310337_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qua

r
Date of Visit: Arrival Time: 4 P p Departure Time: 13 County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: of Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
1 �' - 01- � -0 7o
Swine
Wean to Finish
Design Current
Capacity Pop.
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design
Cattle Capacity
Da Cow
Current
Pop.
W to Feeder
Non -La er
Da' Calf
',.feederEE
to Finish
7 L
D , P.oults
Layers
Design
Ca aci
u ii
$o P.
Dairy Heifer
Dry Cow
Non-Dalry
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts,
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[—]Yes No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[:]Yes ❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes []
❑ 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 rNoo
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili Number: 3 I - 3 Z I jDate of Inspection: 7
Waste C24ection & Treatment
4. U storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): _ Z
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
Yes��Noo
NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
2 rNoo NA
[] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
[:]Yes
No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[:]Yes
No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ErNo ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[ZN 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
[ ❑ NA
ElNE
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
N ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ YesgNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspectio5�No'
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 ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

lFacility Number: 71- Date of Inspection:
24. Did #he,,facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
251s the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes Eff'No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes EfN0 r.N
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes Ej No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
[Dyes No I NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ Yes [7� o
❑ Yes [%]�No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to questton #) Ezplarn'sdy YES answers andJof any addrhonai recommendation r_ arty other commen�fs
Use:drawur s of;facili#o1iiitte6ex Iain;situations nse addMonal- i(jes,as ifecoisary
Reviewer/InspectorName: )O(/t ✓! �c� �. �� Phone: 11a7 f`I �Of'
Reviewer/Inspector Signature: ��-�-�/.�� Date: 7 7
Page 3 of 3 21412015

Type of Visit: Com ce Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: 3aA County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1. -4 S J S cl t' rs
Certified Operator:
Back-up Operator:
Location of Farm: Latitude:
Phone:
Phone:
Integrator:
Certification Number: to
t D
Certification
Certification Number:
Longitude:
r
Swine
can to Finish
Design Current
Capacity Pop.
Wet Poultry
La er
Design C►urrent
Capacity Pop.
Design Current
Cattle Capacity Pop.
DairyCow
W to FeederF
Non -La er
Dairy Calf
eeder to Finish
Daia Heifer
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
Dry P,oult .
Layers
C•_a aci P,o P.
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]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
El'No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
L'J o
❑ NA
❑ NE
of the State other than from a discharge?
Page 1 of 3 21412015 Continued

Facili 'Number: - 3 Date of Inspection: p
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes E2 1 ]Co [] 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): it
Observed Freeboard (in): 233 2
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [a -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 �-�do ❑ 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 [3-Nb ❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E2'go- ❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [j'No ❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑eKo— ❑ 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 C3"R'o ❑ NA ❑ NE
l5. Does the receiving crop and/or land application site need improvement? ❑ Yes [J Qo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes �o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19, Did the facility fail to have the Certificate of Coverage & Permit readily available? [:]Yes Erf�o ❑ 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 [/]'I�o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes E2-No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes E2-No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili yNumber: - jDate of Inspection:
247 Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes J:��o [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes L31 _o ❑ NA 0 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 0 No ]5NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
D—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
ETNo
❑ 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
Q'�Io
❑ 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
[ZCNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[, No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[3No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
to
❑ NA
❑ NE
A'ZV1GWG1f111bFCL;LU1 1V6111G. — ' t• f —...► .. rllullC. [ t - i , - .. 01
Reviewer/Inspector Signature: �"`��'✓ 7 Date:
Page 3 of 3 21412015

A ypt V1 VISII: v l,u anlx 1I 5PMtIVn LJ "PUF tfUll MCVICW LJ atUUUtUUU c,YUll UH01l v 1 C4uul�ill r�a�uulu�r
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: % /r Arrival Time: ® Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: f Title:
Onsite Representative: ) ; ^ r-7 54 W f
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: I 1 11 10
Certification Number:
Longitude:
1!!W�ean
Design
Capacity
rtoFinish
Current
Pop.
DesiNEWgn Current
Wet Poultry Capacity Pop.
La er
Design
Cattle Capacity
Dai Cow
Current
Pop.
der
on -Layer
DairyCalf
der to Finish
3 7Z
"2
Design C*urrent
Dr, P,Qultr, Ca aci P,a ,
Layers
Da' Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Pouets
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes
❑ No
[] NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ 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��No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes E5No
❑ 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: -2—
Spillway?:
Designed Freeboard (in): 11.
Observed Freeboard (in): 3'
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes ETNo
❑ NA
[] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes E�/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 environment threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes rNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
No
9. Does any part of the waste management system other than the waste structures require
❑ Yes Ej
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ffNo
❑ NA
❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yesvl�
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes Er� o
❑ NA
❑ NE
acres determination?
f
17. Does the facility lack adequate acreage for land application?
❑ Yes ['J
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes CJ No
❑ 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 2No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Wastc.Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes �
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes rNo
❑ NA
❑ NE
Page 2 of 3
21412015 Continued

fpcility Number: - 3 J Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ 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
[7�A
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
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?
bit
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [�o ❑ NA ❑ NE
❑ Yes / No ❑ NA ❑ NE
[:]Yes E` No ❑ NA ❑ NE
[:]Yes ONo ❑ NA 0 NE
[:]Yes
[TNo
❑ NA
❑ NE
❑ Yes
E o
❑ NA
❑ NE
❑ Yes
[3N
❑ NA
❑ NE
Phone: 11 P 71 6 7�y
Date: �zf UY
21412014

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 9,R'outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:F Departure Time: County: � • /r)<tegian:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
s
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish I
Design Current Design Current
ixet Poultry Capacity Pop. Cattle Capacity Pap.
JLayer IDairy Cow
Wean to Feeder I
INon-Layer I
El Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current Dry Cow
D . P,oult , Ca aci P,o , Non-Dai
Farrow to Finish
La"ers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes ,EI—No ❑ NA ❑ NE
❑ Yes )ZI No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes 0 No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) [:]Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes 2TNo [DNA ❑ 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

Facili Number: - Date of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes n'i No
25 Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes j`�' No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ NA ❑ NE
❑ NA ❑ NE
❑ 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 allo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ZNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ;❑ No ❑ NA ❑ NE
❑ Yes ,EfTNo ❑ NA ❑ NE
❑ Yes E�J`No ❑ NA D NE
❑ Yes 1' No ❑ NA ❑ NE
❑ Yes �12'No ❑ NA ❑ NE
❑ Yes ONo ❑ NA ❑ NE
❑ Yes [J.No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawines of facility to better explain situations (use additional nacres as necessarv).
� J
c 40 Z 7311011'
�- 6?
/ f• o7 7
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
grt-n I-e - A_
OC�
Phone: y 7
Date;%
214,12 1 r
r Y FN 4
r-r _

type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
teason for Visit: outine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit: �-- Arrival Time: '-t4 Departure Time: ® County:
Farm Name: PAOX_� F[ 6L�)g ��f�nn Owner Email:
Owner Name: ) Au C.- S Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: fA& S '5/. U US Inte rator:
Certified Operator:
Back-up Operator:
Location of Farm:
� Afflicalfiloln �iatAC_S � � � Ce Number:
Certification Number:
Latitude:
Longitude:
Region:
11)Xesi nzLvqrrjent Design Current
Swine Capacity Pap. Wet.P,oultnY Capacity Pop:
o Finish La er
Design C•urrenE
Cattle Capacity Pop.
Da Cow
o Feeder
Non -La er
Da Calf
to Finish
Dai Heifer
to Wean
Design Current
D , P,oult . Ga aci P,o
La ers
D Cow
EFarrowto Feeder
Non -Dairy
to Finish
Beef Stocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
IF
Other
Other
—Keys
Turke Poults
Other
Discharges and Stream Impacts �kNo
1. Is any discharge observed from any part of the operation? ❑ Yes ❑ 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 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
Page I of 3 21412011 Continued

Facility Number: IDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
KNO
❑ 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: - a
Spillway?:
Designed Freeboard (in):
,
Observed Freeboard (in): 3 y L%
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�[
�J No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
T
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
[O(No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
❑ Excessive Ponding 0 Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc��No
❑ 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): 069_AA&tQ14
13. Soil Type(s): HCI)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes �No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
A
No
❑ NA
❑ NE
the appropriate box.
0 WUP ❑Checklists ❑ Design Q Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
0 Waste Application ❑ Weekly Freeboard [3 Waste Analysis ❑ Soil Analysis
❑ Waste Trans
ers
Q Weather Code
Q Rainfall [:]Stocking Q 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

Facility Number: -L, 1 - 33q I IDateofInspection: (o1Q.Qjj1
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA [:3 NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No I 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 j'j No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
�C
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)
J�
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
Yes No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any, other comments .".
Use drawings of facility to better explain situations (use additional pages as necessary).
-
cc.�oc eiX6PAPi LAM T)L D-a1Lf
to -A - 1 9-
511�111 1. �. Y(
191300
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date: !1
21412011

: Division of Water,
F ctlllfy-Number O>DEv►seon of,Soiiian
_ Qr0 lie'" A �«
— t r gency
°
Itty,
ater. .Conservation ,s
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 Acceess,
Date of Visit:
Arrival'Time: Departure Time: County: Region+-•-/
Farm Name: TC{f
1a
t et ('1s _ _ Owner Email:
Owner Name:
Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative:
r� s Integrator: , 4z/ _
Certified Operator:
Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm:
, Latitude: [= o ❑ 6 = « Longitude: [= o =1 0 a
°. Design
Current: Design Currentr ,�.Desrgn Current
S��ne Ca aci
ulation -Wet P,,oultr Cattle'" �"C�a acit Po ulafion
Y Capacity Pop,ulation'� p
"op"_ _
�P, .Y .
_.:Ta ��.
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
n ❑ Non -Layer
❑ Feeder to Finish
Farrow to Wean
�.
I3ry °ate,„
s;k
Farrow to Feeder
�'-`�`' "`"
'"`^
❑ Farrow to Finish
u El Gilts
❑ Boars`
Turkeys=
,
Other
�...e
10 Others
tr�u ur Numb er�of ct es
❑ Layers
❑ Non -Layers
❑ Pullets
❑
❑ Turkey Poults
❑ Other
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ D Cow
❑ Non -Doi
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Broad Cow
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3 _
❑ Yes )�rNo El NA El NE
❑ Yes
P'No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
[:]Yes
JOTTo
❑ Yes
ffNo
❑ NA
❑ NE
El Yes
eNo
El NA
El NE
12/18/04 Continued

Facility Number: ' Date of Inspection
L.
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 E-j No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 2
Observed Freeboard (in):'J
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ YesXNo
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes /E 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-ADNo
❑ NA
❑ NE
8. Do any of the stuctures 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 QKo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [lo ❑ NA ❑ NE
maintenance/improvement? /
11. is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 'Pjl�o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
XfNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
eNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
0No
❑ NA
❑ NE
Comments (refer t6 question`#): =Explainany TES°an"swers aidlor any recommendations or any other comments
a s*
Use drawings of facility,to better;explain;situations. (use additional pages as necessary)
Reviewer/inspector Name A „m, _. Phone:
Reviewertinspector Signature: Date: 3
Page 2 of 3 12128104 Continued

Facility Number: 3 — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?,' ❑ Yes ,ENo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily availa6*? If..yes, check ❑Yes dNoNA ❑ ❑ NE
the appropriate box. i'
❑ WUP ❑ Checklists ❑ Design ❑ Maps '❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yev&o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes,4!JNo ❑ NA ❑ NE
❑ Yes ANo ❑ NA ❑ NE
❑ Yes �o ❑ NA ❑ NE
El Yes NoElNA El NE
❑ Yes No ❑ ❑ NA NE
9
El Yes ONo ❑ NA ❑ NE
❑ Yes )21 No
❑ NA
❑ NE
❑ Yes
I;No
❑ NA
❑ NE
ElYes
/
P No
❑ NA
❑ NE
❑ Yes
No
El NA
El NE
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings: _
t
Ina
/1h �`I ^_4F/ ,r;s
�-
Page 3 of 3 12128104

Facility Number" 3
lvision of Wat
;Division of Soil;
Other A'gency`,'
Type of Visit �mpliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit Proutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: [ Departure Time: County: Region: �
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Z.
,� Design �, WCurrent
Swine y `Capacity Papn[ahon�'
Fs
❑ Wean to Finish
❑ Wean to Feeder
,'2 ❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Y: ❑ Boars
:Other. _
❑ Other
Owner Email:
Phone:
Phone No:
Integrator-
Operator Certification Number:
Back-up Certification Number:
Latitude: = n = I = 11 Longitude: = ° = 6 = u
1l
Wet Poultry Ca
Layer
Non -La er
�..:
Dry _ Point�/';
Layers
Non -La ers
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?
Dairy Cow
Dairy Calf
Dairy 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?
❑ Yes ,fNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
ETNo
❑ Yes dNo El NA El NE
❑ Yes No ❑ NA ❑ NE
12128104 Continued

`FacititS'Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes Er -No ❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes /ffNo
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 'CJ 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 P Mo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0-14o
❑ 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 ❑ Yes 'Rio
❑ NA El NE
maintenance/improvement?
,—,,�
] 1. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind 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 ETNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,Q No
❑ NA
❑ NI-
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes J!fNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes LJ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments
Use drawings of facility to better explain situations. {use additional
w
Reviewer/Inspector Name
Phone: e�—
Reviewer/Inspector Signature:
Date:
12128104 ' Continued

Facility Number: c3 — Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes L� I"NNo ❑ NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ;j 1qd
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and l"
Rain Inspections ❑ Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ENo
❑ NA
ElNE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Yes
El Yes
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes PNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes P�no
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes ONo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes "o ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [ No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Rfio
❑ 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
PIR0
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
-- //
31. Did the facility fail to notify the regional office of emergency situations as required by
El Yes
E3 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[_. <oo
El NA
El NE
33. Does facility require a follow-up visit by same agency?
El Yes
2<
❑ NA
❑ NE
pia -
Addi'666al,;Gomments aadlor Dra ngs:
A
qliildl I-S t'
r
Hv
12l2&04

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 01foutine 0 Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access jJ
Date of Visit: Arrival Time: , Departure Time: County: Region:
Farm Name:
Owner Name:
ailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Owner Email:
Phone:
Phone No:
Integrator: kSi
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o = t ❑ [t Longitude: ❑ 0 = ,
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes )�fNo
❑ 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
❑ No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
EJ No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12129104
Continued

Facility Number: _31 — 33 ' Date of Inspection
f
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 P No
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
7
Structure 5
Structure 6
Identifier.
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ NA ❑ NE
through a waste management or closure plan?
',J�No
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 ZNo
❑ NA ❑ NE
8. Do any of the stuctures tack adequate markers as required by the permit?
❑ Yes ❑ No
[:3 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 �tVo
❑ NA El NE
maintenance or improvement?
/
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes P'&o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes FZT'No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes 0"No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes PNo ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes [Pr No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes PNo ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes DtNo ❑ NA ❑ NE
:Comments (refer to question #):..Explain any YES answers and/or any recommendationvor any other comments
Use drawings of facility to better explain situations. (use additional pages as necessary): .
Reviewerfinspector Name
Reviewer/inspector Signature:
Page 2 of 3
Phone: 7/a 6Z
Date:
12128104 Continued

Facility Number: S Date of Inspection a. 1 Gt
Required Records & Documents
19. Did the facility fail to have 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 ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
12 No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
P No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
CjNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
JZ[No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
7No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
ON
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
(
,1J No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;dNo
❑ 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 concem?
❑ Yes
[;YNo
❑ 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
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
J0No
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
O No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
2 No
❑ NA
❑ NE
Additional Comments and/or Drawings:
V /V/ GrG���,
eoilcod �ec orarf' �� Y
Page 3 of 3 12128104

o6ffivision of Water Quality
F aciiity Number. 0 Division of Soil and Water Conservation
0 Other Agency V
Type of Visit A Compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance I
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
M Arrival Time:
%
Departure Time: County:
Farm Name:&_
C,
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _'_'S�_SgiUf<
Certified Operator:
Back-up Operator:
Location of Farm:
Swine, .
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
x : ❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
. ❑ Boars
Other
❑ Other.
Phone No:
Integrator:
Operator Certification Numher,
Back-up Certification Number:
Region:
Latitude: = o = g = « Longitude: = o = 6
Design Current Design Current
Capacity. .Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
.Design Current.,,.
.Cattle Capacity Population `
❑ Dairy Cow I;-
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:.,
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ['No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
[3 NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑Yes
0No
(3 NA
El NE
❑ Yes
F No
❑ NA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection %7
WWaste 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: / el
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ErNo ❑ NA ❑ NE
❑Yes El No El NA ONE
Structure 5 Structure 6
❑ Yes ;1 No ❑ NA ❑ NE
❑ Yes d No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes to No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
ET No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
?fNo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments
41
Use drawings of facility to better explain situations: (use additional pages as necessary).: _��}s
14 f! j:�A
0015
#
d
Reviewer/Inspector Name �' yl O� Phone:
Reviewer/Inspector Signature: �_ Date: G�
Pale 2 of 3 12128104 Continued

S
wy
Facility Number: Date of Inspection l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 01140 ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes J:?"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 Z No
❑ NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[--]Yes / f No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes 0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes 21 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes �3 No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes O No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 21 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes �2No
❑ 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 J2 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 JZ No
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes ,I No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes P No
❑ NA
❑ NE
Additional Comments and/or Drawings:
Haio2 yp.car 7y, e, .J 6n ��� �u�� No
ctN 1 De-, 3d a 00a
Pl-ea s-a- rrOtj o 444da 16I J 00YI W a 11 4 yk J-
[.
you rid r a,500h
Page 3 of 3 12128104

1 � -.W_
r
IType of Visit 9) Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit o Routine O Complaint O Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: 0 Departure Time:�l !S� County:
Farm Name:%;T ���5 %a2lY� Owner Email:
Owner Name: _ �/Jn��.�4 f���� Phone: _
i
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:��L�� 4
Certified Operator:
Back-up Operator:
Region: d e,6J
Phone No:
Integrator: l��t,.�
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: E__1 o = ' 0 Longitude: = ° = I = It
Design Current
5wme Ca acity Po ulation
p P.
Design. Current
Wet Poultry Ca aci Po ulation
�.tyP
Design Current
Cattle . C
r-_-apacLty opula_ion
❑ Wean to Finish
❑ La er
❑Dai Cow
❑ Wean to Feeder
❑Non -La et
❑ Dairy Calf
Feeder to Finish
Dry Poultry
Dairy Heifer
❑ Da Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
❑ Beef Brood Coui
Number of Structures:
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Layers
❑ Non -Layers
❑ Gilts
El Pullets
❑ Boars
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
❑ Other
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes 19 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
j1fNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
x
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Date of inspection O O
Facility Number: 3 1 — 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ;gNo ❑ 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: [ AAd,6 � G
Spillway?:
-4Z&
Designed Freeboard (in): w al ,.7
Observed Freeboard (in): 5 Z�
5. Are there any immediate -threats to the integrity of any of the structures observed?
❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
JA
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes 10No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes )ZrNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes 0 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
[--]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
l2. Crop type(s) _ AWIY 40 A -1 V.�Qf%�.QS "IeZ
////94/)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo
❑ 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
—Of
❑ NA
❑ NE
7% Gv ';r�ja,e4 T WJ%Oe l; f+Av �srABlrsHz�✓c (1/1�s3
s
Reviewer/Inspector Name r Ajr p „� Phone:Jlv-fo
Reviewer/Inspector Signature: Date: 4,15a O
12128104 Continued

Facility Number:YMO Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box. ❑ WUp ❑ Checklists ❑ Design El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. XYes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 9Waste 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
0 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
JA No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
RfNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
VINo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
O No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
/[�No
El NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
[ No
❑ NA
❑ NE
m and report the mortality rates that were higher than noral?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
El NA
El NE
If yes, contact a regional Air Quality representative immediately
�No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Pen -nit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
XNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ko
❑ NA
❑ NE
Addzttana//l'CommeisEsandLor`Drawings :: , -'. ` {,".i. ���"Or r'
40 rf Nf}C v$ 25 !� v R �i459E
O�ZC�T20..3�
l
12128104

3 Dtvtsto of Water gQalCrty
'" = 't
,S,V. srV
Type of Visit Co pliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit40 Routine Q Complaint O Follow up O Emergency Notification O Other
❑ Denied Access
Facility Number Date of Visit: � Time:
Q Not O erational Q Below Threshold
Permitter) Cerfified [] Conditionally Certified [] Registered Date Last Operated or Above Threshold: ... _. .
Farm Name: .....LD..... (A R-l✓i ...W -- - — - County: ._. .__ ......_ ... ....» .. »» .
Owner Name:
Mailing Address:
Facility Contact:
Onsite Representative:---...)Iq Le& JAVL�
Certified Operator:
Location of Farm:
Title:
PhoneNo: . .. ............................................
- - - - - .......... Phone No: .. , - __........._ .....,
Integrator• .... LiK,I..#.................................................
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ` 4 &° Longitude • & �4
Wean to Feeder
Weeder to Finish
77
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made'? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ 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)
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 Stru�tunel2 --Structure 3- Structure 4 -Structure 5
Identifier:
Freeboard (inches): ,3
❑ Yes ❑ No
❑ Yes 7No
�
❑ Yes
❑ Yes WNo
Structure 6
12112103 Continued

Facility Number: — Date of inspection Eh
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
dNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
M Yes
❑ N
8. Does any part of the waste management system other than waste structures require maintenance)'improvement?
❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
LJ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance!improvement?
❑ Yes
M<
I I. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
[ o
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type &O
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
14, a) Does the facility lack adequate acreage for land application?
❑ Yes
VN
b) Does the facility need a wettable acre determination?
❑ Yes
LJ Zq
c) This facility is pended for a wettable acre determination?
ElYes
To'
15. Does the receiving crop need improvement?
❑ Yes
Q'NO
I6. Is there a lack of adequate waste application equipment?
❑ Yes
r No
Odor I.vsues
17. 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?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes C No
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 3eo
Air Quality representative immediately.
`Comments (ire%r,to question') z Explaan YES`araswers amd/or any recommcendatsons orany other comments.
.Use drawuigs of faci�iy tobetter exglai;i s�tiia#ions (use additional pages as nei�sary)'.
�. ; ❑Field Copy ❑Final Notes �
7.) S O M6- C FASi C.OV EP-• 00 LA C-00 OLD
AL
R� Vf 1 CA NS f �- Ta N FGJ �o dz.�MS,
Reviewer/inspector Name 7�
5WN
�
f.: w
d Reviewelnspector Signature: Date: % o
12112103 r Continued

I.
Facility Number: — 3
Date of .Inspection
Required Records & Document~
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?
(ie/ 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)
3I. 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?
❑ Yes dNO
❑ Yes [�
❑ Yes ( rNo
❑ Yes 0
❑ Yes o
❑ Yes Q�
❑ Yes
❑ Yes N�
❑ Yes j—a/No
es
❑ No
❑ Yes
[io
❑ Yes
❑ Yes
❑ Yes
Q'NOf
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes o
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
12112103

r
Facility Number hate of Visit: D3 Time: �/s4
Not Operational 0 Below Threshold
19 Permitted V Certified]/ [3 Conditionally CeCertified0 Registered Date Last Operated or Above Threshold:
Farm Name: __ _ 06 fK I(? L�� County: �)[�d",
� r
Owner Name:
Mailing Address:
Facilitv Contact: Title:
Onsite Representative:u✓h
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: ✓
Operator Certification Number:
[]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0' 0" Longitude • 0
'Destgn:` Current ;: =, _Design "Current Destgn Current
w _ e ❑ l.PCa aci€v. Pa ulai�ou�`atleStneCCa scEr_
Poon
Layer Wean to Feeder
,
Dairy
Feeder to Finish Z -> ❑ Non -Layer ❑Non-Dai
Farrow to Wean ❑
.:` ❑ Farrow to Feeder Other �-
❑ Farrow to Finish
-Total Desfl Capapq
❑ Gilts
❑ Boats Total sk
IViimber of Lagovus -�' ❑ 5nbsurface Drains Present ❑ Lagoon Area ❑ S rav Field Area
Holdiiii, Posidi"t, Solid Traps ❑ No Liquid Waste Management System
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation? ,,�
❑ Yes tJ NO
Discharge originated at: ❑ Lap-oon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If ves, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes El'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Eff No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes �o
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
Freeboard (inches): 2-7 120
05103101 Continued

Facility Number: 31
Date of Inspection
S. 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 enNironmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type 1.W1/79 L 04 %f V 156-a
❑ Yes Ef No
❑ Yes E No
❑ Yes ErNo
❑ Yes ❑'No
❑ Yes �No
❑ Yes BNo
❑ Yes L'ff-N-o
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes QNo
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
Q 0
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
P'No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
DNo
Required Records & Documents
IT
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
El"'NO
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
2No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Q-No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
Q-No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
.E]
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
0'96
24.
Does facility require a follow-up visit by same agency?
❑ Yes
Q-No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
.0 o
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments(refer to.questton #I) Explain any YES.answers,and/oran y ree.ommendanc;as orai74;otlier commep
m e.
Clse"_iirawir sotfiicd to"better eii lath srtirattonsi nse addttronal a es ss neressa ) - .t
.40 Field Conv ❑Final Notes �
5v;1 61171$ 2 /I%.&,-. j 1-1114e,- Y�rr t I✓t a v t 1 i-on .
fAe a/j la Z &c Pots its &dh - w zJ � yp� td I� tcf� ID"
%d2 0'- 1/d/63 fPf,(y �/'��Iiu�dO.A W/1Q4 6is;ti� 'TIIP J"¢l�C,e�fO�t. -f- /�il/ ltJ�c7
I
�If eAeee��rl,
Reviewer/Inspector Name A e— -
Reviewer/Inspector Signature: Date: Z 4
0510310I
Continued

r
Facility Number: ) % Date of Inspection
Odor- Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes -0-%
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ff Ro
28, is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes E7—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 .� ,Vo
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 E�90
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,Q'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yeso
Add ifional'Comments and/or'Drawipgs:_-
0510310I

Type of Visit }Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit I&Routine 0 Complaint 0 Follow up 0 Emergency Notification 0 Other © Denied Access
Facility Number date of Visit: a� Time:
rO Not Operational ORelowThreshold
LIPermitted ©Certified © Condditionallyy Certified © Registered Date Last Operated or Above Threshold:
Farm Name: /�/�✓� / p�� County: Aohk
Owner Name: ✓Ant 6 Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: /Iak B� Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 " Longitude 0' 0 �"
Design Cu._r.
rent .:Poultr- y -. _CDitesar ctntv_. PCurrent.. �`DC
a uah'©n o u�eilrrenatnCa acity-Po ulation ❑ Wean to Feeder -_] Layer , Q Dairy
® Feeder to Finish = ❑ Non -Laver` ❑ Non -Dairy
❑ Farrow to Wean r
El Farrow to Feeder ❑Other $ f . u ] Farrow to FinishTotAI i"lfSi II_C8 xCtiV
P
_:. ❑
. _ Gilts
❑ Boars Tote( SSLW
Number of IA- Illsubsurface Drains PresenD ❑ La oon Area 10 S rav Field Area
Hoidttig Po64i8k, SoLd sTraps ' eA ❑ No Liquid Waste Management Svstem
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structu
2 Structure 3 Structure 4 Structure 5
Identifier: 1 A
Freeboard (inches):1
05103101
❑ Yes RLNo
❑ Yes ❑ No
❑ Yes ❑ No
El Yes ❑No
❑ Yes &No
❑ Yes I.No
❑ Yes E?[No
Structure 6
Continued

Facility Number: 3/ — jf
Date of Inspection 0
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 anv 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 RNo
❑ Yes ®,No
❑ Yes W-No
❑ Yes N No
❑ Yes NNo
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes M No
11. Is there evidence of over applii tion? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload El Yes M[No
12. Crop type �t/( G. � �U _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes W No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes 91 No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
91 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 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
[&No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
E� Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
CgNo
21_
Did the facility fail to have a actively certified operator in charge?
❑ Yes
&No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes KNo
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes RLNo
24. Does facility require a follow-up visit by same agency? ❑ Yes CKNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ngNo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Contbients (refer ti�`quest art #) Eacplaist any YES snawers andior any r otnisteodaduns or ai�v-otherr comments.
Use tirswrings of.facility to Bette ezplata sitnattoos: (use addibanal pages as necessary)
W _ _ Field Conv ❑ Final Notes i
/i r-r4:; XeJ 7 ke --m % -;;to ���+✓ �d�� w"A/0-J- 4/*. 0 0i` f "F,'r/r'er evt-
,AVO•` saJ/ �,c�r�/c G/�7/4Z 54ws hMe
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
O5103101 Continued

%r.
Facility \umber: Date of Inspection �
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge aVor below ❑ Yes MINO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �ifo
28. Is there any evidence of wind drift during land application? (i_e. residue on neighboring vegetation, asphalt, ❑ Yes TZNo
roads, building structure, and/or public property) V
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes El No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e, broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) ❑ Yes kNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes MN10
32. Do the flush tanks lack a submerged fill pipe or a permanent temporary cover? ❑ Yes &No
I.A(lditional'Comments,2nd/ar Drawings _41
O5103101

Type of Visit 6Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for VisitA!�Routine O Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access
F--Facility Number 3 3
Date or!'isit: I I Time: 12
10 Not Operational Q Below Threshold
© Permitted [3 Certified 0 Conditionally Certified 13 Registered Date Last Operated or Above Threshold: .........................
Farm Name: �Dlr.[`.S Mewl f.... .............................. Count :.,,1r l%........................................... l �............._........
................. 3" I l ..
Owner Name: ..... i�1.Gl.'!`tiGS...av�S��l..r............................................................... Phone No:......................................................................................
FacilityContact: ...............................................................................Title:............................................................... Phone No:.....................
MailingAddress: ...................................................................................................................... ...................................................................................
Onsite Representative. S- � cJ1f Integrator:.,_. q/•, . F4-q/- "1�
..................................
I............................ _ I .............................
Certified Operator:................................................................................................................ Operator Certification Number:.................
Location of Farm:
ZSwlne ❑ Poultry ❑ Cattle ❑ Horse Latitude • " Longitude 4 •4
Design Current Design Current Design Current
Swine ...Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder : ❑ Other
❑ Farrow to Finish Total Design .Capacity
❑ Gilts
[] Boars ';Total'SSLW_
Number of=Lagoons 2— ❑ Subsurface Drains Present ID Lagoon Area ❑Spray Field Area a
-.
Holdt Ponds / Sohd Traps-'6 4 No L.� uid Waste Mana ement 5 steinMz-
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes �10
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 1,!INo
b. If discharge is observed, did it reach Water of the State'? (If yes, notify DWQ) ❑ Yes" No
c. 1f discharge is observed. what is the estimated flow in gal/min'? ti`i ! a
d. Does discharge bypass a lagoon system? (if: _yes, notify DWQ) ❑ Yes )ZrNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes X21110
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
q or 0 /t71 6 nGcr� r'r btD o an 1— Z�" Z- j o o� 2- Z If r,
Continued

Facility Number: Date of Inspection f D Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes .16No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 'E6 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 )1 No
8. Does any part of the waste management system other than waste structures require maintenanec/improvem
F10ent? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes 0 No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes EfNo
11. Is there evidence of over application? ❑ Excessive Pondin�+g ❑ PAN ❑ Hydraulic Overload
❑ Yes �No
j�
12. Crop type 1�Q / h't ✓4�'t. Pay S1'�' ig C�✓`� ��+'1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes '21No
14. a) Does the- facility lack adequate acreage for land application?
❑ Yes "No
b) Does the facility need a wettable acre determination?
❑ Yes ONo
c) This facility is pended for a wettable acre determination?
❑ Yes �No
15. Does the receiving crop need improvement?
,e(Yes ❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes/EfNo
Reguired Records & Documents
IT Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes gNo
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 A No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(id discharge, freeboard problems, over application)
❑ Yes Alo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes )YNo
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 090
:10 yiatigris:or deficiencies ire npft d>lrringsv.is.�t.; d.o
:Y:o.e .w..i :�e:e:�i.y.e
crrnodetebithvsit:h:i::
oe.i. .
,oxnments'(refer to question #} Eaplatn any YES answers and/or anp recommendations or any nfJr Comm nth,
Jse d4,w4 s of facility t6- better'expisin situations (nsenadtlitEonal.P --
S�Gi t SLe d 1 s r�04 L� f n ^,to ve 4 . Silo u ) d & ►^ e m 4 ved
pv�✓aII°/ �a�>'I�� VIA re6,0 �r are
7 .
I&
Reviewer/Inspector Name '2
Reviewer/Inspector Signature:
Date:
5/00

FacilityjNumber: C — Date of Inspection Printed on: 7/21/2000
Oior Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below XYes ❑ 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 )6'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property) /
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes )ZfNo
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!fNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes fi'No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
•
5100

0 Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
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 ❑ Denied Access
Facility Dumber
Date of Visit: !D lZ QQ Time: � ..3% J Printed on: 7/21/2000
3 l 33
tD Not Operational Q Below Threshold
Permitted © Certified E3 Conditionally Certified © Registered Date Last Operated or Above Threshold: ............
Farm Name:!?+ r F S Y, 2. �p(S r County: u l l ±'1 .......................
.........-.c 5............................................................................�.........................................
OwnerName: ......... . ......................... ... b�kT...................................................... Phone No:.......................................................................................
Facility Contact: ....................
Title...........
MailingAddress: ...............�................................,....................._.................
Onsite Representative:.,,) G+ "tee s 54
CertifiedOperator: ..................................................................... ..............
Location of Farm:
Phone No:
Integrator:.. l!✓ y
Operator Certification Number: ...............
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� 0°° Longitude �• �°
Design Current
Swine Canacity Ponulation
❑ Wean to Feeder
Feeder to Finish
rl Z
.7666
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons Z JE1 Subsurface Drains Present ❑ Lag-nn Area ❑ Spray Field Area
Holding Ponds / Solid Traps JE1 No Liquid Waste Management System
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?
Structure I Structure 2 Structure
Identifier: ................_...._..................... �...................... I.....................
Freeboard (inches): ( 2 3
5100
El Spillway
Structure 4 Structure 5
❑ Yes N6
❑ Yes XNo
❑ Yes XNo
k1 4
❑ Yes )91 No
❑ Yes "192 No
❑ Yes XNo
❑ Yes Zf No
Structure 6
Continued on back

Facility Number: 3/ _33� Date of Inspection Printed on: 7/21/2000
j 5. Are there any immediate threats to the integrity of any of the structures observed? Oe/ trees, severe erosion, ❑ Yes JgNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes J5No
(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 50 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes f f No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes X No
Waste Analication
10. Are there any buffers that need maintenance/improvement? ❑ Yes 0 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ' S No
12. Crop type 15e VrV V7 vd el Ha y
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
allo
16. Is there a lack of adequate waste application equipment?
❑ Yes
ONO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
;RNo
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 KNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ,� No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes WNo
24. Does facility require a follow-up visit by same agency? [:]Yes FfNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P No
0: Nd-- olafidhs ©� deficiencies were hated. during 4bis'visit:- Ydif will �eceiye lid futthe'r
corres�&idence. ab' t. this .visit.. .. * 1
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):
i.5 r1ol A L.JA sh iikialy fiS �v��►c�Cn�il.� Gi°1-�c� �o GoveY-
�°pli ocEUrr41 7-V nc OG-�obc+� rq��i q T ` " C
TvIy/e�T 1y AvIVJ� VOP- 73e .sc.,re �o Je4-ke w�,S�e rat►' e- lt��
4es-}e,d 7° fovc>r aPjolSC�r�,'�y1S wl' t �'h �� 4.t yS c' -/Lie dR)-t-, e17
Reviewer/Inspector Name
Reviewer/Inspector Signature: _ �� Date: /Q / 2-IN 5100

Facility Number: — 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 Wor below Yes [:]No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes % No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 71No
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 P'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 99No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )KNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? AYes ❑ No
Additional Comments and/or ravings:
w
5100

- 0 Division of Soil and Water Conservation - Operation Review
0 Division of Soil and Water Conservation - Compliance Inspection
6Division of Water Quality - Compliance Inspection
Other Agency - Operation Review
Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Facility Number 3 '7 Date of Inspection
Time of Inspection :(jp 24 hr. (hh-,n
41 Permitted [3 Certified 1_-] Conditionally Certified [,] Registered 13 Not Operational 1 Date Last Operated:
Farm Name: ...............l�f1111.s. r.4FtC C.ount►•' .......................
Owner Name:
..................... AMR5------------- ------------ ' 1�-....-....................................... Phone No: . 2$........
Facility Contact:..................................................... .. ......... Title:..................... ................... Phone No:
Mailing Address: ... Zt%.... . Zm. ..... S..... +........................................... ........ LA)lit: :W..i...... .C.................... . ..z.`?.9.......,
Onsite Representative: .............. I my�y . mqmk.................................................... Integrator:.. k........................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Farm:
r....................................................................... -----................... ....... .... ............ ...... .............. ......-........................------ ............................................................................
�
Latitude 0 �° Longitude • �` «
Design Current
Swine Capacity Population
❑ Wean to Feeder
Ey Feeder to Finisho1L
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
Design Current Design Current
Poultry = , Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other -
- _ Total Design Capacity *� Z
- Tota155LW
_ Number of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
_
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System _
Discharges &.Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? El Yes No
h. 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? 1J
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? P Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes P No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway ❑ Yes VNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier-. I Z
Freeboard (inches): ..................
.............. . e................-..........Z:.......................................-......................................._.._...................................... ...........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes E'No
seepage, etc.)
3/23/99 Continued on back

S
Fac ity Number: 3�— 33� Date of inspection 1E J�2
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? Yes � No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [I No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? (:]Yes 50 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes EA No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes [)?No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes ()g No
12. Crop type 64Z.Yn%cla SYr+r.1� ck am __.
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes �fl No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
0 No
16.
Is there a lack of adequate waste application equipment?
❑ Yes
[p No
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[P 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.)
Q8 Yes
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
-9 Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes F No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes Qd 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
Rio yiolatiQris or defieiei�cip� •were noted dirrfng this:visit: Yoi} �viil reel i Rio futtbm
corresp6fideike. abaut. this .visit_ - . •
Comments (refer;to gnestionA :.Explain any•YES.answ,ers and/or.anf= Ie,,mmendatiortFs or�any'other comments'
Use drawings of facility.to`better.explainsituations (use additional.-pages`as necessary)
7.
k Nu)
N-C
�.�o� � o��bo�c.k a�rL �� � j�c,�;o,So Io�a�c� �bv- �wt:�x' c�� e�s►cr,� �.K ��04 ��
s e+V o d 4.c 5 k:k -
�� - L_'_(� C'Or` des i yv4 soL t} b� ► r, rt7 rr. Y� cads .
]q, So;l �- wask• �-a� ses Shautt� ��. uQd�{�-�. i�o.��- �1►�a�ia��s Shnu� b� k�p� o
ona- Can T�. k ov o) v -2 [�tims. �lt�lt n � silov�� %e (t'x�oel� a �^
Reviewer/Inspector Name [
Reviewer/Inspector Signature:
Date: I I /2 j A 4
3/23/99

XFay Number: 3 — Date of inspection l Z3
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes 1� 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 [A No
2& Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes C j 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 E�) No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31 _ Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional omments an an_ Drawings�?� _f
3/23/99

r n�*Mnp ;..,..
�❑ Division of Soil and Water Conservation ❑Other Agency s� 4
Division of Water Quality
Q� Routine O Complaint O Follow-u of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection 13 $
Facility Number 31 33 Time of Inspection Iloo 124 hr. (hh:mm)
© Registered 13Certified 0 Applied for Permit [3Permitted JE3 Not Operational Date Last Operated:
Farm Name: frrks...... c l l}s ' County:.......��.!............................................................
Owner Name: ................................ 'IN f—AI .........&!AU Phone No:.. C! � �'�. Zi���f t bb......... ............................................. .................................................
Facility Contact:
Title:
Mailing Address: ....MA ......... ....... .? VY!s.......0. �..
Onsite Representative : ....... ...... �n......... SA'h.................................
CertifiedOperator;..................................................................................
Location of Farm:
Phone No:....
....... ........ W.0.66w.,.....N...........................................-�')1%.--........
Integrator:...... ksl-�--�...y.....................................
....... Operator Certification Number, .........................................
Latitude 0 4 °' Longitude 0 6 66
! Hnldrng Ponds Z LLB Subsurface Drains Present
❑ No Liquid Waste Managen
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 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? iv
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 No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25197
4
4,

Facility Number: It — 33-7
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes Ea No
Structures (Lagoonsjloldine Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: Z
�................................................................................................................................................ I.............. ...................................
Freeboard ft 3-9 L
10. Is seepage observed from any of the structures? ❑ Yes R3 No
11. Is erosion, or any other threats to the integrity of any of the structures observed? ❑ Yes ® No
12. Do any of the structures need maintenance/improvement? 'M 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 [4 No
Waste Application
14. Is there physical evidence of over application? ❑ Yes ® No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ................................. .... S?�Y4.i ....................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes 51 No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
[R 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?
IQ] Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement?
Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
[B No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
M Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
$1 Yes
❑ No
0 No.violations-or. deficiencies.were-noted.during this.visit.-.Y,ou:willreceive'no-ftirther
correspQndehce about this:visit:::
i1.- p�oM t4�acr ��SLc1ti.�iitS S�10u�1[ � y�6tJit�, �� G�"11�e�i �r. �a�Wti.. "i� ( 5%�a�lw fae elu�eUq'dtl�' t
s��AJ�l
�,kt)t._�,a�« d�s:
sko�La
�4 wiq' &v),- ttLCOS.
Z4/t.q. Ovtva..Q %CAC .�Jor_
o Y�1Wocer o,� SmA�� �y�,ri 11` �+,��
Cg�►'•� vll� 4q,Zi Ibq".
ogcr. I✓�ce5� 1ti e
�h«��s� � � �h- 1RRg �.,r«wat`
n;�a�t4.. 1�.
t1.
7125/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: !A m—' / , Date:

E:�a�cilityumber 3l 337
Date of Inspection 2/I0198
Time of Inspection 16:30 24 hr. (hh:rnm)
Q Registered ECertified ® Applied for Permit Ej Permitted IQ Not Opera Date Last Operated:
Farm Name: Pa 1m.ficlAaAdditiail...................................... County: Ruplim ............................................... WiRfJ.........
OwnerName: Jimmy . .................................... Sauk ............................................................ Phone No: 4.10.: .3. 42,86...........................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
Mailing Address: 2.46.. mSauls.Rd....................................................................I............ Wa.tuw..N.C.......................................................... 283911.............
Onsite Representative:........................................................................................................... Integrator: MtLrp IY.FaxWly..k:ax'I1xs......................................
Certified Operator: Jmules...................................... S.auls.Jr ........................................... Operator Certification Number: .12CQ0.............................
Location of Farm:
Latitude 35 ' 03 30 " Longitude E7s •F 08
❑ Wean to Feeder
N Feeder to Finish
3672
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
[ 1 Boars
General
1. Are there any buffers that need maintenance/improvement? [:]Yes ❑ No
2. Is any discharge observed from any part of the operation'? ❑ Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?- ❑ Yes ❑ No
b. If discharge is observed, did it reach Surface Water? (If yes, notify D WQ) ❑ 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? Q Yes ❑ No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes []No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes ❑ No
5
7/25/97

Facility Number: 3I--337
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (L.woonsXoldinz Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure
Identifier:
Structure 2 Structure 3
Freeboard (ft): .......................... ......... .....................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures obst-Tvcd?
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)
[:j Yes © No
[j Yes [] No
Structure 5 Structure 6
................................................................
......................................................................
© Yes © No
15. Crop type.................................................................................................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
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 flan readily available?
24. Were any additional problems noted wluch cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
�J •No•violatiotls: or:deC i�nEies•�vere'noted'dt�lrah tilis•vi$it.-1'•ou 411i'rteefve.no'%�'ther• -.
..--..... ---... .......... ........
cor:res�' adeitct ihouf f[�is.vasat; .... ... .
❑ Yes [] No
❑ Yes E) No
[] Yes [:]No
© Yes © No
................................
[] Yes [] No
Yes © No
[j Yes © No
E] Yes [] No
[j Yes [] No
[j Yes © No
[j Yes E] No
❑ Yes [] No
❑ Yes [] No
[j Yes [] No
it was received that waste was running off spray field into roadside ditch at Murphy #2176. No evidence of waste was found in
Operator was observed pumping at the time and appeared to be keeping proper buffers. No ponding or runoff was observed.
7/25/97
Reviewer/Inspector Name
Reviewer/Inspector Signature: 0_,,(,Ly-, _)CT Date:

M
® Division of Soil and Water Conservation- ❑ Other Agency
❑ Division of Water Quality
149 Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection 11/7197
Facility Number 31 337
Time of Inspection 1400 24 hr. (hh:mm)
0 Registered N Certified ® Applied for Permit 0 Permitted 10 Not Operational I Date Last Operated:
Farm Name: PtlrJs,S.k'xeWs.k'aye'.m ................................................................................ ...... County: D.upUA............................................... ... Q.--.-----
OwnerName: Fark,9....................................... Flema ........................................................... Phone No: 9JQ:-.293.-7.8.86-..........................................................
Facility Contact: dirr my.&Ws................................................... Title: ManAger ............................................ Phone No: 9.IQ-293. 42.86.......................
Mailing Address: 4805.QakaCliff.Rd..................................................................................G.Mgusboro-MC.................................................. Z74.06 .............
Onsite Representative: &..0t.Mclamb.................................................................
Certified Operator: ,J.males...................................... SAWS.dr...........
Location of Farm:
Integrator: lduxthy..FwWly..f arAw..................................
.. Operator Certification Number:.19.62.0...............
Latitude 35 • 03 30 u Longitude
❑ Wean to Feeder
® Feeder to Finish
3672
3672
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑,Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes; notify DWQ)
c. If discharge is observed, what is the estimated flow in gal%min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes ® No
❑ Yes ® No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes 0 No
[>•®►=11�•

f-Pacilit-Y Number: 31-337
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Latroons3folding Ponds Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
structure I Structure 2 Structure 3 Structure 4
Identifier: ad�Iag
a Id...........................................................................................
Freeboard(ft):..............1.,:?5........................... 1.3.5............. .................................... ...................................
10. Is seepage observed from any of the structures?
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ) . .
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
] Yes ® No
❑ Yes ® No
Structure 5 Structure 6
15. Crop type ....... CogstaLBer=da..Grass...... ................................................................
Milo, Oats
16. Do the receiving crops differ with those designated in the Anrrna Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23, Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the'Certifhed AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
•No +violati�rts: ox'd'a%ienEies-�ver'e;note'd'c�l-ing� t�tiS•V�sit.' 1'6�i vuiitl'r'Ceive'ao ��rttei ;-;
.cvrrespaudei�ce abiout this.vasiti ; ; . ; .. _ . ' ; . ; . . .
..............................
❑ Yes ® No
❑ Yes No
Yes No
❑ Yes No
© Yes ® No
R Yes
El No
❑ Yes
® No
Yes
© No
0 Yes
© No
❑ Yes
No
❑ Yes
® No
Yes
© No
0 Yes © No
❑ Yes ® No
*s;,s -
12) Flush pipes into lagoon need to be repaired and extended out into lagoon. Repair waterway to control ponding behind house 42.
Eliminate rodents and repair holes on old lagoon.
16) Only showing 9.7 acres over seed with small grain. Need to revise WUP to include all that has been planted will be applied on.
18) Should manage Bermuda grass to establish as dominant crop.
l 9) Uses custom applicator. Needs to have notarized agreement with applicator.
22) Need to balance N for each crop and need IRR-2 for each crop. Need waste sample analysis within 60 days of application.
23) Need certification form and design on site. Also operation and maintenance plans. Fill out Emergency Action Plan. Obtain
assistance from technical specialist to fill out odor, insect, and mortality checklists. (Issued to on site representative)
7125/97
Reviewer/Inspector Name
Reviewer/]nspector Signature: Date:

DSWC Anlmal'rFeedlot OperationReview s`
❑
I F
�
��� � �
®DWQ Animal Feedlot Qperatlon S1te Inspect><on - � �
„ ��
;� ,�
O Routine O Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection $
Facility Number 3
Time of Inspection UEZU 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:135 for 1 hr 15 min)) Spent on Review r3-1
® Certified ❑ Permitted I or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: .... . ...- -.... ..... _..... ........ ........... ._....__............. ......... ..-......
Farm Name:.. s',r..Counh':.
Land Owner Name:_-Fl u..S,............... Phone No:—__... . ..... . ...... ...._. .
ty .. Title: ........_. Phone 9 D �. ~ i
Facia Canctact:..s�i:^'�..._,�.�-1!.�.�..................................._.............----._...... _ ..�........_... .��..3....__..0g.....
Mailing Address: _A.k.Q l�:...Q. .c l.t.. ..._ .. _ .... _.. _ ..%x�Q s. t' ...�,,.... ._ .Za`.f. A—
Onsite Representative: ........... Integrator: _...N.%...._..... _.......... ...... ...... ....._.
CertifiedOperator- ................ ....... .......... ........ ............ .................. ............................ Operator Certification Number:
Location of Farm:
.r.0 .. L,el a. .. ZL .....�,�
{ i A.-.- I ... t . �.13.3 $.. ...._w.... _ .... _ .... ,�......................._ ..... �
Latitude 4®u Longitude • 08 6®"
Type of Operation and Design Capacity
I , rnt = Design , !u
iCMrraehnot
nCaacPuCattlea acr Po ulatiai
❑ Wean to Feeder 4� Layer ❑ Dairy
® Feeder to Finish '7 2 ❑Non -La er ❑ Non-
` '+ it-: S
Farrow to Wean gam, x
A,
Farrow to Feeder Total DesignCapacity
Farrow to Finish +�
�__- ._ .... .... ........
o w
Total �SSLW 4
Ober�.'-�
y F
Number of LagoansrlYHaldmg Ponds Subsurface Drains Present
�❑Lagoon Area ❑Spray Field Area
€ {
E
n ral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Watef? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gat/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes NNo
❑ Yes ® No
❑ Yes
W No
❑ Yes
,® No
.P I A
❑ Yes
® No
❑ Yes
fQ No
❑ Yes
® No
CK Yes
❑ No
Continued
on back

Facility Number:. T...... —...
6. Is facility not in compliance with a
7. Did the facility fail to have a certifi
ny applicable setback criteria in effect at the time of design?
ed operator in responsible charge?
$_ Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (fi): Structure 1 Structure 2 Structure 3
�2- s .1.... .. r .. ..._
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
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 1L.Q.t al. a `. �.. 5 ... p x.d..........
❑ Yes ® No
❑ Yes K No
❑ Yes 19 No
❑ Yes LB -No
Structure 5 Structure 6
16. Do the receiving crops differ with those designated in the Animal Waste Management Ulan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Fu—Certlfied Facilities 91)ly
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes KNo
❑ Yes I,No
IN Yes ❑ No
❑ Yes E9 No
[I Yes BNo
❑ Yes 91 No
❑ Yes iff No
JR Yes
❑ No
❑ Yes
]&No
Yes
❑ No
❑ Yes
V9 No
❑ Yes K No
❑ Yes ® No
19 Yes ❑ No
Coniiments {refer to _questton'# E'11xplajn any YES answers ;and/or': any recommendations or anyother comments
Use drawings of facrlity to betterlexpiain situations use addihorial-pages as necessary)
M r r,,
'�
5, A I w4 • v+ .... t r V- y g a 1. l O + D _LA �_A S e f O F .r o "� v'ti t W9 i 1 ri d. *�.
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/�
zf
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w o+.K 0, i Y-o r: x.i-c- caV e-v- C'V i
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A t f i La ♦ C �v� W+ l Io G $ Piv► t -� r' o r- r 0 O-+ti r t c-
Reviewer/Inspector Name ` � y 9 r
Reviewer/Inspector Signature: t—._L.t At i~li� �L ' �.� Date: Q ' -7 % f
L-
J 'e.r
ec. Division of Water Oualitv. Water Oualitv Section. Facilitv Assessment Unit d/"tO/97

Site Requires Immediate Attention:
Facility No.,51- M7
DIVISION OF ENVIRONMENTAL MANAGEIMNT
ANIMAL FEEDLOT OPERATIONS SrM VISITATION RECORD
DATE: U - , 1995
Time:
Farm Name/Owner: r+ 2 5 F--2r '] Fe LJS
Mailing Address-
County- __ rA)(.3
Integrator. T Hoc 1 r p� Phone:
nq 3 - 4ZSCo
On Site Representative: Phone
Physical Address/Location: 5. 12"D-1 6-- I m i SR 13 36 (60wde4 S
Type of Operation: Swine J'� Poultry Cattle
Design Capacity: Number of Animals on Site:�0� Z-
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �S <�� ' 33.5(" Longitude: Ilea Elevation: Fee:
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) (oe or No Actual Freeboard: - Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Eel —or —No
Crop(s) being utilized: Corn �- tcl.ij fier'
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings? Ye or No
100 Fee: from Wells? Yes or No
Is the animal waste stockpiled within 100 Fee: of L=SGS Blue Line Stream? Yes o No
Is animal waste land applied or spray irriggated wl-i in 25 Fee, of a USGS Man Blue Line? Yes o No
Is animal waste discharged into waters of the state by man-made ditch, flushinz system, or other
similar man-made devices? Yes o o If Yes, Pleas'. F:cni. yr.
Does the facility maintain adequate waste tranagement records (vo,uu es of manure, land applied,
sprav irrigated on specific acreage vrxth cover crop)? Yes r lk=(D IDtw
Additional Comments: -# i 4
L L t)'k"5---
• Inspector Name Signatuae
CC' Fac lity Assessrncnt Unit
1_°sc Atiwchrnenis if t",Ieeded.