310302_INSPECTIONS_20171231

2 V
NUH I H UAHULINA
Department of Environmental Qual

Fj
Type of Visit: O Co n}plfance Inspection U Operation Review O Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j `� Arrival Time: ! Q Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: e
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number. 7 Y5 S—
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
Da' Cow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -La er
Da' Calf
Feeder to Finish
Design C*urrent
D , Pooult , Ca aci P,o ,
Layers
Non -Layers
Da' Heifer
D Cow
Non-Dairy
Beef Stocker
Beef Feeder
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes U o ❑ 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 1 of 3
21412015 Continued

Facility Number: - Date of Inspection: 0/9
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
[2-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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ))
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
allo
❑ 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 ET]No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes YNo ❑ 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 1=J N o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E3No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ N ❑ 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
�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
N�o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
PA"
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No .
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes EyNo ❑ 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 I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [—]Yes No%❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

FaciliNumber: - Q Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes C3Noo ❑ NA ❑ NE
25 • Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0,Ko ❑ 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 CD -No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No EX/A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
24. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the'facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
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 ONE
❑ Yes No ❑ NA ❑ NE
❑ Yes �]_ ❑ NA ❑ NE
❑ Yes io ❑ NA ❑ NE
Yes
❑ Yes
❑ Yes
ON . ❑NA ONE
y❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments' I
Use drawings, of facility to better, explain situations (use additional pages as necessary):
r�e V O 1" n -c �� �.
Reviewer/Inspector Name: Phone: �i� 9N
Reviewer/Inspector Signature: �Y� Date:
Page 3 of 3 21412015

9Z
Type of Visit: QCo ance Inspection O Operation Review 0 Structure Evaluation O 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: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: t �p yQ G ✓
Title:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: I f 3 1 y
Certification Number:
Longitude:
ish
Design Current
Capacity Pop. Wet Poultry
La er
Design
Capacity
Current aDesign
P
Dai Cow
Current
eder
inish
ean
eeder
rFarrow
Nan -La er
Dai Calf
QT P,ault_
Dign
C_a aci_
Dai Heifer
Current Dry Cow
P,o , Non-Dairyinish
)4fpO
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Turlce s
Turke Poults
Other
Beef Brood Cow
Other
Other
DischarEes and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes E;>e---QNA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ❑ No ❑ NA [_]NE
[—]Yes l�rar❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Wacility Number: jDate 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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: t 2
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 ❑ N>
(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
❑' l�o ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
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
' ]�No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
_[31�7o_ ❑ 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
L_I No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
O N ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VN❑ NA
❑ NE
Reouired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
� -❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
No ❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [::]Design [:]Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? 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 I" 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

Wacility Number: -3 p jDate of Inspection: 11-6r- b
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 2'3Vo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes [3 l`!o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No C]'1 A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes 2 0 ❑ 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 N ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes �o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or. any.other:comments E
�essery).
Use drawings of facility:to better explain situations (use Additional pages as nec
oC'- �� quo oit
S ti s e li TL 5 A
Zoo �
���a�
ca.,c�'►�`'
_' C or / l
S,Z4,
(p •� o /4,� ,L
3 0 9 0
. �� a y� e %
a a vG
!�P
v� ••~l/ r
a �
c�� �a l/
A, "'o /► o r.. S �t
Reviewer/Inspector Name:
Reviewer/Inspector Signatut
Page 3 of 3
00 'I(/-e
Phone:
Date: 5 �b
214126115

Waters Agricultural Laboratories, Inc.
364 West Park Drive Warsaw, NC 28398 257 Newton Hwy - P.O. Box 382
[phone] FAX [phone] Camilla, Georgia 31730
[phone] FAX [phone]
TREY VOTAW SOIL Analysis Report Grower: TREY VOTAW Account#: 7530
753 S HORSEPEN RD Received: 8M12016
NCDA Index Field ID: HARRELLS, NC Processed: 8/30/2016
Water
Lab Number i Sample ID P-I K-1 Mg% Ca% pH Ac S-1: ;Zn-1 I Zn-AI', -Mn-I Mn-Ali Cu-1 ; CEC ',BS% HM% Soil Class
816096SW BAYTREE 397 76 7.2 20.1 5 2.4 49 100 100 21 22 31 3,8 37.2 0.53 Min
............. _.....
Recommendations -lbs./A ons1Al L 426'1 jK20i lMg' i—DS iIC°1 ILn.1, Mn] [See Note!
Crop BERMUDA Pasture M 1.5 220 0 60 25 0 0 0 12
816097SW LEGACY 1 93 28 15.3 48.2 5.7 1.3 19 105 105 53 41 22 3.7 67.4 0,46 Min
Recommendations - ibsJA _ � __, [_ - ��f ,.. _. _..e
Lime -Tons! Np2O5i tK201 l"1y1 # S, Gu Zn� 1!3 !Mnj iSee Note,
Crop BERMUDA Pasture M 0.4 220 0 160 0 20 $ 0 12
816098SW : LEGACY 2 253 ' 54 9.3 41.9 5.2 1.8 24 131 131 71 52 38 4.3 57.6 033 Min
Recommendations -1bsJA jLime-Tons/A] jNj [P2651 K22 91 S] `Cu] LZ91 �Bj jM� tSeeHote�
Crop BERMUDA Pasture M 1.1 220 0 100 25 20 0 0 12
816099SW LEGACY 3 80 10 15.7 44.8 4.6 1.6 19 82 82 31 28 10 4.2 61.8 0.34 Min
Recommendations - Ib9JA [Lime-Tans1AI 1N [P205' 'K2O: 'Mg� {Cu] �Zn �B fin] ;See Nota]
Crop BERMUDA Pasture M 1.1 220 0 220 0 20 $ 0 12
Fertilizer recommendations are based on the philosophy and recommendations of the NCDA Agronomic Division
DWO Laboratory Certification Number 635

i ypr ui rMi: v IL.um uxuUe Lubpecsiun v vperauuU nCVLCw V Oiruciure nva1ua11Un v i ecnniLai A5NIsiauce
Reason for Visit: Qr Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: 1 5 27/!S`1 Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Phone:
Region:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: _ (Q �/ �/p Gi v Integrator:
_T
Certified Operator: Certification Number: z G 3zjz
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Capacity
Wean to Finish
Current
Pap.
Design Current
Wet Poultry Capacity Pop.
La er
Design Current
Cattle C►►opacity Pop.
DairyCow
Wean to Feeder
DairyCalf
eeder to Finish
9
!j
Design Current
v Ga aci P,o _.
DairyHeifer
D Cow
Non -Dairy
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
�f
Beef Stocker
Beef Feeder
s
ja
Boars
Beef Brood Cow
Other
Other
ults
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
[ No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
0 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
[] Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
To
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
fNo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facili Number: - Date of Inspection: 370Z 2t
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: r 2-
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): Z 2�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
4if No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a
❑ Yes
EJ'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 Ej No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes U 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 E:J'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 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):
t3. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes F5-No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Z rNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E:fNo
❑ NA
D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 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 V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes LJ o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

IFacili Number: - QZ Date of Inspection:ZT-71,151
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes ❑ No
EINA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes dNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[:]Yes dNo
❑ 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 E f 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 E No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? [-]Yes EI�No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? [-]Yes ENo ❑ NA ❑ NE
Reviewer/Inspector Signature:
Page 3 of 3
Date: 5-;l-z7 /4—
21412014

rype'ogisit: Compliance. Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason'tor Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date'of Visit: Z /12// (,q Arrival Time-[C.:' ` eparture Time: County-9-C /7 Region V�6:0
Farm Name: [fir,67 (� Owner Email:
Owner Name. -
Mailing Address:
Physical Address:
Facility Contact:
1�
Onsite Representative:
Certified Operator:
Back-up Operator:
w
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Wean to Finish
I
I I Layer I
I Dairy Cow
Wean to Feeder
I
I jNon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D , $Dolt . Ca a�i_ P,o
La ers
Dairy Heifer
D Cow
Non -Dairy
Beef Stocker
11
Gilts"'
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Poults
Other I I III (Other
1\
4 and Stream ImRactS
'barge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
❑ NE
V originated at: ❑ Structure ❑ Application Field ❑ Other:
b�the conveyance man-made?
❑ Yes jo No
❑ NA
❑ NE
c• �dischamc reach waters of the State? (If yes, notify DWQ)
❑ Yes
� "No
❑ NA
❑ NE
d. Does th estimated volume that reached waters of the State (gallons)?
Z• Is there evidence of � barge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
0 No
❑ NA
[] NE
3' Were there Y ob$e i g y part of the operation?
an p"' ischar a from an p
Of the State
❑ Yes
� No
❑ NA
❑ NE
other than from aierse impacts or potential adverse impacts to the waters
❑ Yes
�No
❑ NA
❑ NE
pa scharge?
I ge 1 ofir
ww�wm \
l./
21412011 Continued

Facility Number: Date of Ins eetian:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,,0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ,j No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): egs
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ZNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes J�3 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 _'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes J' 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 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Aoplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ONo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [] Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes -fn No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,E!j 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes ,o No ❑ NA ❑ NE
❑ Yes ,J No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes jf:rNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes ,jNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes_� No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [-]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes J21rNo
/
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J2 "
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
o ❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: 3 7 - Date of Inspection:
24' Did, the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes , j No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ,� No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No
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? ❑ Yes n/ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other.,comments. ,
Use drawings of facility.to better explain situations (use additional pages as necessary).
y9 .;
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No ❑ NA ❑ NE
❑ Yes ;ZI^No ❑ NA ❑ NE
❑ Yes Z No ❑ NA ❑ NE
❑ Yes jo No ❑ NA ❑ NE
Phone: `
Date:
4/10

iype of visit: 5dt:ompttance inspection V uperation xevtew a btructure Lvamanon V recnnicat ikssistance
Reason for Visit: 04outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ' " p Departure Time: County: f%Region:
Farm Name: e art. C�z(�l �l/ ! Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:Vo/,Pi/
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /n Z&
Certification Number:
2c�13
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Cattle
DairyCow
Design
Capacity
C*urrent
Pop.
Wean to Feeder
on -Layer
DairyCalf
Feeder to Finish
Design Current
17, P,oult . Ca aci Pao ,
Layers
Da' Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
D Cow
Non -Dairy
Beef Stocker
Gilts
Non-Laye
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes jEno ❑ NA ❑ NE
❑ Yes 16No ❑ NA ❑ NE
[:]Yes ffNo ❑ NA ❑ NE
❑ Yes EfNo
[:]Yes Ef No
❑ Yes ZNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Ins ection: !
Waste Collection & Treatment
4. -Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes _e C;No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes [3"No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: —
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �7
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes A�fNo ❑ 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 XNo ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes '�TNo ❑ 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
J21'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
ONo
❑ 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
)7,!TNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
j2fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J�f 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
6 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 J2" 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 dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E�'No ❑ NA ❑ NE
Page 2 of 3 21412011 Condnu l
�l

Facili Number: - Date of Ins ection: l
+ 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 0"No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes 6 No ❑ NA ❑ NE
❑ Yes Zf No ❑ NA ❑ NE
❑ Yes P?No ❑ NA ❑ NE
❑ Yes �allo ❑ NA ❑ NE
❑ Yes O—No ❑ NA ❑ NE
❑ Yes JaNo ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [�!rNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ['No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 12 No ❑ NA ❑ NE
Comments (refer to question ff): Explain any YES answers and/or any additional recommendations or any other, comments.` -_'7]
Use drawings of facility to better explain situations (use additional pages as necessary).
Fa ryy,7 + ,fecoy*'GQS
16dlC t50od
10113lf 2 l o 2-
/4 D ( 2
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: (/ / V7
Date:
oil

i
FAcili Number
—0-Division of,Watei• Quality
•..Q,Division oftlSoil and Water Conservatton�;,
Q Other A e cy ..�
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit Rioutine 0 Complaint 0 Follow up Q Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Arrival Time: Departure Time: I County:
Owner Email:
Phone:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Region:
Latitude: = a =' [� Longitude: 0 0 =' =
Design" Current' D
-Swine-�" Capacity Populaf�onp WetP ultry „Cs
❑La erElWean
Wean to Finish- HEI
to Feeder
Non -La er
❑ Feeder to Finish'
k
'~ ❑ Farrow to Wean
Dry Poultry
❑ Farrow to Feeder
❑Farrow to Finish
' ❑ Layers
=; El Gilts
❑ Non -Layers
El Boars
❑ Pullets
El Turkeys
Other
a
�. .q ❑Turkey Poults
❑ Other _ F. ❑ Other
1� Current " "' w
Cattle
tyPopulatton
V ❑ Dairy Cow
❑ Dai Calf
b ❑ Dairy Heifer
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Beef Brood C
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 PpNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
❑NE
[I Yes
El No
❑ Yes
.�No
❑ NA
❑ NE
❑ Yes dNo ❑ NA ❑ NE
Page I of 3 12128104 Continued

Date of Inspection O
-
Facility Number:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
,�+
El, Yes �1 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P 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 0 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)
4. Does any part of the waste management system other than the waste structures require ❑ Yes JZNo ❑ 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 'P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ZI No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ffNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes.16 No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes,,E!l No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 6No
❑ NA
❑ NE
Comments refer to; ueshon;.# E% lain an YES.answer ( q } . p y s and/or any recommendations or any other com ents-
Use drawings of facility to better explain situations. (use addtttonal pages�a necessary):
<,
Reviewer/inspector Name =� �� k-. _ Phone:
Reviewer/Inspector Signature: /� Date:
Page 2 of 3
Continued

Facility Number: — Date'of Inspection O
Reuuired Records & Documents
19., Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ,2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below: ❑ Yes ErNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain 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? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
2fNo
❑ NA
❑ NE
❑ Yes
,d No
❑ NA
❑ NE
❑ Yes
2rNo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
❑. Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes .O No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes ZfNo ❑ NA ❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
allo
❑ NA
❑ NE
Additional.Ciimmen'ts and/6�:Drawings:
Aebo • 76'
VL
cay�s
Page 3 of 3 12,128104

Facility Number Q Division;
.
Other`A
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint O follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: C� County:
Farm Name: esi!�Z C 1 ZSa J >;;.c-/% Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / / Title:
Onsite Representative: /�d�/ &6ki'/ r
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator: 46
Operator Certification Number:
Back-up Certification Number:
Region: �f
Latitude: = o = 4 = u Longitude: = ° = g 0
As
I" Design Xurrent'; {
Swine Capacity Population Wet.Poultry
❑ Wean to Finish ❑ La er
El to Feeder �: ❑Non -Layer
❑ Feeder to Finish '
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish "; ❑ Layers
�" ❑ Non -Layers
❑ Gilts;
❑ Boars ❑Pullets
--: ❑ Turkeys
Other " ❑ Turkey Poults
❑ Other �❑ Other .a
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?
Cow
Calf
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood [
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 J'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
IdNo
❑ NA
❑ NE
❑ Yes
"6No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection 6 ii
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
.[TNo ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Struct}�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
6 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
VfNo ❑ 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
/ ,J�ee,, No ❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
FNo ❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
EfNo ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
gNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
gNo ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes /'--' No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:]Yes g No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
[:]Yes f a'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ONo
❑ NA
❑ NE
Comments (refer to question-#): Explain any YES answers and/or any recommendadons or 4nysother comments
Use drawings of facility-to,better''ex lain situations use'additional' �a es as.ikcessary
g P f pages a ) a�
'�rrn e- /'e'(
Reviewer/Inspector Name I `j- I Phone: 7/U`c�`
Reviewer/Inspector Signature: '/ Date: Co l�/
I
Continued

Facility, Number: ' Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes -ffNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .ETNo ❑ 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 .E!fNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ZNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes .ETNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ;2'No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes [jVo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes 2"lo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes E No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ,ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
��
❑ Yes yE ivo
❑ 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 ETNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
,�
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes YJ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes EfNo
❑ NA
❑ NE
12128104

r
Type of Visit Ajrco/mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit Q Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date: of Visit:
Firm Name:`'
Owner Narne: _
Mailing :address:
Physical Address:
%rrival Time: ® Ileparture "Fame: Counh:
Facility Contact: Title:
Onsite Representative: D
Certified Operator:
Buck -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
Owner Email:
Phone:
Phone No:
Integrator: M /iE7
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude; ❑O = ❑u Longitude: =o ❑ ` ❑ u
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes RfN. ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
JV�qo
❑ NA
❑ NE
❑ Yes
ZNo
❑ NA
❑ NE
12128104 Continued

Number: _304 Date of Inspection
(Facility
Waste Collection &'Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes P 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:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes 0 No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes �' o ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes XNo El NA El NE
`��No
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ❑ 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?
.0
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes FZNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes P No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 ErNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes P No
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes VrNo
17. Does the facility lack adequate acreage for land application? ❑ Yes 7I0
18. Is there a lack of properly operating waste application equipment? ❑ Yes ;;3'No
❑ NA ❑ NE
El NA El NE
❑NA ❑NE
❑ 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):
6 A10 5-ol4ee0e
AL
'T<6RfC, / a X 7/0 ,f Z
EReviewer/Inspector Name,"14 Phone: t�- —
er/Inspector Signature: Date:
12/28/041 Continued

9/0` ol 7/_ 1�2- 7
Facil► y Number: V Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP ❑Checklists El Design El Maps El Other
❑ Yes zNo ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [>1Vo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain 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? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 0 No
❑ NA ❑ NE
❑ Yes ZNo
❑ NA ❑ NE
❑ Yes O'No
❑ NA ❑ NE
10 Yes ❑ No
❑ NA ❑ NE
❑ Yes ,8 No
❑ NA ❑ NE
❑ Yes P No
❑ NA ❑ NE
❑ Yes 2 No
❑ Yes ,Z No
❑ Yes ZNo
❑ Yes 0 No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA El NE
❑ Yes 7No ❑ NA ❑ NE
❑ Yes ❑'No ❑ NA ❑ NE
Additional Comments and/or Drawings:
_tjWA-• Ve5Lr r�Y CG S t "t'% c,e I nS Pec:Lar•
y/ �. o d- a�� rc S S ► co,r+1� Ck n'� S c -F
2 n en r io'/ P,r d pey- S •
3/0 7 ! 1 Pro Per- o vA "--Cs Co (VY� cArls .
1 3 t • N ��- �.��� �a�� � Qt� ri. P
y�,3fd � !..�
�•2- P l a ✓\ . G ro W e, r k^-.s
eno"'Z 1-. I,G.,,ck 4o '�'' C (�
p G Gc.ord►+� '� C4W)
2 • �- arc o -r c'`� a`s s f tA VKel n�
cis-ee'r f rdPer 1lrc.�
�e•n
a S' �c.-foci rs rc ftr/i-�Ple
#,#- 01 r -Oc�_04- 6a-eoc "-,/ b u /-- w1!/ nteel * 10rad�de 2/2VO4

vision of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit ZrZompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine .0-6omplaint A0,01low up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Name:
Arrival Time: Departure Time: County: Region:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
LJ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
Title:
Phone No:
Integrator
Operator ertification Number:
Back-up Certification Number:
Latitude: 0 e ❑ & Longitude: = ° =1
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -Layer
Dry Poultry
❑
Layers
❑
Non -Layers
❑
Pullets
❑
Turkeys
❑
Turkey Poults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifej
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes PrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Q No
❑ NA
❑ NE
❑ Yes
O'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
❑ Yes R No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
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
PYNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
WNo
❑ 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
Z No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ NA ❑ NE
(71 of applicable to roofed pits, dry stacks and/or wet stacks)
JRNo
9. es any part of the waste management system other than the waste structures require
UNE
❑yes
❑ No
❑ NA ❑
ma intenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA ❑ NE
maintenance/improvement?
'12
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
E]Ao
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
•jNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
JZNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
ETNo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J'No
❑ NA ❑ NE
7 ' %1 C.p " Q �7GO�t� i�zrr� a C'Ps�1dP./ �ldG Pltl,f� p�e/a "P!�
/ P!/��c✓/ (P.z l v r �tS� �` P/G �Ll r P s ! / !,S o5S/•�.�
l � ca�o � Gc%tll /I P 7� cCy - �4p %Ar ,-,iJ - V
e 07( ScO4111.S o erg are Pie -r ova 0us-�
02
Reviewer/Inspector Name �.w Phone: p Z t
Reviewer/Inspector Signature: Date: p
Page 2 of 3 ► 61211 17W a X ji7v ✓r jpOSS l le � 12/28/04 Continued
X0, Ac_ -yam , ✓ / v%s /� Ca�1 G(GcC �'1.cl lfi► S ad d GV,?

Type of Visit Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint O'follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: / O Arrival Time: "f,
DepartureTime: County: Region:tFarm Name:Owner Email:
i
Owner Name: Phone: _
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: F/ e
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Sack -up Certification Number:
Location of Farm: Latitude: [= o = 6 =61 Longitude: = o =' = «
Design Current
Population
DesignElurDesign
Wet Poultry Capacitypulation
Cattle
Currencity
Capacity Population
❑ an to Finish
❑ an to Feeder
❑ La er
❑ Dairy Cow
❑Non -La er
❑ Dairy Calf
❑ Feeder to Finish
Dry Poultry
❑ Layers
❑ Non -La ers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to Finish
❑ Gilts
❑ Beef Stocker
El Beef Feeder
❑ Boars
Other
❑ Beef Brood Co
Number of Structures: F7
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
❑ No
❑ NA
ONE
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
❑ No
❑ NA
JEI N
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
❑ No
❑ NA
E
other than from a discharge?
Page I of 3
12178104
Continued

Facility Number: Date of Inspection
Waste tallection & 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
❑ Yes ❑ No ❑ NA P NE
❑ Yes ❑ No ❑'NA E
f�'
Structure 5 Structure
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 [;ZNE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ❑ No ❑ NA [;PNE
through a waste management or closure plan?
DIf an of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. o 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 [aNE
(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 ONE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA PNE
❑ 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 Drifi ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA ❑'NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA ENE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[-] yes
❑ No
❑ NA ff NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA LTNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA r 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):
delCIt�.1 Irf el QwPr . lip—r'1s Ce R�,
hd
A
1.'e h /
71oe
U1/ea 4 W ><ru �^�-+ � 1Cejl�,eee� � ���� � �� �� �,-Q�
T
Reviewer/Inspector Name y Phone:
Reviewer/inspector Signature: C Date:
12/28/0 Continued

!vision of water Quality
Fad ty;Nttmber Q 0 Divisiowof Soil: and Water Conservation
i
-- 0 Other`Ageacy
Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine omplaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: p Arrival Time: / Departure Time: County: /vr Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: //r�.r �P/An Title:
L11
Onsite Representative:
Certified Operator -
Back -up Operator:
Location of Farm:
�a
�. Design Current
Swine Capacity:: Population
❑ Wean to Finish
❑ Wean to feeder
I
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
` ❑ Gilts
❑ Boars
Other:
❑ Other -
Phone:
Phone No:
Integrator• �tztl
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 = 4 = 6f Longitude: = 0 = 6 =
if
Design Current Design Current
Wet Poultry Capacity :Population Cattle Capacity Population
Non -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page 1 of 3
❑ Yes ❑ No ❑ 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?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
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 Cl 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, Zu, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13.
Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ 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 pagesas necessary):
L„_ras nj eG i '0-1 Psiplzps 5-e ai.t .re c r-
GtJi
�eG
Reviewer/Inspector Name — —� Phone: 7 982
Reviewer/Inspector Signature: Date: /Y %oC1 I
Page 2 of 3 12128104 Continued

-FaeUity Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ VAR ❑ Checklists ❑ Design
g ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" 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:
al fGt 1✓4 PaC16 Je&W? irdos G��u� war vpr/
We,/.��. dv s C��/�Sl c�Q Y. �P�r�`c>D �' �2 �N ly '�Q�n�/��✓�
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� lq/
e �/' l f e crt d< Grp a�c✓�
p `[ ! s 'bd C/C "ar'4�/' 6 . /ZC G✓G J tt Gr (/G .f �/' ` h / B Zp�^�
,G
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Tzhd/!�S Z,4,/ j
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on
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H7,
Page 3 of 3 12128104

+ PDivision of Water Quality
p Facility Number 3 © O Division of Soil and Water Conservation,
i
Q-Other Agency .
Type of Visit Q66mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 'Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: d' (�7 Arrival Time: ' t] Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: % f / Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
,��/JP`hone No:
! Integrator: /0
Operator Certification Number:
Back-up Certification Number:
Latitude: [::] c 0 ' F Longitude: °
Design Current` Desiga, Current '-D
Swine. Capacity Population Wet Poultry.. Capacity Population Cattle Ca
Wean -to Finish ! ❑ Layer
ElWean to Feeder ! ❑Non-Laer
! --.---
❑ Feeder to Finish i
❑ Farrow to Wean DryPoultry
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts i
i
❑Boars
Other
❑ Other ! .
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turke s
ElTurke Points
❑ 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures:,: u
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 l of 3
❑ Yes _QNo ❑ NA ❑ NE
❑Yes El No
❑NA
El NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes -I�No
❑ NA
❑ NE
❑ Yes EI-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 ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes dNo ❑ NA ❑ NE
Structure I Structurej-5 '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 .E] No ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ,0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes -ffl No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes P No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ;2rNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ yes .❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
�3 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ONo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ANo
❑ 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):
cla ca r-c�s
I- l
Reviewer/Inspector Name aft/!­L- "Z,,,r Phone: ?161'771eyl:?
Reviewer/Inspector Signature: Date: tiCl � /
12128104 1 Continued

Type of Visit 0"Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit RrRoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: r Arrival Time: ��' Departure Time: County: l Region: I
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No. -
Integrator:
Operator Certification umber:
Back-up Certification Number:
Latitude: ❑ c =' 0 « Longitude: = ° = 1
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish
Farrow to Wean #
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other__I _�_
❑ Layer
❑ Non-Layet Ii
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharees & 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
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocket
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: Ej
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 J2"No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
J'No
❑ Yes
Jallo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104 Continued

Facility dumber: — Date of Inspection % 7
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes .0 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: l_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ONo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ NA ❑ NE
through a waste management or closure plan?
1f 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 J'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 C?&o ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2TNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes A No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs [:]Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside ogA,-eptable Crop Window Evidenceof Wind Drifl ❑ Application Outside of Area
12. Crop types)
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
M-No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,
❑ Yes
LEI -No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
0NO
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA
❑ NE
Q6�/.-z/
'"
Reviewer/Inspector Name � � � � P ooe:
Reviewer/Inspector Signature: /� _� Date:
12121104 Continued

Facility dumber: 3 Date of Inspection
---,
Required Records & Documents ��
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ElE 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 El Checklists ❑Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Wcather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes -0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes Z No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
E NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes ❑ No
12'NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes ONo
•❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes ❑ No
❑ NA
Other Issues
'�YNE
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes ,ETNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes J'No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 16No
❑ 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 jZrNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes ONo
❑ NA
❑ NE
Additional,Commentsand/or Drawings:
��''C— %�c3Or
12,12VO4

!Ty►pe of Visit O Coyhpliance inspection O Operation Review O Lagoon Evaluation
Reason far Visit O Routine O Comptaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number jDateoffisitz- i 1 R04 Time: 3 c
O Not Operational O Below Threshold
Permitted dCertffied 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: . f W9.C'A G ._i�_o t-) County: _ _ QQP _..... .. » .
caner Name: _ _ ... . - ..» .. ._.. Phone No:
Mailing Address:.
Facility Contact: _... _ . . _ _ - - - - ..._._ Title: Phone No:
Onsite Representative: ft CDG Q.-DO _ _ _ , . integrator. M Q&E8
Certified Operator:
Location of Farm:
Operator Certification Number:
w
❑ Swine ❑ Poultry ❑ Cattle ©Horse Latitude "�• C " Longitude • 4 Du
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the Stage? (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 �'NO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier- _.. L Z
Freeboard(inches): _...... ^ 2 ........ 31 ._..._.__._........_........._......W..._._.�.�._........_...._ ....... _._W.........�....�.......
12112103 J Continued

Facility Number: 3 j — S p2 Date of Inspection
i— Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes EfNo
seepage, etc.)
6_ Are there structures on -site which are not properly addressed and/or managed tbrough a waste management or ❑ Yes dNo
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 ❑ No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes 011 0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑Yes Q'No
elevation markings?
Waste_AjRp,h:cation
10. Are there any buffers that need maintenancehunprovement? ❑ Yes d;N7o
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type 3E&nUnP% ( G) SC-10
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?
Odor Issues
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.
❑ Yes �C NNoo
El Yes EA0
❑ Yes 240
❑ Yes mlro
❑ Yes QR°
❑ Yes 04co
❑ Yes @'NO
❑ Yes
❑ Yes Q90
❑ Yes OW/0
Field Cony El Final Notes
7,) 2 u S t�tgsi�QLT 1�t�P�s� ;_CvSl An}O RCS��.��
New WLIP \Wca '31— 362 A►o7 3+-303 3 Oc,-,J jvi 3x-3o?-
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: Oil c1
12112103 Condnized

Facility Number. 3 i -3 D2 Date of Inspection 7 ice:
Renuired Records & Documents
21. FaiI to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes <0
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available? Yes No
(ie/ WUP, checklists, design, maps, etc.) ❑ No
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑'NO
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ yes 7No
'
25. Did the facility fail to have a actively certified operator in charge? [:I Yes
26. Fail to notify regional DWQ of emergency situations as required by General Permit? (ie/ discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/inspector fail to discuss review/inspection with on -site representative? ❑ Yes No
28. Does facility require a follow-up visit by same agency? ❑ Yes 0<
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? [I Yes l3 No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes No
31. 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 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
I21I2/03

Type of Visit I& Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit J1KRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3d3 Date of Visit: Time: �m
10 Not Operational 0 Below Threshold
Permitted © Certified © Connditionaliv-CCe'rtified [] Registered Date Last Operated or Above Threshold:
Farm Name: Z104 d C t! _n I� 1'A%P pl County: fiK p ji tA
Owner Name: TG FAO -AS Phone No:
Mailing Address:
Facility Contact: /' Title:
Onsite Representative: m _ � /, 4MI-I 'LIt
Certified Operator:
Location of Farm:
Phone No:
Integrator: Avcg r/
Operator Certification Number:
, ❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0 0 K Longitude 0' 0 0
Design.Current Design Current - . _,_ Design . ,, C©went
Syrine Ca achy:°° --:Po elation %Point = .Capaciri :Population Cattle .:. V Cspapty aPopolahori
MVi%ean to FeederT
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
' ❑ a Subsurface Drins Present ❑ Lagoon Area
❑ Spray Field Area �-
iYumber o Lag
Holdmg Ponds 1wSWid ' ❑ No Liquid Waste Management System
DischartFes & Stream lmgacts
1. Is any discharge observed from any part of the operation?
❑ Yes CANO
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 "No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes p5NO
Waste Collection_ & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: / 0-
Freeboard (inches): 7 .S
05103101 Continued

Facility Number: 31 — 3�Z 3�3 Date of lnspection �✓
5. Are there any immediate threats to the integrity of any of the structures observed?. (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type I%Y/i1!A 06t 6r i �GV
❑ Yes KNo
❑ Yes 0 No
❑ Yes CR[No
❑ Yes t3-No
❑ Yes 9No
❑ Yes No
❑ Yes No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 91 No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
I&No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
.I No
16.
is there a lack of adequate waste application equipment?
❑ Yes
N No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
0l0
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
)RNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ED No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
SNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
'E4 No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
RNo
24.
Does facility require a follow-up visit by same agency?
❑ Yes
5a No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
5d No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #) E:plalrt any YE _ 4nswers and/ot:'any recommen&dons'or any -other corumehts:
[ise drawings of facdrty to better ezpiatn situations. (use additional pages as necessary)10 Field Cony . C] Final Notes _
�s .`k�' a��� �y S,_O./ j,:slolh
Reviewer/Inspector Name Fa
Reviewer/Inspector Signature: Date:
05103101 19 Continued

Facility Number: 3j — VZ Date of inspeclion�/Z
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atior below ❑ Yes �4—Vo
liquid level of lagoon or storage pond with no agitation? V
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes $1No
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 biade(s), inoperable shutters. etc.) ❑ Yes ,9 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
Additional Comments and/or Drawings:
05103101

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit `16 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: 3 ZZ t7 f Time: •©S Printed on: 7/21/2000
l 34 Z
0 Not Operational Q Below Threshold
❑ Permitted ❑ Certified 0 Conditionally Certified ❑ Registered
Farm Name: r--,
Owner Name: � . If? F ✓�r`'1 S L.L.C.
.. ....... .............. j..........--.................................................
Facility Contact:.............................................................................. Title:
MailingAddress:...............................................................................................................
Onsite Representative:TDVa`��^%_ f'.. qn E� .......
Certified Operator:
Location 'of Farm:
Date Last Operated or Above Threshold: -.
County:.„ V�� t,N
Phone No:
Phone No:.....
Integrator:... _ v °k rc` er%-% S
.....I ......................
Operator Certification Number:..........,
'JEF5wine © Poultry ❑ Cattle ❑ Horse Latitude • t 66 Longitude • 4 66
Design Currettt
Caiiaaty Ponnlation
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
- : Subsurface Drains Present ❑ 1-ag^ n Area Spray
❑ Field Area
Holdr�ug.Pottttfis'I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes ;ffNo
Discharge originated at: ElLagoon ElSpray Field [IOther
a. If discharge is observed, was the conveyance man-made?
❑ Yes ONO
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
❑ Yes -;&o
c. If discharge is observed. what is the estimated flow in gal/min?
1714
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes J'No
2. Is there evidence of past discharge from any part of the operation?
❑ Yes ;W No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes 'EfNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes JR"No
Stru -ture I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .................................... .................................... .............................................................. ....................................
....................................
Freeboard (inches): 317
5100
Continued on back

Facility Number: — i — 3d'L Date of inspection 3 L2 Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes PNo
(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 huffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
❑ No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
❑ No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
El Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20,
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22_
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ 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
....N. .
:Rio -yiolh igris:or- dCA.
cie>r 6O$ •were noted during this:visit; - Y:oit will •f. eeeive Rio further -
;cories'�de... about this visit • .... .
Comments (refer to questirsn #): Explain any YFS answers and/or any recommendations orany other comments: ,
Use drawings of facility to better explain situations. (use additional pages as neces
See G6onyp%e► 4s Fo)- 31 r 3d 3 .
Reviewer/Inspector Name ]3'fG fir, ll <%1�',S r
4 rr� ,
Reviewer/Inspector Signature: Date:

DIIvesion of Water rQualrty£
7i _ Q DlvlsiidII of SoII andi _
Water Conservation
OtlleFAgeIICY.�
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit *Routine O Complaint O Follow up O Emergency !Notification O Other ❑ Denied Access
Facility Number O [late of visit: Time- ® Printed on: 7/21/2000
Not O erational 0 Below Threshold
E3 Permitted 0 Certified ❑ Conditional! Certified [3 Registered 2�Q'Q9
Y g Date Last Operated or Above Threshold: -<..---- ...�1.l..-.
FarmName:............................................................................................................... ......... County: ........... / ...................
Owner Name: .......4r�.1EX7.............. Phone No: 3.1.... ............ ;
let)
.......
Facility Contact: .....U!! ......let).................... Title: ... 1' Yam" Phone No: .610
Mailing Address:....�..�.9.........t,4.1 �?a
...4AI.........................��/�!�.�.......� `�..'..L, .,.........�33..4/.... ..........................
Onsite Representative; .......1..L Integrator:........,t[l/e.....
Certified Operator: ............ :! {1L�......................................---..._.. Operator Certification Number:...` 2 3 7! �
............ ...............
Location of Farm: /
AV
❑ Swine []Poultry []Cattle []Horse Latitude
Design Current
JWHIC
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
�( Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
A.
Um G1 r�/ L.A/ -_
Longitude'
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
F
Dairy Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ L�rea ID Spray Field Area
Holding Ponds / Solid Traps JEJ No Liquid Waste Management System .
Discharges & Stream 3mpact4
1. Is any discharge observed from any part of the operation? ❑ Yes dNo
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) El Yes ❑ No
c. ll"dischan,-c is observed. what is the estimated ]low 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 S No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes WNo
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes N�No
Strom rc l Structure 2 Structure , Structure 4 Structure 5 Structure 6
cnti ic.r: .....................................
Freeboard {inches):
5100 Continued on back

Facility Number: Date of Inspection Printed on.. 7/21/2000
5 Ai•e there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑yes
Q(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
{>(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? 5 � ��
❑ Yes
&No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
VTNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
d6
elevation markings?
❑ Yes
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
QfNo
IL Is there evidence of over application? ❑ E cessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
VNo
12. Crop type&t?yn'bA
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No .
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑Yes
❑ Na
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
0; No-AWAtid is:or• di fciendia5 were ptgfed dit�ring this:visit: - Yoit :will-i•&6*0y 00 fufther
- : - roc.. oridertce: a�aitf this visit ' : ' :: ' : ' :: ' : ' : ' ::: ' :::: :
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes VNo
❑ Yes 9 No
❑ Yes dNo
❑ Yes QNo
❑ Yes U(No
'2'e-
g'r--Al-OVA-n� —
se7zo 2V
10/114
Mp A/✓JM da
0A1 9177- �1jGk_
1 L/9 `I
A.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
tt'4 n. S
Date: 10 4-0 5100

Facility Number: Date of Inspection O Printed on: 7/21/2000
UA(ir .issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge AJor hplow ❑ Yes ❑ No'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ 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 peimanent/temporary cover? ❑ Yes ❑ No
S/00

K
T- Division of Sail and Water, Conservation - OperationReview
i :� Division of Soil and Water Conservation' "Compliance inspecboi,
t
•® Division of Water Quality Complianceinspection
r
D Other Agency Operation -Review _.
Routine Q Com taint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number 3 Z
[)ate of inspection
Time of Inspection 24 hr. (hh:mm)
Permitted 13 Certified [3 Conditionally Certified [3 Registered [3 Not O erational Date Last Operated: /7
Farm Name: ....... [� `� !`L'. County:......... 1;---k .---•.................. ...`--'d..........
Owner Name:.. !� r ...................... c?.LahaM�.�Rf..trr.i-�.................. Phone No:..... GL!( I .�1�1..'..�1. ........_..._.............
7 ,.] . tMM . kv . i y.. ........................ Phone No:
Facility Contact: _-......_.N..............��.1._E.:}....Trtle:............/�..._.. .........`--�.....�
Mailing Address: ......`I. I/" -. 1!.....,n'.`4—e....f.� Li.!!r�l�l... ../f'•:•.G� ...... ................
�`L ..'.............. �. zf�3
Onsite Representative:... . ............. S.I Integrator: ............................................
j
Certified Operator:..../if' ........................... 1�/yttT� .... Operator Certification Number:......'.�� pall
A. `..................
Location of Farm:
,j ............................................................................................. ..................................................................................................................................................................... —
.......................................................... ......... .......................................................... I-.-.- . ...................................................................................................
,Latitude �• �� Longitude �• �� �«
i . Design Current = Design: Current, Design Current
aw111C
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
Farrow to Feeder
❑ Farrow to Finish
❑ Gilts r
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes I�No
c. If discharge is observed• what is the estimated flow in gal/inin'?
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 RNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes W,No
Structure I Structure 2 Structure 3 Structure 4 Structure 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 VNo
seepage, etc.)
3/23/99 Continued on back

Facili4y Number: i —3Q Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require main ten an ce/i mprovemen t?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I _ Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type fft. S C' 1 f7
13. Do the receiving crops differ with tLse designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22_ Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
El.10 vWaii6 is ;or• di f ciendt,s mere noted- during this;visit.- - Y;ou ;W ill •receive iio further ;
;corresporic#eitce aN ' f this :visit. ::: .............. .
Comments {refer to queshoh #) E?tplain any.YES' answers a)idlor any:recommen atious or arty othe
Use drawings of facility to 6et#er ezplatri.situations. (use additional pages_as necessary)
r W
eta
1 �
k'� 042
d d.
Name
Reviewer/Inspector Signature:
0
ANI
Date:
❑ Yes �(No
❑ Yes O�No
❑ Yes KNo
❑ Yes �No
❑ Yes KNo
❑ Yes [�No
[-]Yes QNo
❑ Yes ❑ No
❑ Yes ❑ No
fi?LYzs ❑ No
❑ Yes ,ANo
❑ Yes X No
❑ Yes gNo
❑ Yes KNo
Z Yes ❑ No
❑ Yes [�,`No
❑ Yes Wo
❑ Yes INO
❑ Yes ' [ No
❑ Yes /JQNo
❑ Yes 5rNo
invents'
i
//4 /}) qlO 3� 5- 39� n ,� 3123/99

I.Faclity Number: 31 —3e>2. Date of Inspection
1 Odor Issues
26.
Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes
❑ No
liquid level of lagoon or storage pond with no agitation?
27.
Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
❑ No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
❑ No
roads, building structure, and/or -public property) '
29,
is the land application spray system intake not located near the liquid surface of the lagoon?
❑Yes
❑ 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? El Yes ❑ No
AdditionalComments and/orDrawings: -. - _ . _...
Iq) FVOO iir S�r� i�q ���u�a�i6n 5 wed k Le, w,ka4-r �n�p �rG e, •
J l
�o� a CcYr,!jZ2—Z
r Sk r�� �NtS u - lrJas,4 &.I' �
Y
PG.S irad P , 7- Is p�r�oP �f� and em rrr,n.-6%
3/23/99

Facility Number:
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Laggons.Iiolding Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure i Structure 2
Identifier:
Freeboard (ft): ...........� :.�.....................
10. Is seepage observed from any of the structures?
Structure 3 Structure 4
❑ Yes 9 No
IP Yes ❑ No
Structure 5 Structure 6
❑ Yes R9 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 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?
1P Yes
I&No
(if in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ......_....6'm api7................................... j
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
0 No
20.
Does facility require a follow-up visit by same agency?
Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
❑ 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 AV;W? ❑ Yes ® No
25. Were any additional problems noted which cause noncompliance of the Permit? ❑ Yes ❑ No
D,No.violations-or. deficiencies were -noted -during this;visit. You.will- receive-no-ftirtheri,'
• : � i:orrespondence about this:visit:::::: ; :::::::. :: ; :::.:::..:::: ; ::::: ;::::: • ::::::::::.:: ; ::: ; ::
>> �, x xx
_Omma is (refer tO questaon #) E_rplain any Y 's answers agd/or any oxnmenda tons ar any ther rtt�nre�nts.,
`pagesl
€Use d�rawiiitgs of fac;hty fo better expiam Situations."(use additional as necesSary) � �
'=�? �.x a
''..., .A EI, =sa ^x ��"�"
.�
die- rt (if.ti a.,-d
ll •�! 2- � 1roSi arm aY•eo-5 ey. 'ii.►h : h1���GJ��+ 6 � � ehcxll� c�38e�!•
�at-1 Axta3 SuutU 6eeWe;�.
t�eaS-
:tn j�1ra.; %e�{�. San. ev;aGN11�e �rtima� te9� ii+� �o,n�W
CaO� Ohs
i4'.
7/25/97
Reviewer/InspectorName F sh n �' Y
Reviewer/Inspeetor Signature: Elate: t

0 DSWC Animal Feedlot Operatioit Review
� Dw Animal Feedlot Operation Site Inspection
10 Routine O Complaint O Follow-up of DW2 ins ection O Follow-up of DSWC review Q Other
Facility Number j 3oz Date of Inspection Q
Time of Inspection : S7J 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: E�JR.egistered ❑ Applied for Permit (ex:I 25 for 1 hr 15 min)) Spent on Review 3.5
❑ Certified ❑ Permitted or Inspect -ion (includes travel and processing)
oLOperational Date Last Operated: ...... �_.� .. _... ... _.
Farm Name: �.. 1 � � �� f�i'���. �� .��Y�`.. r _ County: ._ ! t1.. ..._ _ ..... .. .... _
Land Owner Name:..k�£><.... ` P.l� %� 5 ........ J�li f CL C1 • _...._ Phone No: _ �L.J.Z �.��Z ..... _ .... _.
i
Facility Conctact:... ... ........ _ _.. Title: _.. G� 1�_ r.'..�. _ ..._ Phone No- �R f 0��7� ....d 3 i � .
Mailing Address: �!��. �?�+...�fl. �1lLt�+'.� �� ZUq.
OnsiteRepresentative: ..... I�u►�.....�k+ 4?...M�'.: t� _.... _ Integrator:
Certified Operator-. ..??j. _;�rvurux::�s... _.... _... Operator Certification Number:
Location of Farm:
SQL .... �..t .. east. �rxs�!�.__1:�Jdx_'c cs � F :�n_ s - �x,......&aLsaL-r...a ... 5 L 3 L. LE
_..4
.....__....__.......-....................._........... ----•......_ _--...._- - -- - ............_....__.........._..........---,........�....__---- �
Latitude Longitude �• S� ° ®�.
Type of Operation and Design Capacity
F" 4%. DesignCurrent x
Design: Current w F Design Current
act#v 1'o ulaiion 3;"P6111try. _.:Ca achy Po"ulahon `Cattle .> ;Ca actty Po` elation
�.
❑ Wean to Feeder Layer =x- ❑ Dairy
❑ Feeder to Finish a; ❑ Non -Layer Non -Dairy f
11 Farrow to Wean Mz
Farrow to Feeder 6CO Tol Design Capacity tabOU A
Farrow to Finish
£�
"; � �z-Total'SSLWY �
❑ Other 3 N
Number of� �Lagoons 1 Holding Ponds Z ❑Subsurface Drains Present v
❑Lagoon Area ❑Spray Field Area r
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes 12 No
2. Is any discharge observed from any part of the operation? ❑ Yes EtNo
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?-
f
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes Lj No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes E[ No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes RNo
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes E No
4/30/97 maintenance/improvement? Continued on hack

Facility Number: �...L
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?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structur s Lago ns and/or Noldinc, Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I kiLS Structure 2 Structure 3
Structure 4
❑ Yes Ef No
❑ Yes �io
❑ Yes k No
❑ Yes ® No
Structure 5 Structure 6
10. Is seepage observed from any of the structures? ❑ Yes 191 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? 0 Yes ❑ No
12. Do any of the structures need maintenance/improvement? Yes ❑ No
(If any of questions 9-I2 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
I4.
Is there physical evidence of over application?
❑ Yes
No
(If in excess of WMP, or entering waters of the State, notify DW� )
15.
(runoff
�Q�
Crap type - .�i l?Y:!?�71t1 �.... . ? "!�] 1.... coil 1 .... _.. -_ ....
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
fgNo
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
ETNo
18.
Does the receiving crop need improvement?
[3 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
MNo
20.
Does facility require a follow-up visit by same agency?
KYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
For Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
KNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
l No
24.
Does record keeping need improvement?
❑ Yes
RNo
Comments (refer to question f: Explain any YES answers and/or any recommendations or any other comments. '.
Use drawings of facility to better explain situations. (use additional pages. astecessary):. _ t
Eroz;oi. an-Ei..s. wa1i A �LS ia�con 5�1� 1,P �iI(t�a�tu*c�`irc�eeJed.-r��` EroS+c►ti a�
4
oukr we.11 o� 5vmr,,#1 la ain she-}e�lc� be Y-Itty LAft4f%. Uz,.j ou%J reseedO. I'Lut �i�e O'N S
e,rDied N^ee- to"A W a,, rc S�PH A, v'e4l_`�� ai.L'
StUmm- 511LU!(7 }C (J-
1f�
�g. �QtZSTwI t�elimUdL� G4�` i�tCJ�G� l]� ii�.�ieyi:V
Reviewer/Inspector Name . f
Re-tiewer/In sp ecto r Signature: Al Date: s�/z�1i9Z
--r—T—
cc. Division of later Quality, N'ater Quality Section, Facility Assessment Unit 4/30/97

10 Routine O Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Facility Number 30Z
Date of Inspection $l-27b
Time of Inspection !$7] 24 hr. (hh:mm)
Farm Status: Registered ❑Applied for Permit
Total Time {in fraction of hours
(ex:1.25 for I hr 15 min)) Spent on Review
❑ Certified ❑ Permitted
or Inspection f includes travel andprocessing)
p�Operational Date Last Operated: ...._- ....� ....
_ .:.. ..... _ ..... _....._ .... -..........................
Farm Name: _... _rYl,C!-[111..._..AY ...._._.......
County: ..`j! L1.. »...... ........ .... _...... __.... _ .
Land Owner Name:.�43(... i51.1Y �!11...........
Phone No:
Facility Conctact:... ...Ii! .... ....... ......... .._.. Title:
Phone No: � 10��'(¢ ... 03 t �-..
Mailing Address: ��. .... �'..••-� l.L�i _ ! ...!�fl.._.....................
�!�Jl� ...�.1.�� ... .� _... iLU .....
Onsite Representative:....Lau1-_�.... Integrator: t
Certified Operator: .. .. .... ............ .._ ... w.. ... Operator Certification Number:......... :....... ...
Location of Farm:
Latitude =•6®u Longitude �• 5-7 ®�
Type of Operation and Design Capacity
DeS1gQ a°Current r DeS1gQ`� Clll'CCQt DeSlgn �`nCrent
Swine „ ' S 3_ Poultrx @a aciv - Cattle
Ca aci Po elation :?..,::.-. Pv elation. Ca ace Po ulai�on
❑ Wean to Feeder I❑ Layer ❑ Dairy
❑ Feeder to Finish ❑Non -Layer ❑Non Da
Farrow to Wean
El Farrow to Feeder 600 Total Design Capaedy ��
v
Farrow to Finish
b��
xr< ... 9T a SS W zcrl
�❑ Other ' '
Number of Lagoods / HoldiQg Ponds 2 ❑ SQbsurface Drains Present
Spray Fi
eld Area ❑ Lagoon Area
ene 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?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes 12 No
❑ Yes E[No
❑ Yes No
❑ Yes No
hi
❑ Yes ® No
❑ Yes & No
❑ Yes KNo
❑ Yes K No
Continued on back

Facility Number: 3 1 — 3oZ
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures fLagoons.tlolding Ponds, Flush Pits, ete.E
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......-. .................................................................................................................. ....................
Freeboard (ft): ........Z...
W.
Is seepage observed from any of the structures?
❑ Yes
[A No
It.
Is erosion, or any other threats to the integrity of any of the structures observed?
CO Yes
❑ No
12.
Do any of the structures need maintenancelimprove ment?
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
C1 No
Waste
Application
14.
Is there physical evidence of over application?
❑ Yes
09 No
(If in excess of WMP. or runoff entering waters of the State, notify DWQ)
15.
Crop type ............(PA t--.iwl ue!....................................... ................. ...... sir1a l...--._riy..............................---..---....................................--
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/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement'?
❑ Yes
No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
0 No -violations or deftciencies.werenoted during this', visit. - Yddwill receive no further.,
correspondence about this: visit:
" j12. �trosll;o r o�. {
;hrur
wa i iii of
4LS (Ageor, 5�o4 foe- 44J WA Ct+y &J rid
i $ CcaS tc.l �e� rnui}�
co �
S koo 1 t� bt
i in �we j . .
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: AL.— l i 11 � Date:

A*ywe73's1�1�"'�,.�'g�rr`'ti-tr"1i�kice:rrtrfi.CeNiT;..-.s.�Mm*brw•-svr,.r-y»R—..ntis_..;..-w,f's�,:_..e,'�.-..,�«.tr: �.,, .J+i*tr....:r-�,,;��:�-rfr::.,,.oz..e...�r,r"rkv.P'Ts,-..-�',-.r
J
Facility Number: :& I 3UL
8. Ar'e there lagoons or storage ponds on site which need to be properly closed? ❑ Yes No
Structures (LaQoons.flolding Ponds,. Flush Pits etc.)
k
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: HLS
...................... ............. ............................................................... I _. _...............I .. _. _............................................. .
Freeboard. (ft):Z............. .........................................................................................................................................I..................
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 maintenancelimprovement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
l4. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
ff r_
l5. Crop hype ............Cd0.S�i.._. V._3e ........................ I ....................................... ... tMU.......�J....... ................. ..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23_ Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24, Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0l No.violatioits or deficiencies were noted during this. visit..You,will receive- ito further
correspondence about this: visit:• : • ' .:.
lt_ffz. EYos;pt^ ow kywV_V, wa [ 1 0f 9Ls (a�aon S�'04 �6e (di
Caps ��r�nudr~ CV01 SkOV16 -e ;Mpave . -
Structure 6
❑ Yes No
M Yes ❑ No
M Yes ❑ No
❑ Yes [N No
❑ Yes [M No
❑ Yes
6 No
❑ Yes
No
[D9 Yes
❑ No
❑ Yes
[ No
[� Yes
❑ No
❑ Yes
N No
❑ Yes
a No
❑ Yes [N No
❑ Yes No
❑ Yes No
7/25/97

❑ DSWC Animal Feedlot Operation Review
Animal Feedlot Operation Site Inspection
7
_4w,�DWQ
ME
140 Routine 0 Complaint 0 Follow-up of MVQ inspection 0 Follow-up of DS77C review 0 Other
Facility Number `F
Date of Inspection `--'-►�i i
Time of Inspection I5b . 24 hr. (hh:mm)
PERegistered © Certified [3 Applied for Permit © Permitted [] Not Operational Date Last Operated:
Farm Name:..... HL.............. rr.G,rmS.........-.....- County: .... Dfl Dqlizl ........................................ .......................
Owner Name:......[ Zu.fR.2c. .....L...,.....5t .MV_ '.tn....................... ... ... Phone No:�5..-.Q.51.7.........................................
Facility Contact: ..... Y. YL........5�.`.�`.``�rr`! !'l'!'�.............. Title ......... oLj.luY..... Phone No:...��L� i.Z-�L.. :6................................ 1. ......
Mailing Address: ...21.3........ .C.S......W.OvItD......&4.....1N[i........................ ..........t1 i'SG�....................................... ........
Onsite Representative:............SVY,.Pv1.rtjk......................................... Integrator:
Certified Operator; ... ...1kC,iclAlcl[..[...............•atlny,Y.t3tr1!.(....................................... Operator Certification Number, ...... �q.g$...................
..
Location of Farm:
.......c�,i�...........f�......L,�ta... .. m...........a.rsa.r,�...,........o►,trtn....ts....r--.TT1r.�x....,.....m�. �...:..�t.�........�a .....�.....1.. al..---4�.....
!'!orIr•......s��e f `....................................................
Latitude 3r • Dz. 1 2'1 IC
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
N Farrow to Feeder
&(Yj
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude • &
Design Current Design ..:Current
Poultry Capacity Population Cattle Capacity. Population
❑ Layer ❑ Dairy
❑ Non -Layer I I JE1 Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons./ Holding Ponds, ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste )Management System
General
1. Are there any buffers that need maintenance/improvement'? ❑ Yes P No
2. is any discharge observed from any part of the operation? ❑ Yes EP No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance malt -made?
b. If dischaQ-,e is observed, did it reach Surface Water" (if yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/niin?
d. Does discharge bypass a lagoon system? {If yes, notify DWQ)
3. is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not incompliance with -any applicable setback criteria in effect at the time of design?
❑ Yes
V No
❑ Yes
1P No
❑ Yes
qNo
❑ Yes
P No
❑ Yes
yu No
❑ Yes
[i No
❑ Yes (A No
❑ Yes 00 No
Continued on back
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97

-+tom :-'ci.'Yi��+�-WY":.w�•^,�.i---r...�'Vt,44.,yt'�,�'�'+�. ro�"^"�'�.�-•,.r�.,;.;,�o,Q„�,�,q„�,�,14atit,:,�/�-.,.r- ��•-cc'--r+-<'9Zrt..r -TM1._,r,�t_ „ y,, •-••r- -=�.a.�; �.,.,r,�.'�"�r'..,w.-J�+.^..:.�'".a.�
M .. ❑ DSWC Animal Feedlot Operation Review
a ¢
®'DWQ Animal Feedlot Operation Site Inspection
10 Routine O Cllmnlaint O Follow-un of MV0 insnMtion O Follow-un of DSW C review O Other 1
..............
Facility `umber
(,Registered O'Certified 0 Applied for Permit © Permitted
Date of Inspection
Time of Inspe:c:tion EL—= 24 hr. (hh:mm)
3 Not Operational I Date Last Operated:.... ...
Farm Name. HLS1...........��x_.S.........................................................
+ ..................... county-:.....
r.��)1in.................. ..............
Owner N`ame:...... .{f.k!t�'?�.`.k................ SVrext . . i_..Y."t................................................... Phone No: ...... i�?.!A;M. 031.7r.........................I..............
Facility Contact: ...... .Y.y�c. ......Svtl, } �h.............. Title
.......... 0.wk+�.l�...................................... Phone No:....��Ib> � `2G.-.�.�� �......
Mailing Address:.....44773. wkl lf...lNie.yis.......�tl�s.......G............... ....... !'V.r y-s ,s� ...................................... ... iRR.In.......
Onsite Representative:. .-#'1[ Y. Y.T........ MX! kA'�!!1 Intel;rator:..... Mvf.t�hy.............................................................
Certified Operator ;......... .V..IDP.Y.. .............. .V+ X11t L! r'............ -f---................ Operator Certification� Number ....... i !�Ml-.-.-.-..............
Location of Farm: at.
T�! ...........r�.....(. r.... ..........�;�....... ..&;rx......AN..... (I �r.."......... ..m.k.i.......eg.s±.......oE......5.k...1 ,01.....co......
........ A...... S�Q..... [ . .�...:.....
Latitude 35 ` bL ' " Longitude i(
Design -Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
®Farrow to Feeder
G6G
❑ Farrow to Finish
❑ Gilts
❑ Boars
.......... - - ---------- - - ----------- - ---------
Design Current Design ,, Current
Poultry Capacity Population Cattle; Capactty;Population:.
❑ Layer ❑ Dairy
❑ Non -Layer I ID Non -Dairy
❑ Other
Total Design Capacity ,da
Total SS.LW 3 ! boo
Number of Lagoons) Holding Ponds U ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
❑ No Liquid Waste Management System
General
1. Are there any buffers that need maintenance/improvement'!
❑ Yes
[51 No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge orioinated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'
❑ Yes
No
b. If discharge is observed, did it reach Surface Water'? tIf yes, no(ify DWQ)
❑ Yes
No
c. If discharge is observed, what is the estimated flow in C-al/min?
!j �llr
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
[a No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge`?
❑ Yes
No
5. Does any part of the waste management system (other than ]agoonslbolding ponds) require
❑ Yes
No
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
m No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
7/25/97 Continued on back

Facility Number: ....... —... Z
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?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons andfor Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I " Lj Structure 2 Structure 3 Structure 4
.. .... ?'.`� ....... ......... .._..... W ..... __.... .......... .....
❑ Yes gNo
❑ Yes EZ$lo
❑ Yes JVNo
❑ Yes ® No
Structure 5 Structure 6
10,
Is seepage observed from any of the structures?
❑ Yes
Ej No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
19 Yes
❑ No
12.
Do any of the structures need maintenance/improvement?
E 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
E5No
Waste Application
14,
Is there physical evidence of over application?
❑ Yes
JUNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ..................... 1� !� ................. .....
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
R,No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
ETNo
18.
Does the receiving crop need improvement?
[K Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
[�fNo
20.
Does facility require a follow-up visit by same agency?
KYes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
10 No
For
Certified Facilities Only
22.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
RNo
23.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�9No
24.
Does record keeping need improvement?
❑ Yes
C"No
Comments (refer to queshon #)_�.ExpIiin any, YE answers.and/or any recomtnendahons ;or any','other comments x
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cc: 'Utvtston of water Lluattry, ►rater vuattryaecrton, racutry Assessment vnu 4/3U/V 1

Site Requires Immediate Attention:
Facility No. 3/ -IV �� Z
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995 ��' ja._ ��� _ C3� 2—
Time: f &
Farm Nz
Mailing
County:
lntegratt
On Site Representative: _ 0/l Vim' [>_dcLzicz /N _ Phone:
Physical Address/Location:
Type of Operation: Swine t,"_ Poultry Cattle
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude:" _'� (-D" Longitude: /7 q ' ' L5-? " Elevation: Feet
Circle Yes or No
Does the Animal Waste. Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: c2Z—Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or eWas any erosion observed? Yes or
Is adequate land available for spra�? Yes or No Is the cover crap adequate? es r No
Crop(s) being utilized: t.;IA.Ej!7�
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? e or No
100 Feet from Wells? Z e` or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or&T
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or l
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or( If Yes, Please Explain -
Does -the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No T
Additional Comments:
Inspector Name
Signature
cc. Facility Assessment Unit
Use Attachments if Needed.