:
t. Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
:Location of Farm: Latitude: Longitude: c
_b
s Design
�,.
Current,,
me, Capacity aPopylatioii Wet"
Wean to Finish
❑ Lave
Wean to Feeder
1 ❑ Non -
Feeder to Finish
Farrow to Wean
Y l
Farrow to Feeder
Farrow to Finish
Gilts
Boars
s
ter.
:•
Other
•�Design`� .}Current .�
Itry rariacity , P.nnulatio ,z _Ca
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turk Poults
❑ Other
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood C
.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 an art of the operation?
' w P g Y p P
•3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
IPage 1 of 3
Region: C
❑ Yes E�No ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes 6No
❑ Yes No
❑ NA
[I NE
❑ Yes No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .'IV No ElNA ElNE
a. If yes, is waste level into the structural freeboard? El Yes [PNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3_ Structure 4 Structure 5 Structure 6
Identifier:
Spillway?: r
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes
[2No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes
�Ko
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes
[ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes
�No
El 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
YNo
ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes
To
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
1;1<0
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[--]PAN ❑ PAN > 10% or I0 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 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Cl Yes /� No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes I QN
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes / No
❑ NA
❑ NE
y gerneve- S/C( b&- a/�iu/140' A01,0PV1617, &C_S 4P-%_
lu se�v� fie A, ��v - peol r
P45ve_ COA181111� //Z;, 64� Al Ae Al
Reviewer/Inspector NamePhone: ����- 7 %
Reviewer/Inspector Signature: G'T Date: l' 7116
Page 2 of 3
1
Continued

Facility Number: — Date of Inspection
'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
❑ Yes O'No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes ON—
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,PNo
❑ 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 J21INo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes .ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes dNo
❑ NA
❑ NE
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes J'No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes P14o
❑ 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 .Q No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes eNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes dNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes [)/No
❑ NA
❑ NE
w#
1-e
a�3� I
------------
Page 3 of 3 12128104

Type of Visit aCi
Reason for Visit O
Date of Visit:
Farm Name:
ince Inspection O Operation Review O Structure Evaluation O Technical Assistance
ne O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
al Time: Departure Time: County:
IF
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: y�� z C
k614
Certified Operator:
Back-up Operator:
Location of Farm:
21 Region: L_41_4�
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: ❑ c = 6 = « Longitude: ❑ ° ❑ 4
Design Current
ItP
Design
Current
Design C•urreut
Swine C*apacity Population
u oltry
Capacity
Population
Cattle Capacity Popu lation
❑ Wean to Finish
10 Layer I
I
❑ Dairy Cow.
❑ Wean to Feeder
I J[1 Non -Layer I
I
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Layers
❑ Non -Layers
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Pullets
ElBeef Brood Cowl
❑ Turkeys
Other
❑Turkey Poults
❑ Other
❑Other
Number of Structures:
Discharizes & 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 P No ❑ NA ❑ NE
El Yes
El No
El NA
ONE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
,fNo
❑ Yes
X-No
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
12128104 Continued

Facility Number:. — Date of Inspection
Waste Collection & Treatment����%%
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes XNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes VNo
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: ,7c,2 j�C> �U
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �P i9
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ NA ❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
','ElNo
6. Are there structures on -site which are not properly addressed and/or managed
❑ YesXNo
❑ 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 ONo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes Z'No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes dNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA ❑ NE
maintenance/improvement?
�O'No
l 1. Is there evidence of incorrect application? If yes, check the appropriate box below_
❑ Yes JZ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Z'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L2rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
,0�fo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes,
NNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
O No
❑ NA
❑ NE
Reviewer/Inspector Name 1 ^ Phone: 1V
Reviewer/Inspector Signature: Date: d
Pn 7 . r 2 12/2RI04 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
[7No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste
Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain
Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
[ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes 17No ❑ NA ❑ NE
Additional Comments and/or Drawings:
13 a 3 0
43
7
ge c��e
l .S
12128104

Type of Visit /Q �C,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit t0 Routine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region: %✓
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: �c�i�v. �QYL��-t Integrator: P�
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o = ' = Longitude: = ° ❑ 4 ❑ «
Design Curren#
Design Current
Design Current
Swine Capacity. P-opulation
Wet Poultry Capacity Population
Cattle Capacity Population
Wean to Finish
❑La er
❑ Dai Cow
ean to Feeder
F�l
❑ Non -La er
FEE]
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑Beef Feeder
❑ Beef Brood Co
❑ Boars
P.
Other
❑ TurkeyPoults
❑ Other
Number of Structures: E]
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes JZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
E�TNo
[:1 NA
[:3 NE
ElE Yes
, No
❑ NA
❑ NE
12128104 Continued

00
Facility Number: f — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes PKNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �� Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes I] No
[INA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes o
❑ 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 /10 No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes�9No
El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2(No
❑ NA ❑ NE
maintenance or improvement? rr((
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 o
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes _-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
C;�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
["No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
040
❑ NA
❑ NE
I S. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
OT� . Cam` (7.4 �ri�' �Q�Goo.-� 'a �/ il7
fj7 CMG. �di��/ ��'• �,�� . .
rA
Reviewer/Inspector Name " Phone: ! — 17
Reviewer/Inspector Signature: Date:
P"vv I of I 12128/0 Continued

� r
Facility Number: Date of Inspection E&EZG
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 V No ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ 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 P 'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ",Zqo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑'No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes PNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes qNo ❑ NA ❑ NE
Other Issues /
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes /[Ao ElNA ElNE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ElYes 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 VfNo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes P<o ❑ 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
,�No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ NA ❑ NE
Additional Comrrientsand/or Drawings:..'
-�- u-6e-d 0-1r�rc,h
S61 ioo Ld d beoeIG i 6 war �O us C�
ref OS CGS) G, -X�slt
2 ! v �jeeok " c�e S S urr e� r
G6
a $
1� 6 6c,,e,, t 5
kiln (Od�S reG4 r recc(-ds
fiea4 '�' ol" e��t
1 10
Page 3 of 3 12128104

Facility Number f �%
_Ga Division of Water Quality
0 Di-tzsion of Soil. and Water Conservation
0 Other Agency
Type of Visit Q4ompliance inspection O Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit AEfRoutine 0 Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: •-r Arrival Time: �Departure Time: County: G Region: 4J
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ­2011 v. _� r.. t �}, ;1230 lne
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= e = 0« Longitude: 0 01—_1'=
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I— —1 ❑ Non_La et
Other
❑ Other - - - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current
Capacity:. Population .
❑ Dairy Cow
❑ Dai Calf
❑ Dairy Heifei
❑ 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 ,ElNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
ffl-No.
ElNA
ElNE
❑ Yes
,
wo
❑ NA
❑ NE
12128104 Continued

` Facility Number:
Date of Inspection 6 tr
Waste Collection & Treatment
4_ Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,❑'No ❑ NA ❑ NE
a. If yes, is waste level into the structural Freeboard? ❑ Yes ,j No ❑ NA ❑ NE
ructure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [-No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes pNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes PNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �j] No ❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes (� No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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 O'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes [�No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes pNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑.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):
3/a�o 1,3 64,r (.2o =4) 3J,*E/c,7 j14d e Pyort : l4000n 69a3o �. 7g �.�/,,�.,� leile-
!, y PTA, C;63 01 laJr oo,i 01 G 3 1@ 3 • y4 !✓[a �.ncK }
0Tj'1H c A 3I) /Je sure 1a
e��d9%d6 0, 67ito �-q / /� / /� ��1oy1 • f
Reviewer/Inspector Name—A/J" Phone: —
Reviewer/Inspector Signature: Date:
12128/0 Continued

Type of Visit O'Compliance Inspection
Reason for Visit XErRoutine 0 Complaint
- Date of Visit:
Farm Name:
j Arrival Tiime:
ZI /
0 Operation Review 0 Structure Evaluation 0 Technical Assistance
0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access :l �j � Departure Time: � County: Region:
�tJ/l eB
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: h C CYYL�O {-Q-
Certified Operator:
Back-up Operator:
Phone No:
Integrator: Map
Operator Certification umber:
Back-up Certification Number:
Location of Farm: Latitude: = o = I = Il Longitude: = ° = d =
is
Design Current
Swine Caac Po ul hone
p ty p
Design Curre11,
nt
Wet`iPoultam �'�°=
ry" Capacity Population
•attle�`�
C {
Design _ ..Current
�Capacity Population
Wean to Finish
❑ Laver
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
El Beef Stocker
❑ Gilts
❑Non -La Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
ElTurkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ;DNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
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)
❑ Yes ❑I No
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes efl No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes effNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: ]2ffC)l Date of Inspection
Waste Collection & Treatment
4. Is storagd capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �Ni ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
c 1 S cture 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ? t 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ,EYNo
❑ NA ❑ NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ,ENo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P'No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ETNo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [,liVo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PAo
❑ NA ❑ NE_
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s) /j Vp'
G
s,
14. Da the receiving crops differ from those designated in the CAWMP?
❑Yes .�I No
❑ NA
❑ NE
l5. 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 9 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ZI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes t�`No
❑ NA
❑ NE
`Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary):.,
Af
r�oZ 7 t?CcJ v�l�C�,% 16/- 7.
Reviewer/Inspector Name a T - -_.� -- - -- — -- Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes VNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? if yes, check the appropriate box below. A] Yes &o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 4 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 VNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ,0 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ONA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes t•No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA ONE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes J3'No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes �2rNo ❑ 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 �TNo ❑ 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 ElNA ElNE
General Permit? (ie/ discharge, freeboard problems, over application)Pqo
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 XNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
�31ad�-
�ld,a/U6 �� 7 y PZ4,
z t �ctf
Ir 1 -TKR P05
[l 17 jd 6
'Vj ctw 4 r 4rl i
D to 7KH Xn 5^ Corr— a-
��4 t 13i-I'Z 1'ri50 G CCU_f-e a�
6 V eGem %er W kp----4-
,,,� �s �� �, fi sue• CyX-otj5.1 IAV CCVO/
Page 3 of 3 12128104

�"�ivision of Water Quality
L=5:c-ifit,y:Nimber oZ 8 O Division of Soiland Water Conservation
Agency
— M
Type of Vlsit..,_�ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit outine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ElDenied Access
e
Date of Visit: Q Arrival Time: q' Departure Time: County: _ Region: P
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative:c Alh atr i. % b(& _ Integrator: M441A11.1,
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = A = 4i Longitude: = ° = ' [--] "
Design Current
Design Current
Design Current
Swine pa�city< Popitiiation
WretPoult . , C aci Po elation
Cattle'
Capacity Population
❑ Wean to Finish
I
I
JEI Layer . '
❑ Dairy Cow
Wean to Feeder
JEI Non -La et
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifei
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Cowi
❑ Turkeys
Other
❑ Turkey Poults
Number of Structures:
❑ Other
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes ,0 No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes ❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
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)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes ONo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes ZrNo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 1 — Date of Inspection
Waste Collection & Treatment
PNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): r
Observed Freeboard (in): 7 aZ 7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes �i No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ;:'No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes .2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? [:]Yes a 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 eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ENo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes .0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) _L_d'ih. _ "C�'h4;a rx'$ . t'_D
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
Yes10
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
01No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre
determination%❑ Yes
Z 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
J27No
❑ NA
❑ NE
y� AI& , t/ r r�
If ! Dl w fah raC� Grles� �P /C'(/ISeG�
P�-
Reviewer/Inspector Name. �` �'
4 =..w Phone:
Reviewer/Inspector Signature: Date: 7
12128/ 4 Continued

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage 8_ Permit readily available? ❑ Yes 2"N'o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design El Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 12ryes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard J2Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
[:]Yes ,ETNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
ONA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
ETNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
[27NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge'?
❑ Yes 0 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes El No
❑ NA �NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 07No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes FTNo
❑ 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
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
,ONo
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes ZrNo
❑ 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 0 No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
sump, r`.5
ukYc Ae 1k
yore
�4C0YtC ✓\, 90cd O(�%�
12128104

Type of Visit O Co pliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
acility Nr
Date of Visit: v Tune: t3yr
F2
Q Not Operational Q Below Threshold
Permitted Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: ..__ ._ _......
FarmName: ............................... .......... ............................ County:
OwnerName: .... ................................. . .... ...... ....... . . . ........ . . . . ................. . ................. Phone NO: ...................................................... .. ............................. .
Mailing Address:
Facility Contact: Title: Phone No:
l
Onsite Representative: 1;�. ._.._..... Integrator: .... of R
Certified Operawr:....-.��.._._.�._.....__� ..�� _.. �.�._._.......�.�.� Operator Certification
Location of Farm:
❑ Swine ❑ poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 4 44
Design Current ; = Design C9. urrent w Design CnrreIIt
Swine Ca au
=
Po uladon rP'oultry :_ ci-Po �atiaio� Cattle Ca act Po"-Wat<on
_ a ,Ca _ _ .
79 Layer p4 ❑Dairy
❑ Non -Layer e: ❑ Non -Dairy
Other
tiI _ T
Des a a aTotal rgti C p atty�
El
ry
�` Number of"=Lagoons � �=
=
_
s -
tt
wean [o'�Feeder
ab
52
Feeder -to Finish
Farrow1to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Dischare &Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon [3 Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes El No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
a c. If discharge is observed, what is the estimated flow in galfrnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) [I Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes C3 N
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes LSO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: ...................... ........ ice.. _..--................ ...------........... ....................................... .....
Freeboard (inches):
12112103 Continued

Facility Number: — 'j, Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
ZNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
D Yes
No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
8. Does any part of the waste management system other than waste structures require maintenance./improvement?❑
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
Yes
❑ Yes
�U4
d o
7O
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below.
El Yes
7No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with these designated in the Certified Animal Waste Management Plan (CAV;W)?
❑ Yes
N
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
1Vo
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
EX40
15. Does the receiving crop need improvement?
❑ Yes
[ No
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 at/or below ❑ Yes To
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 io
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes o
Air Quality representative immediately.
Comments (refer to question ) xEiplain any YES answers and/or a ry recommeadsttons or any other comments.. ,
Use drawings of l�eiltyto better. explata sitoat.ons {use addit,aaal pages as necessary). i ] Field Copy [] Final
p �`-� :...,.� � .. ms.
2,3.) OFEX> C APSES of WRSTE P►NAL. eSMS P6it_ S,5-o3. !a1JALrY,S,SS ['ooD
Go oaf 1pak"Movs Aoo
MP vCrL \) Cs�� SLlflP�
- r
Reviewer/Inspector Name 2 jJ M
Reviewer/Inspector Signature: Date: (j 6
I2112103 1 Continued

Vacility Number: 3 _ Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the rtified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If s, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
N`TPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
3 L If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes 01No
❑ Y L�[1vo
Yes ❑ No
❑ Yes No
❑ Yes �0
❑ Yes io
❑ Yes J.�'No
❑ Yes o
❑ Yes ENO
❑ Yes o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit A Compliance Inspection 0 Operation Review O Lagoon Evaluation
Reason for Visit 10 Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other © Denied Access
Facility Number Date or isit: Time:
10 Not O erational Q Below Threshold
O Permitted ©Certified © Conditionally Certified Regis red Date a Opp eeraajte&or Above Threshold:
Farm Name: _ Kz LL•
Owner Name: .� \ Q A R L NeeK Mna F_ Phone No:
Mailing Address:
Facility Contact: , Title: Phone No:
Onsite Representative: _ �, fl41� ��MDi� Integrator: ^mu gPhT �� _•„_„ ,,,,
Certified Operator: Operator Certification Number:
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude
W Des�n Curren[ Design Currents Uestgn Current
Swtne, Ca acttvW Po Mahon I'outtCa actty -P ulatiau :_ ..Caine :-Gs' acitr _'Pre ulaaon
Wean to Feeder ❑ Layer ;-; [] Da'
r W
Feeder to Finish ❑Non -La er; ❑Non -Dairy'
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design`CapaCrtrm=# `°
❑ Gilts -
❑ Boars - Total SSLW
W
N:❑Subsurface Drains Present ❑ La oon Area
n
❑ S ray Field Area
M
Holdrn Ponds / SoLd'Tra s .'
p w, P ❑ No Liquid Waste Management System
Discharges & tream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
[] Yes
❑ No
c. If discharge is observed, what is the estimated flow in gaUmin?
d. Does discharge bypass a lagoon system? (If yes. notify DWQ)
❑ Yes
❑l No
2. Is there evidence of past discharge from any part of the operation?
ElU Yes
No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
VrNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
;6No
cture 1 Structure 2 St��re 3 Structure 4 Structure 5
PF
Structure 6
�S
Identifier:
r�
Freeboard (inches): Z 2
05103101
Continued

0
Facility Number: — Z Date of Inspection " .IVI" a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes M No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 10 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes prNo
Waste Annlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes VfNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes VrNo
12. Crop type �.'DKO UULkaAr�l . q �CQdJ4
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 21 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
V1 No
b) Does the facility need a wettable acre determination?
❑ Yes
VI No
c) This facility is pended for a wettable acre determination?
❑ Yes
ONO
15.
Does the receiving crop need improvement?
❑ Yes
;�No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
0 No
Required Re ords & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ONO
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
[ZNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Wo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
[3 No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
A No
22.
Fait to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
VNo
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
WNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
P No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
ONO
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to-queshoti, #) E iplam asy YES answers andlor'any r�ecom em udattons:or any others min nt`s"
Use drawings of facility to;better egpta�n situations."(use add�ttonal pages as. necessary) [l Field Copy ❑ Final Notes
Ner_ep-5 ` - 9E moWRO Mwzc- DF-rr.t,)sV1-_,,1-P-71h-790A]
�9IOU r-� goer
-c e3qc' OP L'�-rPRO
Reviewer/Inspector Name F_,r,jf .
Reviewer/Inspector Signature: Date: Q�
05103101
Continued

Facility Number: —`L8o Date of Inspection I
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
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 FN 0
❑ Yes No
❑ Yes YJ No
❑ Yes ❑ No
Additional Comments and/or Drawings:.:
flip 6u��
RIDLL) CPO s
�002 SOOc.
��� �
� D�,Pm, Klee oRos
9�0� 39s 3900
05103101

-F
Drviston of Water. Quality
-� -
Q Division of Soil and Water Conservation -
o Other -Agency -
-ham 7.
_5
Type of Visit _jO<G'ompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit _ertoutine O Complaint O Follow up O Emergency Notification 0 Other ❑ Denied Access
Date of visit:
16 Facility Number t
1 Time: J3 5D Printed on: 7/21/2000
Z
..l 10 Not Operational 0 Below Threshold
© Permitted 0 Certified t] Conditionally Certified © Registered pDate Last Operated or Above Threshold: ................. ..
14Ck�e /UU �t6 "rJ ...... 15 i �4 �'�ounty: f1 ! l�
Farm Name: ..................................... ^.....�........ J.........G L....)........�� ........
.............................I........... . _LL` II ... r
Owner Name:....d. h'1. F'...�V.f.L.1..La....��Cr/ Phone No::...
Facility Contact: .................
MailingAddress:.............................................G....�...........D.....�...�....
aj!/�Onsite Re resentativeJ...........................................
Certified Operator:
Location 'of Farm:
Xswine ❑ Poultry ❑ Cattle ❑ Horse
Design Cum
5wi>ae Ca ci Po uh
`'y Wean to Feeder
Feeder to Finish
Y�r
Farrow to Wean
Farrow to Feeder
Farrow to Finish
4—U Gilts
Title:................................................................ Phone No:
.................................................................•--....................
Integrator: ? ".G.?l..-.......
................. Operator Certification Number:
Latitude 0 6 41 Longitude • 6 ��«
Design Current Dedlo - Curreat
Poultry Capacity Population Cattle . Ca ap := Po ulaiio
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ,TNo
Discharge originated at: ElLagoon ❑ Spray Field ElOther
a. If discharge is observed, was the conveyance man-made? ❑ Yes J�fNo
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/ruin`! n. / q
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 /dl
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes�No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Str c Lure I Stru •turn 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ...:`...g.......................... .....1...... t`R..-...-.....................................
Freeboard (inches): Z3
5100 Continued on back

Facility Number: _7 - ZgCJ Date of Inspection �5/ %/ Iy J Printed on: 7/21/2000
5_ Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes fTNo
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
(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? ❑ YesjRrNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes-,;3hlo
9_ Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ErNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes 8)Vo
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ElYes/`No
12. Crop type �e r� -�, ud� �-f� �� 11 n q ,` Care W tie So ij bea>n s
13. Do the receiving crops differ with th se designated in the Certified Animal Waste Management Plan ( AWMP)? ❑ yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0`N0
b) Does the facility need a wettable acre determination? Cl Yes-PNO
c) This facility is pended for a wettable acre determination? ❑ Yes01NO
15. Does the receiving crop need improvement? 01yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes EfNo
Reouired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ YesdNo
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_0No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) JZYes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,?17No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ONo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes ,E]No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yes Fe"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 0No
�'�10 yioi tigris;or def ciendes •wire noted• during this;visiC • Y:ou will receive do furthgr ; : /
cories orideiTce: about this :visit ............... .
CofnmeniS {refer to question #) Explain any YE5 answers,, or any recommendlattons or anysother comments
-��::.... �...... ....-�..� •. -•.. ... _...i .. Y: Y. _� a•.�-�._.� .. _ I—.+. _ - _i: _ �,... .. �� a — ... ..v..- -� a - ��L`d'''.S%
.v .�._.z :-: .r... .,.r,.vLr-e...�r s-e..r--.,... �.e ia:e.. v. x._,a v_... s.w ...: . • ...r--......-. ....:.... .x.1 v.—.... _..s.;. ,-�. r�-_ r. v._.a �«.:w .n� � a w-e.e .ems.-�.�+.e. -T. _ _
iS, (,,loI 7a i►►TroVe r,-;- vof
� c�oa s-�a � � � ef s-la rLa '�j ;6e ✓� �+-vd a �; e r•� . ,vo ....
xof sre47 on h;r.f;eld VnIl bef�vdl saytd is �r�j11, ►'ca''��l/
?-%,vr_ V ed,' vSe rot. G r'o� r<' e IQ(f
jri.'ge Svr•e 4.0 flake sd,l s,�r.t1v e� --rQr each-F,e11,4 in j6e wotS4e fla/7 .
$e s "v e fo v s e A w,-_rfe et ,r dAIeld l.,if-thD piaoff'
9f gf"T even-s Irv- ccllcvldji6njr- on fie rer- O'ny"I'mA 40
40ke I�
Revieweranspector Name
Reviewer/Inspector Signature:
Date:
5/00

Facility Number: % —28p Date of Inspection Q/ Printed on: 7/2112000
Ocltir Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes /ElNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes/2fNo
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 -EfNo
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 gNo
32. Do the flush tanks lack a submerged fill pipe or a pennanent/temporary cover? ❑ Yes ❑ No
Additionaomments and/or Dravvings:
i
71 e ��c,f� 7 it nea H7 ke/a/ .
5100

10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection Zp 24 hr. (hh:mm)
(�rermitted © Certified 13 Conditionally Certified [3 Registered 113 Not Operational Date Last Operated:
Farm Name: WI-e-A,
: ..... ._. 3 '...................................... County:.............. ` ��...............................................
Owner Name. Phone No:
.- ......_�(aa..�
Facility Contact: ..............................................................................Title• ..... Phone No:
Mailing Address: .................................................. ........
Onsite Representative: �iv►r....................................................................... Integrator: .........t...........................................
Certified Operator: .................................................... ............................... .............................. Operator Certification Numbejr:..........................................
Location of Farm:
Latitude r-�• �� �it Longitude • 4 G4
Wean to Feeder
r7y03
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
Nuutbei-.of Lagoons
Holding -Ponds I Sold Traps'
;:foul
Design ='Current
Capacity Population _,_;Cattle
❑ Non -Layer ❑Non -Dairy
❑ Other
- Total Design Capacity
Total SSLW
,= -n ❑ Subsurface Drains Present ❑ Lagoon Ares
. ❑ No Liquid Waste Management System
�rrent
Spray Field Area
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
S clure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: T(-� �7p
Freeboard (inches); 3•,� �3 30 ..................
...............................................................................................................................................
❑ Yes VfNo
❑ Yes ❑ No
❑,Yes ❑ No
❑ Yes ❑ No
❑ Yes D(Vo
❑ Yes ZNo
❑ Yes V No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes X No
seepage, etc.)
3/23/99 Continued on back

Facility Number:'] ` —e;$Q Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12• Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
2t. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes MNo
❑ Yes X No
❑ Yes 4 No
DgYes ❑ No
❑ Yes NNo
❑ Yes XNo
❑ Yes %No
❑ Yes E'No
❑ Yes ❑ No
❑ Yes ❑ No
,CYes ❑ No
❑ Yes (gNo
'Yes ❑ No
❑ Yes No
Yes ❑ No
❑ Yes 9No
❑ Yes NNo
❑ Yes 0 No
❑ Yes [XNo
Yes ONovt,
❑ Yes NNo
.: Nd-yiol:attcjns'oT Midend.es -were noted• iltrrt g! this'visit. - :Y:oik will•reeM*y ino fuethgr: • :�
coriess oridence' about: this visit: .. . .
e
Conimenls (refer to question #): Explain`any.'YE$ answers and/or any recommendations or anv other:comments:
Use drawings of facili-v to better.ex lain.situatiions use additional< a ":asnecessa
1 � �
Reviewer/Inspector Name =t `- C} 39�- 9 `J`r`�a�
Reviewer/Inspector Signature: Date: 9— ^QO

Facility Number: -/D-CVI Date of Imspection
Odra Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 14 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes &�No
28. Is there any evidence of wind drift during land application`? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes �6No
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 R No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes Iq No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes allo
Additional ,- omments and/orrawin s:
_ g.
� 1
LS t\M-1 U At LJI��tz-Q- L-k I A. k
K," (A5 c'lo
hat Am 5 4 Ifi�
N� ,` t- `-�- E dJ1� 1 '-tea` �''yQ c�, i•`�, J�.�. t �nG�.r
d'Lt2v5
CO
A-i Vs
rr
�vlsk- IAIC—r._ �x � l„c.►is- r�P d cL. h�s�

Division of Soil and Water,:COIL,
i Division of. Soil and:Water Con
�'Dtvision of Water Quality ,.Coi
Oteer AY g
:
lAge O era�an Revi
_ .. �. .
Routine 0 Complaint 0 Follow-up of
IFacility Number
ou_-;Operation~Review x '
ittod Coiwpliance Inspection s
nice Lispection - M
J = _
D Follow -tip of DSWC review 0 Other
0 Permitted © Certified Q Conditionally Certified [] Registered
Farm Name: ..... I Ski-s�.? .... Y �-1t ............................
Owner Name:......
Date of Inspection
Time of Inspection 1 9 3 Q 24 hr. (hh:mm)
Not Operational Date Last Operated:
County: ..............................�......... .
I n C�
Phone No:. .1 .�..102— !.�7.n...13
FacilityContact.............................................................................. Title:..............--............... .............. Phone No:
. ......................................................................
FlailingAddress:.....................................................................................
Onsite Representative:. ............................................................................ Integrator:...... ........... ........ ...... I................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm: r 1 f A I. t
..:... .... .,..., ........... ........ ...... .... _..............,...............:....................,..............I..........,................ —.............. ...:............ ,.,.ram. ..........
..-... ......
...g ....�013.0 r
Latitude • �` i Longitude hJ • G
Number of Lagoons'' :[ISubsurface Drains Present ❑Lagoon Area][]Spray Field Area
.Hold€ng Ponds /Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon ElSpray 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?
❑ Yes b(No
❑ Yes ❑ No
❑ Yes ❑ No
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 KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ONo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: S ? T
Freeboard (inches): ......'�.L ................. .............1 �......................... a s
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes C�No
seepage, etc.)
3/23/99 Continued on back

Facility Number: 31 -tea Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes XNo
(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?
XYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
&rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
t�No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
N-j'No
1 L Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
W40
12. Crop type
—T�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
bj'No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
XNo
b) Does the facility need a wettable acre determination?
❑ Yes
f%O=j No
c) This facility is pended for a wettable acre determination?
PjYes
❑ No
IS. Does the receiving crop need improvement?
j'� Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required -Records_& Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ YesZV
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 NfNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ,Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [VNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 9No
22. Fail to notify -regional DWQ of emergency situations as required by General Permit?
(icl discharge, freeboard problems, over application) ❑ Yes NrNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes tN
No
.. yi. . . .. . or ...c..... were ... * during phis.visit... ..... >. . . . .Rio i'urth&
ICI res ondence. admit this visit.
Comments (refer-. to questidn #V:F, tplain_ any YES ansvi+ers arid/or any. recommendations or any other comments W
[Jse;deawings of facility to htek explain-situagons {use�addthonal pages as�iiecessary.)
rr r r R
•�ti3��F -� *. ��`u °�+�Q we.�� ot... di.
5-0
A-b
T -- -
Reviewer/Inspector Name
Reviewer/Inspector Signature. ( �� e1 PDate: 'aa 4�
3/23/99

Facility Number:31 Date of Inspection
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
Y11 es
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
�(No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑Yes
kNo
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
1�rNo
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
14No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
EYNo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additiomill Cpyntqents a> .or, rawings;,
11Q 25b Ica. `i � t' V4 1 � S -31 G a— .
� s�1 � � $ p
9�1- 73 3 SUs3 S-. �9*
t
II �
3123/99

5���-'�r �3 -�-,�. ,ate=,:i.�"��-.'�,.,.��:.�Y �-t �'::ca.;:k# ,z:�_.`e�,,:..�.e; ' `..ss3;.aw.mx-,:�'�� --�:r • � �'� � x` .i ,� w"����`-^' ��.
�� ` � ��� � �❑Division of Soil and �'4'ater Conservation ❑Other Agency T -���` �r �.� �-
�`�`
O Routine O Complaint 0 Follow-up of D1,V0 inspection 0 Follow-up of DSWC review O Other
Date of Inspection 1z I " I q r
Facility Number
-j Time of Inspection G - � 24 hr. (hh:mm)
13 Registered ® Certified [3 Applied for Permit [3 Permitted 113 Not Opera Date Last Operated:
Farm Name
?...2................3.-1Z,:.......................
Owner Name: :,l..k.r,...Y...l..� ..! :.�s......... Lr �. r:. ^-�d'.:.........`......�............. Phone No:.... 1ZC . `�...`. _�..... ...................
Facility Contact:......................................................... Title:................. I................... Phone No:
Mailing Address: .�..���:... +. �L... ,: Ly..... i..�. �.... - ^......
Onsite Representative:.jC•. !^ :^.....�.�.�..::....s�:._.i- s.Ss ! Fw� Integrator:... v f...................
_............_....._.
,..... f ......k:.
Certified Operator ....... ...12! _.. ...... .i.h t %Er.f:.............I..................... Operator Certification Number,.. -------...... ----
Location of Farm:
Latitude =a =° =11 Longitude =• 0' "
DestgII Guii ent
qy �' LL Designs r CurrenEr f� x.I}estgn CurrenE
A'.. F
rSw}tie CapacityfPop�lahon�
Potryr�C.t3' C c��Poolaon
E3'.,,.,
.PaPuiai�onrCaffie .P
❑ Layer Y F ❑ Dairy
❑ Non Layer ❑ Non D
E:
Wean to Feeder
,, t1�
Feeder to Finish
fO
Farrow to Wean
a� t y:�$
r
❑ Other MR .��.
w TtKal' esign Capam£y 1(0
��xm"`
ta� �Y �fi
Farrow to Feeder
❑ Farrow to Finish
.❑Boars
❑ Gilts
� r�
Numiiei of Lagous / HWdirig Ponds j
❑ Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
e
..... ......... ... __, ......... ........ .........�
❑ No Liquid Waste Management System
"b.; 'i•i°:"'nK. Y. fYk.' a3�5:
- f,4E,nC E .`>.
y.M`
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ®,No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes El. No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes O.No
c. If discharge is observed, what is the estimated flow in gal/min? Imo; j
-d. Does discharge bypass a lagoon system? (If yes, notify DWQ) El Yes ®No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? &Yes ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes Q No
Y maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [KNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes MNO
7/25/97
Continued on back

Facility Number: Z l —2 9 D
8. Are there lagoons or storage ponds on site which need to be properly closed`'
❑ Yes
No
Structures (Lagoons,llolding Ponds. Flush Pits, etc.j
9. Is storage capacity (freeboard plus storm storage) less than adeq ate?
— )
❑ Yes
O.No
Y�SIaL J
Structure I Structure ? Structur�e 3 Structure 4 Structure 5
Structure
6
Identifier: ........ �^.....j........ ... ......Z.-,S� ...... ...Z....
...................................
Freeboard(ft):.......................................................................................................................... .............
10. Is seepage observed from any of the structures?
❑ Yes
� No
1I. Is erosion, or any other threats to the integrity of any of the structures observed?
&Yes
❑ No
12. Do any of the structures need maintenancelimprovement?
®,Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
13 No
Waste AAnlication
14. Is there physical evidence of over application?
❑ Yes
13 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type i. ............................ _......................... .- -...................................................... ....... .............................. ...............................
........ ...
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
IRYes
❑ No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
[EINo
18. Does the receiving crop need improvement?
ER Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
n No
20. Does facility require a follow-up visit by same agency?
&Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[3No
22. Does record keeping need improvement?
E[Yes
❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25. Were any additional problems.noted which cause noncompliance of the Permit?
❑ Yes
0,No
0 No.violations-or' de ti iencies.were-noted-dufingthis:visit.-Yoit.'Wiil- receive- noAirther:
,=:•correspotidenceabbutihis:visit:•::-:�:�;-:--:•�•:•.�:��.; :�•�.•:�:�:�:::-:- -:�:�'�.:::-:�:•:•
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Reviewer/Inspector Name
t�
L
L.,,)
Reviewer/Inspector Signature:
Date: Z / ) r

Facility Number: 7 j —' irp Date of lnspe tion c a
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7/25/97

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❑ Division of Soil and Water Conservation ❑ Other Agency 2
Division of Water Quality
O Routine O Complaint 0 Follow-uR of mvQ inspection 0 Follow-u of DSWC review O Other
Date of Inspection t qr
Facility Number
Time of Inspection 24 hr. (hh:mm)
© Registered ® Certified 0 Applied for Permit © Permitted 113 Not O erat,onal Date Last Operated:
Farm Name: E_d` .t_.' .lf! st.�^-i..t.f1lil:ty.� _..?f...�... st...A.z ..? 1.: -..�.�J. r S County:..... ..a:.. ... n ...................... 3.
Owner Name:
�.1.G. .r,... .. ,r ...�.� ........ Lr ,c..l:. f rt;'.;. ...................... Phone No:.... jZ. ._ L�.t~' `�.......
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address:.... �:... i. t1. Y.. y...! .�..�.....-....
Onsite Representative:e_. a....� �f t..�_^s1:...1- �s rM.!.:-~- Integrator:_... v_.......
...............
.......
..
Certified Operator;. ,p�k+,.. T. ..5 .h.a_. J.4...:.f .f................................. Operator Certification Number:lat
Location of Farm:
Latitude • =' =" Longitude =' 0' "
r Design' Current
SCapacity Population'
'` ",�I?esignCurrea �}esn�Cnrrenth�
Poultry" CapkcLtyy Ca#tl<e� CapacrtylE'op�ahva
�..,
'� ❑ Layer ❑ Dairy
FWean to Feeder
,4
Feeder to Finish
❑Non Layer ❑Non Dairy
Farrow to Wean
y a��e
I0 Other ��
Farrow to Feeder
>
g 3
❑ Farrow to Finish
y
� � x Total�Des�gn GapaCify F J� lO ts7%
L
❑ Gilts
� �
ozgjz
o Z D�
❑ Boars
_ ._.._.._ . _ ....... .._
.
, ..u,�; .,. �tSSLV;
�."ai'wutL,l
N�uymber ofLagoonslHo�ng Ponds
❑ Subsurface Drains Present ❑ Lagoon Area JE1
Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenancelimprovement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon [I Spray Field El Other
a- If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes. notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ®.No
❑ Yes ® No
❑ Yes B No
❑ Yes ®.No
K) LA
❑ Yes & No
❑ Yes ® No
&Yes ❑ No
❑ Yes 19 No
❑ Yes allo
❑ Yes MNo
Continued on back

Facility Number: 2.1 — Z. s7
S. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
Q No
Structures (Laugoons.l_Iolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adeq ate?
-# r°? [ is f l-� l' • C F,t 4 L k� r-C
❑ Yes
JE.No
Structure 1 Structure ? Structure 3 Structure 4 Structure 5
Structure
6
Identifier: }' : �..........._.. z.--..........._.... .... ............................. _.. .... _.............................
Freeboard (ft).......................................................................................................... ...................................... ...................... .............
.................. ..................
10. Is seepage observed from any of the structures?
ElYes
JRJ No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
El Yes
❑ No
12. Do any of the structures need maintenance/improvement?
®,Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
1S No
Waste _Application
14. Is there physical evidence of over application?
❑ Yes
B No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ... ?.rsn.£...............................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
19Yes
❑ No
IT Does the facility have a lack of adequate acreage for land application?
❑ Yes
12.No
18. Does the receiving crop need improvement?
® Yes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
[3 No
20. Does facility require a follow-up visit by same agency?
& Yes
❑ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ONo
22. Does record keeping need improvement?
9 Yes
Cl No
For Certified or Permitted Facilities Onl i
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25. Were any additional problems.noted which cause noncompliance of the Permit?
❑ Yes
Eallo
O No.violatio'nsor. deficiencie's.were-noted-during this;visiL- You:will recei've'no•ftirther, : •
: correspondence about -this:visit: :
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rmmerrts (r�efelrrto�gaestron �) �Egplaut�ariy�YE.S answers�aadl�ranp4recammendatrons or any o#irer �munl�rrf:;��
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Reviewer/Inspector Name 3
Reviewer/Inspector Signature: , . �, - c Date: Z ) r
7ft 1

Facility Number: 2 i - 2 g' 0 Date of Inspection
Adiiitlonal Comments andlor Drawings:
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7/25/97

0 Division of Soil and Water Conservation ❑ Other Agency
®.Division of Water Quality
10 Routine O Complaint ® Follow-up of DWQ inspection Q Follow-up of DSWC review O Other
Date of Inspection z io q
Facility Number ZA
Time of Inspection d 24 hr. (hh:tnm)
© Registered ® Certified © Applied for Permit [3 Permitted JE3 Not O erational Date Last Operated: ............
Farm Name: ,t ...,,-.. - $t.. County .. i l �^
�.r-t..u_r.. �. �... r..r.. .#. F s .., �.................
2W - -1Z83
Owner Name: .r,.. -.. ................................. Phone No. .... ...sH—Q..)... ....................
Facility Contact:. ........................ Title: ....... Phone No:
Mailing Address: •-- TV..y LSI .1:iill.....I. ................... .......... ..............---....-•----... ..........................
Onsite Representative:p.�1... g. d .L..!µs�v`� �.s-.95..�.�..�^� Integrator:.... V.................................................
Certified Operator:......... c111 ..."..2:................................. Operator Certification Number:..A.44 --._.............
Location of Farm: i
C
'o
Latitude r_�• �' �" Longitude �• �' �"
r
= Destgrt� Cui-ent r m` g 1)es}gn Current °, ' Destgn:Carret
Svruae Population Poultry CapatyPopnlatteinCattle Capacth' Population °
> G=..Gapsactty ; : n
4FO
*
Wean to Feeder bV ' ❑Layer - ❑Dairy
b.:
Feeder to Finish ' ❑Non Layer ❑Non Dairy
Farrow to Wean
- z
' =a' j' `� s €"
❑ Farrow to Feeder
❑Other
z Total Design 'Cap7.10;
❑ Farrow to Finish
❑ Gists
x x ,ff
❑ Boars
tal �^�
s WT Y f�ZT7
�#
e` f^ '�o. �,;Tt�n .iJSa,J
Number of I:agoons / Holdwg Ponds " ❑ Subsurface Drains PresentlEl Lagoon Area
I0 Spray Field Area
-- .. ... ....... .. ..... ... -.:..,
r fi ❑ No Lieluid Waste Management System
_
F
'�. ,
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes UNo
2. Is any discharge observed from any part of the operation? ❑ Yes ®.No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes E9 No
b. If discharge is observed, did it reach Surface Water? (if yes. notify DWQ) ❑ Yes E No
c. If discharge is observed, what is the estimated flow in gal/min? N,
.d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes &No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge? MYes ❑ No
5.. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes (K No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes KNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes C3-,No
7/25/97
Continued or: back

Facility Number:3 —28 p
9. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Holdine Ponds, Flush Pits, etch
9. Is storage capacity (freeboard plus storm storage) less than adequate? 1
C�tQc 1) (P&UtfiP �-`) C$LaclG•-.�.�� Z1
Structure 1 Structure ? Structure 3 Structure 4
Identifier: ......... �...�............... ...... Z _ �............................ ................ .......
.......................... .. .....
Freeboard(ft):...............................................................................................................................................
l0. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
lVaste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type 1 v.sn.Q,................................................................................................
❑ Yes
121No
❑ Yes
I.No
Structure 5 Structure 6
............ .... ............. ........ I ...........................
❑ Yes
R No
®,Yes
❑ No
,Yes
❑ No
❑ Yes
IS No
❑ Yes
iS No
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss reviewfinspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0. No.violationsoir deficiencies. we're-nooted-rluririg this:visit:• You4ill receive-rroltirther_
correspondence about -this'. visit'. ; : ; : : ,
ffYes ❑ No
❑ Yes ®.No
Yes ❑ No
❑ Yes No
19 Yes ❑ No
❑ Yes [3No
E[Yes ❑ No
❑ Yes ® No
❑ Yes ®No
❑ Yes 0No
oS> �Gmmes�(mfer to question #) ; E�cplan;any YES�answers and/or any,�recouirn�er�dattons or any�othe�r camments� ,�.���
better`explatit
U dt'awiogs3af.factlity-to sttuatio�stl (use addittonal:pages as2ne�essary) � ����R��� ���,���
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ReviewerlInspector Name (Y w �' " "
Reviewer/Inspector Signature: Date: Z 1 ) o

Facility Number: -Zg p l:)3te of Inspection z
7/25/97

Division of Soil and Water Conservation:1 Other Agency
_ ,❑ Division of Water Quality
10 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 1219197
i Facility Number 31 280 .
Time of Inspection 0900 24 hr. (hh:mm)
E3Registered MCertified 0 Applied for Permit ❑ Permitted 113 Not O eratianal Date Last Operated:
Farm Name: H1ac1moxg.Hurmcry................................................................................... County: Ruplim ............................................... j?[! RO.........
OwmerName: 3_ahm........................................ B.lackmo re................................................. Phone No: 2.10.-.293.7283..........................................................
Facility Contact: .LubmBlaakmo rr........................................... Title:. OW.mr.................................................. Phone No:
Mailing Address: 110.1urkey.11dLane........................................................................ W—armw...N.0 .......................................................... Z8398 .............
Onsite Representative: :lahAl.l3lafrl<c7atA.re........................................................................ Integrator: MWhy..Famj1y..Fax= .....................................
Certified Operator:,I.ahn.T.................................... BIA& lAxe...........
i nratian of Farm!
Operator Certification Number:,IQG24.............................
I!:a.r�.l�aa�tiaa,;.:Fxann.�:3'aKsan�.,.[JCS.X�.7..�aAxth.�lA..>�atY�.cas,.tuna.lefx.ga.�aRp.ray,,.?.�S.etail�s.�lA..�.iuute�rs�,c�ti�ar�.aLd�ina.�au1s.B�,.�........ �
`e:,af vs
�Iac�a�re..Rsl..z�u�r�x.1,eft.au.B.lac.[camaKc.�sl,...A,p�pxax...X/.4.mile.cl�a�xa�.BlaelinnAxe.lids.la�rgePe�aut..txea.Aga.xighx.tvxth.pAst.B�,t�.Ax. �
Latitude 1 35 • 02 02 u Longitude 78 '_, 08 24
M Wean to Feeder
2600
2600
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes M No
2. Is any discharge observed from any part of the operation? ❑ Yes M No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other .
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (Ifyes 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 D WQ)
El Yes ©No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes M No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes M No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes M No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes M No
7/25/97

Facility Number: 31-280
8. Are there lagoons or storage ponds on site which need to be properly closed?..
❑ Yes
No
Structures (Lai!oonsXolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
N Yes
© No
Structure 1 Structure 2 Structure 3Structure 4 Structure 5
Structure 6
Identifier: 3.1 .,1 M.Q.rj ......... ...........:FWPVSs..................T.UrR y.aD..........................
Freeboard(f():..............1..7.5 ............. .............. 110............. ................$3................ ................................... ................................... ...................................
10. Is seepage observed from any of the structures?
❑ Yes
N No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
N Yes
E] No
12. Do any of the structures need maintenance/improvement?
N Yes
© No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)--
13. Do any of the structures lack adequate minimum or maximum liquid Ievel,markers?
4,
0 Yes
N No
Waste Application
14. Is there physical evidence of over application? .? > -;
0 Yes
® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)-•
15. Crop type ............... .................................................
16. Do the receiving crops differ with those designated in the Anirtial Waste Management Plan (AWMP)?
N Yes
0 No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
N No
18. Does the receiving crop need improvement?
N Yes
Q No
19. Is there a lack of available waste application equipment?
Yes
® No
20. Does facility require a follow-up visit by same agency?
❑ Yes
® No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22. Does record keeping need improvement?
N Yes
© No
For Certified or Permitted Facilities Onlv
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
N No
24. Were any additional problems noted which cause noncompliance of the' Certified AWMP?
N Yes
© No
25. Were any additional problems noted which cause noncompliance of the Permit.?
❑ Yes
N No
-�io �+iotatis ar dsPi�i.eriE�es•were itioted curing rt is �.sit:..>�4011"retelVe nibU lhe'r -_
............................. ...._ .......... ......
:carres�ondence about this:visit .............. .... . • .. • . • • ... .
9) Structure 2 & 3 are both under the required freeboard. Will notify DWQ WIRO. A,
11 & 12) Both Piglets & Turkey Hill need to establish matted vegetation to control erosion. Turkey also has some erosion problems that
should be addressed.
15, 16, 18) No crop planted to spray on. Has not established Bermuda field tract (160 fl ). Also has cotton planted in tract 443 f4, part
of this field. Has irrigated tract 443 fl with no crop. Should contact Murphy or Duplin SWCD for crop recommendations to have a crop
o spray on & have WUP revised to reflect their suggestion.
22) Will need to balance N on records (IRR-2) for crops/ftelds irrigated on. Need waste sample within 60 days of irrigation.
24) Need copy of design for Piglets Playpen.
7/25/97
ReviewerlInspector Name >.0 tr 1 )C+tt�gcrald
Reviewer/Inspector Signature: Date:

Facility Number: 31-280
Date of Inspection F 12/9197
arms cross irrigate & have a combined \ UP. However Piglets is owned by Julia Blackmore. Turkey Hill and Biackmore are owned b
John BIackmore. Should be combined, will check with DWQ about this.
Left message with Andy Hehninger.
Sue Homewood advised no problem to combine and will do such._
4 ndy Helminger was advised of problems and sent E Mail about such. Furthermore a Notice of Referral will be sent.
.1
r, ,
7/25/97

Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSNVC review O Other
Date of Lnspection
Facility Number Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours �--�
Farm Status: El Registered [I Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review I��J
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: _.&)_Q .'Akar..�.yr ._.�.i..> _........ ........... County:..?u�. .................... _.. .1. .
Land Owner Name:.._.,LL�!1 •r„.. ..... _. L a�:C. ..__ ............ Phone No:. .. �. �.� :13
Facility Conctact:
Title:
O `
Mailing Address: _.�......_............Ls�.x• .... ....�1..�.i...�L�..u,...%..........._......
Onsite Representative: .....ICA 9'"X
Certified Operator:....Q R� .... ....... :?.�a` 1i��_ R.w ....__........
Location of Farm:
Phone No:
Integrator: ................... _ ...._ .
Operator Certification Number:
,.Q.r.._._.ut.�s.t.._..5�.�. �.3.i1.S,�...+.....o..��.r�a.�..%.,r�.a. ........__...12....�.5......�xa.,�.l..e<.�I.......�c..%la.......a .............. t?
a
Latitude ©' O ?n ` OZ K Longitude �• ®• �'
Type of Operation and Design Capacity
> Design Current x - Design Current 1 _ DesignCurrent
Swine _ , _. z Poult y ,. ..: Cattte ;.
ace „ Po ulation , .- O' ,.: Ca aci I'o Mahon Y C$ aci <`Pv alatron ti
® Wean to Feeder YI❑ La ❑ Dairy
❑ Feeder to Finish k' ❑ Non -Layer ❑Non-D
Farrow to Wean
�� s
Farrow to Feeder r -Total DesignXapacttyGwY
Farrow to Finish F , IF
SSIN
Y
ON
Number�of Lagoons I Holding Pvuds [] Subsurface Drains Present ^
❑ Lagoon Area ❑ Spray Field Area............
neral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3_ Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
MYes ❑ No
❑ Yes B No
❑ Yes No
❑ Yes B No
❑ Yes
® No
❑ Yes
01 No
❑ Yes
MNo
❑ Yes
® No
Continued on back

Facility Number: _ZI...-
6.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
® No
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
® No
Structures (l.a;oons_ and/or Bolding Fonds
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
[ No
Freeboard (fi): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
_.� .... .._ ...... .... _ .. ....._ ......... _ . ...... _...._ .._
.........................
10.
Is seepage observed from any of the structures?
❑ Yes
HNo
It.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
RNo
12,
Do any of the structures need maintenance/improvement?
S Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
[&No
Waste Application
14.
Is there physical evidence of over application?
❑ Yes
H No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type -........................••—.--••---......... _...._.__..._........ ._...._ ._.. .....
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
Bj Yes
❑ No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
® Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
B No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
0 No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
EKNo
For
C-ertiAmd_Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
O No
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
IN No
24.
Does record keeping need improvement?
® Yes
❑ No
Coniinents'(refer fo guestfon-#)n E.xplam°any YES `answers and/or any recommendations or any'other comments'
Use.drawings of facihty to better explatn.situations (uses d�honal.pages as necessary} '
I M a tjL v ti e. M i : w� .-�. j, o f a r o 25 e t 1, c i-w a e," a r-4-t—
4
S p �k-L o--+�-G1 dl + e-S 0-4- ro o-A I
l Z. C o r re L t" b -o �i Lx,,_4 W t t i.t, S f-v r ,M w e."a 6 1 '► f_t") k eM L'LO V,S f_
�,n+ ova t P.e.
`J
t cw �o ri ry e� 1� o v� Q.v.��� a v, e..j
t b 1
P eL T_ 4-0 .
► g . R `1 t tine d. i a b e_ 1�-0-�-�-�� ' -Q4 c -4 +tiz--J ee.r-kk # 4.
p. -1 e v i-- V S e ln.a�v Q Cv r r-e-v� S o l # a-+ j w ,s i -Q- `' S+ S
Reviewer/Inspector Name
Reviewer/Inspector Signature:aLL". 9-b6 Date: 1
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Facility Number: 33........ ..2,.gD. Date of Inspection:
4/30/97

Division of Soil and Water Conservation ❑ Other Agency
Division of Water Quality
14PRoutine O Coro taint O Follow-up of DWQ inspection OFollow-up of DSWC review O Other
Facility Number 31 795 7�'DateInspection12/9/97
Inspection 0900 24 hr. (hh:mm)
❑ Registered M Certified ® Applied for Permit ❑ Permitted 0 Not O erational Date Last Operated:
Farm Name: Blaeknnoxe.lYuxssxx#2/TurkeY.kLiUNunciry.................................: County:
Owner Name: daho......................................... Black[core........................................ :......... . Phone No:
Facility Contact:
Title:
Phone No:
..IR.O.........
MailingAddress: 150.1urkey.Hill.Lanc........................................................................ WarsAly..N.0 .......................................................... 2839.8..............
Onsite Representative: ............. .............. .............................................................................. Integrator: Mttrnhy..Family-Farms......................................
Certified Operator: John.T. .................................. Blackmort ...................................... Operator Certification Number: .19.624.............................
Location of Farm:
Latitude 35 • Ol 31
Longitude 78 • 08 18
General
I. Are there any buffers that need maintenance/improvement?
❑ Yes
E] No
2. Is any discharge observed from any part of the operation?
❑ Yes
[] No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?"
❑ Yes
[] No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
[] Yes
[j No
c. If discharge is observed, what is the estimated flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
E] Yes
© No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
© No
4. Were there any adverse impacts to the waters of the State other than from�a discharge?
❑ Yes
© No
5. Does any part of the waste management system (other than lagoons/holdiilg ponds) require
❑ Yes
❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect,at the time of design?
❑ Yes
© No
7. Did the facility fail to have a certified operator in responsible charge?- _
❑ Yes
© No
7/25/97

Facility Number: 31-795
8. Are there lagoons or storage ponds on site which need to be properly closed?'
Structures (Lagoons Holding Ponds, Flush Pits etc.) '
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 37 ` :` Structure 4
Identifier:
Freeboard(ft):.......................................................................................................... ...................
10. is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
© No
[I Yes
©No
Structure 5 Structure 6
Yes
© No
❑ Yes
E] No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?,;
(If in excess of WMP, or runoff entering waters of the State, notify DW.Q)
15. Crop type ................
16. Do the receiving crops differ with those designated in the Animal Wastc�Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application? =
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment? .,
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified nr Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
F] Yes
- © No
❑ Yes
Q No
❑ Yes
© No
El Yes
© No
El Yes
© No
❑ Yes
© No
❑ Yes
0 No
❑ Yes
F] No
❑ Yes
© No
n Yes
0 No
❑ Yes
© No
❑ Yes
© No
❑ Yes
El No
2-No•v.iolatiibtls o>r"�e%iericies•Vvere'noted:duriing this -visit., You Vv 11'rUeiVe_nb farther. •"•
.:....e. ..........this:visati........ ........ ............... . .
arm will be combined with 31-280. See this record for inspection.
7/25/97
Reviewer/Inspector Namebb M`+tzgcrald
Reviewer/Inspector Signature: Date:

Y ❑ DSWC Animal Feedlot Operation Revlew
a
®DWQAnlmal Feedlot Operation Si#e Inspection ' .31
�.
Y
G Routine O Com taint O Follow-u of DW ins ection 0 Follow-up of DSWC review 0 Other
Date of Inspection L 1
Facility Number 1 'S �,
Time of Inspection L 24 hr. (bh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
19Certitied ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: x4.ic»� � 1..,-� ...� � s� s ��-A t--o-.»SI.. »� Z County:
Land Owner Name: ..... .._...... Phone No: ..»........ ...
Facility Conctact:.... »...... ............... ...........................».... ». Title: _ ._....»... _ .... ..... » Phone No:
Mailing Address: » �.� Q.. s.t»r ...» I.i»�. .,+.....,....»_..»............jdi. ��? r » �»L .» ......_ .... Z g
Onsite Representative:.._ .o »tom ...... »»...... .. Integrator: ». -Lay—
Certified Operator: ..r�!�1..11.....�nS.. .... ..... Operator Certification Number: 6 1
Location of Farm:
.tl....._ t a�. ; ter+ . »! h..t.I� S .. haa_z. ._ ».....»_ .....» . 4
p »
................... ........ ..... .....-......»......»................»»... _.... » ...._ .....
Latitude • =16 E—Zlu Longitude ®• ®4 ® 64
Type of Operation and Design Capacity
k� Design Curren# `llesrgn Cui renters D.esi �n { ' Current
.max �;..„_PUuI F 4 Cattle g, w.
$wine kCa ace =Po ulahan h y : Ca aciiv x:Po �lat�on- ` Ca ace Po ulatton
Wean to Feeder po❑ La ❑ Dairy
❑Feeder to Finish ❑Non -Layer a z ❑ Non -Dairy
El Farrow to Wean z ��� Vw
El Farrow to Feeder W t e- arro a Total s gn paeiLy y
10 Farrow to Finishil
-�--_.,... x.,.<.. _._
r ❑ Other v� u
< Numlzer ofLagoons / Holding Pohds j ❑ Subsurface Drains Present
_
h �❑ Ill Area [ � Spray Field Area
ne 1
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
0 Yes ❑ No
❑ Yes Iff No
❑ Yes
® No
❑ Yes
Q No
,d)A
❑ Yes
® No
❑ Yes
® No
❑ Yes
0 No
® Yes
❑ No
Continued on back

Facility Number: .. 1.._.—..7.g_
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes [9No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ®.No
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes [NNo
Structures fLanoons and/or Holding Pond
9. Is storage capacity (freeboard plus storm storage) less than adequate? JHLYes ❑ No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
.f..k? .... _. .... .........
�..... _ ....... .. _.......... ... _
10. Is seepage observed from any of the structures? ❑ Yes No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ® Yes ❑ No
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures Iack adequate minimum or maximum liquid level markers?
Waste„ Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................. _ .... ..... ...............................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For_Certifir,d Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
0 Yes ❑ No
❑ Yes 19 No
❑ Yes ® No
❑ Yes
® No
❑ Yes
Jg No
❑ Yes
§9 No
❑ Yes
Iff No
Yes
❑ No
❑ Yes
® No
❑ Yes No
❑ Yes ® No
® Yes ❑ No
Comments (refer to gpeshon #}x Eicplam any YES answers'and/or any recommendations or any other comments
Use drawings of facility to better explain situations' use additional pages as necessary)
A
.0
1 M 0. %Lt S V .,-e 0-� 4 ,., , ,,,,, � v �`� o 5.
4
a. r-e-a. S }� a -d o-.., cl d ► E e:1•.A _� vi o n
v- �- rL 4 t-1 0 ✓1' " [IL V G 1 1L S F E-4 -r q n .r 0, 0- C_
v\, Y-v, &r-v, n
C` L�� i
5• C a t n- c f b; 4 �E-r �` a b t c o r .�—e t✓ f i Ck I a n •� � p� L
c.o Vr ,n -�t Gl t .o f' p v r �jf
cobe,
a
Reviewer/Inspector Name?A..���
Reviewer/Inspector Signature:�Qr i Date: t
cc: Division of Water 4uaU4% Water Oua►ity Section. Facility Assessment Unit 4/30/97

Facility Number:.�_.�..—..�i.a Date of Inspection: 7
Additional Comments, and/or i)rawings Y 'k -'
11.1 Z• v �-ot r P�v t q a r� t I o b cue o-
a l o a !I i-d b e. ►- Q ��
✓+.� u .�-d�nti-P- L � r r-e-►n. i S p t i Q- � S C, vn ct S 1
L fJ o v, a c +- 10
Tr a-G n `� rr- i r� �—i I d v-,
I � ✓fin- ct�v— vLq 'Pivv�.P�,�--�
4/30/97

® Division of Soil and Water Conservation ❑ Other Agency
0 Division of Water Quality
l• Routine O Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O _Other
E Date of Inspection 12/9/97
IFacility Number 31 817
Time of Inspection 0900 24 hr. (hh:mm)
❑ Registered ECertified ® Applied for Permit ❑ Permitted 10 Not Operational Date Last Operated: .
Farm Name:£IgltrjVa.FjAypgjm................................................................................ County: Aupliin................................................ W. JRQ.........
:.. N
Owner Name: ,1ulit..A�............................. .....� Bla�GlunAxe...............................:.. .."....'� Phone No: 9.10.-.3.40.-.292.4 ...........................................................
FacilityContact: .............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: 2239.S.Qjutk.KCencr.Hm'y.................................................................. Stuart -EL....
.............. 34994 .............
Onsite Representative:........................................................................................................... Integrator: ll' Ur.pjhy..k:NWjy..k aM9......................................
Certified Operator:Joba.1,................................... Blachmarc ........................................ Operator Certification Number: .1,9624.............................
Location of Farm:
„I�..lt.7..xQ.�Q�:dims.X:.rctz�tis4.tur�n.>l�fx.,�c.gn..appXu�,,.�,S..nn�ilrs.trz.'der.ate#rx,���tiot►.Xr�r�a.I�:Ft.ux�.B]ac.Isanarr.��d....A�p.prax...tl.:l.�,ilr.... �
urrx.rig>xtar� faraa �Qadn.laa.pask.Ftrsx.baxtt Q.�..aail�x.tlak�t.path.xA.pAg>l�#�t'.p)<aye►,e�n............................................................................................... .
Latitude 35 ' 01 ' 36 u Longitude 78 ' 08 , 36
General -
1. Are there any buffers that need maintenance/improvement? = Q Yes © No
2. Is any discharge observed from any part of the operation? ❑ Yes E-1 No
Discharge originated at: ❑ Lagoon ❑ Spray Field [j Other
a. If discharge is observed, was the conveyance man-made?- [] Yes [] No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) [} Yes E] 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
3. Is there evidence of past discharge from any part of the operation? [] Yes [] No
4. Were there any adverse impacts to the waters of the State other than from a'discharge? [] Yes E] No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes [) No
: maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect af:the time of design? ❑ Yes © No
7. Did the facility fail to have a certified operator in responsible charge? [] Yes [] No
7/25/97

Facility umber: 31-817
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoonsjjolding Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3,,::.: ;,:: Structure 4
Identifier: -
Freeboard (ft): .................... ......
10. Is seepage observed from any of the structures?'.-
11. Is erosion, or any other threats to the integrity of any of the structures'observed?
12. Do any of the structures need maintenance/improvement? .
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes
❑ No
Q Yes
© No
Structure 5 Structure 6
................................................................
❑ Yes
F1 No
[:]Yes
© No
❑ Yes
No
❑ Yes
© No
❑ Yes
© No
15. Crop type..-•••--•-••--••-••••-••-•.......................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
_ r
20. Does facility require a follow-up visit by same agency? _
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onlv
23, Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24, Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
I -No. olatims ar�defiCietides•were'voted-ctuiringg 4is•visit,:You w li'rpteive-nofforther-•:•
•••:correspondenceabiou$•this:visit.�••••--•-•••--�•••••-••'•'-••'.�•.•.-.•:•.•.•.•:•.-.-:•.•:-:•.•..•.•.-.•
..........................................................
Farm will be combined with 31-280. See this record for inspection-
Revierrer/Inspector Name
......................................
[l Yes ❑ No
❑ Yes No
❑ Yes © No
❑ Yes No
❑ Yes p No
❑ Yes © No
❑ Yes © No
❑ Yes © No
❑ Yes ❑ No
❑ Yes No
7/25/97
♦1
TI
Reviewer/Inspector Signature: Date:

DSWC Animal Feedlot Operation Review
a s
'tea% ! YF f 4 Y
�O DWQ Animal Feedlot Operation Site�Inspecflon rrt R
Y
�„ ,
® Routine O Complaint O Follow-u of DWQ ins ection O Follow-up of DSWC review O Other
Date of Inspection
Facility :number 3 $ 1 1
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ® Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Ins ection includes travel andprocessing)
❑DNot Operational Date Last Operated:... ... .... r.._ ...........� »»...............»........ ».... » .. ....._».... .......».... ...........
Farm Name:....[.-: ....... County: � l �. ... ......� ... ..., .� 1
a'.tj2
Land Owner Name:.. 4? t. ..A :. L. . 6 r .................... Phone No: » IQ 3 ..»..�.
Facility Conctact:...aZ4.!`t. .... L a .�,. rt—,n.f. Title:
Phone No:...�
Mailing Address:.A.M.,u).......»S +v o—r f...» .j--.. _»»..» ».... _.3 `}.»1 1.»y
Onsite Representative:...�c .fin , ...�..� �.,-� - Rai gi..r �.... Integrator:._. u.sw..
r- r
Certified Operator: ... �r�n»....�. • Operator Certification Number: .
Location of Farm:
:Q 4....u�►.5.�.�....t.�.x..-...A............. » f. » . a � �•'t:a.�`-L�!�:ta... ..f�.:.... _...x.�.t»� ±ti..r.._.�ra.�.�.�-l4 ..._». 4
ti �^..►L �.nf�. C i�.!�..... W.L �1 5_L�. ��.1.._».........»»............. ................... ...... »»..... ........
..................»».....»...... .... »......
Latitude ©•FOTT Longitude • ®®«
Type of Operation and Design Capacity
3;-�>� �sr, DC$Ig11g"`�Cr1ETEUt � � ,; DeSlgn�CUrrent� .p � r" De51gn '� iUlleIIt �'
Sw °e ^ w. „ x 3 r,Ca 'act P:o'' alation onitry Can act r ulahon x Cattle .:Ca aci Po `elation ;:
❑ Wean to Feeder I❑ La ❑ Dairy
❑ Feeder to Finish ❑Non -La er.jE1Non.-Dairyj
�W
Farrow to Feeder TotalDes gn Capactty� F� ��'
Farrow to Finish
❑
Other
»
� er'i4k
-
Nu�ttber afLagaon§ / Holdtng Ponds' ❑ Subsurface Drains Present
'A ❑ Lagoon Area Spray Field Area
, :�: �-F ;�k .fir .' =_� $__'� �.3, . ���.�:: . � :, �.� 4�,.: � �, ❑ : �
Gtperal
1. Are there any buffers that need maintenance/improvement? ® Yes ❑ No
2. Is any discharge observed from any part of the operation? ❑ Yes J9 No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes 10 No
c. If discharge is observed, what is the estimated flow in gallmin? 4) A
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 0 No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes P9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes $ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes JR No
maintenance/improvement?
4/30/97 Continued on back

Facility Number
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 19 No
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structur s Lagoons and/gr Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
.�� ....... ....... _ ....
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes ®No
❑ Yes ®.No
❑ Yes [&No
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type..]!'.!�.P........... ................... ............. _....__..... ...................... _....... ......... .....
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For -Certified Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes
No
❑ Yes
® No
K Yes
❑ No
❑ Yes
ffNo
❑ Yes
R No
CgYes
❑ No
❑ Yes
® No
N Yes
❑ No
❑ Yes
® No
❑ Yes
O No
❑ Yes
JBNo
❑ Yes ® No
❑ Yes ® No
ja Yes ❑ No
Comments (refer to questton'{f) Expiam any YES answers`and/or,any recommendations or any other comments
Use drawings of facility. to better explain situations. (use addthorial pages as necessary) 3" A �
1. M aV--L s v ,tie,. v f o 2 ,5 f -Le q
Sr e4
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8 L
a V% c 04 h-O .tl a'v Z,e— V 'P_ V` i1 uJ a"' Y )
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r
U-1 •4 b 1?-e — � K-P,+ 0.j L4 �^—t G n s� c +r 0
Reviewer/Inspector Name`` M hrk s
Reviewer/Inspector Signature: y, T , o�Date: !
cc. umtsion o) wafer Livattry, water guauty Jectton, Factttty Assessment Unit 4/3U/97

Facility Number: .3.5...... Date of Inspection:
Addihonal'Cpmrnents and/or Drawings'.�y
Z�I L L a K v Tv —a- Lf 0�� 1@ X k V
r C- C.o ,r L
4/30/97

Site Requires Immediate Attengon:
.S
Facility No. DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 7 - Z , 1995
- Time: 2 ' �l 1 _ /J Ai -
Farm Name/Owner:
Mailing Address:
County: DV
Integrator- %
1;12Ckr4CvrC_ 1 JUr5e
Pa Eo � -7 59 [�osP
On Site Representative:
Phone: 28CJ—21 11
Phone: Zq-;
Physical Address/Location: K CDC 5zw 2 16-39
1 i -7 - 5F-, 133-7 i:E' f- en A) 131 'Z m �� .. ��-� eJ. co P
Type of Operation: Swine Poultry Cattle Nurse
Design Capacity: 2 (P 10 Number of Animals on Site:
DEM Certification Number: ACE f DEM Certification Number: ACNEW
Latitude: '55 ° 02 ' QZ - Longitude: I'Z 09 ' Z41 " Elevation: - Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of l Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes o No . Actual Freeboard: Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or No -4yec.
Crops) being utilized: _ Cdrn-- - -- - --
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings. Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 1.00 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes 00
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes 01& If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? e or No
Additional Comments: K)e C5 more— G l e_-x b L.,.+
L,. (' L , 5
Inspector Name .
Signature
cc: Facility Assessment Unit, Use Attachments if Needed.

Site Requires Immediate Attention:
' Facility No_
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD —
DATE: l7 -Zj , 1995
. Time: 3. 15
Farm Name/Owner: �ti 1 -t 5 F r1 JQR� 91ACKAW91�1'
Mailing Address: -759 kG' - r'� I _ .2S 4S?
County: n +r)
Integrator: OVT%u Phone: 2 Z
On Site Representative: N2G more Phone: 7.2_$ 3
Physical Address/Location: Cl 1 . 60)( 607 W 7X5-.�w 3�
52 133 7 r.'r h f vn /-b 5tZ 134D ? M , e•-, _ on le f!f 5
Type of Operation: Swine �� - Poultry Cattle
Design Capacity: %( Number of Animals on Site:. 24
DEM Certification Number: ACE ✓ DEM Certification Number: ACNEW
Latitude: _° _ 01 Longitude: 8 ° O g ' ZSS Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event��,��
(approximately 1 Foot + 7 inches) Yes r No Actual Freeboard: 2- Ft. Inches
Was any seepage observed from the lagoon(s)? Yes o o Was any erosion observed? es or No
Is adequate land available for spray? d or No Is e cover crop adequate? Ye or No
Crop(s) being utilized: &rn, )V;J�k Gros6 .
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings9 E>sr No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, Iand applied,
spray irrigated on specific acreage with cover crop)?t Yes or No 1
Additional Comments: K�d Or 2SS o^ Sl _S QCOrd 1,1-eD
e:
L tl) Q`2 L &A � /' 5
Inspector Name Signature
cc: Facility Assessment Unit
Use Attachments if Needed.