310287_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

(Type of Visit: C Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit: &Routine O Complaint 0 Follow-up 0 Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: �� Departure Time: County: Region: �{/I
Farm Name: �,� 6yy r t ! 2, Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 0-0 ^
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: /
Certification Number: 1 iO
Certification Number:
Longitude:
Swine
n to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
can to Feeder
sv 0 Z4Q
Non -La erEE
DairyCalf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
D . Pauft ,
Layers
Design
C*_a aci
Current
P,o ,.
Dry Cow
Non-Dai
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Other
Other
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Caw
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes - No ❑ NA ❑ NE
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
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

r1
"I'lFacili!jNumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? 0 Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 6No ❑ 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
`, - ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t, notify DWR
7. Do any of the structures need maintenance or improvement?
❑Yes
No ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
io❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes
o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
alloO NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
5:4NA ❑
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
o ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
ff No ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
No ❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[DIZ ❑ 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 Ins ection:
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 o ❑ 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 ff No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No 015A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other;
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
❑ Yes No , ❑ NA ❑ NE
❑ Yes No [] NA ❑ NE
❑ Yes C rN0E__1 NA ❑ NE
❑ Yes
❑ Yes
❑ Yes
No ❑ NA ❑ NE
NoNA ❑ NE
[]' ow ❑NA ❑NE
Reviewer/Inspector Signature: `{ Date: - eje A- 6Z_
Page 3 of 3 21412015

0@)
#iiiiiiiil,,ot_s_oiil[affc[LWater!LUIonser�vationM
`""ion of Water cility Number - Zffr Agency
Type of Visit: 0 ?Rooutine
ance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Q Complaint 0 Follow-up Q Referral 0 Emergency Q Other Q Denied Access
Date of Visit: L 2 Arrival Time: 3 Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: PO'^ 1 / t� Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
We to Finish
can to Feeder top 5A9 o I
Wet Poultry
Layer
INon-Layer
Design
Capacity
I
Current
Pop.
Design Current
Cattle Capacity Pop.
DairyCow
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dr.. P,oultr,
La ers
Design
Ca aci
Current
P,o
Dairy Heifer
D Cow
Non -Dairy
ker
Gilts
Non -Layers
er
Boars
Pullets
d Cow
Other
Other LjOther
Turke s
Turkey Poults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes 6--NQ-❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: jDate of Inspection: 2-
Waste Collection & Treatment �
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 1Q Ko ❑ 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 Z—
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):� Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �o ❑ 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 El No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes EfNo ❑ 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 E:fNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l 0% 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 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 EfNo ❑ NA ❑ NE
l6. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes Q'No ❑ NA ❑ NE
❑ Yes La'&'o ❑ NA ❑ NE
Required Records & Documents
Did & Permit
Yes
N '
NA
NE
19. the facility fail to have the Certificate of Coverage readily available?
❑
❑
❑
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 t ppropriate 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 I" Rainfall Inspections
/ ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[—]Yes
❑rNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

IFacHk Number: - 26- Date of Inspection: 2
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 qo_ _❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [ ""' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑-}A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes JZjo ❑ 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 6 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
E3No
❑ NA
❑ NE
❑ Application Field ❑ LagoonlStorage Pond ❑ Other:
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
[� N
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments.(referAo question ft Explain any YES.answers.and/or any additional recommendations or any other comments.
Use.drawings.of facilitvto.better explain situations fuse additional uaffes as necessarv).
1 C-0 /` S —Y 94 C
'� �''I �2 Lt S l �. L ./ n ? Gi ` s s G�•.- 9L, ?-S i �� �D
o fl v c--
Reviewer/Inspector Name: 90L ✓r7 ���.-G f I Phone: f q
Reviewer/Inspector Signature: �,�- Date: Z /lam
Page 3 of 3 21412015

Type of Visit: Cam nee Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: FTF2 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: 0 O nn { 1 /C h o r n t'j�b 7-
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Integrator:
Certification Number: t f G 1-3
Certification Number:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
@urrent
Fop.
Design Current
C*attle Capacity Pop.
Dairy Cow
can to Feeder qzoo ,Sqo
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D , P,oultr.
Design
C•_a acit
C++urrent
Pao
Dry Cow
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes Er5o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes
❑ No
❑ Yes
to
[—]Yes
[]No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3
21412015 Continued

Facility Number: 7 - Z Date of Inspection:
" Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
EfNo
❑ 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: Z
Spillway?:
Designed Freeboard (in): Iq•5
Observed Freeboard (in): ) r' It 3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ff7No
❑ 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 ENo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ONo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 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 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N-o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
f
i
❑ N
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
ReQuired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes FD"No ❑ NA ❑ NE
the appropriate box.
❑ WUP [:]Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the.appropriate box below. [l] Y s ❑ 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: '9�- Date of Inspection: if 2S
' 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [D No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETNo ❑ 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?
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)
[:]Yes ❑- 0
❑ Yes ❑ No
❑ Yes ENo
❑ NA ❑ NE
NA ❑ NE
❑NA ❑NE
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes []"No ❑ NA ❑ NE
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
[—]Yes [E: N.
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes [ "No
❑ NA
❑ NE
33. Did the ReviewerAnspector fail to discuss review/inspection with an on -site representative?
❑ Yes —
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes �rNo
❑ 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). .
ZI Ft e Q 2—A ��K� rA lfz3 i0/1, if M ?..1 9 V 5 C �7sS73,
nv p�ir'uPP��`ca"o "
Z fo�6 12 0lY k5,ej k4 Q^ sl�7/' Y
'a ,i 1 jr• ~ usC'rf 1n09"'re` v L`/pnn 1i✓Iq_
F �0{%!`rJ 9 tC P/C"' OT1�Gi"DnS A,c� �'C�4ofds
?;Zo 1 Ll -- 6/2-91 S -
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3of3
0.4, fC( Co --e ((
Phone: j1gnj 7
Date: [L
21412015

Type of Visit: omptiance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 2 / Arrival Time: eparture Time: County: /� Region: G
Farm Name: �Q,(% Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Swine
Design Current
Capacity Pop.
Design
Wet Poultry C*apacity
Layer
Current
Pop.
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Finish
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
Dr. P,oul Ga aci
ILayers
Non -La ers
Current
P,o ,
I
Dairy Heifer
Dry Cow
Non -Dairy
113eef Stocker
113eef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other Ao
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
4
Page I of 3
❑ Yes j' No ❑ NA ❑ NE
❑ Yes 4n No
❑ Yes ,"No
❑ Yes ,Efilo
❑ Yes .[fl No
❑ Yes JEJ'14o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
21412014 Continued

.�xe)
Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 014o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [! No ❑ NA ❑ NE
Structure 1
Identifier: <
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes JZ 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 0"'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 2rNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �o ❑ 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 V No ❑ NA ❑ NE
maintenance or improvement? TT
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need [:]Yes LD�No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. eyes ❑ 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',E No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes Z No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable [—]Yes ETNo D NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes 8 No ❑ NA ❑ NE
❑ Yes JZ No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes ,fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,f No ❑ NA ❑ NE
the appropriate box.
❑W1JP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other.
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 1EVNo
❑ 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 16 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ETNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412014 Continued

Facili Number: Date of inspection: 1
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E�rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes fffNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ,�No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes El"No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes J 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 Eno ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes Pa"&o ❑ 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 FZrNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ED% [DNA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes E�]rNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes f2'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 additionahpages as necessary).
Il l t 1 ()-eec( Je-) d-ejSapP62, Y01 61en Z • Z-A-1 levt- Css
leue'f plec-5c w5r�PLe
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9a771! 7(12 iy
Date: —5
12 -7 // �/
l/4/2 4

Type of Visit: _Q 6 npliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: �outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:01
Arrival Time: V 0 c- g R&Abparture Time: County: D_tp/4� Region:
Farm Name: �_ Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: '�)d' r \Jjj `
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current
Wet Poultry C•apaeity Pop.
ILayer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder I
INon-Layer I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C*urrent
D P,oultr.. C►_a aei P,o
Layers
Dry Cow
Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
P!TNo
❑ NA
❑ NE
❑ Yes
Vj No
❑ NA
❑ NE
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 E�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
21412014 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
- 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes Z[ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ' �^
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �J !�-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes JZ 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 En No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ff No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
2No
❑ 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 21 No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes ff No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑ Checklists ❑ Design [:]Maps ❑ Lease Agreements
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes Q" No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
o
❑ Yes EfNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes [[J
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 2 o
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check _A"Yes ❑ No
the appropriate box(es) below.
*f _i r ailure 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 �❑i 1No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes J2-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 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
❑ Yes [2'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 2 No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes O�No
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ,E!fNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes 0 No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any -additional recommendations, orany other comments-, :.
Use drawings of facility to better explain situations (use additional pages,as necessary).
s-ctrv_en P62,
�L 4,� r
''%a/i' oz r0,i-of add le<) -le dod"
Reviewer/Inspector Name: Phone: #6;
Reviewer/Inspector Signature: �^ / Date: r, A d
Page 3 of 3 4/2 4

Type of Visit: om Hance Inspection Operation Review O 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: Z Arrival Time: Departure Time: County: Region:
Farm Name:.Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone: .
Onsite Representative: Integrator: In Zo
Certified Operator: Certification Number:
�o
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
I
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Daig Calf
Wean to Feeder
INon-Layer
I
Feeder to Finish
Design Current
D P,oult . Ca aci P,o
I Layers
Dairy Heifer
Dry Cow
-Non-Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
keys
Turkey Poults
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 P No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ff 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)
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
❑ Yes .yNo
❑ Yes. 6 No
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

FacWty Number: jDate of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,ff No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ,E] No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes F,�TNo
❑ 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 ZNo
❑ 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 0 No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes J2,�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes Z No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes P No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
[] Yes 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?
'J2
❑ Yes P No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes [,_,�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ;�!'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes PrNo
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the 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 No ❑ NA ❑ NE
the appropriate box. T
❑WLIP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. l'Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? [—]Yes P"No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes JEJ'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes -0 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ff No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
;2 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
.0 No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
Flo
❑ 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
�TNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
�ZNo
❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[Z No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
Vi No
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better ezolain situations (use additional naves as necessarv).
P_ - ,SGcg% SUnueD exF. liy4IS .o"2c,/y..C-6r
y/If 113 6 11 AP.- I LI 11 q/ 13
01ab)(r �Av used
z V-6t5k "TKal� 511
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
k61�5a
Phone:
? /6-
Date:
21412011

Type of Visit: __C�-Cbmpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: j-Routine 0 Complaint 0 Follow-up 0 Referral 0 EmerQencv 0 Other 0 Denied Access
Date of Visit: Arrival Time: .' parture Time: County:
Farm Name: 6'r _&L'ef / Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Phone:
Phone:
Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number: -
Longitude:
Region: C�
Design .Current Design Current
Swine Capacity Pap. Wet Poultry Capacity Pop.
Design Current
Cattle Capacity Pop.
Wean to Finish
I ILayer
Dairy Cow
Dairy Calf
Wean to Feeder
I INon-Layer
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
I) , P■oul. Ca aci P,o P.
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Beef Brood Cow
Boars
Pullets
Ot
Other
Turke s
9 ITurkeyPoults
I 10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes.A!�No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Ye& 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)
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?
rJ
Page 1 of 3
❑ Yes ZNo
❑ Yes E No
❑ Yes T214
❑ NA ❑ NE
DNA ❑NE
❑ NA ❑ NE
21412011 Continued

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

Facility Number: Date of Inspection:
24. DiO the facility fail to calibrate waste application equipment as required by the permit. [:]Yes ETNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes,tNo ❑ 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 No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ YeszNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes z No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes ;D No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes �No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 6No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes (�j No
❑ NA
❑ NE
C_omments (refer to question:#)::.Explain any -YES answers and/or.>any additio�n_a.l, ,recom�m. en_ dat:i�ons_ or. any, other-,c� omwm�ents
Userdrawgf facltytbettpuse{additional. pages as necessary), Ai``"-�",,. ; tom• =�.�
^
4J (�fp_e
1��!rU lecr.
l'6
[� I
0
���rz l'3 0
/sQ
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
4h,s yc�i
Phone: ( 6
/
Date: i�
2 4/2011

�Dtvision of Water ualtty
,0A
Facility Numb°er f 'ision ofiSoil and Water,Ctr onservaon
Q O theeAencj
Type of Visit Q ompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit outine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit:1.467A?"'Prival. Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: _ Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: DIAWd&4WRV4 Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: o =]' 0 « Longitude:
7XP C
Design %CurrentDesiga . Current
Swore Capacity Population Wet=Poultry ^ CCapacity Population
❑ Wean to Finish ❑ La er [
❑ Wean to Feeder , ❑Non -La er
❑ Feeder to Finish [
jw
;' ❑Farrow to Wean
Poultry g.
❑Farrow to FeedDryer
❑ Farrow to Finish
Z ❑ Gilts
❑ Boars
Other Y
❑ Other
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
attle� ` 1
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Co
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 ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
El Yes
El No
❑ Yes
❑ No
❑ NA
❑ 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 ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St toe I Skuctyre 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or i 0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments.(refer,to. question #): Explain any YES answers and/or eny re'c lommendations or any other comments''`
Use drawings of facility lob. etter.explain,situations. (use. additionalas necessary):,.
P g : a es;'y
..
0 Need 26 6?d'61 eA'eqX1- 4��66
/4 �&' /.&, 1h/A'15 k a
Z/
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
Page 2 of 3
12/2VO4 Continued

Facility Number: — Date of Inspection 000
��
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
WYes
❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
#Rainfall ElStocking ❑ Crop Yield X 120 Minute Inspections ❑ Monthly and 1"
((Did
Rain Inspections ZWeather
Code
22.
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
G
Did the facility fail to calibrate waste application equipment as required by the permit?
s
)W`
ZNo
ElNA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
7Yes
❑ No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
-and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
�o on s1f.(d�sai�s
assu (kW S (A)3c sulvl�i
11014flIo -FFom �Gd$
sludy sur+kot��
Page 3 of 3 J,A,j,42eGy'lv'-1, 1f- NO fic"

Facility Number: - Li f ' ' jDate of Inspection:
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 [DNA ❑ 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 ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes
0 No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
33. Did the ReviewerlInspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): 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).
w
/D/r//° &G ,Z / L A 'ej 9tri )14 Q C_�� /
pLG A / .S- �Q� ao� TJO en -77 Z�
AM � �, &S
.Y W� ti•� hover -e
frd
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
fa��s. /,b
Phone: �< G� 7< 6
Date: D le
V4/2011

Type of Visit (Ortompliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Q outine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: % (j Arrival Time: 0111 d • Departure Time: County:
Farm Name: d/ ltLCd. C 2/�7�/cP Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representativ
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone/Now
Integrator• 11 �r J
Operator Certification Number:
Back-up Certification Number:
Region: A -
Latitude: = o = . Longitude: = ° = 1
Design
Swine Capacity
Current
Population
Wet Poultry
Design
Capacity
Current
Population
Design Current
Cattle Capacity Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
I ILI Non -Layer I
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Farrow to Wean
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
❑ Boars
OMe
❑ Other
El Pullets.
❑ Turke s
JEI Turkey Poults
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
0 No
❑ NA
❑ NE
❑ Yes �No ❑ NA ❑ NE
12128104 Continued

Facility Number:-j — Date of Inspection
Waste Collection & Treatment F4H�'
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes.,,J�No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [--]Yes )2'No ❑ NA ❑ NE
Struc re 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 4TNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ,FZNo ❑ 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 El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Apnlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes )E No ❑ NA ❑ NE
maintenance/improvement?
l l . Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ,21 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 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
12'No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
W No ElNA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ YesWNo
El NA
El NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ NA
❑ NE
Comments (refer to question" Explain any YES;,answers -an dior any recommendat�onsFor any.other comments * ,
Use drawings, of facility to better explain. situations (use additional pages as necessary)
��.:. M_.� `max.
in -
.� U G 1 � D� S�Gc�e s��v .5 /�SScprj-���
AL
Av,,,
ReviewerA n spector Name ; Phone: Q
Reviewer/inspector Signature: Date: Z O
12178104 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 WNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Xyes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard jzrwaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections [:]Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
ErNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
Pfio
❑ 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
�Ko
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
;3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
;3'No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;3No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
o
ElNA
ElNE
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
[INA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
e UCc7� o� w��e 4�a yPdPs��s
y / /
12/2&04

Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Foilow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: /Arrival Time: : d 0-Departure Time: County: T
Farm Name: < 4 j Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
2 2 /(,- J7�'
Certified Operator:
Back-up Operator:
Phone No:
Integrator: /
Operator Certification Number:
Back-up Certification Number:
Region: 6`r4_
Location of Farm: Latitude: = o = d = d Longitude: = ° ='
= "
Design Current
Swine Capacity Population
Design C*urrent
Wet Paultty Capacity Population
Design
Cattle Capacity
Current
Population
❑ an to Finish
10 Layer
❑ Dairy Cow
❑ an to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Boars
10 Non -Layer 1
Dny Poultry
El Layers
❑Non -La Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
O#her
Number of Structures:
❑ Other IFEI Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes VNo
❑ 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 ETNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes P�No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: ' — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Ffo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes YrNo ❑ NA ❑ NE
lure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 07
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ;2^No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,�(
6. Are there structures on -site which are not properly addressed and/or managed ❑ YJ 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 )ONo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes )ZI No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 16No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes t T 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.ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
EfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
[I NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
�No
7No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Ej,�lo
❑ NA
❑ NE
ao,��ao
r
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: G
Page 2 of 3 1 8/0 Continued

Facility Number: — Date of Inspection
Reauired 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 ZJ'No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes )TIo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ZfNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ONo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes fi3'No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes V�No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes ANo
ElNA
ElNE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes P,(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 0 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 PNo
❑ 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 [7No
❑ NA
❑ NE
Page 3 of 3 12128104

�0 Division of Water Quality
Facility Number, 2 .Q Division of Soil and Water Conservation
-- - 0 Other Agency
(Type of Visit ,Q-Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit r/ Arrival Time:, � Departure Time: County:
Farm Name: f[2� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: v7Phone
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
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
Boars
Back-up Certification Number:
Region: e-AJ N�j
Latitude: = o = = Longitude: = ° ❑ i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
I--- ❑ Non -La et ---
Other
❑ Other
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
EFDry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:
i
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 El No El NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ 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
❑ 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: 7
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were -answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
E] Yes
❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste A lication
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
t4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No ❑ NA ❑ NE
Comments (refer to question 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):
L
er/Inspector Name U H �f (� Phone:er/Inspector Signature: Date: cS—
IL1161114 c.onttnueu

Facility Number: — 8 Date of inspection
t
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. ZYes ❑ 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?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Additional Comments and/or
/Drawings:
V Q vV-CJ�-� li'� t� _ Y,�` Ci✓6 (5z
12128104

❑ Wean to Finish
can to Feeder
p-C
GQ
❑ Feeder to Finish
i
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
EL—i
Other
❑ Other — - - - - - --,
Division of Water Quality
. FFa6lity Number M
� Q.:Division of Soil and Water Conservation
M
-_ _!
CYOther Agency -
Type of Visit Compliance Inspection Q Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: LAXl3�'7G Arrival Time: 1Q[)�.1Departure Time:: County: Region:
Farm Name: Y�� / �,,WIV /ya.K�e,</ l o� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No. -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = =' [=] Longitude: = n =' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ La ers
❑ Non -Layers
—
El Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
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?
Page I of 3
/f
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
El No
El NA
El NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ 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?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?. -
Designed Freeboard (in):
Observed Freeboard (in): 2
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector NameU� 1�a� Phone: — 7
Reviewer/Inspector Signature: Date: 6 D
Pave 2 of 121f8104 Continued

-Facility Number: 3— Date of Inspection y Q
ReQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 1'es ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield L3 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with -an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
��'� G�
J ��36
C1
�l ' (/)
441
1' 7
;7 ' 3 i°
/' T
1 C l a� - e r- P-6 Yhk nit �e �'�w•6' i n5
n/,✓� � � ,r.�evu-.� ray � � �
%GarclS �r C s i'r�
[a)
1. 7
43
C�
/F
Page 3 of 3 12128,104

Type of Visit 11 o pllance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit( Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: % G Arrival Time: 06 Departure Time: County Region:
Farm Name:.,��S�+Q r �r�,u� rS��.a Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite RepresentativeT.0_nA _��
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
Other
❑ Other
Phone:
R Phone No:
Integrator: lyLl .ip.�„�
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = I ❑ Longitude: = o =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
-2-000 O E ❑ Nan -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Ileifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (Byes, 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
El Yes
No
El NA
❑ NE
❑ Yes
Rio
❑ 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 ';2110 ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ yes ,.L�Mo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes',(2'1Qo ❑ 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 ONo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ,2 No ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ErNo ❑ 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 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 12'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ErNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination![]
Yes L'No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ,2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;;<o
❑ NA
❑ NE
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date: 7 d S
12128104 Continued

Facility Number: 3 —'IV
©ate of Inspection 7
Reauired Records & Documents
19.
Did the facility fail to have 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
❑ YesZ No
❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
zYes ❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stockingrop Yield �r20 Minute Inspectionsonthly and 1"
Rain Inspections El Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ,23'No
❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,2 No
❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 2No
❑ NA ❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 020&o
❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes L;JNo
❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ;;jfilo
❑ NA ❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes,,[20&o
❑ NA ❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �?No
❑ NA ❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ONNo
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
�
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes ZI No
❑ 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 EfNo
❑ NA ❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ' �"<
❑ NA ❑ NE
Additional Comments and/or Drawings: ;=
l
lease 'Ce c co C- c� �-'r `� e� S
• 1 v\
12128104

(Type of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: d Tune: •� G o
- ... Not rational 0 Below Threshold
�Permitted�Ce �ed � Conditionally Certified 13 Registered Date -Last OpeZz��.a
or Abo a Threshold:
[[iFarm Name: .. �1 QLI __.c!�'� `/ County: ___..
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative: r,
Certified Operator:
Location of Farm:
Phone No:
Phone o:
Integrator. !�
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' « Longitude • 4 Chu
Discharges & Stream imp Ms
1. Is any discharge observed from any part of the operation? ❑ Yes �10
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other d
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 galtmin?
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 -ff *N'-o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes .TNNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes .2" 0
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: _ — z
Freeboard (inches):
12112/03 Conirnued

Facility Number: — Date of inspection
5. Acre there tiny immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Pilo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or C] 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 -Ef No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? [3 Yes 3 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes Jjallo
elevation markuugs?
Waste Application
10. Are there any buffers that need maintenancehmprovement? ❑ Yes ;],IQo
11. Is there evidence of over application? If yes, check the appropriate box below. [:]Yes 2 No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops
with those designated in the Certified Animal Waste Management Plan (CAWNIP)? ❑ Yes ,allo
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre detonation?
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?
Odor Lssues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
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
Air Quality representative immediately.
,-ff
0/e
Reviewer/Inspector Name 2
ReviewerAkspector Signature:
❑ Yes EI'No
[:]Yes J2110
❑ Yes 5rKo
❑ Yes ZN-0
❑ Yes �No
❑ Yes 0110
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Feld Copy ❑ Final Notes
Date:
l7n7in3
Cendnrted

Facility Number: % Date of Inspection $ P
M
Reduired Records & Documents
21 _ Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes ,algo
22_ Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
❑ Yes ETlio
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes J:wo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes ,01 o
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes E'Ro
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
(ie/ discharge, freeboard problems, over application)
_,ETRo
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes ,,8"No
28. Does facility require a follow-up visit by same agency?
❑ Yes 2'lgfo
29. Were any additional problems noted which car=ce noncompliance of the Certified AWMP?
❑ Yes 42*o
I
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes ONo
3I. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ 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
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit:
12112103

Type of Visit ® Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit Urnoutine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Facility Number
Date of Visit: f i d Time:
Z
�,,,�
Not O erational Below Threshold
0 Permitted Certified [/ Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: �I4�F�A4�U70V� �'f''��°'�Z _ _ County �l�1.•�_
Owner Name:
Mailing Address:
Facility Contact: Title:
Onsite Representative: Aj4
Certified Operator:
Location of Farm,
Phone No:
J�Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a 0u Longitude 0
-'
Design Current Design Curretrt @esEgn - Current
Somme Ga ae3ity PoliM*66n Pouf ". Ca acit6-.Po ulatian Gattie Ca acxty -Po' tiliti(i
❑ Wean to Feeder W _`' ❑ Layer x-; ❑ Dairy
eeder to Finish !7 ❑ Non -Laver = (] Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Totsi=Uesigri Capacity.
❑ Gilts
❑ Boars Totai�SSLW
Number of Lagoon Y_: ❑ Subsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
)Eioldiiig Pa©tls / solid.Trips 'Di p ❑ No Liquid Waste Management Svstem
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d_ Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: [ 'L
Freeboard (inches):
❑ Yes EgNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [9-igo
❑ Yes E3-m
❑ Yes o
Structure b
05103101
Continued

r
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes [9-Ko
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ED-Ivo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do anv of the structures need maintenance/improvement? ❑ Yes L.1 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
L41No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
99-55
Waste Application
I0. Are there any buffers that need mm aintenance/improveent?
ElYes
,,,71v�
Lo
11. Is there evidence of over application? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload
El Yes
[��
�'
12. Crop type ,,// 14 6z' T —
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
B&
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
RIN-0
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
ENo
16. Is there a lack of adequate waste application equipment?
❑ Yes
Q o
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes EiN-o
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 EFNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes Em
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑1q0-
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 0-110
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes O 1`l0
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Elr�o
24. Does facility require a follow-up visit by same agency? ❑ Yes 231qo-
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [9<0
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to -'question #) Explain "y YES anwe—ri s°arid/©r any recammendations,or any other comments. _ N
Use`drawt>tgs of facility to better explain sttiiahons.T(nse ad Ira nal pages'as necessarvj 0`Field Copv ❑ Final Notes7.
' ten 9 A'ee- d ��s 604 �oo0.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: 1 l

- ..
Facility lumber: — Date of inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. 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 C5-.qo
❑ Yes [fro
❑ Yes Ei-'50-
0 Yes ®-No
❑ Yes [9'1To
❑ Yes Ei da
El Yes [5-'o—
Additional Comments and/or Drawings:.,
O5103101

! ,* f Water Q
DIVLsIon o uaLty
4 a ✓4}
Y
'At
r, r Y
{
0 Division of Soil -and -Water. Conservat,on
0 g Other A en�
� �"ti�
�....:
�
��•
,fix. ... ...
.. .� ._.
.. .... .. ,.. .....,20
F
Type of Visit )9Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit jXRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 Z Rate of Visit: I
E3 Permitted Certified © Conditionally Certified 0 Registered
Farm Name: J2f vUC Nvese r [ � Z
..........•.............................................
..........
.......
.
Owner Name; o r vi e Gt ar O t 3' s ,
............................................................I.......
Facility Contact: .....
�Ti�nc: 17. SS Printed on: 7/21/2000
Not Overational O Below Threshold
Date Last Operated or Above Threshold: .........................
County:..D-.11 f .�.` ..........................................................
Phone No:.,
..... Title: ........................................ -
MailingAddress:...................................................... .................
Onsite Representative: ... D ... .!?'... e..1,,,.............,.. ..! .. �
Certified Operator :..................................................
Location of Farm:
Phone No:.,,,,,,,,
.•.............................................................I.....--•--.... ..............
Integrator:...!" .. q!-m— .............................
Operator Certification Number: ........................
.M`5wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� �� Longitude �• �' °°
Design Current
Design Current Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle Capacitv Population
Wean to Feeder
132-0 Q
4 f 00
❑ Layer
I
I
Dairy
❑ Feeder to Finish
IFI Non -Layer
JEJ
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lags on Area ❑ Spray Field Area
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System .
Discharges & Stream Impac
L Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. 11 discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State'' (It yes, notify DWQ)
c. if discliarte is observed. what is the cstitnated flow in gaVmin?
d. Does discharge bypass a lagoon system'' (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
,Structure I Structure 2 Structure ; Structure 4 Structure 5
Identifier . ................ Z
Freeboard (inches): Z r
5100
❑ Yes V No
❑ Yes 5No
❑ Yes A No
kijr,
❑ Yes �R No
❑ Yes � No
❑ Yes N No
❑ Yes -] No
Structure 6
Continued on back

Fac ity.Number: ' — Z 8`] Date of Inspection 2� Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes eNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes JZNo
(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 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes WNo
12. Crop type (' a r rt 1 (nle q� S U b CA t�' 5
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes }XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes N No
b) Does the facility need a wettable acre determination? ❑ Yes 5fNo
c) This facility is pended for a wettable acre determination? ❑ Yes 5a No
15. Does the receiving crop need improvement? ❑ Yes 0 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
P No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
EffNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WLJP, checklists, design, maps, etc.)
❑ Yes
BrNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
19 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
9No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
JA No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ic/ discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
•Yi. tigi}s.or• deticienc{es •were pQfed dt ihm �his;visit. •Yoh wiii•reegiye 4o fu�th�r'
cories otidence. a] au this visit_
Comiments ("refer to gnestton #} )Explain any YES answers andLor any recomznead 66& orr any otl etr conlit A
Use dra,twi�ngs"of fa Id. itytto better explain sitaatrc►ns (use add'ifro mal pages as ssaryj �
>{g, 1vGedi T6 010rfL'rIC14 w)'4(, reeordS.
I , 5o"e b-P 41,f �� �iot� e-Vt►7-IS L lefe recoeded As o c corpet"V9 dn.
Sy' �
Gl ifrerG-4 n meeGti L+ •� QC(!ure-eq Oj1, Use GkV4+ate ahOt
✓fit p�Ql ei/e�t-�-S o, ► 'TK?K - Z'S on i G pe'r yPci y Qree% .
O•�P��f1, (c; N4 4 recor4f wetj kerf.
Reviewer/Inspector S�o�:tLvh� `,4}. S�.r� _ ._ _FA `a,' '_
��
Reviewer/Inspector Signature: J �`� Date: -Z/z L3j✓ 01 5100

Facility Number: Date of Itvspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge 3Jor 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 VNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes $ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )�No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32_ Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Kona : ordments:an orDrawings:
+I
J
5/00

Routine
Facility Number
Follow-vo of
of DSWC review O Other
IDate of Inspection I (�►—UrJ I
Time of Inspection F—'71-Q—1 24 hr. (hh:mm)
0 Permitted © Certified © Conditionally Certified © Registered L
Farm Name: .....��7rC{4°-1....`..T.�-�?.. ..................
Owner Name. ............... ------...... .
Facility Contact:
Title:
t O erational I Date Last Operated: ...................
t.
County:....: !.�.......................
Phone No-
.......................... Phone No:.....
MailingAddress: ..................................................................................................................... ..................................................................................... ..........................
Onsite Re resentative• Inte rator• J
p ... G�.................................................................................. g .. .. f,.,,�: fir.... ..............................................
CertifiedOperator: ...................................................................
Location of Farm:
Operator Certification Number:.............. ............................
Latitude 9 1 4& Longitude 0 & 44
Number of Lagoons ❑Subsurface Drains Present ❑ Lagoon Area .
Holding Ponds % SoI�dXraps ❑ No Liquid Waste Management System
❑ Spray Field Area r
N _i
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
P(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes
❑ No
c. If discharge is observed, what is the estimated Flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes
JxNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than.from a discharge?
❑ Yes
�RNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
29 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (inches) : ............� l !� ..................................e�...1.............. .... ............................... ........... I ........................ ....................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
BfNo
seepage, etc.)
3/23/99
Continued on back

-9s
Facility Number: '3— 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
b(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
j(No
S. Does any part of the waste management system other than waste structures require maintenancelimprovement?
El Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
XNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
�'No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
U(No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
VNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�XNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
U(No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes 4No
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 ONo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes IN No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes X No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes bf No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
Wo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
t6o,
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
BX No
N6 •yiiilaiidris :or• di f ciencies •Were noted• OiWing this: visit; • Y;oh will •r, e06W do further
6res�otideik e: about. this visit:: . ...... .
Comments (refer: to question #} Explain any=YES °answersand/or any recommendations or=any other comments '
Use_drawings of facility to better;explain situahuns (use additional pages asnecessary) r t ��14.
- d
_. _. _ T
A.
�i a� �G vtc►-tee - .- , s � L,'z- p�
t,'j-
Reviewer/Inspector NameDeal,-1
Reviewer/Inspector Signature: C A Date: ��

acility Number: —'oL l Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
6(No
liquid level of lagoon or storage pond with no agitation?
2T
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
t�No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
4190
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
O�No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
�No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ YesVo
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
MNo
Additional,.Commentsan or° rawings:
r

Di -Anion of Soil and Water Conservation -Operation Review ,`
'O Division of Soil and Water Conservation :Compliance Inspection`hF
rr
'.r Division of Water'Qual�fy Coinphance Inspection z
- ,Other Agency: 'Qpeiat�OnREVIEW '
....,..
Routine 0 Complaint 0 Follow-ue of DWQ inspection 0 Follow -tip of DSWC review 0 Other
Facility Number Date of Inspection
Time of Inspection 6 24 hr. (hh:mm)
Permitted © Certified © Conditionally Certified © Registered [3 Not Operational Date Last Operated.
/ t Farm Name: 5�+ .( a1 �-2.. ` 'r........................................... County:... ....�!�.}).�...................................... .......................
Owner Name:
Facility Contact:
Phone No: -..
..Title:................................................................ Phone No:...
MailingAddress:........................................../..............................�........
Onsite Representative: ;,,,,+ �J �•
Certified Operator:............................................................................
Location of Farm: r
.......................................................................................................
Integrator:../!" ........................... ......
,,.,,,,,.,I.,,,,,, Operator Certification Number;,,,,,,,,,,,,,,,,,,,,,,,,
N.� ...fit � �.. 1. ....Q�- ..lw! ` `, .tid` .. ... .1 15. 1...4�.':a..... G.-r.`t.. t .......1
..........�. 5 .� Rd...................:............................................................................................
Latitude �` Longitude • �� ���
Design Current Design Current. Design Current
SwinePulottCapacity Po ulation "cityPopulation Cae . .Capacity Population.
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
-------- .
Number of Lagoon ❑ Sub
s_:.: surface Drains Present ❑ Lagoon Area 10 Spray Fiefd Area
Holding:Ponds.I Solid Traps ❑ No Liquid Waste Management System
Discharpes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes brNo
Discharge originated at: 'El Lagoon ❑Spray Field El 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 ycs, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes allo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes qNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes t..No
Structure I Structure 2 Structure 3 Structure 4 Sir -(,Lure 5 Structure 6
Identifier:
Freeboard(inches): .................................. .�.............................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes Q9 No
seepage, etc.)
3/23/99 Continued on back

Facilify Number- 3 — Date of Inspection
r_
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 maintenatice/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid Ievel
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?
2l. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0; No-yMaiidris'or defieie dial were noted- dtWingthis-visit'. • Yoet wi1l•reeeiye Rio further
vorrecn�ric�err ' e. a1hntit thic .visit . .
❑ Yes VNo
❑ Yes VNo
❑ Yes 9 No
❑ Yes 04 No
❑ Yes U11
❑ Yes C5No
❑ Yes 14No
❑ Yes VNo
❑ Yes UNo
❑ Yes [9No
❑ Yes J�(No
❑ Yes 17 No
❑ Yes XNo
Ayes ❑ No
❑ Yes XNo
❑ Yes 56 No
❑ Yes ( No
❑ Yes 0 No
❑ Yes EINo
❑ Yes 0 No
❑ Yes KNo
3/23/99

Facility Number: Date of Iirspection
w
Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
9Yes
❑ 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
kNo
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
[)-rNo
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
Mo
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
WNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
0 No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
XYes
[ONo
3/23/99

r
t..
13 Division of Soil and Water Conservation ❑ Other Agency
® Division of Water Quality
Routine 0 Complaint O Follow-up of DAVQ inspection 0 Follow-up of DSWC review 0 Other
rr w.w ��.rrnuri�^w i.�r�
Date of Inspection 7-2
Facility Number Z `7 �
Time of Inspection 24 hr. (hh:mm)
0 Registered t&Certifled [3 Applied for Permit B[Permitted JE3 Not Operational Date Last Operated:..,........
Farm Name: .--..... -.------.�.St:[`:��sj �...�`Z-:.. County: ......tv�! �J�................----.--.....--•-.-•--........................
Owner Name :.......(Z.ACY+�i.G�....... � ....E....l M.:............ .................................... Phone No: � ....1L�l�.G.��-..�?.!��0.......................................
Facility Contact: ....... �,�......1? fx.Ys .. ................. Title: Phone No: .........
.................
Mailing Address:....... 2,L..5C4A.V ......... orx,.........to .....................•• ir............................................ Z
Onsite Representative :........3.al1kvdk........... V, m'\&t�........................................... Integrator: ....... 11!L1L�r..9S4t,1........................................................ ..
1 !
Certified Operator:................................................................................... . Operator Certification Number;........................
Location of Farm:
r. ....i ...ar... ..... , �...o ..... i .......... ..........................
.. .. ... ...............................................................
Latitude • ' 0" Longitude 0• 04 046
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
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 Iagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes R1 No
[__1 Yes MNo
❑ Yes ❑ No
„j
❑ Yes No
❑ Yes W No
❑ Yes N] No
❑ Yes V No
❑ Yes t] No
❑ Yes 00 No
Continued on back

{
FacilityNumber: 3( —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes [A No
Structures,(Lap-obns.tloldinr Ponds, Flush tits, eti.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
...�....................................2-......... ..... ................ ................ -................ ..--...-.-....... ..... ................................... ...................................
Freeboard(ft):........................................Z.:�....................................
10. Is seepage observed from any of the structures'? ❑ Yes 59 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?
Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public F health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
[� No
Waste Application
14.
Is there physical evidence of over application'?
❑ Yes
No
(If in excess of W,MP, or runoff entering waters of the State- notify DWQ) _
-
15.
Crop type .Qr..Y.--...---..,� }.i .............5............ -........ ........ .......................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)'?
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
No
20.
Does facility require a follow-up visit by same agency?
Yes
No
21.
Did Reviewer/[nspector fail to discuss review/inspection with on -site representative'
❑ Yes
No
22.
r
Does record keeping need improvement?
10 Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
24,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
(P No
25.
Were any additional problems noted which cause noncompliance of the Permit'?
❑ Yes
® No
0 No violations or defidencie's.were-noted during this.visit., You. will receiveno further
correspondenct about this.visit..' ,' .. :
C6mments' (refer io quesiion`#):.Explain any ,V FS answers and/or any recommendatxans or any other comments "
Hof
Use:drawings factlity:#o Iietter`e.xplain situatiiins. (use, additional pages as necessary) `'. t'.
!L- M &(u, arounc {yku, 1le �rn(b_ e, �1 ShovIr� �e �iIC, Ctw� y�c5ee Con�n�e.
JJ
�
.S4ma t �qr� 6N
16-b-L. TOL O � 1&1414 ,v, �iejk f, corc,r\,�kWi, 5;0 6r- r066 ibn- Ha, 56c.16 � P- c+.m.c,t,,Q
�r 11
`�-O )"LW. pr cco , � ct
71ob
So : � 'f kk, M A�� eKQ1 a1s��1, . 'Sl) Ybw
I
f 6 vs �Yom
7/25/97
ReviewerAnspector Name �,{ •. • hs , .
Reviewer/Inspector Signature: Date:

® Routine Q Complaint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 1 z$ Date of Inspection 10 tz 9
il
E_ Time of Inspection l 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: El Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: .... ........._ .. _ .......... ..... ...... .... _..... _................. .....
Farm lame:County:.t1.�.�_: ._... ....._ .....__ ....jj. A..��i
Land Owner Name: Phone No:.�.-a_�_._ `7 `i.l7 ..
Facility Conctact :............_................ _ .... Title: .._..... ........... . Phone No:
Mailing Address: _ ?.�._ .�s..i t. .......
.... .x _... ._....._ ....................I- t._....Q.1' `it...7.... .. ..._ .... $. ..
Onsite Representative:..�.Integrator:.1A_%A.
Certified Operator:..... ..... ..... _.... ..... ..... _..... _ ....... Operator Certification Number: _.....�.94......__.
Location of Farm:
.LyZirl._...k)..L2.?r..?�_�.S!�? �.�.........�..t.. Q._.�......... �. �rR ..�.�P..LS..�..r�.�.. _A.. _._.....:.......... wa.�..�.i`�....Jk:1.e_...
S?.D.._;.....__....... .... ..._....
�....W_.. - __....._.� ly
Latitude •6 u Longitude • • 14
Type of Operation and Design Capacity
> Design Current �. Design Corrent� t Design Current
Swine rc Ca aci Po elation oultry F Ca act .Pa elation the ? 'M,Ca aci -Po uta_Q -
�r
❑ Wean to Feeder > •10 Layer ❑ Dairy
❑ Feeder to Finish ❑Non -Layer ❑ Non Da
Farrow to Wean
r € W1 �.
Farrow to Feeder T talD�e gIICap city
',
Farrow to Finish a
_..... i, .. z ISSL
' w
❑ Ota
Other ,�Y�;:: °3iF'-=3_ '-«•ik .. '� .n.� =�.:� ^'`b`. .•`�`� �� � x _.e`:�..>` ` %i% � mr � �,
T Number of Lagoons/ Haldmg Parids -` ❑ Subsurface Drains Present - f
M „� rea Sp Field ❑ Lagoon A ❑ ray F Area
ne 1
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?
S_ Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes Iff No
❑ Yes allo
[I Yes ®No
❑ Yes [,No
❑ Yes
J@ No
❑ Yes
®No
❑ Yes
J4 No
❑ Yes
54 No
Continued
on back

Facility Number:.3A...... --� .....,.
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 (Lagoons and/or Holding ]Pon .sj
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
10. Is seepage observed from any of the structures?
❑ Yes
CR No
I l . Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
EffNo
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
® No
Waste Application
14. Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type , C q x .. ......_......... ...................5 e ..�o �- _.... �.... - ...
16. Do the receiving crops differ with those designated in the Animaltaste Management Plan (AWMP)?
❑ 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
R1 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
For ertified EacilitiesOnlv_
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
® No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
K[No
24. Does record keeping need improvement?
IN Yes
❑ No
Comments {refer to queshon.) Explain tiny YES answers`and/or`any recommendations or any other comments x r
Use drawings of facility to better explain situations '(use additional. pages as necessary} Ex
.::,.
Z L a o o r. ,N LA r e caw. c.a %Xs +-+-V c, k ot- v t� t �n c a V_a i i0
ftti e Y- o c_e-.t s t � N. e s f-xt� E ; s k_kC . M a k-c, e. .x o n dL S Cv_* 4_
c� v e� 0. (~► a ". d o e s a C-o ,.�. er Q S 4 I, S kA_OL
v ..,. �h o �L.1-+r r c-G r�sl.i o ►-a - S i C.
0 v. c 0 v S t-- t !p v— p i +^C v.. t 1n ; i o L } Yv. a k-4 $ v r e-
R e o1� e fa l j ,•,.l ; n v w.. (� ` �16 w ; e-x - - v ►+-d�.e.+� t--o 04 w e -G, � L o o
n S V t. c. f i C �l P. f w. Gt V-0--s V%- V rs Q-, l Y 2— •I/ N V r r, I j i i-i
to 1'b ,— — 0� a v L V "U, uObi
•tom" $,.,, ,�. .�1 �` u
Reviewer/inspector Name
Reviewer/Inspector Signature: Date: i 2 Q
cc: Division of Water Quality, Water 4uality Section. Facilitv Assessment nit 4/30/97

'h
DSWC Anima! Feedlot Operation Review
� r ®DWQ al�Feed�lo �pera lion S to Inspection
[®Routine 0 Com faint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection '}
Facility Number
Time of Inspection z3 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status* ❑ Registered ❑ Applied for Permit (ex:1.25 for I hr 15 min)) Spent on Review
0 Certified ❑ Permitted or Ins ection includes travel andprocessing)
❑ Not Operational Date Last Operated: .._ _.. , .......... �.............. ....._........ _ _..._ ...� .............
Farm Name: P.tc. .a.� L.ru.:G� ?� r..i_ .. .. L......_...... County:.,D.".. - ya.......... _ ........... _�11�.1. �
Land Owner Name: .$�p.�enc�.. . �4�1a,.... ..I'Title:
Phone No:
Facility Conctact:
....._....._............ _.............................._...---................ Phone No:
Mailing Address:.W .�_ .5. 5 .....� .� .._.. r�.: _ .......... ..M... :.....Qia.�l �.f._ f� .... __.... 211:3 °S..
Onsite Representative:.... _ .....
Certified Operator:....,?�.R,s-� ....S.Z..e... ..... .Lit L'! Operator Certification Number: 1�bbQ-
Location of Farm:
.........`.....ar.... ._. _...Y!�.f. ....I� k'.0 _
Ys J ... Il..._ i.Xk G ]f.1 1i L.�c L.A .!!�........L►L.l..i._"f ... �3.Wi..1.�. 0�. —....
Latitude Longitude �• ®i "
Type of Operation and Design Capacity
s �' e , i;D CUrient
Designs C`nrren't _ Design Current N � UesJ
act Po ulation� s oultry Ca acitv,.,Po iilahan Cattle h a�i " Po ulation
®Wean to Feeder D
❑ Feeder to Finish iry
€ Farrow to Wean .
Farrow to Feeder Total Design ua act
1171 Farrow to Finish kSSL
._ _ _ . _ _ _ r..
❑other �o W6
Number of Lagoons / Hpldittg Ponds ❑Subsurface Drains Present
� �����,� "� �� _ � � ' �� � ��� �� �: � ❑Lagoon Area ❑Spray Field Area
❑D
n ral
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 ❑ 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 gaUtnin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes RNo
❑ Yes 10 No
❑ Yes
®No
❑ Yes
IR No
a1A
❑ Yes
®No
❑ Yes
Eff No
❑ Yes
®No
❑ Yes
5d No
Continued on back

Facility Number:. ...... —... Z$...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ISNo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes allo
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes allo
Strue- Tres (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes gNo
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
%.�_ .. ....... __.... ._.......... _W.... _..... .......... ....... ....... ,......
_
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?
Wade 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 ..r-nac.► L ..... _ ..................._....... ..._.... _....... ..........
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 Fagilities Qniy
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
R No
❑ Yes
P9 No
E4 Yes
❑ No
❑ Yes
O No
❑ Yes
® No
❑ Yes
[K No
❑ Yes
Ef No
❑ Yes
P9 No
❑ Yes
ff No
❑ Yes
El No
❑ Yes
g[ No
❑ Yes
O No
❑ Yes
KNo
10 Yes
❑ No
Comments, (defer tq question #) Explain any YES answers' and/or; any recommendations`ar any other comments # x
Use drawings of facility to better explain situations : (use additional pages as necessary} 4
x
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Reviewer/Inspector Name
Reviewer/Inspector Signature:^� Date: 17
�rrr-ter. �r�✓-. i�r•ir r i r��w r�r.
cc: Division of Water Oualitv. Water Oualitv Section. Facility Assessment Unit 4/10/97