310349_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: C) Co ante Inspection U Operation Review O Structure Evaluation U Technical Assistance
Reason for Visit: Routine Q Complaint O Follow-up Q Referral 0 Emergency O Other O Denied Access
r
Date of Visit: I J Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: K fLGr r t Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design
Swine Cwo-aci
WeanFinish
Current
MWEtIRTURtal
Design Current Design
Capacity Pop. Cattle Capacity
Layer I I Dairy Cow
Current
Pap.
3Wd@i to Feeder
El
jNon-Layer
I Dairy Calf
Feeder to Finish
2 -4
o
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
=Msign C*urrent Dry Cow
Dr P,ouI Ca aci P,o , Non -Dairy
I Lavers Beef Stocker
Gilts
Non -Layers
I 113eef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes No ❑ NA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
ONE
[:]Yes ❑ N ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes gNtEINA [] NE
Page 1 of 3 21412015 Continued

Facili Number: - Date of Inspection: 7
i ✓
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [,] Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 2.-t, s
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E o ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a [] Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t at, 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 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 ONo ❑ 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 ibs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
EX ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
FN ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
][� ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
rNo ❑ 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
❑ Yesg�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes L1JXNo
❑ 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

Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑ Yes o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑z
l to complete annual sludge survey ❑Failure to develop a POA for sludge levels
n-compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: 40 IL
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ONo ❑ NA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ A ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [] Yes ffNo ❑ 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?
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)
3 L 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?
Comments (refer to quesfio_n.;#) Ezplahn any YES answers:and/or. any additional recommel
Use drawings -of Iacility toabetter_e8plam':iituatithis '(use additional Rages as nece"ssary
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
[:]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[—]Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
El Yes � ❑ NA ❑ NE
[:]Yes rNo ❑ NA ❑ NE
S
�
Sit, �jc w+ !1'e [
1 ye✓ st 'P .5%a , t~
JRe%
-, e p0a y
Phone: L � 7
Date: 17 Ll
21412015

Type of Visit: m Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit:4#1 Arrival Time: Departure Time: ® County: AVTL_(�J Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Tittle:
Onsite Representative: 360 Y erdjgor
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop.
C*attle
esign uent
DCrr
C+apacity Pap.
Wean to Finish
La er
DairyCow
Wean to Feeder
Non -La er
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,oult, C•_a act P,o ,
Layers
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other Turkey Poults
Other Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Fe�/No
No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

F cili Number: r,7 Q C1 Date of inspection: G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? ❑ Yes
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure II Structure 2 Structure 3 Structure 4 Structure 5
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
[�No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes 167No D NA ❑ NE
[:]Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or mental threat, notify DWR
7. Do any of the structures need maintenance or improvement? oyi",07 ❑ o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes -Wo ❑ 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?
11r1sie evidence of incorrect land application? If yes, check the appropriate box below. Zes ❑ No ❑ NA ❑ NE
cessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑WUP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements
[:]Yes do ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
❑ Yes YNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA VN
❑ Yes ❑ No ❑ NA
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA 0 NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes ❑ No
❑ Yes ❑ No
❑ Weather Code
❑ Sludge SR11;
❑ NA
❑ NA �(NE
21412015 Continued

Facility Number: 74 i jDate of Inspection
- � yr
24. bid the facility fail to calibrate waste application equipment as required by the permit? [] Yes ❑ No ❑ NA eNE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No ❑ NA
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
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No ❑ NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes E fNo ❑ NA ❑ NE
zyes
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ �ye
34. Does the facility require a follow-up visit by the same agency? s
❑ No ❑ NA
❑ NE
ZN,o ❑ NA
❑ NE
rNoo ❑ NA
❑NE
❑ NA
❑ NE
❑No ❑NA
❑NE
Comments-(r(,-fer topquestion:#):;.Expiain any YES, answers.and/or:any 'additional recvmmendahons `or an bother comments
se drawn of�faciii io�better:ex lairi•situationstY . P (use 'addrhonkf a es'as necay o- '
7) P6WE I 6vAJxUG- -zW wAr(,vw4 V, ovj 1(- . PVC
pt OT 9 -Inc- 5-fiA Tt r
11) po tgr�JG OF �A �'�� SO �XEUD 'P>e yedsF,
G6N-VLd uE Tb 6 Fb o p_.
�znl b s Po N3 t 1JG e Ca �� �L1� C OF Sf V--n
swro DT�-rCA' FXCTVRj, '�A k Erg 01� 00 � Cam P LZ40 C E _Tm) C--S,
TO 96 A; AC --tar,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�0 r�4�1C 0.q vRL
D--t
Phone 910D56"
Date: i
5

Type of Visit: (0 Co pliance Inspection O Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: Departure Time: County: Iegion:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative:
Certified Operator:
Phone:
Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Current
Design
Current
Design Current
Swine C►apacity, Pop.
Wet Poultry
Capacity..
Pop.
Cattle
Capacity
`VPop.
Wean to Finish
La er
Dairy Cow
Wean to Feeder
I
INon-Layer
I
Dairy Calf
Feeder to Finish
Heifer
Farrow to Wean
Design
Current
—Daia
Da Cow
Farrow to Feeder
D, Roultr,
C_a acit
P,o ,
Non -Dairy
Farrow to Finish
I Layers
I Beef Stocker
Gilts
Non -La ers
I Beef Feeder
Boars
jPullets
Beef Brood Cow
Turke s`
Other
Turkey Pouits
Other
Other
1
E::�
.
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes 0 No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes [:],No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3
21412015 Continued

acifi Number: 3 1 - Date of Ins ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �� ��_"`",�{!�"J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ENO ❑ 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 environments breat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes LA
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yesyo ❑ 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 VNo ❑ 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 D 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
ZYes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
El Yes
9zo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
D Yes
o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yesg�No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 214120I5 Continued

P-FacilityNumber: - Date of Inspection:
4s 24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [:]Yes VNo ❑ NA [] NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ YesWNo
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? [] Yes EfIx"o
If yes, contact a regional Air Quality representative immediately. /
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes ❑ No
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 El No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes U N
34. Does the facility require a follow-up visit by the same agency? ❑ Yes t�J `w
❑NA ONE
❑NA ❑NE
DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Comments (refer to -question#) Explam any YES'ahswers and/or, any additional, recommendations or.any.other. comments. .
Use drain s-of facility to'betfer explaim'sitaations use additional a es as.neces
Reviewer/Inspector Name:
Reviewer/Inspector Signatur
Page 3 of 3
2o[ 6 atj ACC6 �� RzK 0619 R0,
�c 0"W&oL " aes por ,E6 ryl
,tj 6 jqDk-�SS4G4D Ac.o g 01rJG7 rO T�M 1
Date:
5
\.r

Type of Visit: 0 Co pliance Inspection Q Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: (Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 0000_!�j Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: L)L> P }- �. �� }✓�•� Integrator:
Certification Number: 2e o? /
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Longitude:
1 e novLemirent
Swine Capacity P.
Wean to Finish I
Wet Poultry
ILayer
Design
Capacity
Current
Pop.
F
Cattle
Da' Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
D , $oult ,
Layers
Design
Ca aci_
Current
P,o
Da Calf
Feeder to Finish
Da Heifer
D Cow
Non -Dairy
Beef Stocker
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
I
LEI
Boars
Pullets
Beef Brood Cow
Other
Ocher
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]Yes No ❑ NA ❑ NE
Discharge originated at; [3 Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes [] No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �fNo
o
❑ Yes
[:)Yes gNo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412014 Continued

Facility dumber: - Date of inspection.
Wd to Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes /No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes YNo ❑ 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 I threat, notify DWR
7. Do any of the structures need maintenance or improvement? [:]Yes [ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E/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 �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 t'J 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 Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes � o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes *NNo
❑ 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?
ElYes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 6 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
❑ Yes VNo
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists El Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes LNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes rNo'
0�❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes ❑ NA ❑ NE
Page 2 of 3 21412014 Continued

FaciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? Ees 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 ailure 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 540 ❑ 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? ❑ Yes [;Jl<o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ;;]"&o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes �40
❑ NA ❑ NE
Comments (refer to question#):Explain any YES:answers andlor.any additional recommendations or- any other comments..
Use drawings.of facility to'better explain situations (use.additibnal pages as necessary).
lv , )((-g 5LJ)05:r P64
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
/40 [A
tJ
�a T 3 b j s.
LJ
❑ Yes P�No ❑ NA ❑ NE
❑ Yes ENo� ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes &/ No ❑ NA ❑ NE
Phone/ 9/0 1
Date: 9 Av 1
se-
'214AO15

Type of Visit: (D Coinpliance Inspection O Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: V1 Routine O Complaint 0 Follow-up O Referral O Emergency 0 Other 0 Denied Access
Date of Visit: , Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
J _
Onsite Representative: �,d jJ AY �{� f Y �- �E/�` Integrator:
Certified Operator: Certification Number: Z /a a75
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop.
I Layer
Design
Cattle Capacity
Dairy Cow
Current
Pop.
Wean to Feeder
Non -La er
I
Dairy Calf
Dairy Heifer
Feeder to Finish
Farrow to Wean
Design Current
Dry Cow
Farrow to Feeder
Farrow to Finish
D , P,oultr. Ca aci P■o ,
Layers
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
OtherI
Turke s
Turkey Poults
10ther
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �3o ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[:]No
❑ NA
❑ NE
❑ Yes ❑ N ❑ NA ❑ NE
❑ Yes ll! lY ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: q I
a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes No D 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
IgNo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
Wo
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment l threat,
environment
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
[yio
❑ 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
[:[4o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[3/No
❑ NA
❑ NE
mai t once or im t9
n en provemen .
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes C✓J 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
[7No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
b"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 detern ination?
4o
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
D NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
EZ<N
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
go
❑ 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
E31No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:]Yes
�o
[DNA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
C3<0
❑ NA
❑ NE
Page 2 of 3
21412014 Continued

Facility Number: - Date of Inspection:
r
244. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? [—]Yes <o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes L, Ko ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes EXO ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes 0 No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes Cj No ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
0 Yes [1] ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes 6No, ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes No ❑ NA
❑ NE
Comments (refer to question,#):,Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional. -pages as necessary).
LDS S� ZL�- N E c--A ► 40 M7 h/0
1
Reviewer/Inspector Name: rA AN
Phone:
Reviewer/Inspector Signature: QJADate:
t
Page 3 of 3
V412014

Type of Visit: (D Com fiance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: L 3 Arrival Time: Departure Time: County: gew"' Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Title: Phone:
)0M9THAr/
Latitude:
Integrator:
Certification Number: - U D 7 9
Certification Number:
Longitude:
Design C►urrent
Swine Capacity Pop.
Wean to Finish
Wet Poultry
La er
Design
Capacity
Current
Pop.
Design C►urrent
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Wean to Feeder
Non -Layer
D . P.oult ,
Layers
Design
Ca aci
Gurrent
l;o
Feeder to Finish w
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Non -Layers
Boars
Pullets
Beef Brood Cow
Other
Other =11
jjurk'�'ys
key Poults
10ther
Discharges and Stream Impact
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)
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 ❑ o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ YesgNo ❑ NA ❑ NE
Page I of 3 21412011 Continued

Facility Number: - Date of Ins ection:
Waste Collection & Treatment
4.Js 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 l 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 19 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 environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Ld 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 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?
s
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
KNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
a No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
��N
❑ NA
❑ NE
the appropriate box.
❑WtJP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other: 14
21. Does record keeping need improvement? If yes, check the appropriate box below. [:]Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ElSludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yesy ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of inspection: /p fig
24. Did the facilityfail to calibrate waste application equipment as re required b the ennit. Ye No NA NE
PFq Y F � ❑ ❑
A Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes ❑ No ❑ NA ❑ NE
the appropriate box(es) below.
❑ F ure 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 LdNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ 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
U 1V U
❑ NA
❑ NE
❑ Yes
2f No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes Zo ❑ NA
❑ Yes ❑ NA
2/yes ffio ❑ NA
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
6e'drawings of facility to better explain situations. (use additional pages as necessary).
❑ NE
❑ NE
❑ NE
s� NAYFz�'c.9s 0 & -51 � -r�i a�vt✓+ r� � sT PORTAr<N�; kitc.
�E vsS�T' �n--w� S�r�i�� F o ow STD Ps F"V-1-uU'j L`� 5e*.r
J? E F'b a_C—. 1(7 NdTNajC, N ST 0,1p6 -174S5 -rim6 (MA y L-600 T6 �V
2s;) ?6 A f6K SLuo&'c 01-t✓ 116jv.
34. F� z� 6� * y F.rc z.JPf
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: LQID
Date: 10/1 fih�
1 011

Type of Visit: 0 Co pliance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit: Ro tine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
i
Date of Visit: (/ Lrk Arrival Time Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
i
Onsite Representative: C_)0N 7 Integrator: rr��
Certified Operator: Certification Number: D9 6o-7 9
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Capacity PoP.
Finish
r
Design Current
Wet Poultry Capacity Pap.
La er
Design Current
Cattle C►apacity Pap.
Dai Cow
Feeder
Nan -La er
Dai Calf
o Finish
b
DairyHeifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oult , Ca aci P,o
ILayers
Cow
Non -Dairy
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Turkeys
Turkey Poults
Other
Beef Brood Cow
QYher
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
[—]Yes
No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
[] Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (if yes, notify 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
❑ No
❑ 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
5No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

FaciliNumber: - 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 ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: •A 6voJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ YesYNo ❑ 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 hreat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �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 /No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EyNo ❑ NA ❑ NE
maintenance or im rovement?
P
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Z0 ❑ 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
[D No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
[!rNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�Ko
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
go
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Nc
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Lam' 110
❑ 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 ErNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �N❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �/o
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: +✓
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o [DNA ❑ NE
25. Is`Lhe facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes U 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 [�_ 4 ❑ 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?
/No
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
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, aver -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
f4c
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any otger;commentI
Use:drawings of facility"to better explain situations (use additional pages as necessary). u=
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:t I}
dgjA Date:
,
21koll

M
(Type of Visit: (D Cam ance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ( p Departure Time: County: lDUKZAJ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: tJ d Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current
Design Current
Design
Current
Capacity Pop.
Wet Poultry Capacity Pop.
Cattle C►apacity
MONSOON
Pop.
7S,W-vine
an to Finish
La er
airy Cow
ean to Feeder
Non -La er
airy Calf
eder to Finish
airyHeifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
Dr, P,oultr, Ea aci P■o
Non -Dairy
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Turkeys
Beef Brood Cow
Other
Turkey Poults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[:]Yes C: No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes �No
[] Yes FdNo
❑NA ONE
❑ NA ❑ NE
❑NA ❑NE
Page 1 of 3 21412011 Continued

Facili Number: jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No [DNA ❑ 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: LA[-voAJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ��}
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes E�lNo ❑ 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 DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes fNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes �No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[] No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes
[ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure
to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
es
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
F31No
❑ NA
❑ NE
Required Records & Documents
l9. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes [Z/No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ff No ❑ NA ❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes YNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes YNO
N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Condnued

Facility Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes E!ro ❑ 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 Ievels
❑ 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 YNo ❑ 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 file 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?
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes [3/No ❑ NA ❑ NE
❑ Yes [/NNo ❑ NA ❑ NE
❑ Yes / No ❑ NA ❑ NE
❑ Yes [3] No ❑ NA ❑ NE
[]Yes [/"No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
[/] Yesgo ❑ NA ❑ NE
Date:rl 1
2 120 A

�.7
Facility Nui<tiber �C
f
Division of Water Quality
0 DtvEston of $oil and Water Conservation_��
"�Q OtherQAgency
�� ..
Type of Visit Ca liance Inspection O Operation Review O Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: 6 Arrival Time: /Z } D Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: 0 0 0 ` = Longitude: = o = 6 =
Design --- Current"
Sw>rie .Capac4yF Population _Wet Poultry g
=
❑ Wean to Finish
❑ Layer
❑ Wean to Feeder
❑ Non -Layer
Feeder to Finish
g
�
Dry Poultry .
❑ Farrow to Wean
❑
Farrow to Feeder _
❑ Farrow to Finish
Z- ❑ Gilts
❑ Boars
her -
❑ Other
[gn Current:. F
❑ 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?
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
/d��mF�nranf Cfrii
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 LI No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑NA
[__1 NE
El Yes
El No
El Yes
LAN'
El NA
[-INE
El Yes
No
❑ NA
❑ NE
Page 1 of 3 12128104 Continued

Facility Number: —3q I Date of Inspection 5
Waste Collection & Treatment
4: Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure } Structure 2 Structure 3 Structure 4
Identifier: l"rQ�6"" J�/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 111-11
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 E(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6.
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thr t, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LI 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 ZNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes RJ No ❑ NA El NE
maintenancetimprovement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LZTNic ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes�NZ
El 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•
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
LI No ❑ NA
❑ NE
Comments (refer to question #).: Explain any YES answers and/or any recommendations or,any otheicomruents ` ,
Use drawtngs..of facility to better.explain situations: (use addtti©nal pages as necessary): �q4 • s';
r
.F�4L.
6A odA16 uEE C fra7 fA2MtR 14AS Ur' C>t60
VEL. DDLVAI.
-� 06�,-_V ro 00 LI-ME.
1W
Reviewer/Inspector Name
JJ d
Phone b — b
Reviewer/Inspector Signature: rt
Date: G
Page 2 of 3 1 12128104 ' Continued

FaciN;Number:,3 I — Date of Inspection
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
21/wo
❑ NA
ElNE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
ElYes
No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
/No
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ 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
/o
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
Zo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ErNNo
❑ NA
ElNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
s
E No
El NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
eYes
❑ N
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
❑ NA
❑ NE
Other Issues .,
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? El Yes 2 ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report the mortality rates that were higher than normal? 1-11
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [ZNo ❑ NA El NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Insector fail to discuss review/ins ection with an on -site re resentative? ❑Yes No ❑ NA El NE
P P P
33. Does facility require a follow-up visit by same agency?
El Yes
No ❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit O Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit ;Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: to 9 Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: A 1MAL_Lx�
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= e = L =is Longitude: = ° ❑ 6 = u
De"sign Current
Design Current
Design
Current
Swine
Capacity Population
Wet Poultry Capacity Population
Cattle Capacity
Population
❑ Wean to Finish
10 Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -Layer
❑ Dairy Calf
® Feeder to Finish t.{ '60
❑ Dairy Heifer
❑ Dry Cow
❑ Farrow to Wean Dry Poultry
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
❑ Gilts
❑Non -La ers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Poults
❑ Other
Number of Structures:
Discharges & 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 discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ N
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
❑ NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
Elfo Yes
❑ NA
❑ NE
other than from a discharge?
Page I of 3
1228104
Continued

i
Facility Number: — Date of Inspection r 0
,Y
WAte Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El Yes
,_.(
R 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: LA(VerIJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 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
0 Yes
f
2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
0. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
[ No ❑ NA ❑ NE
maintenance/improvement?
I t . Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
[ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
es
'LI No
ElNA
ElNE
15. Does the receiving crop and/or land application site need improvement?
,❑
U Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
j No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
�No
❑ NA
❑ NE
s (refe'r to question;#) Explain any YES `answers aud/or any recc
_
1S,} T•Crw WAL-(_ {JAB Lr=Ta O►sNU'l— oN Ph A-r4T
sr^ N o o #j u44� - F.—LE LD, D 0 &' F o U_'O ,/ L'9 ,-*�,l rP R...� G- }b
V ZS=T A CTSO ►.S.S lift lC To _Tm eo-44C le T4w to
,JZSz-{ AS
�) C,s�/E rL [a-2�`.r T 1 e �/ t�Z (ct� W ►nL�- ITZL'Lt ►joz- pD 6 Q vIRTC ash AD
G-D CE s5 • G
Reviewer/Inspector Name Phone: �! ti I d
Reviewer/Inspector Signature: Date: 6c h o

Facility Number: — Date of Inspection !b
1'
Reduired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box.
❑ WUP ❑ Checklists ❑ 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
❑ Yes L1 No ❑ NA ❑ NE
❑ Yes EdNo ❑ NA [:]NE
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes EMI No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes dNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes r�No ❑ NA ❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[F('No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
EJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E]�No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
OJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
0/yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Diawings:,
Page 3 of 3 12128104

Type of Visit l(Compliance Inspection 0 Operation Review 0 Structure Evaluation Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency Other ❑ Denied Access
Date of Visit: Arrival Time: 3(1 Departure Time: County: �% Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= o = { = N Longitude: = ° ❑ 6 =
Design Current l IIIDesign
Swine Capacity Population Wet Poultry Capacity
❑ Wean to Finish ❑ La er
❑ Wean to Feeder n-La er
C►►urrent Design Current
Population Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑Dai Heifer
❑ Dry Cow
ElNon-Dairy
❑ Beef Stocker
El Beef Feeder
❑ Beef Brood Co
Number of Structures:
❑ Feeder to Finish
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Gilts
❑ Pullets
❑ Boars
Other
I JE1
❑ Turkeys
❑ Turkey PoU:':ti=k__]
Other
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes �No ❑ NA ❑ NE
❑ Yes O No ❑ NA ❑ NE
12128104 Continued

Facility Number: ] — 3K Date of Inspection r 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
,�
U Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
ZNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier: C!VX^,
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): f g
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
D 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
,_,/
L9 No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes D"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 2No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 9 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes Ej"/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
UNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
0/yes
❑ No
❑ NA
❑ NE
16_ Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
LT No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
/No
ld No
❑ NA
❑ NE
(euei a»a m
optfetterezPlant hnaa es as necesUsedrawgsoffacrhrty stuons(usead..
rY)
fi wtS seA,4 IV) li,1,.
AL
IJ r►�1d5 �✓t �U��vufyh.� 67
Reviewer/Inspector Name r - �- - d �A' 1'tt; ,na if" r�yvy_1ia a :F gip, ij� 1�p Phone: 40d 7 —33 XF
Reviewer/inspectorSignature: Date: ~'l/ I t16
1212814 Cnntinued

t
Facility Number: 3 — if Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA 7NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes ❑ No El NA
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ' /NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
[DINE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
�E
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
YNE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
E'J NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
ERNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
dN E
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
E7NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
�NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
/No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑XE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
G2NE
12128104

Type of Visit e) Compliance Inspection O Operation Review O Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: l,o i Arrival Time: is Z} Departure Time: County: QXAP Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: I Title:
Onsite Representative: JUrj R Tank/ V1 gLL k&
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = ' = Longitude: 0 0 = ' =
esigu Current
FID
Design Current
Design Currentr�W�ean
apacity Population
Wet Poultry Capacity Population
Cattle Capacity Popularioo
to Finish
❑ La er
❑ Da Cow
n to Feeder
❑ Non -Layer
❑Dai Calf
19 Feeder to Finish Z ?.o'U O
❑ DairyHeifer
❑ Farrow to Wean
10) Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
_
❑ Layers
❑ Beef Stocker
Gilts
❑ Non -Layers
Feeder
PEJBoars
❑❑Beef
Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Pouets
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 ErCo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
❑ NA
❑ NE
❑ NE
❑ Yes
El Yes
VN
❑ Yes 91 ❑ NA ❑ NE
Page I of 3 12128104 Continued

't
�cility Number: Date of Inspection
-Waste Collection & Treatment
$. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
,_.,�
El Yes I1No
❑ 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: I A &-osq/
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 110
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes P<o
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes Q 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 environm tal threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes 0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? N
(Not applicable to roofed pits, dry stacks and/or wet stacks) El Yes ERo El NA ❑ NE
N
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 'dNNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ es
ff No
[I NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ICJ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
<o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
Q�
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Zo
❑ NA
❑ NE
L.,fVat_.L.5 S-t tUL, N 1`(--o too N E CpL)C L
is) HAV& UL-MrL F�, r,, AC--ffi-�arw=Jt r r N 6 SP�tra'� FrE�r 2
(?etLvv1 t! 0 A G n,* wTNT i`"N Pd�'[ t�llJ ►'� �TElL-
Reviewer/Inspector Name �.Ja d Ar—U1— Phone:
Reviewer/inspector Signature: Date: ! A a $
I YSG !+ VJ J � rir�i vT vv��ar�sYGY

facility Number: -5-3147 Date of Inspection ya d
`'Required
Records & Documents
r19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
rNNo
❑ 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 appropirate box.
❑ WUP El Checklists [-I Design El Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
L'I No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
dAnnual 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
[:3/No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ld No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[�'�10
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
_Q'<o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
P-�o
❑ 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?
ID Yes
,��
MNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
O No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
[I Yes
,��, //
E'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
El Yes
[1 o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
'
32. Did Reviewer/Inspector fail to discuss reviewlinspection with an on -site representative?
❑ Yes
El NA
[I NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
L zo
❑ NA
❑ NE
Additional Comments -and/or Drawings:
Page 3 of 3 12128104

Facility Number
Division of Water Quality
0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit Oto�mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit t.,)'Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit:
Q l l
F/ _TT
Arrival Time: Z b
Departure Time: County: AL/1�7l+/ Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: _ c le)Vp tbN�-[.t��
Certified Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: c i:i ` E::i ,, Longitude: 0 o "
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current Design Current
Capacity Population Wet. Poultry Capacity Population
❑ La er
I ❑ Non -La ei
Other
❑ Other --
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
I . 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",--]
El Daipr Cow
❑ Daffy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures:. 71
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes IJ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
[No
❑ NA
❑ NE
❑ Yes 9/o ❑ NA ❑ NE
12128104 Continued

Facility Number: — 3 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
El2d Yes
,�/
o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
r tructufe 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): t/
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
PNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
ElD Yes
/
No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
[]/Yes
❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
O'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require
❑ Yes
eNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
dNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
eNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu,
Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
U(o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
WN o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
O 1Vo
❑ NA
❑ NE
IT Does the facility lack adequate acreage for land application?
❑ Yes
EK o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
ElYes
LJ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
?) t6d WAR k DOW6 PJ osk6 U/ALJL -
2A) UPOAV tA&-g� MfCfi SVM mAK i
Reviewer/Inspector Name MUL Phone: 9 79 3
Reviewer/Inspector Signature: Date:
12128104 Continued

acility Number: Date of Inspection d
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 CAWW readily available? If yes, check 04 s ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ,Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
L`J Yes
❑ No
❑ NA
❑ NE
❑ Waste Applicati ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ErStocking ❑ 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
2No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
�/No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ZNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
["NNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
E�4
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑,I4o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
L'I N
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
dNo
❑ NA
❑ NE
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�N
El NA
[I NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
;No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

Q-Hfvision of Water Quality
Leffity Number0 Division of:Soiland Water Conservation
- __ �._ - 0 Other Agency
Type of Visit .'Compliance Inspection 0 Operation Review 0 Structure Evaluation O Technical Assistance
Reason for Visit Q-Routine O Complaint 0 Follow up O Referral 0 Emergency 0 Other �i ❑ Denied Access
Date of Visit: 0(o Arrival Time: Departure Time: County: �p`� _ Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone N-
Integrator:
IV
Operator Certification Number:
Back-up Certification Number:
Latitude: = c = t = " Longitude: = ° =
Design Currenb: Design Current Design Current-
" Swine Capacity,�.Population Wet Poultry Capacity Population Cattle Capacity Populatton T
❑ Wean to Finish ❑ Layer
❑ Wean to Feeder ❑ Non -Layer
Feeder to Finish
Farrow to Wean i- Dry Poultry;- ❑Farrow to Feeder
b ❑ Farrow to Finish I
❑ Gilts "
❑ Boars
Other
L J Other
❑ La ers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
---- ---_—
--
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Dairy Cow
3
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
f,
❑ Beef Brood Cow_
—
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Date of Inspection L
FaSility,Number. —3&1
1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
❑ No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard
(in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
❑ No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
❑ No
❑ NA
❑ NE
through a waste management or closure plan?. �
,
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
❑ No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 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) JlVall 65,,67//�
13. Soil type(s) Z'2:2
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
❑ No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
l S. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.,. Ra
Use drawings of facility to better explain situations. (use additional pages as necessary):
Camel. 6 7e r1a
eo tva �
Reviewerlinspector Name Phone:
Reviewer/Inspector Signature: f Date:
Paee 2 of3 - 11/28704 Continued

.Fadility Number: — Date of Inspection !� G
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. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking 0 Crop Yield )Z120 Minute Inspections ❑ Monthly and 1" Rain Inspections '{Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
❑ NE
27, Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[J Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
Additional Comments and/or Drawings:
z
y11q /0G,
c
oc&
> Al
serf �
Page 3 of 3 12128104

3r M. 3qq
Type of Visit Co liance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: owo" Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: jj Title:
Onsite Representative: �C1ub L<eyw i
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm:' Latitude: = o ❑ 6 = u Longitude: ❑ o ❑ g ❑ u
11=11,111''S.11111 Current
Swine -Capacity POD elation
Design Current_._
Wet`Pai' l C c ty =Po a ttI{ on
...:._ Design- Current
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑Dairy Cow
❑ Wean to Feeder
❑Non -La er
❑Dairy Calf
® Feeder to Finish
❑ Dairy Heifei
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
Beef Brood Co
_
❑ Turke s
Other
❑ Other
❑ Turkey Poults
10 Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes QC ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
D� No
❑ NA
❑ NE
❑ Yes
LdN
❑ NA
❑ NE
El Yes
No
❑ NA
❑ NE
12128104 Continued

Fsicility Number: —3
Date of Inspection /9 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: _A 6" I
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 eNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes CKN ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? O Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes E! 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 LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ETNo ❑ NA ❑ NE
maintenance/improvement? Z
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El
Yes ❑ 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) 1B cY ,v^ ulv -ra. ( W ) CJ; 1,J 560
13. Soil type(s) Avl-rYLV t(J_ ZL1F i 6YZ6 S 0XI
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Vf�o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
L Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination`
❑ Yes
�o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
0o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ILJ No
❑ NA
❑ NE
1 � Gp Ajy %✓Fn— a/,/
'tle'69 P6 0 c00T OL-
O44CC !gyp q ' rWSS fia (3f wv("QP 01VV
AN-D ��rt- - v�✓ CAAsf CO✓ R, 96WV6 NAZI
Reviewer/Inspector Name V c� j�` y, �:. ' L -CA Phone:�Lti — 7a(o,5
Reviewer/Inspector Signature: Date: Slid/o
12128104 Continued

r_.
Fficility Number: 3 — Date of Inspection S .l
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
❑ Yes E3 /No [:j NA ❑ NE
❑ Yes eNo ❑ NA ❑ NE
21.
Does record keeping need improvement? If yes, check the appropriate box below.
Yes
❑ No ❑ NA
❑ NE
aste Application ❑ Weekly Freeboard El Waste Analysis ❑ SoilAnalysis❑ Waste Transfers
❑ Annual Certification
Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections LJ Monthly and 1"
Rain Inspections ❑ Weather
Code
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
[]/Io ❑ NSA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No VA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
Wo ❑ 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
�
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElYes
IJJ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
LJ 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
Eg No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
;/No
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Cl NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[A No
❑ NA
❑ NE
A�ddit,oral,Commentsanil/or�Drawui�s��,;`,�°°., ���. ��,r�,�,� ����`� �• �� - , ":~
12/28104
12/28104

(Type of Visit jWCompliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit O Routine o Complaint O Follow up Q Emergency Notification O Other ❑ Denied Access I
Y �11II�IYYYY�^YY I I I
Facility Number Bate of Visit: Time:
Q Not Operational Q Below Threshold
,IfPernvtted 0/C}e�ed © Conditionally Certified © Registered Date Last Opera`tedd Above Threshold: ..... ...� ... .
Farm Name: .! V .Apm!!I � _...._.._ - County:..1��!�G�l�........ ...... ... .....
__ ........
Owner Name:
Mailing Address:
PhoneNo: .................................... .......... .. ..... .. .....
Facility Contact: ...... _ ....................... ...W ........ TRI - ... Phone No:
Onsite Representatrver✓ IJ / ----Integrator: _4'ac. ne .....
Certified Operator: .................................. . IOperator Certification Number: - - - •...... .__.�....
Location of Farm:
swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 " Longitude • 6 44
Svi+ii7e
a X
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Discharges & Stream Imracis
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon Xspray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
,xYes ❑ No
❑ Yes J�No
Yes/❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
[]Yes
)!fNo
Structure 5
Identifier: . ........................._----............................_. .._ .
Freeboard (inches):
12112103
Continued

r
Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed andlor 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 maintenancetimprovement? Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? XYes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes ❑ No
elevation markings?
Waste Anuiication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? If yes, check the appropriate box below. XYes ❑ No
Excessive Ponding ❑ PAN Hydra 'c Overload ❑ Frozen Ground ❑ Coppe d/or Zinc
P r
12. Crop type(Zaa
13. Do the receiving crops differ with those deligriate6 in the Certified Animal Waste Management Plan (CA )? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? XYes ❑ No
I6. 1s there a lack of adequate waste application equipment? ❑ Yes ❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ 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 ❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes ❑ No
Air Quality representative immediately.
Comments (refer to question'#)_ ExpNaut any YFS answers amd/or any recommendations or airy okleer commeut& F _ i ,
_ - -
Use drave�ngs of facility to better exglaan sitaahoa5. (use adclrtxonal pages as necessary): otes� 7�
4, `� T/
�C� Z ✓� !J �� Gf/�9 S �,E �Ol�vG l �.tl�o �ig f �1 �¢an1� '�` fit'
J6 etc
/VD JlvGrJ5 Ac 5F�✓e0 ©W V1711,9�4
A0 AS
A,gau J�gn�C�rz�Js
ReviewerAhspector Name
Reviewer/Inspector Signature: Date:
lwl Ziva t.onr[nuea

Facility Number:
Date of Inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the 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)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
)rYes ❑ No
❑ Yes
❑ No
❑ Yes
j�No541o""'
01Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I " 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.
jqPP4fl�- to
✓�N r �j n10 AO�
(/�,ee4Z 1Vh_,,5A'X
�AtL s � r����� �'zv� �✓� , arm ��S � A
Ow G�
i fj�6
12112103 JV6,0 CuT 6y �-��- x n,� 61_5Fr

Facility Nuinber:.! .. -- Date of Inspection:
No �A _ t4
OPP/- dAl
F*- ass
vo
"r Da
8i9cf-c o ofzf2v� Ign/ *L
4/30/97

Type of Visit eOGompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint Follow up O Emergency Notific�ation�-0 Other ❑ Denied Access
Facility Number Date of Visit: I r . . Tune:
O Not Operational O Below Threshold
Permitted 13 Cerfified [3 Conditionally Certified © Registered Date Last Operated Above Threshold: ... .. _.
Farm Name: ....._ . L ."..Gr . (.�iil�...w .W ...._._ ...._................. County: ... ..�L/".............. ........ ........... ..........
_.
Owner Name:......... /✓ ...... !� ........ ...... _ .. Phone Na:........... - .... __.._ ... _.
MailingAddress: -_............................................................. ..........
Facility Contact: .......................................................... _ Title: ................. .. .._. .. jPPhone No:
Onsite Representative: �ilJFllr Integrator:... /�.le'r......... .......... I ... ............ _..............
Certified Operator :......................... ..........._ ._ .....WW......... ....... Operator Certification Number:........ .......__ .
Location of Farm:
IF
,.,{Swine Poultry Cattle Horse Latitude �• �° ��� Longitude �• �� �di
K� ❑ rh ❑ ❑
Swine 'Ca act _�;Po �i
-;.` ❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
ju laths
Boars
Other
Non-
Discharges & Stream Impacts
I. 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 l Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes,dNo
Structure 6
Identifier: . ...................... _...... �._ ......-.
Freeboard (inches):
12112103 Continued

TFacility Number: _3 Date of Inspection /
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
22, 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
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
27_ Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
28. Does facility require a follow-up visit by same agency?
;ao�es
❑ No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
113 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
&,CA,,J 4,0
D 11 �ocJ� �i9Sr�E /q/vo � c /%ram rukE
�<,C7
'&r/V
/rlPA/KeZ� AlAe�r4�_ cilm //'VV_-Al
Good,
C(ku
GCOLrJ ��S L�NyzG [.vas q� �S
12112103

. -
Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
#Permitted 0 Cer ifiiid �©JConditionaily Certified Q Registered
Farm Name: J .: l F�.C-•--- r�%�1!! �s�..
Owner Name: - aZ 40 , ..... �i !�t�
l tailing Address: ..... . .......... . ...................... . .... . . ........ . . . .- -- - — —
10 Not Operational O Below Threshold I
Date Last Operated or Above Threshold: _ ._ .... ..
County:...,��<lo, z.J......................................
PhoneNo: ... . ......... . ................................ .
Facility Contact: ............................................ . ........ Title: ... ..... Phone No: _.........................
Onsite Representative: In# tor: 'fp�
P _�kflL� ' .� .. ...._ . ...... ..... ......... 7!1.... 1Y.................................. ......... ..
Certified Operator :.... ........................................ .................... ...................................... Operator Certification Number: ........................... .
Location of Farm:
,d Swine ❑ Poultry ❑ Cattle ❑Norse Latitude • 4 is Longitude • 4 44
Swims
E, G ;',Lila aQ
rV pidpOii„
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
N
[] Layer
❑ Non -Layer
Other
-� Number of;Lagooris � x
- —nv
Discharees & 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) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure
Identifier: .............1... .............. .............................. ..................... .......... .._................ .. _.
Freeboard (inches): ✓ ������
12112103 Continued

Faeiiify Number: Date of Inspection iq a
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? - ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenancehirnprovement? ❑ Yes ❑ No
0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
❑ No
elevation markings?
Waste Application
10. Are there any buffers that need maintenancehmprovement?
❑ Yes
❑ No
11. is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
.❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
j] 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
❑ No
19. 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)
20. At the time of the inspection did the facility pose an odor or air quality' concern? If yes, contact a regional
❑ Yes
❑ No
Air Quality representative immediately. .
Comunaents (refer to question 1#) 1?a%pla�a any YES answeis and/or any:recomniendations orany o[lier coa�ents _ � � ` ==�°p
-Uge drawings: of face�ty to better explarn srtuataoas. i(use addibonal pages as necessary) ❑ Freld Copy ❑Final, Notes �'' e
AL
-7-zC�' � on-•�F_ Ga, ,�o /.moo r
.
/fir { S"IRE
�s C-lom F
f•Ur�iER ��9 �F� a/m„
/J� C � L�ZE� �•9� ���- /�DFD � C.�a'
_5et ,,6 T /-&D rhie 4rnO'r)?
/� r
uu f F,� S Ci�vm ! V&V ;Z1 a- ,�i✓
ReviewerlInspector Name
Reviewer/inspector Signature: Date:
0
12/I2/03 Continued

DrvWon of Water Qualiity
Q DIV15Eon of Soil and: Water Conservi ttan
O-Other-Agency
(Type of Visit O Compliance Inspection O Operation Review O Lagoon Evaluation
(Reason for Visit O Routine O Complaint Q Follow up O Emergency Notification O Other
❑ Denied Access
Facility Number 31 349 Date of Visit: 1/22/2004 Time: 2pm
Q Not O erational Q Below Threshold
® Permitted ® Certified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold:... ....................••
Farm Name: NNew..Gr.QmRd.XArj11................
County: l�upli�n................................................ V. TRA.........
OwnerName: 13pnniY...................................... Ke70landy..................................................... Phone No: ...........................................................
Mailing Address: 2li..N��g1Rdy..,txt�................................... .....>'i10.1�.111..C................................. U.S.72 .............
..................................... ...............
Facility Contact:
Onsite Representative: G9jaQ.KeURCdY...
Certified Operator:
Location of Farm:
........Title:
Phone No:
Integrator: NYjuxphY..>Faxnilx.k arms .....................................
Operator Certification Number: ..........................................
north of Beulaville. North side of SR 1735 approx. 0.25 mile East of SR 1732.
w
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 34 ' S8 43 Longitude 77 46 51
Design Current
Design
Current _ ,_.
Design Current
Swine Capacity Population
Poultry Capacity
Population- Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
-'`
❑ Dairy
® Feeder to Finish
2448
JEI Non -Layer
I
JE1 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
2,448
❑ Gilts
-Tofa1 SSLW
3309480
El Boars
Number of Lagoons 1 Subsurface Drains
Ljoldinty Ponds / Solid Transi F__
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?
❑ Yes ❑ No
❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................. I................. ..............................
Freeboard (inches): 38
12112103
Continued

Facility Number: 31-349
Date of Inspection 1/22/2004
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancehmprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
I I - Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
❑ Yes ❑ No
❑ Yes ❑ No
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12. Crop type Corn, Soybeans, Wheat Coastal Bermuda (Hay)
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge actor below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
® Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Comment Arefer to uestion # Ez Iayn an YES answers and/or an :recommendations or:any other com ments:
Use diawmgs of facility to better esplarn sitaatidus (use additional pages as`necessary) 0 Field Copy ❑ Final Notes
7 There is a lack of vegitative cover that has caused alot of erosion to occur on the lagoon wall. The eroded area needs to be filled
+
back in, top soil needs to be brought in and vegitative cover needs to be properly established. This is a seveir problem that needs to be
aken care of as quick as possible.
15 The weed growth in the triangle field needs to be addressed to prevent it from overcoming the bermuda.
T
Reviewer/Inspector Name ;Gale-Stenberg - -
Reviewer/Inspector Signature: Date:
12112103 Continued

Facility Number: 31--349 Date of Inspection 1/22/2004
Rem[ uired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(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)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
12112103

Type of Visit ACompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit aRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Date of Visit: � Time:
Facility Number
— - W� Id
Not O erational 0 Below Threshold
'Permitted E eerrt�tified D Condition by Certified ❑ Registered pate Last Operated or Above Threshold:
Farm Name: �UL>tcl l�yDlJ� , /"ems County: !/ 1, r
Owner Name: Phone No:
Mailing Address:
Facilitv Contact: Title: Phone No:
Onsite Representative:Integrator:
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0 0 K Longitude 00 0
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lajzoon ❑ 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? ❑ Spillwav
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
❑ Yes E�1�o
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes -No
❑ Yes NA
❑ Yes [.Ale --
Structure 6
Freeboard (inches): -53
05103101 Continued

Facility dumber: 3/ —
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?-
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Aonlication
❑ Yes . [I-Fo`
❑ Yes [I"No
❑ Yes - Ea-N*
❑ Yes �o
El Yes �No
10. Are there any buffers that need maintenance/improvement? ❑ Yes 6-No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes E o
12. Crop type ��_ ��
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes L§'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
&.slo
16.
Is there a lack of adequate waste application equipment?
❑ Yes
99-Ne
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
93-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
E No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
Q-ble-
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
QmKO
21-
Did the facility fail to have a actively certified operator in charge?
❑ Yes
F4NO
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
I�INo
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
[3 Yes
GNO
24.
Does facility require a follow-up visit by same agency?
❑ Yes
E�N'
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
&Luo
[] No violations or deficiencies were noted during this, visit. You will receive no further correspondence about this visit.
Comments:(refer_tb quesbon #) 1ieplsin any YES ansr ere andtor any recommer«lattans;araay ►then commenter =
y
Use dra;"gs ofYaciIity to.lietter exvlam situattons:10use addttionavM..s as necessary] #
- ,❑ Field Cory ❑ Final Notes
H
..
Reviewer/Inspector Name r"
Reviewer/Inspector Signature: Date:
05103101 z
Continued

Z eA
Facility Number: JZ — 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
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e_ residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
Additiona Coin mcnts-an or :D rawings:.
O510310I
❑ Yes F3-ID
❑ Yes [n 6
❑ Yes t No
❑ Yes d*o
❑ Yes Ergo
❑ Yes E-1-40
❑ Yes %L Un

Facility Number 3 1 3 Date of Inspection '7 1 z- oD
Time of Inspection 1 Z ' D 24 hr. (hh:mm)
10 Permitted © Certified © Conditionally Certified © Registered 113 Not O erational Date Last Operated:
Farm Name: Aje w ("ra Le ►�'A r i"� County: �''^..........................................................
�e........................................... .................................................. ..................
Owner Name: ............................. ............... .. Phone No:
n...eP.nC.d........................................
Facility Contact:......_....................................................................... Title:....................... Phone No:
Mailing Address: ........... ..................................
7.1
Onsite Representative: G e �e n �l� �tj iU �+' e 1 Integrator: ' l 1I r
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
Latitude ' ' 46 Longitude ' 6 44
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes PO No
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'? (Il'yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: r
Freeboard (inches): ........3..1 ....
❑ Yes ® No
❑ Yes No
❑ Yes No
❑ Yes P No
❑ Yes 14 No
❑ Yes Ej No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes 14 No
seepage, etc.)
3/23/99 Continued on back

Fac;:ity Number. �3 ] — 3 Date of Inspection 1 2 QD
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes 8 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 [3 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes BNo
9. Do any stuctures Iack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? [I Yes ID No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes J�] No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes 'EFNo
12. Crop type 13e�mud�, k� . S 11 6rq;.-, Ga��t ,l L-Ae �-� Sotibe0nf
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes El 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?
16. Is there'a lack of adequate waste application equipment?
Required Records & Documents
IT. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20 Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
J'-*•violati6ris'or• dtficiendje$ * 'Or noted• during this'visit; • Yoo will reeeiye fio fu4 then
ctirrespo d6 ' abi f this visit. ' . .
omments (refer `to gneshgn #}Explain any YES answers and/ar any recommendations or any othercomaie
-. . •,
BYes ❑ No
❑ Yes 0 No
❑ Yes Ef No
❑ Yes ZNo
j Yes ❑ No
❑ Yes ❑ No
❑ Yes tj No
❑ Yes Ca No
❑ Yes IgNo
❑ Yes ® No
❑ Yes 'O No
'7. Con4ee/ ZNwds or, in'ler IctJ00'q k"q
IS. f?erK-uetrj i-I lola�i cue U
demly"q(7WeC�pIS- LJ6r,� �a ✓cMot/e bev-yy?OdK
-/o be,'mvdq �'�'eldj �1000✓�,�-�o
(,, 11 ; 4A call,! g1e,- o� /qc-e 11,11
hcS Y+aat ye4. �jeG'zi OI�YI� - 1
R1ew wl�t�-c Anal �s;s n�e�� i••1v�,�ia�tly qS �+'t�� ►-Lreek? +rf, feG�
Reviewer/Inspector Name <D �j i? t�;�1 �( `"x-
Reviewer/Inspector Signature: Date: wil

FAr.Mity Number: 3 j — 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 Eg 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 jS� No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes EfNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? E] Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 0 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 0 No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 9[ Yes ❑ No
Additional ommeints an or ravings.
! 1604T� 3/231 D 6. Ftl so Go�reG� 's r 6� Us i��
]] hey✓ ooe iS Y'e- u,-yee
d�:,.
b,b k (�Rte �h6 A�� �� G�1-tic��, GVeh� s �Oy reLJ G+iq c c7ylq��S,S�.
Gra[v ey n eedr �o«� G,��td w•','�}cY1 {� rG�CJ�! ram/
"OTC; gay �� i•G S y ea-��,� aha v,�/ �. yPq r o jd S4,00el be ro?" av 4
'Cr o ,mot 5 U 1' 1 Z�l/i • 'n U7! b " O h4 7
3/23/99

lor
Date of Visit: Time:
Facility Number
Q Not O erational Q Below Threshold
Permitted [3 Certified 0 Conditionally CertiW 13 Registered Date Last Operated or Above Threshold: _ . ....
]7�L� County Farm Name: 2�' i....................... `\................................................
OwnerName: ................................................... ........................................................................ Phone No: ................... ............................. ».......................... ....
.
Facility Contact: .. Title:...................................................._.._......:. Phone No:..................................................
MailingAddress: ......................... ............. ................................................................... -......... ............................................
Onsite Representative: _ ��,.�� .... Integrator:..... �........ ....................... ..........
�,
Certified Operator:.--............................................................................................................. Operator Certification Number: ..................... .....................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • ' fit Longitude 0 4 �C.6
Design < Current _ . _ Design Current " Design';` Current_
Swine ' "Ca aci Po` elation Pouit -Y " Ca ` aci Po illation ? Cattle - . - .. -
_ _ Ca aci .,.Po elation ._
❑Wean to Feeder ❑Layer ❑ Dairy
eerier to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
u ❑ Farrow to Feeder ❑Other
❑Farrow to Finish TOtal=Design Capacity
Gilts -
❑Boars Total SSLW
PA
Number of.Lagoons ❑ Subsurface Drains Present ❑Lagoon Area . ❑Spray Field Area
Holdug Ponds / Solid Traps ❑ No Liquid Waste Management System $
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes A No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed. did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes 13 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes OTo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes gNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ........................................................................................................................
....................... .................................... ....................................
Freeboard (inches): �j 8
5/00 Continued on hark

racility Number: 5 L — 3-9 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
9No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
WNo
closure plan?
❑ Yes
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7:. Do any of the structures need maintenance/improvement?
)<Yes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
tZNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
PNo
_Waste Anvlication
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
)P-No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
&No
4-\
12. Crop type C_ �.s15cl—r
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
X No .
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
JgNo
b) Does the facility need a wettable acre determination?
'Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Yes
(ie/ WUP, checklists, design, maps, etc.)
❑
FlNo
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EfNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
S'No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
gNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
RNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
Wo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Po
iq yiol�t iQnjs :e def c�e� ies wire nWo d>lrri fig #�tis:vp. tt • Yoo wig# •tee�iye iiti ifti tpgr
1.".'C0riis6inideimc'e_'ahbU'f
this visit' •.................................. .
Use d awtngs, of lfaciltty tolbetter exph situations. (use:addihoi pages as neccssa y:)
CZSee
�{
- -.
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: a—[ G—G 5/pp

•
Facility Number:' — 9 Date of tuspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ;9*'es ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes )4No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P(No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes RNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Q5 No
Additional! Comments an or Drawings:,
FF� 1. [ A
1�4�
tae- U zyfo-m ' --S� K-� lzj�.
I Uk ip"
F 114

r Division of Soil and Water'ConservatYon _'Operation Review =
0 Division of Soil^and:Water,'Conservation :Compliia�nce Inspection 7
visionof Water Quality Compliance Inspection �.
q
Other Agency = Opera4ou Review A ° :9b
r a8 .
:.
Routine Q Complaint Q Follow-up of DWQ inspection O Follow-up of DSWC review Q Other
Facility Number �Q Date of Inspection t��g .,�
t Time of Inspection 24 hr. (hh:mm)
Permitted derrtified Q Conditionally Certified © Registere 10 Not O erational J)ypz1-'Ajz
Daate Last Operated: .Farm Name: ../.!(�r � o.u..r"� County• ........................... ... .......
Owner Name:.....,.} ...... -1.�.........�r(?/l' �C�. ..... ........... Phone No: ...��Jv�...>��.~.kze.¢ .
Facility Contact: . :{!1(1............4,Ae., m. Title : .................................................... ............ Phone No: _. ................ �..T
Flailing Address: ........ `' .... 1 hit l ........J -ft Vt..�....................... ....... ., Z�(..1...,/..k`..�.r......... ........ ./�d�..77,/ L
Onsite Representative: Alt ..... ev—JOi.2.QG....:.........:................................. Intel;rator:....�,.�,Z-1............................................. I............
"10
Certified Operator: .................................................................................................... Operator Certification Number:..........................................
p A
Location of Farm:
..............................................................................................................................................................................................................................................................
Latitude 0 9 ' Longitude • 6 [f
Design Current.' - ^ Design Current Design Current
Swine - Ca achy Po ulation Po try: : =- Ca achy. Po ulation Cattle - Ca acity Pv ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total DeM& Capacity
❑ _.
Gilts _
- ❑ Boars Total -SSLW
Subsurface Drains Present ❑ La oan Area ❑ Spra E�eld Area
Number of Lagoons ❑ g Y
HolcUng 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.? ❑ Yes KNo
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes 4No
c. if discharge is observed, what is the estimated flow in gal/min? All k
d. Does discharge bypass a lagoon system'? (If yes, notify DWQ) ❑ Y s P'No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes A No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes] No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard(inches): ............... ................................................................................................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes �] No
seepage, etc.) �`
3/23/99 Continued on back

Facility Number: jWj Date of Inspection /
`a 6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑Yes
0 No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement?
❑ Yes
�'No
8. Does any part of the waste management system other than waste structures require maintenauce/improvement?
❑ Yes
0,No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
[(No
.\\
`Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
1)4No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
No
12. Crop type Y_ 5(s.
.8
13. Do the receiving crops differ with t ose designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
[ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
'�rNo
b) Does the facility need a wettable acre determination?
ElYes
Wo
c) This facility is pended for a wettable acre determination?
❑ Yes
%No
15- Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
)'No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
VNo
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
gNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
JZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑Yes
No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
KNo
24. Does facility require a follow-up visit by same agency?
❑ Yes 9No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
%No
... . violaiigris :Q� de ciencie5 mere noted• daring -(:his: visit: - Y'oi} will •receive iid fuirther • : :
......... ... ....:.....------....
.. correspon�eMe:aboutt�is visit_
Camments(referto question #) Explai�-any YES ainswers and/or any recomnendations or: any other cortriments:
_ -
JUse:drawings of faciihty to better explain situattoias: (use additibnM- a es as-necessa )
F g _ ry. >`
ri Oln Arri4A44,� doas"
4"Us are✓ e094A 7�)
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: //_.
3123/99

Facility Number: 7.— Date of Inspection
Odor Issues r7��
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes
liquid level of lagoon or storage pond with no agitation?X'No
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 'WO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes RrNo
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 F—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 RrNo
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/teriiporary cover? ❑ Yes o
,AddiE►onal�,� omments:an or�DrawinB&s�,���'; h �. �' ��s���a'v. .�.:� `:,��-���;� ` ' � .
A
'will k. " c M rm4ll
r �Iotixed
a
�J
3/23/99

D Division ofTSoil and Water Conservation` -'Operation Review T
e3 Drvisiori of Soil "and Water Conservation -Compliance Inspection
Division of Water Quality = Compliance Inspection `
- -El Other Agency - Operation Review -
10 Routine WComplaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other J
Facility Number 3 Date of Inspection
Time of Inspection 24 hr. (hh:mm)
1EXTermitted 13 Certified © Conditionally Certified [3 Registered JE3 Not Operational Date Last Operated:
Farm Name: County: .................L.�
Owner Name: ,,. �` lC�`��^� Phone No.
Facility Contact:
.......... .. .......... ........................ Title:...................... ....... .......... Phone No:
MailingAddress: .............. .......... ............. I ..................... ..........................
Onsite Representative:.. ?'Vi,. � '.V. ...F !�"�:': � r......... Integrator:...... f.. ...'.`!...F.F.................................
Certified Operator ................................... Operator Certification Number:...................................
............................................................................. .. .....
Location of Farm:
---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Latitude �•�� �•� Longitude �• 0` 0°j
Design Current
Swine Capacity Population
❑ Wean to Feeder
Feeder to Finish
❑ 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 1E] Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area 10 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 (If yes, notify DWQ)?
Discharge originated at: ❑ Lagoon ' Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`'
h. If discharge is observed. did it reach: Surface Waters ❑ Waters of the State
c. If discharge is observed. what is the estimated flow in galhnin?
d. Does discharge bypass a lagoon systern?
2. Is there evidence of past discharge from any part of the operation?
3. Were there any 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 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
0 Yes ❑ No
XYes ❑ No
)�Ycs ❑ No
Q.6S d,1
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
1 /6/99
Continued on back

wFacility Number: — Date of Inspection
5_ Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7_ Do any of the structures need maintenance/improvement?
8_ Does any pact of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required top of dike, 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? ❑ Ponding ❑ Nitrogen
12. Crop type..............................................................................................................
0
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes. ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ❑ No
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes ❑ No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes ❑ No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes ❑ No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ❑ No
21. Did the facility fail to have a certified operator in responsible charge? . ❑ Yes ❑ No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ❑ No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ❑ No
24. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No
0. NA.vioJations:or deficiencies .were noted. during . his.wisit.. You wiI1're�eive nay further .:.
eorresporidence; about; this visit.. • . .. • . •. • . • ... •. •. •. •. •. •. •. •. •. •. • ......... • ............
Comments (refer to question.#): Explain any YES answers and/or any recommendations or any other, coinments
-
Use drawings off facility to better explain situations. (use additional pages as necessary) y
i^' S �Iti` C;
cc
5 ar �c+; ctn�v2�t` ctioSyeS (1 C�35, 3 c s`,►
fiv► `^ f t �CY� d0 t�-. v�2G �
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
1/6/99

a
0
pd-

-.+_-- ¢5:,,. �;3-M..s;.•:�:,..._ �ts�.s:-a ==',:w:s4Ys:s..:<.:._.ca=->s:<�,;:- .r.:.� _ __-':,�.,&a:.R
ri ❑ Division of Sail anti 1'4 ater Conservation ❑ Other Agency
10 Routine O Comnlaint O Foliow-up of [)«'O inspection O Fnllow-up of I)SWCreview O Other
Date of Inspection L ' ?
Facility Number
Time of Inspection �24 hr. (hh:mmm)
©Registered a Certified © Applied for Permit © Permitted JONotOperational I Date Last Operated: .......................
FarmName: _......Ni? ..._..Gt .... _.... R"-�.................................................. ........... County:.}........�p� y,.................................._........................
OwnerName: ...................n....Br-A f.............�R........................ I.................... Phone No:.................
Facility Contact: ........... Dk.Y. I........1.......................... Title: .... t.Ama"tr.................................. Phone No: ....
MailingAddress: ....... ..... t ......t: w. Z:!i!........................ .�i!1I�...�iil � � L................................,?rya ....... �...----'.................. .......
Onsite Representative: ..............[ k1g... c.1� Integrator:..-.......IVM.SJy(V� 7
.............................................
Certified Operator;............................................................................................................... Operator Certification Number .... _................... ........... _....
Location of Farm:
..1( ....i7,7bl.. .........'i k.....{i...:.....5.t�.......... ....}. d:. .elm k.5.... e�i:...... . f ........5R..... S 4.2........................................... .
Latitude a 4 &C Longitude ° 49
%n
AM Design Current r�
Swine , vCapactty Populabon
❑ Wean to Feeder
_DesignChrrent a Design Current ,
Poultry. v „ F .Capacity]Populattan Cattle CapacYty Populatiaa
❑ Layer ❑ Dairy
❑ Non -Layer' ❑Non -Dairy
�� r . .� . .,� „�•M....
❑ Other€ ..
rn r
�. � � 9Tota1 Design Capac�ty�-
'3 H tal SLW
C
Feeder to Finish
❑ Farrow to W eatt
❑Farrow to Feedere
❑ Farrow to Finish
❑ Gilts
rs
El BoaSz
Number of Lagoarrls I Holding Ponds
R�
❑ Subsurface Drains Present ©Lagoon Area 10 Spray Field Area
0 -No Liquid Waste Management Sv stem . r
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes N 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 it observed, what is the estimated flow in QaVmin? WIN
-d. Does discharge bypass a lagoon system? (If ,yes. notify DWQ) ❑Yes M No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes ER No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes [29 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require Yes ❑ No
maintenancelimprovement?
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 19No
7125/97 Continued on back

facility Number: 3 t — 3 Q
8_ Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lapootts.11oldin Ponds Flush Pits etc.
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure ? Structure 3 Structure 4
Identifier:
Freeboard (ft):.............L.................
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)
❑ Yes [ i No
❑ Yes
IF] No
Structure 5 Structure 6
❑ Yes
IR No
❑ Yes
53 No
[4 Yes
❑ No
13. Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes 0 No
Waste Application
14. is there physical evidence of over application? ❑ Yes 19 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ........... ........ t ��....... f I�� ..............!C"T.......... .� t............S+ri . ................ .P�`G.W..
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes (9 No
I7.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
E9 No
18.
Does the receiving crop need improvement?
Yes
❑ No
19.
is there a lack of available waste application equipment?
❑ Yes
In No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
jf No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
22.
Does record keeping need improvement?
%Yes
❑ No
For Certified or Permitted Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
O No
0_ No:violationso' deficie'cies'were,ntited;during this:visiL Yon:will receiveno' irther-:
eofrespondence ab:oid this_visiL.
Cpmm is {refer #a;quesi on #} Explain y �iES answers andlor, any econ met taons or any other comm�nt��
¢Use draw ngs of a y tv better explaui sttuatro>%(u addit44io44na[ pages
,as5ngcessarvj
lli
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1L
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ca��tlrt ✓Za1 ice• 1 7/25/97
2.
Re«ewer/inspectorName-_, .�M
�.
Reviewer/Inspector Signature:zt� �_. Date: 7

@ Routine 0 Cam taint 0 Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection -► 1 %t 1411
Facility Number 3 ti
Time of Inspection = I D j 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review 0
Certified ❑ Permitted or Inspection includes travel and processing)
❑ Not Operational Date Last Operated:
Farm Name:. 4 ^i_r......._-...._ ........ ....._ County:...lP. !!_ .. ._.. _ .........., .
Land Owner Name:.. _ .. g p.Ya .._ _.... _......_ ..... Phone No: ....... ..........
Facility Conctact:Title: Phone N
Mailing Address: . �. I�.� ... Z` �_.�. _.... _.__..._..... ...� h.�: �1. r T 2, ......... .... 2 S S7 Z
Onsite Representative:.. � ..... _...L.. ....... Integrator: ! l..wC ap
Cerdfiied Operator:.... �-!... .... ... _ ..... ..... .... �.... ._ .... _... Operator Certification Number: I..L✓�
Location of Farm:
Latitude ®• ®6 ® K Longitude �1 • ®`
Type of Operation and Design Capacity
Design �CurreuE
Swtge� �1?o ulatian
�� Design3 Current Y:� K Design Current
Poultry �Po mottle Po ;
W> Ca act
.. _ ,Ca` aci ulatiom, ulatton
Ca act
Layer ❑ Dairy
❑ Wean to Feeder
® Feeder to Finish
2
�❑
❑Non -La er ❑ Non -Dairy I
Farrow to Wean
Total Design Capacity
TO
Farrow to Feeder
Farrow to Finish
otai o r
L
n ❑
er
'w,_..
Numiter of�Lagoons / Holding Ponds ❑ Subsurface Drams Present
K
❑Lagoon Area Spray Field Area
neral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenance/improvement?
❑ Yes ® No
❑ Yes ® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
® No
❑ Yes
&[ No
❑ Yes
®.No
❑ Yes
20 No
Continued on back

Facility Number: .3 A....... �..s��..`�
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons and/or Holding „Ponds)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (11). Structure 1 Structure 2 Structure 3 Structure 4
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?
❑ Yes
® No
❑ Yes
® No
❑ Yes
RLNo
❑ Yes
E[ No
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type b , :: Si ............... .............................. 4 .. _ ..w- ..................
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?
Fox-Certirmd Facilities Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes MNo
❑ Yes 0 No
K Yes ❑ No
❑ Yes [,No
® Yes ❑ No
&Yes ❑ No
❑ Yes RNo
❑ Yes ® No
❑ Yes ® No
❑ Yes E[No
❑ Yes ®-No
❑ Yes ® No
® Yes ❑ No
aYes ❑ No
Comments (refer to question #l)y Explain°any YES answers'andlor"any recommendations or any other continents
Use drawings.of facility to better explain situations (use additional pages as necessary) ;6 n
7r
17 . 10 c-yr-c a-Yt_a-3 0 ct o-E a t 1 w, 0 a t.P�p 9
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ua-vim Ga 1cv iat,00 6,�•%i "D �g4M aQ gah
l
t
Reviewer/Inspector Name •�13f�c,, ,�, £. H 3. r
�W � -
Reviewer/Inspector Signature: �/"j . %A - y n Date: -y ) i I ' q `1
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Imamediate Attention:
Facility No.i
DIVISION OF ENVIRONMENTAL MA-NAGE�4ENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: l , 194
Farm Narrielowner:
_ Time: 2
-� lei �- ev.1 rZ
Mailing Address: _. , 2 �© l j
County: ��. _ —--
Intez,ator: ' —�° 1't Phone:
On Site Representarive: w f , - _ Phone: '2�'�' 3 3 2'7
Physical Address/Location: 4 t 7 3 S �Tn�rvx O. _ "' 574 /730
Type of Operation: Swine D� _ Poultry Cattle
Desi--n Capacity: _ ��� — Number of Animals on Site. _
DE:14 Certification Number: ACE DEM Ce:Lficarion Number: ACNTW
Laritnde: 34 Longitude: �77 ° lid Elevation: Fct'
Circle Yes or No
Does the Animal Waste Lagoon have sufficient ueeboard of 1 Foot _ 25 yea 24 hour storm event
(approximately 1 Fooc 7 inches) )85;r No Actual Freeboard: -Ft.4 _ Inc ies
Was any setpage observed from the iagoon(s)? Yes or 10 Was any erosion observed? Yes u:
Is aaeauate land available for sprav? 9r do Is tale cover crop adtcua:e? Yes o<�
Crop(s) beir.t- utilized: N000 6 — --
Does the facility meet SCS minimum setback criteria? 200 Fee: uom Dwellinas? y gor N-
100 Feec froth N ells? or No
Is the animal waste stockpiled within 100 Feet of USG Blue Line Sueam? re or tv
Is animal waste land applied or spray irrigated within 25 Fee: of a liSGS elan Blue Lire? Yes o, s!!P
Is animal waste discharged into waters of the state by rnan-made ditch, ushin� svV—s1m_ or othe:-
similar Fran -made devices? Yes c�"�ei If Yes, Please Explain.
Does the facility maintain adequatc-waste management records (volu.,hes of manure, lard applied,
sprav irrigated on specific acreage with cover clop)?
Addirional Comments: i�J O �( �'— �eK'�g4 -t, C'�'�� Gr a /-
_ •�' iv! sir 1C f �iL, �'— �L�O,
f
4:
inst�Lctar dame �n iture
cc: rscility Ass`ssmcni Unit

Site Requires Immediate Attention:
Facility No. / -979 P DIVISION OF ENVIRONMENTAL MANAGEMENT
i ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3 , 1995
Time: / ` 6 6
Farm Name/Owner: Ro � fi -
Mailing Address:
County:
Integrator ,�'R�oky _ Phone: at 5 - a /0
On Site Representative: 'riff Cx ,(�P�ri �-�? Phone: 3 4
Physical Address/Location: Iy X / 73 bz= /n _
-tea! �i 3 ri9��n nr Z2/f f
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: Y 4`
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: - _� q ° ' `" � " Longitude: ---I 1 - � ' 5-1 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) De
or No Actual Freeboard: �- Ft. Inches
Was any seepage observed from theiagoon(s)? Yes or No Was any erosion observed Ye r-No?K'
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes or
Crop(s) being utilized-
Jti
Does the facility meet SCS minimum setback criteria? 200+eet from Dwellings? esOor No
100 Feet from Wells? r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with, cover crop)? Yes ortwo-)
Additional Comments: .` /'`� /
Inspector Name Si nAture
cc: Facility Assessment Unit Use Attachments if Needed.

:.[... 'ti•, k j:�..�1'•:M: �• '�:F + ''�" J `• r '5+ -77� .,fi\ {4�.f..y. _ _ x f• tam - -
_•A hl A [ ..4 ;lYj ,^� �`"1 r'i'•. r' W __y� M.rw
�Kh SiteRP,CjlllreS:1FIIIIled13Ze;iAttL'Iltion.
'
Facility; Numiier�_
Sri:.vzsr Tor, RECORD.
,f. DATE:
Owner:
County: t' / .
Agent Visiting Site: c.,41 e. C �r�� �G �"+�h'• Phone:
Operator: Phone:
On Site Representative: Phone:
Physical Address: / o en S 73
Mailing Address:
Type of Operation: Swine... s Poultry Cattle
Design Capacity: Number of Animals on Site:
Latitude: o L�on�'tude: "
Type of Inspection: Ground" Aerial
Circle Yes or No
0
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) G or No Actual Freeboard: _ — Feet Inches
For facilities with mare than one lagoon, please address the other lagoons' freeboard under the
comments section.
Was any seepage observed from the lagoon(s)? Yes or No Was there erosion of the dam?: Yes or No
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments: :t Tian
f
_�dnau c^ � _ _ Le .
Fax to [phone] Y Signature of
N 94)