310325_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Quai

Type of Visit: S�'C0 lance Inspection U Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:f 4 f 130
Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: rl G t.4'X / n
I Ile"__
Certified Operator:
Phone:
Integrator:
Certification Number:-) 9 / rj
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop. Wet Poultry
Wean to Finish Layer
Design Current
C►apacity Pop.
Design Current
Cattle Capacity Pap.
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
[} P,©ul
Layers
Design Current
Ca aci P,o
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cm-d I
01
keys
Otkey Puults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
o
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters, of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
[] No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑31 NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
EINo
❑ NA
❑ NE
of the State other than from a discharge?
Page l of 3 21412015 Continued

Facili +Number: - Date of lus ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes [] No ❑ NA [] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): r3 S-01-_ 47
_
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes to -❑ NA ❑ NE
❑ Yes D<o ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thre ,notify DWR
7. Do any of the structures need maintenance or improvement? ❑Yes o 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
ErNo ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
o ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
l4. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[ o ❑ NA
❑ NE
l5. Does the receiving crop and/or land application site need improvement?
❑ Yes
6/No, NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
o ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ YesNo
g❑ NA
❑ NE
Required Records & Documents
�❑
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[]Yes RNo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
?
❑ Yes �o
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes No
❑ NA
❑ NE
Page 2 of 3 2/4/2015 Continued

s
Facili Number: - Date of Inspection: 3
7,, 7
24. Did the facilityfail to calibrate waste application equipment as re required b the er nit.
PPq Y P �
❑ YesrNo
❑ NA
❑ NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check
❑ Yes❑
NA
❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
[:]Yes
No ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[:]No NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
[] Yes
E rNoo 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
o [] NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
P40 ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or GAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Reviewer/Inspector Signature: ✓" Date: 7 t 3
Page 3 of 3 21412015

(Type of Visit: Q CCopliance Inspection U Operation Review Q 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: Arrival Time: Departure Time: //�-1 County: Po �Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
1-11
Onsite Representative: ()6 A d, 4A d r ' CEL LE1i
Certified Operator:
Sack -up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: I b l
Certification Number:
Longitude:
Wean to Finish
I
ILayer I
I Dairy Cow
Wean to Feeder
Nan -La er I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Dairy Heifer
DesigW D Cow
D , P,oultr, C_a a_c.Non-Dai
La ers Beef Stocker
Farrow to Finish
Gilts
Nan -La ers
Beef Feeder
Boars
I Pullets
I lBeef Brood Cow
Poults
Other
Discharges and Stream Impacts
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 0 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
0 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
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes❑
NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
rN
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

[Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �Q I CA(<_4/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen I 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 FZ/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 F� No ❑ NA ❑ NE
maintenance or improvement?
Waste, Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ZNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ENo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14, Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required_ Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ WUP ❑Checklists [—]Design ❑ Maps [:]Lease Agreements
❑ Yes
® o
❑ NA
❑ NE
❑ Yes
Zo
❑ NA
❑ NE
❑ Yes
Vo
❑ NA
❑ NE
❑Yes
[] o
❑NA
❑NE
❑ Yes
2o
❑ NA
❑ NE
❑ Yes
� o
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E7No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesWNo
o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

f
FacilityNumber: - Date of Ins ection:
24;.Did the facility fail to calibrate waste application equipment as required by the permit. ❑Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes VNo ❑ 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? 0 Yes [DNA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 2 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
[:]Yes Wo ❑ 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 C51NI o ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes []/�o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes F3/No❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
ElYes ❑ NA ❑ NE
Comments.(refer to question:#): Explain any YES answers and/or any additional recommendations or any other comments. ,
Use drawings 'Df-facility to betterexplain situations -(use additional pages as necessary)..:
„
ReviewerAnspector Name:
Reviewer/Inspector Signatw
Page 3 of 3
Date:
IM

Type of Visit: Vompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 01koutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: ��'�.��� _ Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region: LL4)
Swine
Wean to Finish
Design Gurreat
Capacity Pop.
Design Current
Wet Pouitry Capacity Pop.
ILayer I
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er
I
ED
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design C►urgent
D . P,ault , Ca aci P,o
La ers
D Cow
Non-Dai
Beef Stocker
Gilts
Non -Layers
Beef Feeder
I L=
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Dischar es and Stream Im acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes E]�No ❑ NA ❑ NE
❑ Yes
�No ❑ NA ❑ NE
❑ Yes 1/I No ❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ YesVNo
o ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facility Number: y Date of Ins ection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes '2 No ❑ NA ❑ NE
r
a. If yes, is waste level into the structural freeboard? ❑ Yes P'No ❑ NA ❑ NE
structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I 42_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �'No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) �"
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes 5,*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 ZNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ;2"No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes RfNo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VfNo
❑ 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 > tO% 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 JZNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes O No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes eNo ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
I S. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes j2fNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes J?fNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. �.
❑ W UP ❑ 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 I " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNo
o
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes
❑ NA ❑NE
❑ Weather Code
Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the pe t? [:]Yes ff No
25. Is She-faciAty 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
❑NA ❑NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes Q No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an.odor or air quality concern? ❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes 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 f' No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �TNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes P�No ❑ NA ❑ NE
C.ommeats (refer to question { Eaplam any, YES, answersandLor.any edditional recommendations oryany other comments; w w k
Use drawings of facilih''to'1iater-ez_P`1iilsituations use additional pages as necessary)
W
AJ �� S� �Q/ lh
103
of 1 o?d/c/
GJr l / lcd�' s/llQ,�i �S urU�e�
�.. 3 / LeXI G✓e e -
/'rl//✓� o� /'eCol,�lj looP j,,5�
i
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:�3
Date:
/4/201

type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: �,Q { Region: V
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Integrator:
Certified Operator! Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry. Capacity Pop.
Wean to Finish Layer
Cattle
Dairy Cow
Design C*urrent
Capacity Pop.
Wean to Feeder
-Non-ILa er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . Poultr. C►a aci P,o
Layers
D Cow
Non -Daily
Beef Stocker
Gilts Non -Layers
Boars Pullets
Turkeys
Other Turkey Poults
Other Other
Beef Feeder
Beef Brood Cow
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes,oNo ❑ NA ❑ NE
❑ Yes )2ro
❑ Yes j2-No
❑ NA ❑ NE
❑ NA ❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes TTf2No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes �N ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

1
Facility Number: 113ate of Inspection:
Waste Collection & Treatment
a
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yese,[!:rNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes V No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): `!±42
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes VIo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
TT
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes ! I No
❑ NA
❑ NE
waste management or closure plan?
IIIII
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Da any of the structures need maintenance or improvement?
❑Yes j�I
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes o
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [;?Ko
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes IfI L
❑ NA
D NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes )6No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesgNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
l_
❑ Yes Zr No
❑ NA
❑ WE
_Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Y-es .JZNo
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes KNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
[—]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste T nsfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspecti6,-
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yeso
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes o
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

Facility Number: IDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E!rNo ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes PNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes '04 No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes ;TNo ❑ NA ❑ NE
❑ Yes U(No ❑ NA ❑ NE
❑ Yes ,U No ❑ NA ❑ NE
[—]Yes KNo ❑ NA ❑ NE
❑ Yes 7 No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facilitv to hetter explain situations (use additional napes as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: AZ�Z;.tLl�kb
Date:
21412011

i ype m visit: JU uompuance inspection v uperauon rceview v asrucrure nvaivanon v i ecnnicai Assistance
Reason for Visit: f�Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: Lk ICJ County:
Farm Name:_�QOwner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region:
Onsite Representative:
Integrator:
Certified Operator:
6Certification
Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design Current
Capacity Pop.
Cattle
DairyCow
Design
Capacity
Current
Pop.
Wean to Feeder
Non -Layer
EEI
Dairy Calf
Dairy Heifer
Cow
Non-Dairy
Beef Stocker
Feeder to Finish
I) . Poult ,
Layers
Design Current
Ca aci P,o
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 J�TNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 71 No
❑ Yes r No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

V
Facility Number: jDate of Inspection:
Waste Collection & Treatment `
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes VfNo
a. If yes, is waste level into the structural freeboard? ❑ Yes [—]No
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: s� U_
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3S
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes )nNo ❑ 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 VTNo ❑ 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 P No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VtNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes J�TNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ZfNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ;27No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes KNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes ;2rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes )E[ No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes �No- ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ,?5"No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? [:]Yes ;a No DNA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes KrNo ❑ NA ❑ NE
Page 2 of-3 21412011 Continued

1'
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA FINE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes 4No ❑ 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 /I No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 4 No ❑ NA ❑ NE
Other Issues
29. 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
7T No
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
❑ Yes
[Z No
❑ NA
❑ NE
❑ Yes j] No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 91 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes V1 No ❑ NA ❑ NE
Reviewer/Inspector Name: �V►� �/
Reviewer/Inspector Signature:
Page 3 of 3
Phone: l
Date: 5/3013
21412011

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: / Arrival Time: 3 Departure Time: County:
Farm Name: �jaQ {Vt Owner Email:
Owner Name: SCC;rr `lam Q_Q�� Phone:
Mailing Address: 1 FS (-6,4 V 'cz'rc� LA 1 LL D SoZ
Physical Address:
Facility Contact:
Title:
Onsite Representative:LLu
! (Z Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current Design Current
Wet Poultry Capacity Pop. Cattle Capacity Pop.
Layer Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
Daja Heifer
Design %ur en Dry Cow
Dr, P,ouIt , C►_a aci.Gy, P. Non -Dairy
ILayers I Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes [—]No
❑ Yes ❑ No
❑ NA ❑ NE
DNA ❑NE
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 No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: jDate of Inspection: /
Waste Collection & Treatment P�qo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑]No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 1 r-
Spillway?:
Designed Freeboard (in):^
Observed Freeboard (in): 3 L� 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 3_XNo ❑ 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? 0
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes6KNo ❑ NA ❑ NE
maintenance or improvement? """" ����
Waste APPHeation
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 4No ❑ 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.No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? Yes [:]No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes P No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Required Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA
❑ NE
the appropriate box.
0 WUP QChecklists 0 Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
Waste Application Q Weekly Freeboard Q Waste Analysis Soil Analysis ❑�aste TXNo
ers 0 Weather Code
Q Rainfall ❑ Stocking ❑j/rop Yield 0120 Minute Inspections Q Monthly and V Rainfall Inspections 0 Sludge Survey
i
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 0 NE
Page 2 of 3 21412011 Continued

Facility Number: 31- Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ONE
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 A NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes No
If yes, contact a regional Air Quality representative immediately. 0
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No
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 PrNo
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �{j No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes TYt' No
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ` &o
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #1): 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).
Lo I )
wg/j, 1.(,r 6.q8
0191111 49.1 911
UAW) ic�v Dtti
FED N - L` ^1 * FI G L S
FG./VeCA� cap aF��� o1�
m
alL�
gu4Cf1Ut_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
w� c� CY-- _ ;� r�ax G
Phone: �JQ " 1 I (o
Date: / "t/I
21412011

Type of Visit: Compliance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: X Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: llV Region:
Farm Name: �� �� Owner Email:
l9)(�S��Ci3G8CN
Owner Name: Sc ar"r S �� Phone: ( si
Mailing Address: 1Vg-+ '1�-EI� I -AIL.(_ Q� ]gc_gOQ jSCa��,XI C Ds-, S ' T
Physical Address:
Facility Contact:
Onsite Representative: ��Lk t—P, (':::� to 1 l 14
Certified Operator: OTT i '-:, . QZuS &
Back-up Operator:
Location of Farm:
Title:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Design Current Design Current
Swine Capacity Pop. v_ - lip.oultry Capacity Pop.
Wean to Finish Layer
Design Current
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Farrow to Wean
Design
Dr, P,©ult , Ca achy P,o ,
Lavers
Dairy Heifer
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[:]Yes [:]No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑NA []NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facility N mber: '3 t jDate of Inspection: / f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 ) (4`!
❑ NA ❑ NE
❑NA ❑NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste,management or closure plan?
❑ YesNo
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 6No ❑ 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? IX
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 lO lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptabblee Crropp�Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): REg= .V'
13. Soil Type(s):
O1 t-c _
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes [�kNo ❑ NA ❑ NE
❑ Yes 10 No ❑ NA ❑ NE
❑ Yes 9 No ❑ NA ❑ NE
❑ Yes to
o
❑ Yes
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
QWUP El Checklists QDesign Q Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
VX
Q Waste Application ❑ Weekly Freeboard Q Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
Q Rainfall ❑ Stocking ❑ Crop Yield Q 120 Minute Inspections Q Monthly and V Rainfall Inspections Q Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

[:FacAty Number: jDate of Inspection: G
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rX
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yeso ❑ 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 Q] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes % No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal? [A
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [ No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
34. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes MI 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
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ YesgNo
No
❑ NA
❑ NE
i
34. Does the facility require a follow-up visit by the same agency?
❑ Yes th No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other, comments .
Use drawings of facility to better explain situations (use additional pages as necessary):
u30MAK oN & 1ETTI1I6% SV MAk4q�S AC -ET F-oR- c_'C)CWS
SOIL- ee?oq, �)A--,cr�' MV/1 is FrjR- 'ID - 5+ 1(--L ntc--E % CV4(-: f--otz ') I
-ru-)o SA++A(VLk S C ALL r c3THAN a T o F u tAMoSToTOC-R 5 CAL-L
�� µp�.� �r H AN I r bF Lr a► � - J�� EE D 'ram t_ cx� l nr �n (rt � � F oCi` F t lr t_ S]S
w.A- I a
0013111 1.5 /.(0
/p/1C) 1. s o .�T
,l,g1jo 3.�
FAW srNcr
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
IO�A�-I�ib� FQ�F�3c�AQ� RCcaRDS
Phone: ����%% �3091
Date: CS&k&
21412011

Faculty Number
I ­ �
az -
E.._
DIVISion of Water Quality
Type of Visit 01Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit ,Routine Q Complaint 0 Follow up , 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: kQ/ jrrJ/p I�-Arrival Time: I _62 70 m' I Departure Time: County: uN Region:
Farm Name: - r'� S r 1�n+`'� Owner Email:
Owner Name: C'07T Phone: t`D5l M 55ca0--"335 iw�)
Mailing Address: i�� ILL Kam` I�L�ti2I-saw, IAC DR5_0
Physical Address:
Facility Contact: Title:
OnsiteRepresentative: �ce U()v1r I
Certified Operator: �7'T l�� --,, • \`o"l C-
Back-up Operator:
Location of Farm:
Phone No:
Integrator: [[��
Operators Certification Number: 19 -421
Back-up Certification Number:
Latitude: = c = 1 =Ag Longitude: = o = 6 0 If
Design
Current Design' Currentry
Swine
Capacity
�Populatron Wet PflultryCapacry Population'.
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish
(�
"
Farrow to Wean
"D
Potilt
_ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
urke Poultsther
ET
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 ^
Dairyy Heifer
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?
Page 1 of 3
El yes Y No ❑NA ❑NE
El Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
Wo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
12128104
Continued

4Faci4y Number: `5 1 —3�5
Date of Inspection o
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: ! CL
❑ Yes V No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑ NA ❑ NE
Structure 6
Spillway?:
Designed Freeboard (in): pr)
Observed Freeboard (in): ti
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No El NA El NE
(ie/ large trees, severe erosion, seepage, etc.) �..,(
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes [J No ❑ NA [I 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 KNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes A
No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? .
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ANo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes $�No ElNA ElNE
ElExcessive Ponding ElHydraulic 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 AcceptableCropWindow ❑ 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
o
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rNo
❑ 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 aestion # Ex Lain mn:
(' q ) ;; : p any YES. answers°`and/or aiiy recommendations or any other comments •
Use drawings of facility to better explain situations. (use addi#ionahpages as necessary)
Reviewer/Inspector Named
ll') AN0A 6'AJ/IGrE _ Phone: ��I�o30'
Reviewer/Inspector Signature:
pw�(Lb Date: to
Page 2 of 3 12128104 Continued

1 _
Facility Number:3 j �S I Date of Inspection
ReQuired Records & Documents C ,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes �[J No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes)kNo ❑ NA ❑ NE
the appropriate box. El WUP ❑ Checklists 0 Design 0 Maps ❑ Other )i-No
21. Does record keeping need improvement? If yes, check the appropriate box below. El
Yes ❑NA ❑ NE
0 Waste Application El Weekly Freeboard 0 Waste Analysis 0 Soil Analysis ElWaste Transfers ❑ ,� inual Certification
El Rainfall ❑ Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and 1" Rain Inspections El Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
ElNA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
§No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
ElNA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
ElYes
No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ANo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
'KNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
gNo
❑ 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
9No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
P No
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss reviewtinspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
)6-No
❑ NA
❑ NE
Additional Comments and/or Drawings:,,-, r - n a;, 4
rZ
iC-,N T O S �& I F R - EE3o-tom GA-n/
7- AC��a� Q�S16� a� Sttiwt,�AR�S�l
w-A - ► a
5I,`410 .D
a11(9110 i. a1050 )'o
j­5L',-'C>1q6-7 ��s
CaAae0AT )atc G � C7�1l
12128104

Type of Visit kcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit J Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: FW2-t1c=r, Arrival Time: Departure Time. County: ' t11 N Region:
Farm Name: _EQk S.F79CLM _ _ Owner Email:
p � [� 19 -ems -v3�Ch
Owner Name: Y _ITT 1 J �a�s Phone! VSc9- 5 &.0 -S,4 3 S rwA
Mailing Address: ) 8 tG;::j t � �A ► LL_ A L_G J: SCy►/ , WC CQg.S(2&
Physical Address:
Facility Contact: Title:
Onsite Representative: \-cE L a g i f-l�
Integrator•
Phone No:
Certified Operator: Operator Certification Number:
Back-up Operator:
Location of Farm:
Back-up Certification Number:
Latitude: 1 o = ' = Longitude: E__1 o = ' 0 u
Design C*urrent
Design
Current Design Current
Swine Capacity Popula#ion
Wet Poultry Capacity
Population Cattle Capacity Population
❑ an to Finish
❑ Layer
❑ DairyCow
❑ an to Feeder
❑ Non -Layer
❑ DairyCalf
ceder to Finish
❑ DairyHeifer
❑ Farrow to Wean
pry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
❑Pullets
u
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
]MCf Structures:
Discharees & Stream Im acts
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 Po ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
❑ Yes
ANo
❑ NA
❑ NE
12128104 Continued

l
Facility Number: 3 -395 Date of Inspection
Waste Collection & Treatment XNo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes [INA ElNE
a. If yes, is waste level into the structural freeboard? ElYes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 91d�
Spillway?:
Designed Freeboard (in): ��. S �•
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 �f.] No
❑ NA
❑ NE
through a waste management or closure plan?
l�1
If any of questions 4fi were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes No
19
ElNA
[INE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑ Yes Iq No ❑ NA ❑ NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ':�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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)
156
13. Soil type(s) PuTaLk tm C_L_C
14. Do the receiving crops differ from those designated in the CAWMP?
❑Yes I No
[I NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes _Wo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ yes J!P4o
El NA
❑ NE
17. Does the facility lack adequate acreage for land application?
,,
❑ Yes `CI�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes �KNo
❑ NA
❑ NE
Comments�(referpto,�gnest�ony#) *�Explarn any�YES�answers,,andlar�,any`recommendat�oas or�any other comments:
kUse'd�awmgs�of facilityFtoRbetter�expla�n�situahons.(use�add�honallpages�astnecessary).
G�uC3CtRTIoiu sNcE'r FoCZ 12-)t�1o� NE��S TU 6F S SG�NE1]
!N 01c, DG-sl6 Vl! nox/ Fcv� ` Alin S /NpICa47j-ES
�ppN F� y,C6A/ `�iA� A S a 1 C_ � t<CF}SE � �►l i� cc� A0� " Q I G ca�p
C CZ R C JV a �A7dC�- �� : A rnigAIC)R C-� Ar�vEs r �acznrNq �
n1CDFivR - t'�wC3k wicru�t� � NG ap`io5
PE P 9 10 - 350-pwLl 1W
Reviewer/Inspector Name [ M: (=5 Phone: 9/ram- 'Tia
Reviewer/Inspector Signature: C lmftnosg Date:
Page 2 of 3 12128104 Continued

Facility Number: — S Date of Inspection w--+ E
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes P<No ❑ NA ❑ NE
the appropirate box. 0 WUp ❑ Checklists ❑ Design
g [] Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
[] Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ /V9ste Transfers ❑/nual Certification
ElRainfall ElStocking ElVrop Yield ❑ 120 Minute Inspections ElMonthly and 1 "Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes D9 No ❑ NA ❑ NE
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
"zNo
❑ NA
❑ NE
❑ Yes
o No
❑ NA
❑ NE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA bLNE
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ONo
❑ NA
❑ NE
❑ Yes �kallo
❑ NA
❑ NE
❑ Yes KNo
❑ NA
❑ NE
❑ Yes ,gfNo
❑ NA
❑ NE
[]Yes
A No
❑ NA
❑ NE
❑ Yes
&-INo
❑ NA
❑ NE
Additional Comments and/or Drawings:
w � A• t 6�
j1-4) 4 9 a L f L!
L AGOON
j _ �4b Ad j S F C iY� A�iZ-1�-��C.+4nlr �� WILL
C< fC)tZ_ ME - r� i �S ��i
'ro � � il+� 5 %►4 �� �
Page 3 of 3 12128104

Division.of Water Quality s z
Facility Number 0 Division of Soil and Water Conservation
- _ — --
D Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Timer Departure Time: County: u /" Region:
Farm Name:
Owner Name: J CC>TT ; `QLiS F
Mailing Address:
Physical Address:
Facility Contact: \\ // Title:
Onsite Representative: _ . 3C� wAt � LAw i F iz-
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 6 = Longitude: = ° = S =
Design Current,, Design Current: 'Design .Current `<�
Swine Capacity Population ' Wet Poultry Capacity Population Cattle CapacityPopulation'
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
t0�
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
.. ❑ La er
❑ Non -Layer -
Dry Poultry
Other
❑ Other r
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey 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?
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
I
Number of Structures'_
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
[I NE
❑Yes
❑No
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
.
❑ NA
❑ NE
12128,104 Continued

Facility 1Vamber:3 j — 3a Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
t4 No
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA ❑ NE
Structu-re-_1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
� Identifier: 5CJCYA/
Spillway?:
Designed Freeboard (in): 19.5
Observed Freeboard (in): y 1-1
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
JgNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
IN 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
]o No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA ❑ NE
maintenance or improvement?
Waste Apolication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
C�No
❑ NA ❑ NE
maintenance/improvement?
. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[(No
""
❑ NA ❑ NE
El Excessive Ponding El Hydraulic Overload El 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 EYN0 ❑ NA ❑ NE
UT
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 D� No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes kNo ❑ NA ❑ NE
❑ Yes %No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments. .
Use drawings of facility to better explain situations. (use additional pages as necessary):
IrT c�u�o F cd C- P€ 17- * PCA-T w/ (LGcne � s
wp wIRr—
�Fw
_
Reviewer/Inspector Name I Phone: O"
Reviewer/Inspector Signature: Date: CO ! D�
Page 2 of 3 I2128104 Continued

Facility Number: 3 -3a Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? NYes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 6No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall 0 Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
yN No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
PfNo
❑ 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
RNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
O(No
❑ NA
❑ NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
RNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
D�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
f'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
K No
❑ NA
❑ NE
Page 3 of 3 12128104

Facility Number 2
Division of Water Quality
0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time:� Departure Time: County: Region:
Farm Name: -5 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
Cr4 62.4
Onsite Representative: L �f� Integrator: _, � � �U/Qa4%/✓
Certified Operator:
Back-up Operator:
Location of Farm:
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 ` Longitude: = ° ❑ d
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish '�) rip
El Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non-Layet
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poutts
❑ Other
Discharges & Stream Im acts
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
❑ Daia Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Da'
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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 ZdNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes ,�(No ❑ NA ❑ NE
El Ye P No ❑ NA ❑ NE
12128104 Continued

Facility Number: — Date of Inspection
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA El NE
a. If yes, is waste level into the structural freeboard? ❑ Ye ❑ No ❑ NA ❑ NE
Structt /,Px
1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �gODZ�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ' L-157
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 X No
❑ NA
ElNE
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 [� No ❑ NA ❑ NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [� No ElNA ❑ NE
maintenance/improvement? 1 f
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ElYes �No ElNA ElNE
❑ Excessive Ponding ElHydraulic Overload [IFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 1 O lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P, No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
VNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/inspector Name Phone:
Reviewer/Inspector Signature: Date:
12128104 Continued

M
r -
Facility Number: 3J-5 Date of Inspection Z p
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No [I NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El)ZI'No
Yes ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
2 l . Does record keeping need improvement? If yes, check the appropriate box below. 4 Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking P, Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail -to install and maintain rainbreakers on irrigation equipment? ❑ Yes YTNo ❑ NA ❑ NE
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? (ic/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
WSJ /4LC F_
❑ Yes QANo ❑ NA ❑ NE
❑ Yes XNo ElNA ❑NE
[IYes ❑ No ❑ NA ❑ NE
❑ Yes PfNo ❑ NA ❑ NE
❑ Yes
A, No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
UNo
❑ NA
❑ NE
r/
No t9dy';'
i
fh ,J 7i5Lz 1j
12128104

Type of Visit .12Mompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,(:rRoutine O complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Lj%/f L6 Arrival Time: 661Departure Time: County:
Farm Name: �e�s ) ir!/J't Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator
Back-up Certification Number:
Region:
Location of Farm: Latitude: = c = d =11 Longitude: = ° [= 4 = 6i
Design Current
Design Current
Design Current
Swine Le FPTC I t—VA Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
El Dairy Cow
❑ Wean to Feeder
❑Non-L]aer
El Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Boars
❑ Beef Brood Co
Other
❑ Other
Number of Structures:EJ
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turke Poults
❑ Other
Discharges & Stream Imoacts
1. Is any discharge observed from any part of the operation?
❑ Yes ZI No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
ENo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[fNo
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

0
Facility Number: — Date of Inspection f
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes El-Ko ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L
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 OrNo ❑ 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
S. 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 , /UNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes eNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Vf No ❑ NA ❑ NE
If
❑ 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 ❑ Applicatign 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
l5. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.'
Use drawings of facility to better explain situations. (use additional pages as necessary):
jerqr S tL 5L6/ G'-V
TO dtpar► a)
tec/s 44f1jL
w a a ILG 9li/ / 6 70��27
Reviewer/Inspector Name 6,
Reviewer/Inspector Signature: Date: lg d
Page 2 of3 1212RI04 Continued

Facility'Number: , Date of Inspection d
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes J2 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J'1Qo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 12 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ONo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ONo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ,2 No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 0 No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes ,8 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ErNo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
,fNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
J No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
O-No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
LJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El.0 Yes
,
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
El NA
[I NE
Additional Comments and/or Drawings:
�y
- VOL T 67
5 6Adl-t 6d
p ,,, PqFeg
—,c3 (tee (e'rnv J�d 4 (�Y - ,
c 1,
4-- L,.5
ek ,
�,n2�
1
feLOT��ar�'"'fS
Page 3 of 3 12128104

Type of Visit t7Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of' 0 Arrival Time: i t;} Q Departure Time: County: Region: W t
Farm Name: _ 9-4— `S h� r'rry\ Owner Email:
Owner Name: !E YYtYYLO — [__. 1t O\-k6 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: isC. A+ O'k_se ,
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
/� Phone No:
Integrator: ly �1"03a.�.
Operator Certification Number:
Back-up Certification Number:
Latitude: = o =' 0 Longitude: 0 c =' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layet
awe
❑ Non -Layer r ar• �
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: 71
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
HNo
❑ NA
❑ NE
❑ Yes
eNo
❑ NA
❑ NE
12128104 Continued

Facilitj Number:31 — Date of -Inspection S�
J
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: j ?-
Spillway?: f
Designed Freeboard (in):
Observed Freeboard (in): g
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 ,8'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 .F] 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 t]Ko ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2rNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2No ❑ 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 Drill ❑ Application Outside of Area
12. Crop type(s) a `�je>riYL Id6ra, 6, arc X,_VC cre 10-13. Soil type(s) ..R��'
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ,2 No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations ❑ Yes T=3 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes ETNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes &No ❑ NA ❑ NE
Reviewer/Inspector Name I Phone: + �R ���
Reviewer/Inspector Signature: el Date:
12128104 Continued

Facility Number:'. [ — Date of Inspection
r
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O'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 ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 13'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
Q-No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
a No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
XYes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
L]'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
,ZNo
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
j2tNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
j;jNo
❑ 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
;❑i'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
2-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
ONo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
;3- `4o
❑ NA
❑ NE
Additional Comments and/or Drawings:
"fit
r i S %p?�- eeearzli ��el- Y4- lo-
�o�
(ibI*a}lo►�s 0n ��-Fie, 6A I,IcC'�ort CTuIp,, ��..
�� No �.a P� A
- Please 6p sure- +D e+ e wf PVw`L f - ca 1) bra �e.cy
yearly
12128104

Type of Visit ZrCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit outine O Complaint Q Follow up Q Emergency Notification O Other © Denied Access
Date of Visit: Time:
Facility Number m
Q Not Operational Q Below Threshold
Permitted�Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: . --_.� ....__..
Farm Name: ...'.._ �I Y4... -- - County: .l .!'1.....».....»....» ......__. ..
Owner Name- --- ------- ------ _-------------.............. -......... --- Phone No:
INfailing Address: .... ....................... .......................................................................... .............. ....... .......................... .......................
Facility Contact- .._..... _ ..... » Title: .._...... ......... » .» ....._..» _. Phone No: ...
_........................................
M Ljt 1:10
Onsite Representative: ..�.W1�.�...._.__._.»._. „ .».. Integrator:
-------
Certified Operator:._... _... » .....»... ». ....... _ .. .... ._....._. Operator Certification Number:.................. --.
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �` �" Longitude �• �` �«
DeSlgi 4� Curr�llt �a Y Curiellt
` ei ? P. _ Wation ` Cattle .- . Carp ty` Population »'
Wean to Feeder
❑ Layer
EEEEJ
_ eeder to Finish
R
11 Non -Layer
Farrow to Wean
Farrow to Feeder
❑Other
El Farrow to Finish
x To.tR Desk;
Gilts='
r
7 r
EJ Boars
N
Disci & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gallmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
I t
Jj
R`
❑ Yes 10
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier• r A
❑ Yes ❑ No
❑ Yes ENo
[]Yes Ja o
❑ Yes 6 o
Structure 5
Freeboard (inches): r2 -7
12112103 Continued

Facility Nvzrnber:jj— Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes Rrf4o
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
j] Yes P'No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ONo
8. Does any part of the waste management system other than waste structures require maintenancerimprovement?
❑ Yes 014o
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes o
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes eNo
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes 9<0
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type '!!�6 awz f_eea) r:r_ �6�.
13. Do the receiving crops differ with those designated in the Certified Animal ante Management Plan (CAWMP)?
❑ Yes JT&o
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ,ET11I0
b) Does the facility need a wettable acre determination?
❑ Yes ZNo
c) This facility is pended for a wettable acre determination?
❑ Yes ONO
15. Does the receiving crop need improvement?
❑ Yes 0'�Ko
16. Is there a lack of adequate waste application equipment?
❑ Yes Ea-fio
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
❑ Yes ,R!rNo
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes ,ofio
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes /0090
roads, building structure, and/or public property) .
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
❑ Yes ❑.Alo
Air Quality representative immediately.
:Comments {refer to question(#) Explain aay YFSra savers and/or any recompiieudatip or;any tber comments. mm p
_Final
Use drawwngs of lgcty to hetterexpisui sifuatio s use additroiiai pages as necessary) Field Co Notes
.. .. _„ ....., >.,-,.0 ..r . _ .� �-= - . �..... •. _ �r£r ate-_ . �., _ ._
Reviewer/Inspector Name° -
Reviewerllnspector Signature: Date: j
12112103 Continued

Facility Number: Date of Inspection 7
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below_
❑ Stocking Form ❑ Crap Yield Form ❑ Rainfall [:]Inspection After 1 ° Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ,�No
❑ Yes R<
❑ Yes P4o
❑ Yes E'No
❑ Yes ,3'Ro
❑ Yes ,ff No
❑ Yes ,ONo
❑ Yes ;afgo
❑ Yes J�Wo
,pKes ❑ No
❑ Yes ZNo
❑ Yes ,jawo
[:]Yes RMO
❑ Yes �To
❑ Yes PTO
12112103

Type of Visit . 'Compliance Inspection O Operation Review 0 Lagoon Evaluation
Reason for Visit Q*Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
la Permitted MCertified Q Conditionally Certified D Registered
Farm Name: �f✓ %��%^'t
Owner Name:
Mailing Address:
Facility Contact: O/�Title:
Onsite Representative: Gaff` Rd06 e.
Certified Operator:
Location of Farm:
QZ Time:
Nat O erational 0 Below Threshold
Date Last Operated or Above Threshold:
County:
Phone No:
Phone No:
Integrator: "1 GLYI�lt ✓
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 6 " Longitude a
Design
Swine Ca acity
Feeder
Finish
Current
i'o elation Poultry
❑ Layer
❑ Non -La er
Design Current Design Current
Ca aci Eo elation Gattl_e Ca aci P.o elation
❑Dairy
❑ Non -Dairy
o Wean
FFarrow
o Feedero
Total DesigTotal SSLW
Finish
Number of Lagoons ❑ Subsurface Drains Present ❑ La oon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management S stem
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: Freeboard (inches): d
05103101
❑ Yes K] No
❑ Yes RNo
❑ Yes ENNo
❑ Yes ® No
❑ Yes E9No
❑ Yes D4No
❑ Yes [RNo
Structure 6
Continued

Facility Number: 3r - zs
Date of Inspection 2Z
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 maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes K,No
❑ Yes PNo
❑ Yes 0 No
❑ Yes ® No
❑ Yes ® No
Waste Aonlication
10.
Are there any buffers that need maintenance/improvement?
❑ Yes
;}No
11.
is there evidence of over application? El Excessive Ponding ❑f PAN El HydraulicOverload
El Yes
® No
12.
Crop type &,ki dA, _ a� tz, — IA<Y) 5;4ol er , �l�P�fC�IC �Clt�
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
23 No
c) This facility is pcnded for a wettable acre determination?
❑ Yes
® No
15.
Does the receiving crop need improvement?
❑ Yes
S No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[A No
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
® No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
ZINo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
EBNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
ESNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
tgNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes V-No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 51 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
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #} Erplaiii. ,ES answers and/or.any recgmmendahons or'an rottier�comments.
Mse drawingsiobfacilityto better ezplaip situnti©ns.,(use'addrtional`pages a necessary) , ❑Field Copy El Final Notes ^ ,
/ /*AL
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: T.
05103101 v Continued

Facility Number: ` — Date of Inspection ZZ Z� Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 64No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes h No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 09 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 RNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes N[ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes MNo
5/00

Facility Number Date of Visit- 3 4/ Time: 8 : � Printed on: 7/21/2000
0 Not Operational 0 Below Threshold
ff Permitted ❑ Certified © Conditionally Certified 13 Registered Date Last Operated or Above Threshold: ...............
Farm Name: ................... County:.....................................................................................
............
Owner Name: ....r"t �-�' G D U Se
..................................................... ...... ................................................... Phone No:.......................................................................................
Facility Contact: ..................................................................... .... Title Phone No:
Mailing.address:.... .................... .............................. ............................................ .............................
Onsite Representative: S off Qot-,xe Integrator:... r0& ..?^'"'`.J.............................
Certified Operator:................................................................................................................ Operator Certification Number: ..........................................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �' �'
��� Longitude �• �� U°�
Design Current
Design
Current Design : Current
She .-.Capa6tv Population
Poultry Capacity:
Population Cattle .._-..CajjjdWPjjpWatjon.,
Wean to Feeder
❑ Layer
❑Dairy
-
Feeder to Finish j&J 2
ElNon-Layer
❑ Non -Dairy
Farrow to Wean
':.I;;
Farrow to Feeder
❑ Other
Farrow to Finish
Total Design Capacity
Gilts
Boars
TotW,SSLW
Number af:Lagnons � � ❑ Subsurface Drains Present ❑ Lag�nn Area TO Spray Field Area
�aHoldiiug`Pon&:/ Solid Traps 10 No Liquid Waste Management System
Discharges & Strearn I,mpacks
1. Is any discharge observed from any part of the operation?
❑ Yes XNo
Discharge originated at: ❑ Lagoon [ISpray 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? P (A
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Yes jHNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes J�f No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4
identifier : g.'..... r G 1 l ` ..................................................................................
............. .....
Freehoard (inches):
5/00
❑ Yes 9No
Structure S Structure 6
Continued on back

Facility Number: '2] —3 Z Date of inspection Z Printed on: 7/21/2000
4 Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion, ❑ Yes -CA 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 -2rNo
(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 ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes gNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ONO
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
'' ❑ Yes A No
12. Crop type �/ m vG{rst � Z C q M, S OK ei l 6,A,'! F—c Sc. v G H� y
13. Do the receiving crops differ with those designated m he Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,XNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 0 No
b) Does the facility need a wettable acre determination? ❑ Yes J45iNo
c) This facility is pended for a wettable acre determination? ❑ Yes �ffNo
15. Does the receiving crop need improvement? ❑ Yes fig No
16. Is there a lack of adequate waste application equipment? ❑ Yes -j No
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes -KNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes ;KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes 4No
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 s® No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes 19No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes f No
24. Does facility require a follow-up visit by same agency? ❑ Yes j No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
..N.6. 8ki hti6ris;oi- deficiencies -were h44 during �bjs;vjsit: You will reeeiye ii6 fui-ther
correspondence.about this visit: • • • • • •
Comments (refer_to gties6ori #): Explain an YES answers and/or any ,recominendations or any other comments
Use dcawu►gi of facility to better explain, situations.additional�pages as necessary)
Ee s""er- use- ih wafle- olna &I s Of"iled L"'g1L;'1 Gd 4r r of
An'A /"ece'- s Gt✓'e ve, t.J�6� kePT- GaOP( 10�7
Reviewer/Inspector Name�G?
Reviewer/Inspector Signature: Date: 3 P
smo

Fa ility Number: S 1, — 37 Date of Inspection � Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge �itlor holow ❑ Yes X 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 R(No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 16No
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 fffNo
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 J'No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes $1 No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
[:]Yes ❑ No
Additional Comments and/orDrawings:
AL
5100

Type of Visit `Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ,,Routine O Complaint O Follow up O Emergency Notification O Other V. tV ❑ Denied Access
Facility Number Date or visit: ime: Printed on: 7/21/2000
0 Not Operational 0 Below Thresbold
4 Permitted 0 Certified 'i Conditionally Certified ❑ Registered Date Last Operated or Above Threshold
Farm Name: County............ ..�.1�.. .......... .
... .......
OwnerName: ............. t.m �........".... u. ........................ Phone No:...................................._..................................................
c yr
Facility Contact: ......5..A..•.. Zl.,...........Title:.......✓...... ... Phone No: ...:L..��LGIs-..r•:�
Mailing Address: .............. ........................................
Onsite Representative:.,.,.,..„�Q.., . ,.�1-�•� ,:�„
.............. ....{r ..................
Certified Operator:........ —4. :.....................1.2 ..............................
Location of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse
_ ". Desfga 'Cpnree
r W-
... ........ ......
Integrator : ................ f...,
...................................(.............
Operator Certification 1`Tumber:.,..,F/41 [�...„_.....
Latitude �• �d 64 Longitude • 4 96
o Feeder
to Finish
t< 7
to Wean
to Feeder
r
to Finish
Design Current Design Current
Poultry Ca aci Po nlation Cattle Ca aC1 Po ation
❑ Layer ❑Dairy
❑ Non -Layer 10 Non -Dairy
❑ Other
Total Design' Capacity
Total SSLW
Nniber. a L 10Subsurface Drains Present ❑ Lag — Area ❑ Spray Field Area
T _Holdw-Ponds I Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon El Spray Field [I Other
a. If discharge is observed, was the conveyance man-made?
b. 1f discharge is observed, did it reach Water of the State? (1f yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?,
d. Does discharge bypass a lagoon system'? (if yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
identifier: ............. .�. /
...................................................... ............................
Freeboard (inches):
5100 J j
❑ Yes $No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes
❑ Yes $-No
Structure 6
Continued on back

l
Facility Number: — Date of Inspection",diel
11t7T� Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures obsrees, severe erosion; ❑ Yes (No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes O No
(If any of questions 4-6 was answered yes, and the situation poses an \
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes VNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes tNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ANo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes KNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes kNo
12. Crop type I!) K _ III-) Ln , __3C-A ren
i
13. Do the receiving crops differ with those designated in th Certified Animal Waste Management Plan (CAWMP)? ❑ Yes KNO
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
b) Does the facility need a wettable acre determination?
❑ Yes
1No
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
ONO
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
DNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
o
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?
(iel discharge, freeboard problems, over application)
❑ Yes
No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
Xf No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
KN0
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
KNo
�Q+Vibl;itidfis .ol' di f cj6ndes Wire' h6 ed• during itliKvlslt. • Y:OO ' 11� I e�PiVe il0 ftil'ttte['
eor-respondeit& a)60' U : this :viisit�...:.:.::::::::::::::..::..:..:..: .
Comments {refer to.question #). Explain any YES answers and/or any recommendations or;.any other coniment4
Use di awiitigs of [aciliiy to beiteryexplaiu situations {use. additioual pages as necessary) -
�l
�Grr�{ nfi p�~ �i^.�� 1-ol.L+ L+� • �u,�w �a,r�C— e i YN���°v`S
13ts2` 1
K f
lrk s ,,,.`_ v� � s �. PI P e-wr- .6 iks r z l;+ �
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ Date: j'j_ 1 �Db (drop

r
Facility Number: �S"Date of Inspection U Printed on: 7/21/2000
Odor Issues Eq
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes kNO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes l�No
28. Is there any evidence of wind drift during land application? •(i.e. residue on neighboring vegetation, asphalt, ❑ Yes '�F0
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 XNo
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 MNo
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 �10
Additional omments and/or Drawings: - --
�j7 G ir�fo� euPv.s s;�-e, io sLvw
'V
5/00

e (a Division of Soil and Water -Conservation -.Operation Review
x D.Diyision of Soil and Water-Conservatlon -Compliance Inspection 5
W Dhision-of Water Quality -,Compliance-inspection -
_ : 0 Other Agency Operation
Routine O Cum laint O Follow-up of DW2 ins ection Q Follow -tip of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection E=24 hr. (hh:mm)
Permitted [[ Certified Q Conditionally Certified 13 Registered 113 Not Operational Date List Operated:
FarmName: ...... E -...................................................................................................... County: ...... .YC,�.:!!..'a-................................ .......................
Owner Name:... ................................................. .... Phone No:...................... .
FacilityContact:..............................................................................Title:...........-•---•............................................... Phone No:
MailingAddress: ...............Q........................................... .....................................................
Onsite Representative :............................ ................... G `{.. 1fl P.................... Integrator:......(. .............................I........................
t.
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Ipcptign of Fkarl*s r a t k ( 1' _ 1
r.-.jr---p
Latitude G it Longitude 0 4 44
- =
Design Current Design Current
- g ...Designi,. arrant;_. _
Swine Capacity Population ._Poultry Capacity Population _ Cattle Capacity Population;--
❑ Wean to Feeder
fflFeeder to Finish
3 1?a
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Number of.°Lagoons ®Y ❑ Subsurface Drains Present Jill Lagoon Area ][]Spray Field Area
Holden Tonds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? []Yes NfNo
Discharge originated at: []Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
h, if discharge is observed, did it reach Water ref the State'? (If ycs, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed. what is the estimated flow in gal/min?
d. Docs 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 j�j No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes V"No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 0 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
J
Freeboard (inches): ...............:.............................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes No
seepage, etc-)
3/23/99 Continued on back

_ .. _ .: i`l-sy . T :� ^y`R -�_...V�.'�f: '.��if '1'rl. ���` 1 • .. ., q. � -a r _ " 1, w'� .. _'-'-_�j,'_ +c .« _ , F; r _ ... - .. , -
`' R
4 ,
;4

Facility Number: rI� — 37 Date of Inspection
6. Are there structures on -site which are not property addressed and/or managed through a waste management or
closure plan?
❑Yes
XNo
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes
XNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
allo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
'J No
11. Is there evidence of ove application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12. Crop type `
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
k10
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
KNo
b) Does the facility need a wettable acre determination?
❑ Yes
RNo
c) This facility is pended for a wettable acre determination?
❑ Yes
ZrNo
15. Does the receiving crop need improvement?
❑ Yes
r'No
16. Is there a lack of adequate waste application equipment?
❑ Yes
XNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
P�'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
WNo
(ie/ WUP, checklists, design, maps, etc.)
❑
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
9No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N1 No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
hp" No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes P6 No
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 19No
24. Does facility require a follow-up visit by same agency? ❑ Yes 57No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
If
Rio yiglaiitjris:oi- def cier�cies mere neted dpring �. s.visjt: Y;ou will reeeiye {io: #'nether
co'ri-esnonc�eRce:aboutthis visit. : '..............: :-.-.-.-::.-.-...-...-.-.-.....
Comments {refer to questi&i*: Explain an YES answers and/or any '
y_ -
reconnmendatrons'ar any other comments: ,
Use.drawings of facility to�better explain situations (use additional pages'as necessary) "-
- _. _
3/23/99

_
• x �
fir.
r� -
� � ,_ -.
_
�. T
t
i r � _ r i

Date of Inspection
Facility Number:
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
0 No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
fVrNo
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
X 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
kNo
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
r10
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
1 No
3/23/99

Division of Soil and Water Conservation ❑ Other Agency
M Division of Water Quality
HD Routine O CO ntplaint O Follow-up of Doi` tnspcction O Follow-up of DSWC review O Other
Date of inspection (, 10
Facility Number 1 Time of Inspe�c tion 24 hr. (hh:mm)
© Registered 10 Certified 13 Applied for Permit © Permitted 10 Not Operational Date Last Operated: ..
FarmName: ............ ts.....F. r...-.................................................................................... County: .......bu\k....................................... .......................
Owner flame: IEAM11..kkC ,�,..................... a .......................... : s Oil) G�."..9���.. ....................
............ U .......................... Phone \o• ............ .... ----.....-•--•---
Facility Contact: ................................................... .......... Title:.................. ...... Phone No:
D1
MailingAddress:.......�� ...s` R.41.....Gi:.t�.1.:..�9.......... :............................................. . ........................................... ..��C.`P..g........
Onsite Representative: ...... .....4tiv:......... ..... Integrator:..........
A.w�� ......................
Certified Operator:..................................................................................................... Operator Certification Number,.........................
Location of Farm:
.an ...S "i ...5L .4...i ..........�1......ix*.:t..I...uxs�►.t,.....� rah# ... of ....... .. 1.1 i................................. ........
................ ......."....................................I................... .
Latitude �•.�' �" Longitude
General
L Are there any buffers that need maintenance/improvement?
❑ Yes
No
2. Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
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?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of'the waste management system (other than lagoons/holding ponds) require
❑ Yes
[P No
maintenancelimprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
L No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
No
7/25197
Continued
on back

Facility Number: —
8_ Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La oons Hold in fonds Flush Pits et .
9. is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4
❑ Yes [ j,INO
❑ Yes C,0 No
Structure 5 Structure 6
Identifier: ................................... .............
Freeboard(ft): 3........... .................................... ................................... .................................... .............
10. is seepage observed from any of the structures'?
11. Is erosion, or any.other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers'?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) _
15. Crop type ................. . V 1.01 :................. , 4SCIV ..--.............................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
w
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'?
No.violations or deficiencies were•note'd during this,'visit.- .Yo'U.will receive no further
correspondence about Phis:visit:- ... ;
❑ Yes 0 No
❑ Yes N.-No
Yes ❑ No
❑ Yes M No
❑ Yes No
❑ Yes
1�j No
❑ Yes
0 No
C5LYes
❑ No
❑ Yes
ED No
❑ Yes
09 No
❑ Yes
® No
/�
❑ Yes
No
❑ Yes N No
❑ Yes ❑ No
❑ Yes No
Co ents (refer to.question #): -Explain any:YES answers and/or'any recommendations or anyother comments m = t
Use drawmgs.of facility to better explain situations. (use additidnal pages as necessary) g,
IZ. L�oo a;� walk Sko AO �. l�aued-
19- C_oin�jwwe, e. F-" :ta i ►�,. 4, aye 6e_vtK 0_
7q. C,_Y-k,� �,— 34-7 L 1 �'Oetor b�.se >� u i� z45a.
�uc, Am,, jco010 733- 091 er# S�Z
7/25/97
Reviewer/Inspector
Reviewer/Inspector Signature: y Date: 0 S
0

® Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection Z5
Facility Number
Time of Inspection I5: 5 24 hr. (hh:mm)
Total Time (in fraction of hours �----�
Farm Status: ❑ Registered ❑ Applied for Permit (ex:I.25 for I hr 15 min)) Spent on Review I�
CR Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:.,..... _ ._ ........._ ...... .
Farm Name: County:. �.sa� �.1 st1.. . _....................... ALIR.SI.
Land Owner Name:Phone 1 �
..........
Facility Conetact:.............._..... , ..... ....� .... _.... _. Title: Phone No:
Mailing Address: ...1 5..... ........................
OnsiteRepresentative:...1...,1A....S.. ".L-L._....... . .. Integrator:. %�5.,,,�,�.�..
Certified Operator:.. . �,, .... �Ae g°`v »� ...... Operator Certification Number: ju.
Location of Farm:
4x� . - $-F � .�s ... s.i.d�,... c ... .1�.1.3. ,_.a �.�.�ca. �.. . c� .. x..1 e �....,Sa.►1.....� ATE. To
......................
Latitude ©• ®� r a5 Longitude ©• ®` ®"
Type of Operation and Design Capacity
' Designer " Gtirrent = Desrgn Cu'Frrent ­ Desi ncL� Cu ent�E
Swine Ca aci �Po ulathi Poultry .Y 'Ca acity Po illation Cattle Ca aci s Pa Mahon ; .�
❑ Wean to Feeder
❑ La ❑ D
Feeder to Finish ❑Non La er ❑ Non-Daia
Farrow to Wean F k E Y
Farrow to Feeder Total DestgnCapacit�y
c3
El Farrow to Finish
3'i❑Other
Number gfLaggotrs /Holding Ponds ❑Subsurface Drains Present
� s
_,�.,,,M�_': ��' � � `� `� � � �` � � ❑ Lago rea ` a'' ❑Spray Field Area on A 4
G—eneral
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ® No
b. If discharge is observed, did it reach Surface Water:/ (If yes, notify DWQ) ❑ Yes 0 No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes 14 No
4< Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes ®No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes 14 No
4/30/97 maintenance/improvement?
Continued on back

Facility Number:—.3. 5
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
[$ No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
®No
Structures (Lagoon. and/molding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
9No
Freeboard (ft): Structure I Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
!A.O ...... E; Z ..... �_...._-...... __...... .... __..... ........... _.. __.....__..... _....
__............_.......-
10. Is seepage observed from any of the strictures?
❑ Yes
($ No
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
0 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?
❑ Yes
KNo
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type % �.�r. kr .s.L �........... ...... �.c �t�, . ..... _......... ......... _....
16. Do the receiving crops differ with those designated in the Animal Waste Management PIan (AWMP)?
❑ Yes
No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
0 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
For-CertifiedEacilities 0X
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
24. Does record keeping need improvement? ❑ Yes 0 No
Comments;.{refer to :question #) E'&a- i i any YES'- ikii`s and/oi•-any recommendations'or any �other comments '
Use drawingsrof facility to Better explain situations: (use additional pages as necessary)
1 Ss' - Co r r c [ kJ @ p +- o to i fMR ✓+ �7 �/lrti+�t_ v tta Q
o�►�e�w se, c i toc k- t �ood .
a
Reviewer/Inspector Name.�;� s14
Reviewer/Inspector Signature: Date:gad
6 2S
ec. Division of Water Ouality, Water Oualitv Section. Facilitv Assessment &nit 4/30/97

JUL-14-199' 15. 22 FROM DEM WATER QUALITY SECTION TO
W I P.O P . 02.i02
0
Site Requires immediate Attention:
Facility No. I -,It I, -
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1 , 1995
Time: 0
Farm Name/Owner. _ r-4. 5 . E#__kj _ gakz -C- - _
Mailing Address: —
County: )
Integrator- -V—sl _ _ _ _ Phone: ? �'
On Site Representative: iN,-F L�A,lt _ Phone:
Physical AddreswLocation: a L ;1 -p c v +.�_. c s s I-Vr
Type of Operation: Swine —]Z Poultry Cattle
Design Capacity:? 3�A I Number of Animals on Site: 3b'7'1
u
DEM Certification Number: ACE DEM Cerd.fication Number: ACNEW
Latitude: �L - 07 ' 0 (. " Longitude: 2? " �� ' 3 Y*"' Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) e�r No Actual Freeboard: �_Ft. D Inches
Was any seepage observed from the
Is adequate land available for spray?
Crop(s) being utilized: " i ti
n(s)? Yes or No Was any erosion observed? Yes or No
or No Is the cover crop adequate? Ye or No
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Qor No
100 Feet from Wells?0 No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters o state by man-made ditch, flushing system,, or other
similar Fran -made devices? Yes or -o If Yes, Please Explain.
Does the facility maintain adequate was management records (volumes of manure, land applied.
spray irrigated on specific acreage with cover crop)? Yes or No
Additional Comments:
co
Inspector ame
Sicznaturly
Use Attachments if Needed.
cc: Facility Assessment Unit