310385_INSPECTIONS_20171231

V
NORTH CAROLINA
Department of Environmental Qua

TypeofVisit: (7C pliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit: 7Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time:[]//= DepartureTime:[ Mff] County: DUIPLZ:�') Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: _Jo0A-T 14 AJ 10L-LLZd-_&.
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Wean to Finish
EL
7
DesignMoNgn,
1:111111pult ap acihm OP.
Layer
Design
bagaci
ow
u t
Wean to Feeder
I
INon-Layer
I
alf
�<
FFeeder to FinisL_ 11- -76 UO
eifer
Farrow t o Wean
ED-e-s_i-g-nKCbtF7 re n t
I t —qy�@ qq�p—flA—(c i P�
II -avers
I Dry Cow
I
Farrow to Feeder
I Farrow to Finish
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
113oars
Pullets
Beef Brood Cow
F—Tther
s
y Poults
DischarlZes and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure E] Application Field Other:
a- Was the conveyance man-made?
Yes 5d"No 0 NA Ej NE
Ej Yes F] No [:] NA 0 NE
b. Did the discharge reach waters of the State? (if yes, notify DWR)
E] Yes F] No
[DNA
[3 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)
Ej Yes [:] D
E] NA
E] N E
2. Is there evidence of a past discharge from any part of the operation?
E] Yes [ZK"o
U
[:] NA
0 NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes WN o
Ej NA
[:] NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

lFacility Number: jDate of Inspection: I
1 115 / U�
Waste Collection & Treatment
4.,Is'storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes 2 No 0 NA EJNE
a. If yes, is waste level into the structural freeboard? Ej Yes [—] No F] NA F] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
No
�1�
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
dNo
NA
NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
E)/�cs
[] No
NA
[D NE
8. Do any of the structures lack adequate markers as required by the permit?
[] Yes
ZNo
NA
[:] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
Yes
[2/No
0 NA
NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
Yes
2/No
NA
NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
Yes
2/No
NA
NE
M Excessive Ponding E] Hydraulic Overload E] Frozen Ground E]Heavy Metals (Cu, Zn, etc.)
F]PAN F-1 PAN > 10% or 10 lbs. Total Phosphorus [:] Failure to Incorporate
Manure/Sludge
into Bare Soil
F] 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?
El Yes
U<o
Ej NA
C] NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
[2/No
Ej NA
[3 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
FZ/No
[:] NA
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Ej Yes
91-No
F] NA
E] NE
18, Is there a lack of properly operating waste application equipment?
Ej Yes
�(N o
E] NA
0 NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
0 No
NA
N E
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
Yes
5/No
NA
NE
the appropriate box.
E]WUP ElChecklists 0 Design F] Maps [:] Lease Agreements E] Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. El Yes 6 No [:] NA E] NE
F� Waste Application 0 Weekly Freeboard 0 Waste Analysis E] Soil Analysis E] Waste Transfers E] Weather Code
F-1 Rainfall 0 Stocking E] Crop Yield 0 120 Minute Inspections 0 Monthly and 1 " Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? 0 Yes 6140 NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes PrNo NA E] NE
Page 2 of 3 21412015 Continued

I /
IFacility Number: jDate of Inspection: SJ It, i
24. Did the facility fail to calibrate waste application equipment as required by the permit? Yes E�j No [:] NA NE
25. . 'fs the facility out of compliance with permit conditions related to sludge? If yes, check �Yes [:]No 0 NA N E
the appropriate box(es) below.
ailure to complete annual sludge survey Failure to develop a POA for sludge levels
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance.
26. Did the facility fail provide documentation of an actively certified operator in charge? El Yes 2fNo NA NE'
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? 0 Yes 0"No NA NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes 0 /No NA NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? Yes ErNo NA ONE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the Yes E!'] No 0 NA [—] NE
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropiiate box below. 0 Yes ZJ/No [:] NA 0 NE
0 Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? Yes 0 NA 0 NE
E] NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes N9 0 NA
34. Does the facility require a follow-up visit by the same agency? 0 Yes No 0 NA N E
Comments (refer to 'p ES.Inswers and/or any additional recommendations or any other comments.:
questionfl:: Ex lain any Y.
Pe,.diawings of'foeffity to bettek�explain situations (use additional pages as necessary).
WA L-c,
C4-C-AA) B 4) S 11 Llc�3 ) (-r C, - e-4 L) fJ
JOTrL, SC —FT T'�' PQVC SL
5
Reviewer/Inspector Name:
Reviewed] nspector Signature:
Page 3 of 3
jo
-1
PhoA!C?/
Date:
2141201.
-1-W

Reason for Visit: 16 Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Title: Phone:
Integrator:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
W e to
Wean to Finish
a
Layer
Dairy Cow
W e a n
Wean to Feeder
J
JNon-Layer
I
Dairy Calf
e e d r t4 I
Weeder to Finish I):/
Dairy Heifer
w t
Farrow to Wean
0
w t
Farrow to Feeder
0
w t
Farrow to Finish
t
p
p
Layers
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Its
Non-Laers
Beef Feeder
oars
r
B 0 s
Pullets
Beef Brood Cow
ot 111111
� � hi I I lei r
ther
oults;
Discharms and Stream Impacts
1. Is any discharge observed from any part of the operation?
[:]Yes
E�No
E] NA
F] NE
Discharge originated at: E] Structure E] Application Field Other:
a. Was the conveyance man-made?
Ej Yes
E] No
F] NA
E] NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
[3 Yes
[:) No
E] NA
F] NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
Yes
E:]/No
NA
NE
2. Is there evidence of a past discharge from any part of the operation?
Yes
[21 N
NA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
VNo
NA
NE
of the State other than from a discharge?
Page I of 3 21412014 Continued

Fadlity Numben Date of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? s D NA D NE
a. If yes, is waste level into the structural freeboard? [:]Yes IN'No Ej NA [1] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? Yes [2(No NA D 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 M No NA [—] NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? F 0
] Yes 0"N D NA D NE
8. Do any of the structures lack adequate markers as required by the permit? D Yes YNo D NA D 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 EI/No D NA [:) NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need D Yes eNo DNA ONE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes C:�No [:] NA [:] NE
0 Excessive Ponding M Hydraulic Overload D Frozen Ground 0 Heavy Metals (Cu, Zn, etc.)
M PAN M PAN > 10% or 10 lbs. Ej Total Phosphorus [:] Failure to Incorporate Manure/Sludge into Bare Soil
E] Outside of Acceptable Crop Window 0 Evidence of Wind Drift [D Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAW_MP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
[—]Yes [737
D NA
D Yes 0 No
D NA
[:]Yes FZ<o
D NA
Yes
Yes
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check Yes
the appropriate box.
D WUP OCheeklists [:]Design DMaps E] Lease Agreements D Other:
2 1. Does record keeping need improvement? If yes, check the appropriate box below. [—] Yes CZ/No [—] NA [:] NE
Waste Applicat ion Weekly Freeboard D Waste Analysis 0 Soil Analysis D Waste Transfers D Weather Code
Rainfall D Stocking Crop Yield 0 120 Minute Inspections ED Monthly and 1 " Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? Yes EjXo D NA [:] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes &k<O [:] NA E] NE
Page 2 of 3 21412014 Condnued
NE
NE
D NE
[,!�(No NA [] NE
No NA D NE
NA NE
NA NE
� IN

WE; Number: Wate of Inspection:
�t ' - — 71 71A 0 2 —1
24. Did the facility fail to calibrate waste application equipment as required by the permit? E;/Ies [Z /No DNA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check [�Yes DNo DNA ONE
the appropriate box(es) below.
g railure to complete annual sludge survey Failure to develop a POA for sludge levels
2,0M
Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance: F-5 P4 -2ZI/ /&-Imv 10,13
26. Did the facility fail provide documentation of an actively certified operator in charge? 0 Yes VfNo D NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? D Yes eNo D NA D 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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
D Application Field [:] Lagoon/Storage Pond D Other:
DYes [Z/No
[:] Yes [�/No
D Yes [�/No
DYes C�No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? D Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? D Yes
34. Does the facility require a follow-up visit by the same agency9 D Yes
E No
Z<C
W Ei� 0
No
0 NA D NE
D NA D NE
0 NA E] NE
[—] NA D NE
D NA D NE
DNA D NE
0 NA D NE
Comments (refer to question ft Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
WA5 /�O-FAQ76,0 1410 Fa660MV
3A r";V�
<- Po 56 C 0 M C JV WT 13 (1v 7-
-'r h
6 Y�/f
Reviewer/Inspector Name:
Reviewer/Inspector Signatui
Page 3 of 3
Phone: ft,)& — 13 49
Date: lboh ' :L
21412015

Type of Visit: (D C pliance Inspection C-) Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: erRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: �OPEJ�t,/ V41 LA-CIL Integrator:
Certified Operator: Certification Number: -7 ;�-W
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swifie
Wean to Finish
�We—t1P,7QuIfr,_vjWfbFP—Aci
PIM
I
Dairy Cow
t
Wean to Feeder
I
INon-Layer I
Dairy Calf
Feeder to Finish (0
I Mu�_e_sign bur ent
Qny' U I a aci
ILayers Rio .
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
I
Farrow to Wean
Warrow to Feeder
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Ej
Pullets
Beef Brood Cow
[10—ther
HuTkeys
T—urkey Poults
)ther
Discharaes and Stream Impac
1. Is any discharge observed from any part of the operation?
Discharge originated at: E] Structure E] Application Field E] 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 Or -/No E] NA [:] NE
Yes
E] No
[:INA
NE
Yes
[:] No
[:] NA
NE
Yes 0 -No E] NA 0 NE
Yes �_ C-] NA NE
Yes YNo [::] NA NE
Page I of 3 21412011 Condnued

FacilityNumber: Date of Insp
Wqs�e Collection & Treat*Melnt
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? DI Yes 0 -No E] NA D NE
a. If yes, is waste level into the structural freeboard? C] Yes [3 No D NA [:] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (iri):
Observed Freeboard (in): X
5..Are there any immediate threats to the integrity of any of the structures observed? Yes [�N NA D 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 7No D NA D NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health o "onmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? rZYes 0 DNA NE
N
8. Do any of the structures lack adequate markers as required by the permit? Yes V 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 C5"No D NA NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes E2/No [:] NA NE
Excessive Ponding D Hydraulic Overload D Frozen Ground D Heavy Metals (Cu, Zn, etc.)
PAN M PAN > 10% or 10 lbs. Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
D Outside of Acceptable Crop Window 0 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 CAWNW? No
Yes dp NA NE
15. Does the receiving crop and/or land application site need improvement? Yes FTN NA NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable Yes VNo D NA D NE
acres determination?
17. Does the facility lack adequate acreage for land application? Yes EK E] NA D NE
14
18. Is there a lack of properly operating waste application equipment? Yes WNo [-] NA [:] NE
Reguired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes
E3�
D NA
C:] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
C] Yes
rNo
NA
NE
the appropriate box.
E] AFIR [:]Checklists DDesign DMaps Ej Lease Agreements
[:]Other:
2 t. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes
ElrNo
NA
NE
F1 Waste Application D Weekly Freeboard [:] Waste Analysis 0 Soil Analysis
D Waste Transfers
D Weather Code
0 Rainfall [:] Stocking D Crop Yield E] 120 Minute Inspections D Monthly and I " Rainfall InspectionsV
D Sludge
Survey
22. Did the facility fail to install and maintain a rain gauge?
C] Yes
1
[n �d
[:] NA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
C:] Yes
&No
[:] NA
NE
Page 2 of 3 21412014 Continued

I I .
lFacility Number: FD-ateof Inspection: 9
24. Did* the facility fail to calibrate waste application equipment as required by the permit? Y EdNo 0 NA ONE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check 27r's [:]No [:] NA [_—] NE
the appropriate box(es) below.
��/i.lure to complete annual sludge survey Failure to develop a POA for sludge levels
0 _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 jj'N DNA NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? Yes VNo [DNA NE
Other Issues
28. Did the facility fail to property 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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
n Application Field 0 Lagoon/Storage Pond 0 Other:
32. Were any additional problems noted which cause non-comptiance 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?
Comrnent&�(refer to question,#): Explain -any',YES. answers and/ouanyadditionlal
lise dra'w:'`fiis!s 6f ficiiiii to beiier 'exD'l iin I situati I on . s (use I a . d I d! . tionaI-DaLses:as1ne'ee'4
0, )
CLeAj
6 VMS
01)(4-
kIALL,
1�5 )
5Lt10Ck
F60 PIA51
r3e(-d
IDO&t-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�_Y61JWFAPL-d EC L'
OYes
[/NNo
D NA
0 NE
D Yes
No
D NA
0 NE
D Yes
WNo
D NA
0 NE
/No
Yes
V
[-] NA
NE
El Yes
o
D NA
NE
D Yes
o
FNo
D NA
0 NE
D Yes
D NA
0 NE
6n��'dr'itnv,'other.'comments��;-,-'�'
Phone:
Date: it
�1414014

Type of Visit: (3 Co Hance Inspection 0 Operation Review C) Structure Evaluation 0 Technical Assistance
Reason for Visit: =Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: Jd)JA-MAtJ MJ4...,bCk_ Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
ean to
Wean to Finish
Dairy Cow
it
Wean to Feeder
lean to
Non -Layer
Dairy Calf
>4 Feeder to Finish 2_76
Dairy Heifer
LFarTW
arr ow to Wean
Farrow to Feeder
Farrow to Finish
I
Layers
MEWEeMgn
Dry Cow
-Non-Dairy
Beef Stocke
Gilts
Non -Layers
Beef Feeder
I 113oars.
Pullets
Beef Brood Cow
lieler,
L_L2ther
oults.
Discharizes and Stream Impacts
1. Is any discharge observed from any part of the operation?
[D Yes
No
Ej NA
0 NE
Discharge originated at: [D Structure Application Field Other:
a. Was the conveyance man-made?
0 Yes
[D No
C] NA
E3 NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Yes
[] No
[D NA
E] 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)
[D Yes
[:]�o
Ej NA
Ej NE
2. Is there evidence of a past discharge from any part of the operation?
Yes
V 'o
tNo
NA
NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
Yes
NA
NE
of the State other than from a discharge? y
Page I of 3 21412011 Continued

FFacility Number: Date of inspection:
Wastc�Collection & Treatment NE
4js storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes
E�fNo NA
a. If yes, is waste level into the structural freeboard? Yes [:] No NA NE
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure I Structure 2
a �Z
6 t,
d_j
Structure 3 Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
. "o
Yes jZfNo [D NA NE
Yes No F
NA NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment�a breat, notify DWQ
7. Do any of the structures need maintenance or improvement? [0:] Yes INN E] NA E] NE
N
8. Do any of the structures lack adequate markers as required by the permit? []Yes VNo Ej NA E] 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 VNo [:] NA [:] NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need E] Yes /NNo,, E] NA NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes No [1] NA NE
M Excessive Ponding E] Hydraulic Overload [:] Frozen Ground E] Heavy Metals (Cu, Zn, etc.)
F]PAN [:] PAN > 10% or 10 tbs. Total Phosphorus [:] Failure to Incorporate Manure/Sludge into Bare Soil
M Outside of Acceptable Crop Window [:] Evidence of Wind Drift 0 Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
[] Yes
� [:] NA
E] NE
15. Does the receiving crop and/or land application site need improvement?
F] Yes
�N�
[3'N E] NA
E] NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
Yes
No [3 NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes
o E] 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
yNo
NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
E] Yes
E] NA
E] NE
the appropriate box.
[:] WUP El Checklists 0 Design L] Maps 0 Lease Agreements E] Other: /1'
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes No E] NA [] NE
Waste Application [3 Weekly Freeboard [:] Waste Analysis E] Soil Analysis E] Waste Transfers [:] Weather Code
Rainfall []Stocking E] Crop Yield E] 120 Minute Inspections E3Monthly and V Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? Yes [3 NA E] NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes �No [:] NA E] NE
Page 2 of 3 21412011 Continued

I I
IFacili!y Number: �ateof Inspection: loh-6
24. Pild the facility fail to calibrate waste application equipment as required by the perm id Yes NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check El Yes YNo 0 NA NE
the appropriate box(es) below.
Failure to complete annual sludge survey Ej 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:
N NA NE
26. Did the facility fail to provide documentation of an actively certified operator in charge? E] Yes 0�1
rl
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)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
0 Application Field [:1 Lagoon/Storage Pond [:1 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?
Ej Yes E2<o [—] NA 0 NE
[]Yes 01<0 NA ONE
Yes ZeNo NA NE
[:)Yes C1 /No NA NE
E] Yes
[,�,o
0 NA
E] NE
0 Yes
MMN4/
NA
NE
E] Yes
o
F/
NA
NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other commentk.
Use drawinas of facilitv to better exiDlain situations (use additional Pages as necessarv).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: q10) M -73
Date:

Type of Visit: 0 Co Hance Inspection Q Operation Review (_-) Structure Evaluation Q Technical Assistance
Reason for Visit: 7Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: 1�� A?L,T Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title:
Onsite Representative: '�J6NATH'%'j K)'7-LLE&' Integrator:
Certified Operator:
Phone:
Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
- 1-1)-Iq
Wean to Finish
I
I I Layer I
I Dairy Cow
Wean to Feeder
I
I INon-Layer I
Dairy Calf
Feeder to Finish
Farrow to Wean
Dair_yHeifer
i Dry Cow
Q_ry_jP,6ultiW, @Wpa psa rMt Non -Dairy
Layers Beef Stocker
Farrow to Feeder
Farrow to Finish
JGilts
7-
Non -Layers
Beef Feeder
I
[Boars
11FPullets
I Beef Brood Cow
Poults
Other
Discharges and Stream Impact
1. Is any discharge observed from any part of the operation?
Yes
C2/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 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)
Ej Yes
Ej E] NA
NE
s there evidence of a past discharge from any part of the operation?
Yes
Er�90 j NA
NE
-e there any observable adverse impacts or potential adverse impacts to the waters
Yes
�Zo NA
NE
�,State other than from a discharge?
\:f
3
21412011 Continued

I /
Facility Number: jDate of Inspection: CV /,;Z
'31 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes Er/No D NA D NE
I
a. If yes, is waste level into the structural freeboard? [—]Yes [:]No D NA D NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? 0 Yes Ij!f/No [—] NA [] NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not property addressed and/or managed through a 0 Yes JZ/No D NA D NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or en
,�o mental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? D No NA NE
8. Do any of the structures lack adequate markers as required by the permit? Yes U�No NA NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require D Yes O/No NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes ZNo DNA Ej NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes LEf/No [:] NA [—] NE
D Excessive Ponding D Hydraulic Overload [:] Frozen Ground E] Heavy Metals (Cu, Zn, etc.)
M PAN M PAN > 10% or 10 tbs. Total Phosphorus D Failure to Incorporate Manure/Sludge into Bare Soil
Ej Outside of Acceptable Crop Window D Evidence of Wind Drift Ej 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? 0 Y s E�rNo D NA DNE
15. Does the receiving crop and/or land application site need improvement?
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
DWUP 0 Checklists DDesign DMaps D Lease Agreements
E3'*Yes D No D NA D NE
D Yes F?<O [:] NA [:] NE
o D NA D NE
D Ye:s U� -
D Yes �/o [:] NA D NE
Z
Yes N NA C] NE
0
E) Yes /N [:3 NA E] NE
DOther-
2 1. Does record keeping need improvement? If yes, check the appropriate box below. [—] Yes Z No D NA [] NE
M Waste Application El Weekly Freeboard D Waste Analysis D Soil Analysis D Waste Transfers C] Weather Code
D Rainfall D Stocking D Crop Yield D 120 Minute Inspections D Monthly and I " Rainfall lnspection!s,,�E:] Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? D Yes E:�4o [:] NA D NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? D Yes E� No D NA D NE
Page 2 of 3 21412011 Continued

-7 / I
Faciltz Number: [Date of Inspection:
24. Did -the facility fail to calibrate waste application equipment as required by the permit? I I es [21N NA NE
25. Is tl�e 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?
[:]Yes ff�N
0 NA
ONE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:] Yes �rNo
[:] 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-apptication)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
D Application Field D Lagoon/Storage Pond F1 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?
D Yes O/No [DNA 0 NE
[:)Yes 2rNo [DNA ONE
Dyes [2'No [DNA [:]NE
Dyes ffNo [:]NA F]NE
Yes
Yes
El Yes
KNNA [—] NE
i��p
o/ NA CD NE
0 No NA E] NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations. or�;ny. other,comments;t�':'i,�';.,
Usedrawinits of facilitvto better explain situations (use addition'alpap-es asnecessary).
It i�,� �TXLL, AACOS �fC—(—P C0vT9-1)L_, &4LC DA,� kef461,1 MOD
Reviewer/Inspector Name:
VAN
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date:

319
Type of Visit: (Z) C pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 7Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: DLA:ZoJ_ Region:
Farm Name:
Owner Email:
Owner Name- Phone;
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: SWCE HA-0 MaLA_Cou Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Certification Number:
Certification Number:
Latitude: Longitude:
Wean to Finish
Layer
Dairy Cow
t
Wean to Feeder
[Non -Layer
Dairy Calf
Feeder to Finish
I Z77
Of) 0
Dairy Heifer
Far -row to Wean
Farrow to Feeder
jFs-i2n
D
R i
DEZCow
Non -Dairy
Farrow to Finish
ILayers
B ef Stocker
Gilts
Won -Layers
Beef Feeder
Boars
I
Pullets
113eef Brood Cow
1
[Other L A—
L__2thcr
Turkeys
Turkey Proults
1
I
DischarZes and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: E] Structure E] Application Field Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
[:] Yes [�No E] NA [:] NE
E] Yes
E] No
NA
E] NE
[:]Yes
0 No
NA
E] NE
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 E] o
[:]Yes fvb
E] Y e s WN,o
NA NE
NA NE
NA NE
Page I of 3 21412011 Continued

IFacility Number: FDate of Inspection: q it
Waste Colliction & Treatment
4. Is stor�ge capacity (structural plus storm storage plus heavy rainfall) less than adequate? Yes ET<O
a. If yes, is waste level into the structural freeboard? Yes F] No
Structure I Structure 2
Identifier:
Spillway?:
Designed Freeboard (in):
NA E] NE
NA [—] NE
Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in): X3
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
Yes ErNo E] NA [—] NE
[-]Yes /No E] NA E] NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental reat, notify DWQ
len!"
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 El -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 [ErNo NA NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes C�j /No E] NA E] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. E-] Yes ETNo [:] NA 0 NE
Excessive Ponding E] Hydraulic Overload 0 Frozen Ground E] Heavy Metals (Cu, Zn, etc.)
PAN PAN > 10% or 10 lbs. Total Phosphorus L] Failure to Incorporate Manure/Sludge into Bare Soil
F-1 Outside of Acceptable Crop Window Evidence of Wind Drift 0 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 0 No E] NA NE
15. Does the receiving crop and/or land application site need improvement? El"Yes E] No E] NA NE
16. Did the facility fait to secure and/or operate per the irrigation design or wettable F-1 Yes [Z/No C-] NA NE
acres detennination?
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 2 No NA NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
El Yes [�/yo
[:] NA
[] NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El YesWNo
[D NA
E] NE
the appropriate box.
EJWUP EjChecklists E] Design [] Maps [-] Lease Agreements
Other:
21 . Does record keeping need improvement? If yes, check the appropriate box below.
E] Yes PfNo
NA
[—] NE
M Waste Application Weekly Freeboard El Waste Analysis [:] Soil Analysis
Waste Transfers
Weather Code
E] Rainfall [:] Stocking Crop Yield E] 120 Minute Inspections 0 Monthly and I " Rainfall Inspections
Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[:] Yes Ew�"'o
EINA
NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:] Yes , o
E] NA
NE
Page 2 of 3 21412011 Condnued

lFacility Number: FD-ateof Inspection:
.11 -39S
24, Did the tacility fail to calibrate waste application equipment as required by the permit? Yes [2f) 6 NA NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check Yes rNoc NA NE
the appropriate box(es) below.
Failure to complete annual sludge survey D Failure to develop a POA for sludge levels
Non -compliant sludge levels in any tagoon
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? D Yes E3PN D NA D NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? D Yes �zo NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document Yes C(No NA NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
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 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
0 Application Field D Lagoon/Storage Pond M 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 EfX0 NA NE
0 Yes [!/]No NA NE
[] Yes o [] NA [:] NE
El Yes r�No DNA ONE
Yes Ed o NA [:] NE
Yes YNo D NA ONE
Comments (refer.to question #): Explain any YES answers and/or any additional recommendations oir�anyother comments;vnptprz�e
iii�Arawings::of facility to betterexplain situations (use additionalpages as necessary)'."
pj6co To Da :ro M �C_ LIC (--P COAITO-OL. CL60k) Ak#WO Olk-C 1,M1 C,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
ONO
Phone: 13 f r
Date:
21412011

Division of Water Quahty
F*61ity%N6mber- O.Drvision of,Soil and Water;Conservation Am
N
Type of Visit 6 C pliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
Reason for Visit -- Routine 0 Complaint Q Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: OI ! Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: Q0 T
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [=o �, Longitude: °
Design Current; riDes�gn� Current -'Des n Curren#
n.Swtne. Capacity Population �, _Wet Poultry Capacity Populahan Cattle Capaty Prop_ lation
❑ Wean to Finish :a ❑ Layer _ - ❑ Dairy Cow
❑ Wean to Feeder
JEJ Non -Layer
I
I
I
❑ Daia Calf
" ❑ Feeder to Finish
®; -
`< ❑ Daia Heifer
❑ Farrow to Wean
D
El D Cow
❑ Farrow to Feeder
l'oult w
X'�r'P•'F-s� `., � :s- �$ , 4'.`.a.. 49�° r�` d"�^-x `9
❑ Non-Dai
' ❑ Farrow to Finish
k El Layers _
❑Beef Stocker
" El Gilts
❑Non -Layers
r ❑ Beef Feeder
~� ❑Boars
" ❑ PulletsEl
Beef Brood Co
❑ Turkeys
m ❑
Other• Turkey Poults.
a❑ ❑ Other ' Other
Numttn ergo#Struct„ures.�
� : ,
= Z� .. .
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ErNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes NoEINA ElNE
❑ Yes ❑'1 o ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
11
4 . Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
-1 NA NE
'ZNo [_
a. If yes, is waste level into the structural freeboard?
El Yes
0 No [:1 NA El NE
Structure Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: UA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
El Yes
U]"No [:] NA [I NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
El Yes
53/No El NA ONE
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?
El"Yes
C1 No [3 NA [__1 NE
8. Do any of the stuctures lack adequate markers as required by the permit?
El Yes
E�No [:1 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
El Yes
ONo [:1 NA EINE
maintenance or improvement?
Waste Application
10. Are there any req . uired buffers, setbacks, or compliance alternatives that need
El Yes
PNo El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
EINA [] NE
0 Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
E I PAN E:IPAN>10%orl0lbs 0 Total Phosphorus 0 Failure to Incorporate Manure/Sludge
into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift 13 Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
[I Yes
[�No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
11 Yes
�`No
[I NA
[I NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
V� No
El NA
0 NE
.
IT Does the fac ility lack adequate acreage for land application?
El Yes
VNo
[I NA
[] NE
18. Is there a lack of properly operating waste application equipment?
El Yes
5�`N.
El NA
0 NE
Comments (refer to.,quesfion.#): JExplain any YES answers i4orain 'r-e-c'oiii�eiid4tidiis-'or'an"y'o
Use drawings of facility to better explain sittration.s. (use additional pages..as necessai-y'):
f-pL-LL- IVA S"*K6 IVD-C.,C�
40 01—t—f- kl-A U— C'm/tIA/06 V 0 -fZ*_6
P
&�o 6-0- df kc-'o, 5 V&-c FiL�y� CC-r 6)(76"M
64ZA
Revie er/Inspector Name Phone: 91J
73VY
Reviewer/Inspector Signature: Date:
Page 2 of 3 1212404 ' Condnued

Facility Number: 13 Date of Inspection
ReQuired Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes /No [] NA El NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes dNo El NA [I NE
the appropriate box. 0 WUP El Checklists El Design [:1 Maps [I Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 1:1 Yes EZ/No [I NA 0 NE
D Waste Application [I Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers
El Annual Certification
El Rainfall El Stocking 0 Crop Yield El 120 Minute Inspections E] Monthly and I " Rain
Inspection
Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
El Yes
; No
EINA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
0 Yes
12<N"o
El NA
C1 NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
��b 0
[:1 NA
[:1 NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
WN o
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
o
[:1 NA
[:1 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
No
El NA
[:) NE
Other Issues
28.
Were any additional problems noted whic h cause non-compliance of the permit or CAWMP?
El Yes
0�o
E:1 NA
Ej NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
Z
D NA
0 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?
El Yes
ZN o
NA
El NiE
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
&No
NA
El NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
[2rN.
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
0 Yes
O'No
[] NA
El NE
lAdditional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit 6 Compliance Inspection 0 Op tion Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint <;; rFollow up 0 Referral 0 Emergency 0 Other D Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Maittng Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator:
Back-up Operator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 =' =6. Longitude: = o =' = "
esign - pwnt
e
P ou"
!Qr_,YAMQb5F—ac RA ii
�y PL�ilffti
.7y 1115�5 I ti
-W —aci Pop.— -ti
�g P
Wean to Finish
L a r
El Layer
El Dairy Cow
on -L
Wean to Feeder 10 Non -Layer
N a c
El Dairy Calf
Feeder to Finish
El Dairy Heifer
El Farrow to Wean
Anoult
"ny Poult
El Dry Cow
D Farrow to Feeder
El Non -Dairy
El Farrow to Finish-
Layers
El Beef Stocker
Gilts
L
10 Non -Layers
E
EJ Beef Feeder
Boars
EED Pullets
]
3
El Beef Brood Cow
El Turke�
El Turkey Poults
Other
El Other
urn e ruc ures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
0 Yes
0"No
El NA
[3 NE
Discharge originated at: El Structure D Application Field D Other
a. Was the conveyance man-made?
El Yes
El No
El NA
El NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
El Yes
0 No
El NA
D NE
c. What is the estimated volume that reached waters of the State (gallons)?
71
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
11 Yes
E]No
EINA
ONE
2. Is there evidence of a past discharge from any part of the operation?
0 Yes
d� 0"
NA
[:1 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
Wo
NA
EINE
other than from a discharge?
Page I of 3
12128104
Continued

0
Facility Number:31:39:
Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
E�/Yes
El N El NA El NE
a. If yes, is waste level into the structural freebo ' ard?
[]Yes
�Zo [INA [I NE
Structure I Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: CA
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
0 Yes
ErNo [__1 NA [] NE
(ic/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
Yes
Zj'No 0 NA [I NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environ ental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
7yes
0 No El NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit?
0 Yes
E�No [I NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
j
9. Does any part of the waste management system other than the waste structures require
El Yes
EI`N�o El NA [:1 NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
0 Yes
Er/No El NA EINE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
El Yes
C2/No [I NA [:1 NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu,
Zn, etc.)
El PAN El PAN > 10% or 10 lbs. 0 Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
E]Yes
0 No El NA
0 NE
15. Does the receiving crop and/or land application site need improvement?
0 Yes
WN, [:1 NA
El NE
16, Did the facility fail to'secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
�7N o Ej NA
[:1 N E
17. Does the facility lack adequate acreage for land application?
E-1 Yes
dl, [I NA
yNo
[] NE
18. Is there a lack of properly operating waste application equipment?
D Yes
� El NA
[:1 NE
T-oler-jo.q
jJse i-w-in of�acjl�
WALL- �JJD-C-
t_p,, e_C &-tio I I AS ATep F-6 -[5 (EL)T
.r FN _ — (Z.A
?Urr)p C6W�j WD "AVG
Reviewer/Inspector Name Phone,;
Reviewer/Inspector Signature: JX-1 Date: "3 b 110 1
1 _'1Z61U4 uununuea

- Facility Number:31 1 Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes El No El NA O/NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check El Yes El No El NA ONE
the appropriate box. D WUP El Checklists El Design El Maps El Other
2 1.
Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes
0 No
El NA
11ZX11
El Waste Application [I Weekly Freeboard 0 Waste Analysis D Soil Analysis
El Waste Transfers
E] Annual Certification
EIRainfall ElStocking E]CropYield El 120 Minute Inspections El Monthly and I" Rain Inspections E]WeatberCode
22.
Did the facility fail to install and maintain a rain gauge?
El Yes
El No
[:INA
ZfNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? Yes
El No
El NA
WNE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[I No
El NA
QrNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
0 Yes
El No
El NA
U<E
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
El No
El NA
2<E
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
0 Yes
[__1 No
El NA
2�E
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
O/No
T] NA
El NE
29, Did the facility fail to property dispose of dead animals within 24 hours and/or document
E]Yes
Z3/No
[INA
[] 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?
'D Yes
L/No
El NA
El NE
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of ernergencysituations as required by
El Yes
LX0
El NA
Ej NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
C2"N.
EINA
D NE
33. Does facility require a follow-up visit by same agency?
42/yes
[] No
Ej NA
El NE
l�iddiii-o�-ai.�Co'iniii�nts-;aifdlti-r Dra*inLys:
Page 3 of 3 12128104

1�
Type of Visit 0 Co Pliance Inspection 0 Operation Review C) Structure Evaluation 0 Technical Assistance
Reason for Visit � Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: bJPLZ$3 — Region:
I
Farm Name: Owner Email:
Owner Name: , Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: 'S*J-nTWRjj__ MZA_t_.� — Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = 0 =I = 11 Longitude: = o =' = "
jEelsi�65g,ent
t esign gent
N Me M=
ncit
P .YAPjp
ulation
__pg_ 11
Ce1jIfqu Ltr.yjffC,=cj flition irp—acit Pop -.ti--n
10 Layer El Dairy Cow
10 Non -Layer I I Dairy Calf
El Wean to Finish
El Wean to Feeder
M Feeder to Finish
nJ2
Dairy Heifer
El Farrow to Wean
Dry Cow
El Farrow to Feeder
El Non -Dairy
El Farrow to Finish
El Layers
Beef Stocker
El Non-LayeTS
El Beef Feeder
PCIGilts
Boars
[I Pullets
El Beef Rmocl Cow
D Turkeys
Ot e
_T
10 Turkey Poults
1[j Other
FE-30theT
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes
6 No
El NA
El NE
Discharge originated at: El Structure D Application Field El Other
a. Was the conveyance man-made?
E]Yes
[I No
0 NA
0 NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
Yes
E]No
El NA
[I NE
c. What is the estimated volume that reached waters of the State (gallons)?
- -
I
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
[I Yes
E]No
EINA
EINF,
2. Is there evidence of a past discharge from any part of the operation?
El Yes
e o
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
Wo
El NA
[] NE
other than from a discharge?
Page I of 3
12128104
Continued

1,Facility Number. Date of Inspection
e Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? D Yes 21"No [:1 NA El NE
a. If yes, is waste level into the structural freeboard? El Yes El No El NA El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6raojJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1-3
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes Z�No El NA [] NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed El Yes 2�No El NA 0 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 th eat, notify DWQ
7. Do any of the structures need maintenance or improvement? El Yes o [:1 NA [:1 NE
8. Do any of the stuctures lack adequate markers as required by the permit? D Yes [YN'o El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes O/No [:] NA [] NE
maintenance or improvement?
Waste ADDliCatiOn
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes C3/No El NA [j NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes [3/No El NA 0 NE
El Excessive Ponding [:1 Hydraulic Overload El Frozen Ground [:1 Heavy Metals (Cu, Zn, etc.)
[:]PAN [--IPAN>10%orl0lbs El Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
0 Outside of Acceptable Crop Window El Evidence of Wind Drift [JApplication Outside of Area
12. Crop type(s)
13. Soil type(s)
14.
Do the receiving crops differ from those designated in the CAWMP?
El Yes
[:rNo
El NA
[I NE
15,
Does the receiving crop and/or land application site need improvement?
El Yes
[2<�
El NA
[:1 NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
Elyes
7No
El NA
El NE
17.
Does the facility lack adequate acreage for land application?
El Yes
EP�o
El NA
C3 NE
�Zo
18.
Is there a lack of properly operating waste application equipment?
El Yes
ONA
El NE
que"
�C 6kiients (iefif 6 -stion "Explaiin ainv V ES, answers andt'or an- y'rico'ki
k1i
1;6 . . . ,, ­­ " aiiio� i.
�,­. k._14ficilit ' -oi
wi
idid ng yj, ter;�exp.;akik sktqp14ons e'k ii pagesfas,ni&.
Phon(
Reviewer/Inspector Name 74 __hVF
Reviewer/Inspector Signature: Date:
IZ/Za/Uli uuntlnuru

IFacility Number: 3) —3 Date of Inspection
Required Records & Documents
19, Did the facility fail to have Certificate of Coverage & Permit readily available? 0 Yes N [:1 NA [:1 NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check [I Yes No El NA El NE
the appropriate box. El WUP 0 Checklists 0 Design El Maps El Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes C�(No El NA [I NE
• Waste Application El Weekly Freeboard D Waste Analysis El Soil Analysis El Waste Transfers 0 Annual Certification
• Rainfall El Stocking El Crop Yield El 120 Minute Inspections El Monthly and V Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? El Yes E�No [I NA 0 NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes d-,� 0 [:1 NA [I NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
0
[jNo
[I NA
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
ET�o
El NA
0 NE
26,
Did the facility fail to have an actively certified operator in charge?
El Yes
ffN.
[:1 NA
[:1 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
ONo,
[I NA
[:1 NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
cl<o
El NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
WNo
El NA
El 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?
El Yes
E�No
Ll NA
E] NE
If yes, contact a regional Air Quality representative immediately
3 1.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
E(No
El NA
[__1 NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
1:1 Yes
EI/No
El NA
[:] NE
33.
Does facility require a follow-up visit by same agency?
El Yes
E�No
El NA
El NE
N. R A,
jAdditiona'I Comments' d/oeDriwlAgs"v'_'
an
12128104

TypeofVisit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0110'ther Denied Access
Date of Visit: Arrival Time: Departure Time: County: CX-e(-1-1")_ Region:
Farm Name: , Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone No:
Integrator:
Operator.Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: =0 =g =46 Longitude: =0=6 =dg
llle—si�OU-Trent
ne LC* No —a e it 2
Pjp—u I& i TJ -n
Y'r NMI
011 [ MEM
04 - 9 5_5 c i RA III INti
I 1111111� r] ur!:ent
i Wo -ac i �o p u I jilltui
Wean to Finish
10 Layer I
1
0 Dairy Cow
Wean to Feeder
10 Non -Layer I
I
El Dairy Calf
Feeder to Finish
El Daia Heifer
0 Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
0 Gilts
Layers
El Non -Layers
El Pullets
El Dry Cow
Non -Dairy
El Beef Stocker
0 Beef Feeder
1[:]
Boars
El Beef Rrcvod Cow
-
10
111110ther
Li iurKevs
Num e
Turkey Poultsi
er
Dischames & Stream Impacts
1. Is any discharge observed from any pan of the operation?
0/yes
[j No
El NA
[] NE
Discharge originated at-. El Structure [I Application Field dother
a. Was the conveyance man-made?
D Yes
dNo
[I NA
El NE
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
0 Yes
0"No,
[j NA
E] NE
c. What is the estimated volume that reached waters of the State (gallons)?
- - 1
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
dyes
DNo
El NA
El NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
EdNo
0 NA
[:1 NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
0 yes
U�No
[:1 NA
E]NE
other than from a discharge?
Page I of 3
12128104
Continued

IYacility Number: 31 =9 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus stonn storage plus heavy rainfall) less than adequate? El Yes E?(No [-I NA El NE
a. If yes, is waste level into the structural fireeboard? El Yes El No El NA El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA 6=0
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): —LA5
5. Are there any immediate threats to the integrity of any of the structures observed? ElyesdNo
El NA [] NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed Ell�es
El No
El NA El 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? El Yes
ZNo
0 NA El NE
& Do any of the stuctures lack adequate markers as required by the permit? D Yes
E!rNo
[I 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
El No
El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes
0"No
Ej NA 0 NE
maintenance/improvement?
IL Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
E:fNo
El NA C3 NE
El Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
El PAN [] PAN > 10% or 10 lbs El Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window 0 Evidence of Wind Drift El 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
�Ko
D NA
El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
E!fNo
El NA
El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
[:] yes
No
[I NA
NE
17. Does the facility lack adequate acreage for land application?
El Yes
o
El NA
NE
18. Is there a lack of properly operating waste application equipment?
El Yes
WNo
[3 NA
0 NE
_'­6fiii�Fn— i-- '__y._0_t'___!tc4okEmen s_
Comments (refer to question ft Explain any YES answ6is. ind/or abyrec onsW,.
Use.drawings. of facility,to b tte e j6se'additiOnA V
,a jn
.p
xplain situations
...........
0 CIO tZ KMIL 0 C &,.VL0%QC. RA D (A 1PIP6 CLOG 4 DTSC44A'LcC0 , bzl) #4 at LC-AIJ4 ;:A R-M S��XC Rj%�LLAJ�, t-,5
f4c,.rzf oo& OF zrSSUC,
?-AT WD LG 5 ALj_ ftoo 6- MkC wA LL_ - rX,650 C)UT, -ra Uk 013a W AL-1— S LX-& 4r(-'?
L4#J 5Q-C —jrtjjXL,5 FfLov-, TWC- LA6-"jJ -M A SP4-t W14&_4LC- Co" ,,AS PL'r roa- 060Z.
W v vjTr ii c-, �Z q-t c,. jj (-E- r) T,, 6 4 k-XLI,- & 0 LA &�tz j-j " K-_ 0 S tg (Rc- PL%-R(-_o r.>ak.'J�
�Wc> -VWW CaAj 5V U- 0�/ Orkfz,-, 11JtX,,tZTY AN D NOW aSt 'r6
Reviewer/Inspector Name _j 1-,j Pe'-w-'u-
Reviewer/Inspector Signature: ��64AAJ Date: A�Lo

-Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes El No 0 NA U�NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [I Yes [I No [INA 'ZNE
the appropriate box. El WP El Checklists El Design D Maps 0 Other
21. Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
El No
El NA
O'NE
El Waste Application [I Weekly Freeboard [:1 Waste Analysis 0 Soil Analysis El Waste Transfers
El Annual Certification
DRainfall ElStocking E]CropYield El 120 Minute Inspections El Monthly and V
Rain Inspections E]WeatherCode
WN
22. Did the facility fail to install and maintain a rain gauge?
El Yes
El No
[:1 NA
E
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
[:1 No
0 NA
Ej<E
24, Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[:1 No
El NA
0'�E
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El No
El NA
E1/NE
26. Did the facility fail to have an actively certified operator in charge?
El Yes
El No
El NA
E�; E
27. Did the facili fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
El No
El NA
El NE
Otherlssues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
[__1 No
Ej NA
E3`NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
[3 No
EINA
EfNE
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?
E]Yes
E]No
El NA
BNE
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
EI/Yes
[] No
[I NA
[:1 NE
General Permit? (ic/ discharge, freeboard problems, over application)
eNE
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
El No
0 NA
33.
Does facility require a follow-up visit by same agency?
El Yes
[:1 No
[I NA
2<�
Lkddifi af.C-6_mii�m�e
'D
Tg�Ap_,FC-fL, LEO& rn-Ov— 14OG gouSC To LA&—Aj rJ� Woa_X-X_�6' A""n N46�� 5
?.c_,?FkzF, ac Fc5cc-_ %,qoR-c PdSSXr3L-r, ()ZZjjtjk&(. FTaL)1CS
I 19rSCAA 94(�IE
3 L ) fAr LLj fu� -T6 Watzfl A 3 - 0-t P Z5C_AAA_(4
j6m&P_(- UEVCL 1.)45 Up -ro 14 %K) &vA(UCkft_j eE(r,�'T
A cAm EF'
W_,0V4: L_cov4o A4 Z, 0
C_ V9 0 -5c-c ALDIYC,, TJOSTOC
&-Ch'< -rJ7(:"'
,< 5� kC4-
-Tiq y. ALL
TVV�
titi P
12128104

59.s�
Type of Visit (!) Co pliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 7Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other [I Denied Access
Date of Visit: Arrival Time; Departure Time: County: QVPLtJ* — Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite R epresentative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = =I = Longitude: = o =' = "
Effe—sig ur i enill
1111C.1—paci
esign 0 U K, be a
ne pan—u I 5y, i
I U e—H I�C*,_qt�Ecitj P
�y&
n I ti
UMRH�DDD___U lfi
El Wean to Finish
Layer
0 Dairy Cow
El Wean to Feeder
EJ Dairy Calf
R1 Feeder to Finish
12,1(o
'76Y
0 Daia Heifer
El Farrow to Wean
Ej Da Cow
El Farrow to Feeder
Layers
El Non -Dairy
[I Farrow to Finish
0 Beef Stocker
El Gilts
El Non -Layers
El Beef Feeder
Boars
D Pullets
El Beef Brood Cow
urkeys.
e
urkey Pou
Other
ther
UIM1,11 11'111111'111011!��� ruc ur sl,:�
Dischames & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El 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?
[I Yes Z'No C1 NA 0 NE
[I Yes
[__1 No
[I NA
El NE
El Yes
El No
C1 NA
[:1 NE
[:1 NA
El NE
Yes
[I No
0 Yes 7N El NA El NE
El Yes No El NA [] NE
Page I of 3 12128104 Condnued CIA

Facility Number: 31 -3cl Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? Elyes - 4�1/No El NA El NE
a. If yes, is waste level into the structural freeboard? [I Yes [] No D NA El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA Cx—vvJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats'to the integrity of any of the structures observed? Yes
[�No [I NA El NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed 0 Yes
2/No 0 NA 0 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? El Yes
P� 0 El NA ONE
8. Do any of the stuctures lack adequate markers as required by the pennit? D Yes
7No [] NA D 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 0yes
dNo [:1 NA El NE
maintenance or improvement?
Waste Aoplication
W. Are there any required buffers, setbacks, or compliance alternatives that need E]Yes
d�N El NA [__1 NE
maintenance/improvement?
7No
I L Is there evidence of incorrect application? If yes, check the appropriate box below, El Yes
El NA El NE
0 Excessive Ponding [:1 Hydraulic Overload El Frozen Ground E]Heavy Metals (Cu, Zn, etc.)
0 PAN EIPAN> 10%or 10 lbs El Total Phosphorus DFailure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window El Evidence of Wind Drift El Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? D Yes El El NA D NE
15. Does the receiving crop and/or land application site need improvement? 0 Yes rNo [j NA 0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes EIN"o [_1 NA El NE
17. Does the facility lack adequate acreage for land application? 0 Yes [Z 0 NA El NE
18. Is there a lack of properly operating waste application equipment? El Yes �t El NA El NE
Phone: -_7
Reviewer/Inspector Name _�L6 ) 7�e
ReviewerlInspector Signature: Date: ____//0L 0
D__ I _r 2 17 " -9 111.4 rl_ #;_ .4
-.5 _11

Fa�ility Number:3 1 Date of Inspection
!R�guired 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. El wup 0 Checklists El Design El Maps El Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below.
El Yes 2fNo, NA E) NE
El Yes o EJI NA El NE
El Yes O/No [:1 NA [] NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis El Waste Transfers El Annual Certification
El Rainfall El Stocking El Crop Yield El 120 Minute Inspections El Monthly and I " Rain Inspections [I Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
El Yes
gN( El NA
'4
[j NE
El Yes
N EI NA
NE
Yes
NA
NE
El Yes
�r/No [:1 NA
[:1 NE
El Yes
W'4 El NA
[__1 NE
El Yes
20 [] NA
[I NE
El Yes
D<o [:1 NA
El N-E
El Yes
0_Nc El NA
El NE
El Yes
;N/o[--] NA
NE
El Yes
-0 'No [INA
NE
0 Yes
0
�0 NA
VNo
El NE
El Yes
El NA
[__1 NE
Page 3 of 3 12128104

V Division of Water Quality
Eacility Number 0 Division of Soil and Water Conservation
0 Other Agency
Type of Visit Gr'Comp -ance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
ReasonforVisit (:�Zopulitlne OComplaint OFollowup OReferral OEmergency 00ther El Denied Access
Date of Visit- Arrival Time: Departure Time: County: 9)UPL-ri Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
M)Q T�l A�J M.ILLeg_ Integrator:
Onsite Representative.
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number -
Location of Farm: Latitude: 0 =' =] " Longitude: = 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
10 Wean to Finish
0 Wean to Feeder
Feeder to Finish I Z-7 L /b8l,
El Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilts
El Boars
Other
10 other
El Layer
1[:] Non-Lavei
Dry Poultry
El Layers
El Non -Layers
El Pullets
0 Turkeys
I Turkey Poults
1
10 ther
I
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field El Other
a. Was the conveyance man-made?
Design Current
Capacity Population
El Dairy Cow
I
El Dairy Calf
I
El Dairy Heifei
El Dry Cow
El Non -Dairy
El Beef StockeT
0 Beef Feeder
,E] Beef Brood Co�
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge ftom 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?
El Yes WNo El NA El NE
0 Yes
El No
[I NA
ONE
El Yes
0 No
El NA
El NE
El NA
13 NE
El Yes
El
[:3 Yes
�`N:
[:3 NA
El NE
El Yes [2/No El NA [I NE
12128104 Continued

Facility Number: 31 Date of Inspection
) Collection & Treatment
W�ste
I-
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? El Yes E21/4o El NA 0 NE
a. If yes, is waste level into the structural treeboard? 0 Yes El No El NA El NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A kwtJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in)-
5. Are there any immediate threats to the integrity of any of the structures observed? El Yes RfNo El NA El NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed 11 Yes dNo El NA El 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 t eat, notify DWQ
11 Pr
7. Do any of the structures need maintenance or improvement? El Y� No E] NA El NE
8. Do any of the stuctures lack adequate markers as required by the permit? El Yes D"No D NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require E]Yes EfNo El NA [] NE
maintenance or improvement?
Waste Avolication
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes
QNo El NA
0 NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes
eNo El NA
El NE
0 Excessive Ponding El Hydraulic Overload El Frozen Ground El Heavy Metals (Cu, Zn, etc.)
E]PAN E:IPAN>10%orl0lbs El Total Phosphorus El Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window 0 Evidence of Wind Drifl DApplication Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? El Yes
O'No 0 NA
0 NE
15. Does the receiving crop and/or land application site need improvement? El Yes
QX6"� El NA
[__1 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?E] Yes
EK' El NA
El NE
17. Does the facility lack adequate acreage for land application? El Yes
EKo El NA
[:1 NE
18. Is there a lack of properly operating waste application equipment? El Yes
��o [] NA
El NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name IVALL- Phone:( yh'1 AF61 7j-lrr I
Reviewer/Inspector Signature: Date: .4Z
12128104 6ndnued

Fa�cliy Number: Date of Inspection
I �
RAQuired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readi . ly available? El Yes 2diN 0 El NA [I NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check D Yes No El NA El NE
the appropirate box. 0 WUP El Checklists 0 Design El Maps El Other
2 1. Does record keeping need improvement? If yes, check the appropriate box below. 0 Yes [�j /No [I NA EINE
0 Waste Application 0 Weekly Freeboard D Waste Analysis El Soil Analysis
0 Waste Transfers El Annual Certification
DRainfall ElStocking E]CropYield El 120 Minute Inspections El Monthly and I" Rain Inspections
Weather
Code
22. Did the facility fail to install and maintain a rain gauge?
El Yes VNo
[__1 NA
El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes B/No
[] NA
[] NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[:1 NA
El NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
El Yes � No
[__1 NA
El NE
26. Did the facility fait to have an actively certified operator in charge?
El Yes C�Xo
0 NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? D Yes [:1 No ETNA El NE
Otherlssues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than norrnal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
3 1. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33, Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
El Yes
B 'No
El NA
[I NE
El Yes
VN o
[-I NA
[__1 NE
E]Yes
WN o
[_1 NA
El NE
El Yes
EJ No
[-INA
[3 NE
El Yes
[/
e No
El NA
El NE
Yes
2/
No
El NA
[] NE
12128104

- ---------
_21jiv'ni te fflalifl�!�
M " 10", 1 IN, senvati6i
ne gen - - — - I
Type of Visit
C M pliance Inspection
C
0 Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visi(tD(2ftutine
0 Complaint
0 Follow up 0 Referral 0 Emergency
0 Other 0 Denied Access
Date of Visit, Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
MaHing Address:
Physical Address:
Facflitv Contact: Title-
Onsite Representative: GCIJ�-" JCCkJ13EDY
Certified Operator: I<f IJN% o �_
Back-up Operator:
Location of Farm:
Swine
F F-I Wean to Finish
El Wean to Feeder
R Feeder to Finish
El Farrow to Wean
El Farrow to Feeder
M Farrow to Finish
Boars
Other
JE1 Other
Phone:
Phone No:
Integrator:
operator Certification Number:
IBack-up Certification Number:
Latitude: =0 =4 Longitude: =0=1
Design Current Design Current
Capacity Population WetPoultry Capacity Population
El Layer I
El Non -Layer I
Dry Poultry
[:1 Laers
El Non -Layers
El Pullets
El Turkeys
El Turkey Poultsl
El Other
I
Dischar2es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: El Structure El Application Field 0 Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
[I
Dairy Cow
I
El
Dairy Calf
I
El
Dairy Heifej
E]
Dry Cow
Non -Dairy
Beef Stocket
Beef Feeder
El
Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
El Yes dNo [D NA El NE
El Yes
El No
E] NA
El NE
El Yes
El No
El NA
El NE
El NA
0 NE
El Yes
El No
El Yes NA El NE
El NE
0 Yes No El NA
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? 0 Yes 3 /No El NA El NE
a. If yes, is waste level into the structural freeboard? E]Yes 0 No El NA [] NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: fk 3
Spillway?: NA
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? Dyes dNo ONA ONE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed 0 Yes ZNo El NA [__1 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? E]Yes [ZNo El NA El NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? El Yes El"No El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require El Yes Z(No El NA El NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need El Yes VNo El NA El NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes 0"No El NA El NE
0 Excessive Ponding El Hydraulic Overload 0 Frozen Ground El Heavy Metals (Cu, Zn, etc.)
DPAN EIPAN>10%br101bs El Total Phosphorus 0 Failure to Incorporate Manure/Sludge into Bare Soil
El Outside of Acceptable Crop Window 0 Evidence of Wind Drift 0 Application Outside of Area
12. Crop type(s) &,0
13, Soil type(s) �_. A
14. Do the receiving crops differ from those designated in the CAWMP?
El Yes
[21 No
El NA
[__1 NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
UI'No
0 NA
0 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination',
El Yes
EKo
El NA
El NE
17. Does the facility lack adequate acreage for land application?
0 Yes
[�<
El NA
0 NE
18. Is there a lack of properly operating waste application equipment?
El Yes
Zo
El NA
El NE
11 111 �]' 11 jj�j
I ii Aitiatiois..0se'Additiona !pagevaspeceI
ener:exo aiw
I C'0 6c-s "-�II �Au_
TCLA
6J
Reviewer/tnspector Name a Phone.
Reviewer/inspector Signature: Date: !�' as'o
1212704 1 Condnued

4
_4 3 VSJ Date of Instiv
14. Facility Number: Ttion
Required Records & Documents
19. Did the facility fail to have Certificate Coverage & Permit available?
[:]
of readily
[2/yes
El N
NA
El NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
Zo
El NA
[:1 NE
the appropirate box. El WUP El Checklists [I Design 1:1 Maps El Other
2 L
Does record keeping need improvement? If yes, check the appropriate box below.
0 Yes
/No
El NA
[:1 NE
El Waste Application El Weekly Freeboard El Waste Analysis El Soil Analysis 0 Waste Transfers
El Annual Certification
El Rainfall El Stocking E]CropYield ED 120 Minute Inspections El Monthly and 1"
Rain Inspections E]WeatherCode
22,
Did the facility fail to install and maintain a rain gauge?
El Yes
E�/No
[:1 NA
0 NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
ETNO
[:1 N
NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
[] No
N
El NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El o
NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
WNo
El NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
[] No
D<A
El NE
Other Issues
29.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
D Yes
ZI No
[I NA
[:1 NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
dNo
[__1 NA
[:1 NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the faci I ity pose an odor or air quality concern?
El Yes
[2/No
[I NA
[:1 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
E�/No
[] NA
E:1 NE
General Permit? (ie/ discharge, freeboard problems, over application)
El
El
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
Yes
o
UreNo,
�No
NA
El NE
33.
Does facility require a follow-up visit by same agency?
[I Yes
�
El NA
[j NE
AdditiiD'iial�C6miTieritg.�and/6�r D'
rawun-gs:
;U'
12128104

Type of Visit ID Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
ReasonforVisit aRoutine OComplaint OFollowup 0 Emergency Notification 0 Other El Denied Access
Facifity Number Date of Visit: - Time: I I
I UM0 �Qmrational 0 Below Threshold
19 Permitted 13 Certified [3 Conditionally Certified [3 Registered Date Last Operated or Above Threshold -
Farm Name: 'y"'j14JVj' jr:�
County: A, / 161/1,11
Owner Name:
Mailing Address:
Facility Contact: —Title:
Onsite Representative: Z�.,, v 1,:�e,7 4 e /tj
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator: &&ed )e
Operator Certification Number:
0 Swine 0 Poultry 0 Cattle El Horse Latitude 0 L " Longitude 0 4
Uren DRign -11F
i RUP—mu-15-tion t -apaci
WNE]
o' ]a U a acifMrovulatio
Wean to Feeder Layer
Dairy
21 Feeder to Finish 1AZ 74 Non -Layer
10 Non -Dairy I
El Farrow to Wean
—
El Farrow to Feeder Other
El Farrow to Finish
001 5ei
El Gilts
Boars
IS �::]Eio Subsurface Dra�insPre�sent JOLagoonAren 11:1 Spray Field AreLi
--Ps§F— ID No Liquid Waste
J&Hi;ldi-n-izIP,Tn-ds7/iSF)IidiTra3ps
Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? El Yes El No
Discharge originated at: El Lagoon C1 Sprav Field El Other
a. If discharge is obsmed, was the conveyance man-made? El yes El No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) El Yes El 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) El Yes [__1 No
2. Is there evidence of past discharge from any part of the operation? El Yes El No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El Yes El No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillway Yes No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): Z_
05103101 Confinued

73F
FF2JIft�- Number: IT 9�_
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ 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, notM- 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 anv stuctures lack adequate. gauged markers with required maximum and minimum liquid level
elevation markines?
El Yes E3 No
El Yes EINO
,r,'.2,rves El No
El Yes []No
El Yes 0 No
Waste Application
10. Are there any buffers that need maiiitenance/improvement? El Yes E]No
11. Is there evidence of over application? 0 Excessive Ponding 0 PAN, El Hydraulic Overl cad 0 Yes El No
12. Crop type Alm ml�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? Yes 0 No
14. a) Does the facility lack adequate acrea,ge for land application? [I Yes ONo
b) Does the facility need a wenable acre determination? Yes [:1 No
c) This facilin is pended for a wettable acre determination? Yes El No
15.
Does the Teceivina crop need improvement?
Yes
[3 No
16.
Is there a lack of adequate waste application equipment?
0 Yes
0 No
Reouired Records & Documents
IT
Fail to have Certificate of Coveraae & General Permit or other Permit readily available?
Yes
0 No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oel WUP. checklists, design. maps. etc-)
El Yes
0 No
19.
Does record keeping need improvement? (ie/ irrigation. freeboard, waste analysis & soil sample rq*rts)
Yes
[:1 No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
ED Yes
El No
21.
Did the facility fail to have a actively certified operator in charge?
Ll Yes
El No
22.
Fail to notiS- regional DWQ of emergency situations as required by General Permit?
Oel discharee. freeboard problems.. over application)
El Yes
[I No
2 33.
Did Re-,riewer,'Inspector fail to discuss reviewlinspection with on -site representative?
EJ Yes
El No
24.
Does facilityrequire a follow-up visit by same agency?
El Yes
El No
25.
Were any additional problems noted which cause noncompliance of the Certified AWNT?
El Yes
0 No
No violations or deficiencies were noted during this visit You will receive no further coiiespondence about this visit
nts� Oger qt�,
_y Z:Z��
Use drawings of facflio,to better expwm Sittiiii6nV, (use addifional,pa wnei
,gesp Field Copy Final Notes
A VAJ
le, Aez� w At- 7_13110 7- /,(j 1,0501yl-�,W VeAe)
11,4(14 -fo Ao 1/0 /,'/ �Ao�10 40 IV S' 'e 3 157,,A�yle Melloe Or '40�- 7!�r4
r1,4-Aej, A
1�le , /��
Reviewer/Inspector Name
Reviewer/Inspector Signature: ej &fd Date: _& —2
05103101 Condnued

Facility Number: '3 --4441 Date of Inspection
OAOM IMU
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. Arc 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' p�rmancntftemporary cover?
I AdditionalCornmeqfsandjor. Drawings-:�
0 Yes 0 No
El Yes El No
El Yes El No
El Yes El No
El Yes El No
El Yes [:1 No
[:1 Yes CINo
A�VO *i A 9 e, 04 -/—'0 0*4 /A
leelo ��-oyl
mad 1,111,4,0
/A 4-40 -oCAV4,%r1 144 A-ew� k,-14�,� Ze,&,'Of
17A,1-
44- A e,� 6t�
0
f le'o Ae' cw,-Wi -�:7 �k
05103101

D Wean to fee EerT
19 Feeder to Finish
1 17-76
El Farrow to Wean
�F=o�wto Feeder
�Farro�wto Finish
0 Gilts
Bo�ars
Type of Visit '0 Compliance inspection. 0 Operation Review 0 Lagoon Evaluation
ReasonforVislit ADA&464' OComplaint OFallowup 0 Emergency Nottfication 0 Other 0 Denied Access
FFacilitv Number Date of Visit: Time: E�
IQ Not Operational 0 Below Threshold.,
0 Permitted M Certified MConditionally Certified DRegistered Date Last Operated or Above Threshold:
Farm Name: Count";
Owner Name. Phone No:
Mailing Address:
Facilit-31 Contact: Title: Phone No:
Onsite Representative-
/ -,"A e4 Intelyrator:
Certified Operator: Operator Certification Number:
Location of Farm -
Swine El Pout" El Cattle El Horse Latitude Longitude
�;Design Current -,..-,Design
�Sjjjae P tky .-C
adtv' P i �apacitv!
Ciii oviiiation otil
JLJ Non -
other
Desi C
gn , , urren­
d Catdi;� idabidtiv';�
Dairy
Non- adry
%
­.TotW!-D'eS1 -C-40*iAYP�
jr.r_',Z[O Subsurface Drains Present 11E] L-Van AT. 11:1 Sprav Field
EZ. 7;�ITI, -TA,
Ljr�.rjZs:-jjLJ No Liquid Waste Management Svstern
Di5charges & Stream Impacts
1. Is.any discharge observed from any part of the operation? El Yes 0 No
Disch argeoriginated at: E] Lagoon El Spray Field El Other
a. If discharge is observed, was the conveyance man-made? El Yes El No
b. If discharge is observed, did it Teach Water of the State? (If yes, notify DWQ) El Yes El 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 D No
2. Is there evidence of past discharge from any part of the operation? El Yes El No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El Yes El No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? spillway Yes [:1 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inchcs):
05103101 Continued

[facility Number: Y/ — XF Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (Je/ 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 t6e 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 maintenance/improvement?
9, Do any stuctures lack adequate, gauged markers with required -maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement?
11. Is there evidence of over application? D Excessive Ponding 0 PAN El Hydraulic Overload
12. Crop type
El Yes El No
D Yes El No
El Yes El No
El Yes El No
El Yes 0 No
1:1 Yes 0No
El Yes El No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
Yes
[__1 No
14. a) Does the facility lack adequate acreage for land application?
EI-Yes
El No
b) Does the facility need a wettable acre determination?
El Yes
El No
c) This facility is pended for a wettable acre determination?
El Yes
[I No
15. Does the receiving crop need improvement?
El Yes
0 No
16. Is there a lack of adequate waste application equipment?
El Yes
El No
Reuuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
ONo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
0 yes
El No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
0 Yes
D No
20.
Is facility not in compliance with any applicable setback critcTia in effect at the time of design?
0 Yes
El No
21.
Did the facility fail to have a actively certified operator in charge?
Yes
[__1 No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problem, over application)
[I Yes
0 No
23.
Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
El Yes
El No
24.
Does facility require a follow-up visit by same agency?
El Yes
El No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
E3 Yes
0 No
113 No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit
"r 11
'M Myj
enM,
Copy D.Fin;
A 4 &V A
41101
t4P 4.0 1 CA#le cn
lflo� Xelit".
,V
.Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
05103101 Continued

Facility Number: 3j! Date of Inspection
ZWj
Odor Issue
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 stor9ge 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. Aiere 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 penTmentitemporary cover?
El Yes El No
El Yes E]No
El Yes El No
El Yes [--] No
0 Yes 0 No
F-1 Yes El No
El Yes El No
OSIO3101

Type of Visit % Compliance Inspection 0 Operation Review 0 Lagoon Evaluation
Reason for Visit 6�-Routine 0 Complaint 0 Follow Up 0 Emergency Notification 0 Other 1:1 Denied Access
Date of Visit: Time:
Facility Number
L__ IQ Not Operational Q Below Threshold:]
M Permitted UCertified E3 Conditionally Certified DRegistered Date Last Operated or Above Threshold:
r, F ,I .
Farm Name: County:
Owner Name: LO!2-/-
Mailing Address -
Facility Contact:
Onsite Representative: /_rew .0 &,"L', 4, r e 4z
Certified Operator:
Location of Farm:
Title:
Phone No:
Phone No. -
Integrator- Z96r,641/
01 f
Operator Certification Number -
El Swine 0 Poultry El Cattle 0 Horse Latitude 0 4 " Longitude 0 1
rD'es.1 ;C D
Design Current urrent Xuirenmt
77 1:,
-Hw '
-Caiden
Swiie'
Wean to Feeder
Feeder to Finish
El Farrow to Wean
DFarrow to Feeder
Marrow to Finish
Gilt,
Boars
M Laver
ay r I I Q Non -Dairy I
Non
10 Other I
'T' 4W
0
Discharges & Stream Impacts
1. Is any discharge observed from any part df the operation? Yes IK No
Discharge originated at-, El Lagoon El Sprav Field n Other
a. If discharge is observed, was the conveyance man-made?
El Yes 0 No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
Yes M No
c. If discharge is observed, what is the estimated Dow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) El Yes El No
2. Is there evidence of past discharge from any pan of the operation? El Yes ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Yes M-No
Waste Collection & Treatmen
4. Is storage capacity (freeboard plus storm storage) less than adequate? El Spillwav El Yes WNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (i riches): 216
OSIO3101 Continued

[Facility Number:
Date of Inspection
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 W2S answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/impTovement?
El Yes 9 No
El Yes [XNo
1;701 Yes D No
j9=9
8. Does any part of the waste management system other than waste structures require maintenance/impTovement2
0 Yes
M No
9, Do any stuctures lack adequate, gauged markcrs with required maximum and minimum liquid level
elevation markings?
Yes
5�No
Waste Application
10. Are there any buffers that need maintenance/improvement?
Yes
2 No
11, is there evidence of over application? 0 Excessive Ponding C1 PAN El Hvdraulic Overload
Yes
54-No
12, Crop type — 4611117C,14 "im// I�Wbz AW4'��
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWT")?
F-1 Yes
EgNo
14, a) Does the facility lack adequate acreage for land application?
El Yes
[A No
b) Does the facility need a wettable acre determination?
El Yes
RNo
c) This facitity is pended for a wettable acre determination?
0 Yes
RINo
15- Does the receiving crop need improvement?
& Yes
El No
16. Is there a lack of adequate waste application equipment?
E3 Yes
�gNo
Reguired Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
El Yes
JZ No
18. Does the facifity fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ AW, checklists, design, maps, etc.)
El Yes
RLNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El 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 facitity fail to have a actively certified operator in charge?
Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General PeTmit?
El Yes
1�1 No
(ic/ discharge, freeboard problems, over applicali n)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
El Yes
191 No
Lao
24. Does facility require a follow-up visit by same agency?
El Yes
W] No
25. Were any additional problems noted which caiiie noncompliance of the Certified AWNV?
El Yes
E@ No
JE3 No violations or deficiencies were noted during -this visit. You will receive no further correspondence about this visit
_71 W=i E:iZ,] PL4 i r, 4 M —J, i- i t 1: 1
Q—' Ile— -7�
qle
a dvf k1w.1 lecwl-_� tv,V� .4,411,z� &,Vv.
A Y"e xa""p
Reviewer/Inspector Name
Reviewer/Inspector Siggpature:.
Date:
05103101 Candnued

I Facility Number: 3 1 - ;f 5-1 Date of Inspection 135pil
Odor Issues
26, Does the -,discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid levd] of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
29. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure. and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31, Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill Pipe Or a permanent/temporary cover?
[3 Yes [I No
[:) Yes 0 No
El Yes El No
El Yes E]No
El Yes No
El Yes No
0 Yes No
Wddifional,C7 omznentB!knd1orVka*ing=
FW1
05103101

Type of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation
(Reason for Visit IJOf.Routine Q Complaint Q Follow up O Emergency Notification O Other ❑ Denied Aocess I
Facility Number Date of visit: ® Tune: =
NNot Operational O Below Threshold
Permitted [3 Certified 0 Conditionally Certified 0 Registered Date Last Operated or �Above Threshold:
FarmName:..........M.L1W't................................................................. ...... ...................... County:....�� •�1.L � _ ..... ....... _._ W.�_.
OwnerName: ........................ . ......................... ........................................................................ Phone No:.............................................. ............ .......... ..... _.....
FacilityContact: ............................................................................... Title:................................................................ Phone No:
MailingAddress: ..................---•-•-----••----....................................................................... ........ .......... ......... ..... _.......... ................... .... ..........................
Onsite Representative:.. ........................................... Integrator:....!.�r.........................
.......
.................
Certified Operator: .. ............................................................................................................. Operator Certification Number:1........................._................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` " Longitude • 9 «
opine -.� •1
at .' Design : Cureent =
ion Poriltry ... Ca, aci . Po ulation Cattle
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer °- Non -Dairy
❑ Other
Total Design Capacity
Total SSLW,
Nnmber;of Lagoons ❑ Subsurface Drains Present ❑Lagoon Area . ❑ Spray Field Area
Holding Poods /Solid Traps;:x.❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
9No
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
kNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Y6s
KNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
O(No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 5
Identifier: ..................................................................................................................... ........................... .......................................................................
Freeboard (inches):q
5100
Confinued on buck

Facill>< y Number: 31 — 3S ! 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
P(No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
g(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?
XYes
❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
' dNo
elevation markings?
_Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
0 No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
fi5No
12. Crop type e , •SG _
13. Do the receiving crags differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
hfNo .
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
,N No
b) Does the facility need a wettable acre determination?
❑ Yes
t'No
c) This facility is pended for a wettable acre determination?
❑ Yes
ONo
15. Does the receiving crop need improvement?
❑ Yes
E(No
16. Is there a lack of adequate waste application equipment?
❑ Yes
JyNo
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes )ONO
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes KNo
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes KNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ONo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes ;ZNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes WNo
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 0 No
25, Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes XNo
�: yiola�iggs:ejr wire noted . pang �� Vp1t; Yo0 void teoivo 40 iutit gr :
6riis deuce: aloof: this visit:
Comments (tier to questiuri #) :: Explaw any YFS answers an(dJ /or any, recou4mendshons other br.any comments.
Use- of facitity to:better: i;X_PlA 'situatiothis. (useaddttlanal pages as necess ►ry).
'7) a c� �l S s-.a.� 1►� o b v^� eS 5 l�� `c.�5 C�.v�� -.`� -► A.
-2�
[ �
� r (( V-\ C[�i'1� l
ReviewerAnspector Name ,A
Reviewer/Inspector Signature: Date: 1— �j 5100

IFacility Number:
Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 0(yes [] No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animal's not disposed of properly within 24 hours? E] . Yes P'No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, D Yes kNo
roads, building structure, and/or public property)
29, Is the land application spray system intake not located near the liquid surface of the lagoon? 0 Yes D(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.) 0 Yes RNO,
31. Do the animals feed storage bins fail to have appropriatc� cover? El Yes jq� 0
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? El Yes dNo
Additional Comments and/or -Drawings:
A�
A16
A
CIA— 1-4�4
5/00

10 Routine O Complaint O Follow-up of DWQ ins ection O Follow-up of DSWC review O Other
Facility Number Date of Inspection '7 1( OD
Time of Inspection Si Z S 24 hr. (hh:mm)
13 Permitted [3 Certified © Conditionally Certified 13 Registered 113 Not Operational Date Last Operated:
Farm Name:........ �.t.. 1.�.f..!......a r."............. County:.. U.(..�.`1.
Owner Name. -....
r yt a
................. S . .......
.......................
7................................... Phone No:.................................................................
Facility Contact:
............................................_.........................._....._
Title:........................... : Phone No:
MailingAddress:............................................................... ................................•-_--...........-_........................................................._...._.....-•----•.....-----...... ._....-_•--.............
Onsite Representative: •��t`'� T ke'I ncd- � eavlg k2l p) l Integrator:..�u.���?�.....................................................
.......................... .... /
Certified Operator:.................................................................................--............................. Operator Certitfication Number:......----................................
Location of Farm:
Latitude Longitude
- - r
= Design _ - Curretit`: Design-urrent Design Current
$wine
Ca acity-Po"ulahoa Poultry.Ca acr 1'o ulatiod Cattle - Ca acisPopulatton,
❑ Wean to Feeder
Feeder to Finish
/Z
�j 4
❑ Farrow to Wean
❑ Farrow to Feeder
Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer
".: ❑ Non -Layer
❑ Other
I❑ Non -Dairy l I I'
Total Design Capacity
:Total SSLW--
Discharges & Stream I, mpacts
1. Is any discharge observed from any part of the operation? ❑ Yes kZJ No
Discharge ori¢inated 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)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: /
Freeboard (inches): 2
❑ Yes ® No
Yi /g
❑ Yes ® No
❑ Yes El No
❑ Yes ID No
❑ Yes tA No
Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes ® No
3/23/99 Continued on back

Facility Number:.?/ —, �?Q S Date of Inspection 7 1 Op
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes .TNo
(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 (5 No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes CgNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes El No
Waste Aonlication
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ® No
11- Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Yes P$No
12. Crop type 6er•,,OdZ,,p 'Pot Sfv,e1 .SN,4 11 4rg;,I
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Ej No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15.
Does the receiving crop need improvement?
❑ Yes
0 No
16.
Is there -a lack of adequate waste application equipment?
❑ Yes
R No
Required
Records & Documents
IT.
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?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
B Yes
❑ No
20
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
(@ No
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
® No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Yes
M No
(ie/ discharge, freeboard problems, over application)
❑
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
51 No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
[21 No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
j?No
-yiOTpticjnjs'ojr ddicie'h6' s -were hO eo O(Wiog �bis'visit' - Yoir< wiii-reeeiye iiti fuirthe: -
ttirres deuce abotiti this :visit: ... .
(/Se a/ -,rvG;/Io61-c -pveyp;-1A AR�s 4e /sLir
7d �reparc to- a`-'Jr*1C hU/'-'^f6a;ie-si w'�
15 C.Jork -rto �emov� ��y we6d 6 doer rennel
iGi�oavt le-vG 41'9 S)ar t v01Y
�rom rlGi✓�iG bee -2Ud4 p4s4,,,L,
19 • F r tee boG Ir
S 1
y� P✓ i 099
✓✓1 1 I r c�
P J
Reviewer/Inspector Name z
PrefNa _
Reviewer/Inspector Signature: „ Date: J71n -� Q o

FaciJity Number: -
Date of Inspection
Odor Issues
26. Does the discharge pipe frorn the confinement building to the Storage pond or lagoon fail to discharge at/or below E:1 Yes E9 No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? 0 Yes ES No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, E] Yes J!J No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? Yes No
M 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.) El Yes No
31. Do the animals feed storage bins fail to have appropriate cover? El Yes �5No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? C] Yes S No
AdditionaUComwiti�hts-ai3d/or-,,DraWings
T�
IU,9 7-E: I-Vois4a f)o-i J2�P e.,, e/n c,,, e K Y"L L/
u A e 1 4 11 ur v S-e c,," q f 0 kJ -C
/1'7 WA-reL- Fe-I)otl a
OCC'V)e're01 01-1 ' /Pr
L, do tIS ;-7 LVel ' 4 e- F I e, )'9 .
3/23/99-

-ition
onserv., -:Oper
[3 Division of Soil and Waitier C atioli kivi�w,
Vai r-,"onserva on�-7�,C�molian�6�Inspeetidii,l��,�-'�.
sE].Pivision of Sofl and 6 C ti
a
7-
13.1) vision -of Water:Qiiality;
-�Cb�pjO ian e-Ingpectioh
�Reiriiw_­
-Other Agency.- 00�
77
IQ Routine 0 Complaint 0 Follow-up of DWQ inspection 0 Follow -tie of DSWC review 0 Other
Facility Number Date of Inspection
I Time of Inspection 24 hr. (hh:mm)
rinnitted Certified [3 Conditionally Certified E3 Registered 1[3 Not Oper �pQ- el,a�st Operated: ..........................
0(pe K(
............ ......
Farm Name . .......... &.1wu ................... lifA-k County: ........ .. ........ ...... 670
............ I ............................................. ................
Owner Name: -r- . ...... ptfd��
..... .. ........
Facilitv Contact: ..Q-:6qV ............. Title: .........................
Mailing Address: ....... (e ......... Ch.b"V-C_A_z ...... ?"O't ........ I ...................
Onsite Representative- .( 4 . ..i.AkIle .. d-
:3fil. 4 .......... * .........
CertifiedOperator: ................................................... ............................... 7 ..............................
Location of Farm:
Phone No . ..............
Phone No:
Integrator: ...........
...............................................
Operator Certification Number: ..........................................
I.&
........................................................ ........... .......................... I ......... L ........... I ...... ...................... L ....................... L ........... I ....... ........................... r
,W ......................... .................................. ................ .......................................................................................... ..............................................................
Latitude 0 Longitude 0 6 46
Design Current Design.. CurrOit Design _ Current
ulation. Poultry Catde' 'Capacity Populatioii-
-Capacity Pop Capacity Pooulation
[]Wean to Feeder
E] Layer Dairy
Feeder to Finish 2- JE1 Non -Layer I I El Non -Dairy
7- -7
Farrow to Wean
�7 Farrow to Feeder Other
Farrow to Finish D&igp ��*Pad�y
Gilts,
Total.
D Boars -$.SLW
.Number­�6f Lagoons 11 Subsurface Drains Present 11C] Lagoon Area 10 Spray Field Area
�Holding Poii& 0 No Liquid Waste Management System
7 Solid Traps
Discharges & Stream Impac
1. Is any discharge observed from any pan of the operation? El Yes XNo
Discharge originated at: [I Lagoon El Spray Field El Other
a. If discharge is observed, was the conveyance man-made,? E]Yes �LNO
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) Y� K110
2. Is there evidence of past discharge from any part of the operation? El Yes KNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? El Yes 0
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? [j Spillway Yes Y� No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: 2-
Freeboard(inches): ................................... ................................... ......... .......................... ................................... ...... ........ ................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, E] Yes 10 No
seepage, etc.)
3/23199 Continued on back

&0 1 kty N4j m her. 3 / — _? S' Date ol'Inspection
6. Are there structures on -site which are riot 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 Application
10, Are there any buffers that need maintenance/improvement?
11. Is there evidence -Of over application? [:] Excessive Ponding El PAN
12. Crop type
41-
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
ReQuired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ief WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback critefia 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?
this'visit:- 4,Wi1h-eb6*i66 fu h...
061apor*�of. ' ' ' ' ' ' ' * ' ' ' ' * ................. * ' ' '
'61:r�so6iride' -e*ab' * th'
HC bruf LSA I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0 Yes * 0
0 Yes P(No
[:] Yes RNO
El Yes P(NO
0 Yes 9, No
[]Yes 9(N0
El Yes *0
L] Yes K�No
El Yes q!�No
Cl Yes T(N0
Ayes El No
Ej Yes VN 0
E]Yes 1�1_No
0 Yes �Po
El Yes CPO
0 Yes r14'No
,M_
E] Yes KYNo
T
El Yes 1ANO
Yes 0
No
El Yes r
0 Yes 0 No
C6rdiments (refer to qu�stiow Eipi am VES: an�§ we: irs; "anidMir anj rino imrnefiddtion-s'� 4r,iny- oih eir_aiommi' iF�n&.� �F'
Uge-drawingspf 1:acffity-mto better-ex-pliti- nece§sa
AL
1e4A,;a
Reviewer/Inspector Name
W U
Reviewer/Inspector
Date: //�
3/23/99

FFa-cilityNurnbery� Date of I nspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to. discharge at/or below El 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 . ? 0 Yes AO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, Yes eXNO
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 960
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. �'roken i�n belts, missing or
or broken fan blade(s), inoperable shutters, etc.) Yes 0
31. Do the animals feed storage bins fail to have appropriate cover? El Yes No
Xr
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? C1 Yes XNO
3/23/99

.'; as �` .y„«6a:'�- :='xw"�'..s„,a - -�::'" �:- ..:,:::. z.E-�•.7"d-:-,;,,. .,».. ;7:�..,§�. �s', ,4' .�¢'�
❑ Division of Soil and Water Conservation ❑ Other• Agency
Q�Division of Water Quality
.ram-^-,.;.a�>r� '.,^s��;� '� �,•x s s-:a�- . �-,.� .,_*a;�r..,^;"x�.,,�.. ax� ..�,e•,«- ,�.a.?�y;",r• � �' ..�'� �� . ��'h ��'.'� �.r_�:�7g
10 Routine O Complaint O Follow-up of MVQ inspection O Follow-uE of DSWC review O Other
Date of Inspection
Facility Number 1
Time of Inspection U. 5b 24 hr. (hh:mm)
© Registered Certified 0 Applied for Permit [3 Permitted 1E3 Not O erationa! Date Last Operated:
,I
Farm Name: �- -_,l.a..C:S......Fi1kI. .. ...... County:....1/ i*.................................................................
Owner Name: 23,s.R......................t` {d Phone No:.41110..n-IR7...
FacilityContact: .................................... . ........................................ Title:.............................................................. Phone No:
clwm)4lailiug Address:....... ........... lr...._LY!............................................................&AL--A..}�N(. ,........................ .-2W.71.......
Onsite Representative ......... ;rj,-eV.1Q. Integrator ........ fl+ILi 6
Certified Operator..............................................................................................--...........--.. Operator Certification Number, ........................ .......
— ...
Location of Farm:
Latitude . • ' LC Longitude • 06 46
a ��LL
Deslgn r Cuij'rrent �� t DesignGurreIIt hlII llileAt-
MCapacrtyw=Population
Swme,.
Poultry" " Capacity Population' Cattle Capacityy PoPulaoa01
s
❑ Wean to Feeder
❑Layer ❑Dairy
Feeder to Finish
t �j ❑Non -Layer ❑Non -Dairy
Farrow to Wean
Y,S�i-r> u_
❑Other
gj ❑ Farrow to Feeder
��. ., -x. �.:�� x.l
❑Farrow to Finish
Total DeSrgn Capacity
❑Gilts
•
- E
[3 Boars
_3y T
otal SSLW-,.
Nurniter of Lagoons JkHoldmg Ponds ❑ Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area
.. .... ........ :>
«� ❑ No Liquid Waste Management System
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 0 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 Rater? (If yes, notify, DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gal/min?
-d. Does discharge bypass a lagoon system? (If yes. notify, DWQ) ❑Yes (� No
3. Is there evidence of past discharge from any part of the operation? ❑ Ye;:^] No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes 1�3 No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes No
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ( No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes No
7/25/97 Continued on back

FFa_C,1ityNumber: 31 — I
8, Are there lagoons or storage ponds on site which need to be properly closed?
Structures (La2oons.Holding Ponds, Flush Pits..etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier. .......................... .... . ............................. ...................
Freeboard(fty ............. ............... .................................... ................................... ...... ...................
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?
Z�
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an inumediate public health or envirommental threat, notify DWQ)
13, Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Applicatio
14. Is them physical evidence of over application?
(If in excess of WMF, or runoff entering waters of the State, notify DWQ)
15. Crop type ......... CX . ................. 5.4.1 50,li . ........................... . . ..................... .... . ..
TrojcL .1 ........ . .........
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities 0n1j
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available7
24, Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
13- No'violitio-n"s-or-.,defi�ie'ncie-s.-w-e-re-'n'ot'ed- during this,visit.- Yo6-wiR receive- no f&ther'-. -
....................
El Yes r"INo
VV
0 Ye's P(No
Structure 6
0 Yes No
0 Yes No
)@ Yes D No
D Yes MNo
0 Yes X No
El Yes ;"o
0 Yes 0 No
PiYes PNo
0 Yes 1�1 No
0 Yes 09 No
0 Yes P No
)AYes �(No
Yes No
Yes No
Yes JA No
hLe VA 14�5ml- <kwo be,
ympeve, U"Ovdk, 0y, (�P_Q 0.k&CeA-
160AC� Olt Jtw
7/25/97
F-1
0,,Z�, Nf�'.
Reviewer/InspectorNarne :BV
ISM
Reviewer/Inspector Signature: Date:

l(KRoutine O Cam [aint O Follow-up of DWQ inspection O Follow-up of DSWC review O Other
Date of Inspection - a
Facility Number 3 r 3isS
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
FarmStatus• ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr I5 min)) Spent on Review
® Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Notl Operational Date Last Operated: ................ ...... �...._ ..... ....._ ....�.. ..... ._._. .. ..._ ....... .
Farm Name: ,1 1� I ..... I!^�?..........._._... _.... _ .... _............... County: ._,..I —Y ..._..... ...._..., ..
Land Owner Name:.. rY1 f 4 .... _.. lTr.AVI—'-.X.­-­­.­­.­
Facility Conctact:....{........ _""....... _r........ ......._........ ........_...._._....__... Title:..... ..... ,
!Mailing Address:.
._... _ _ _
_ ..._.... _.....__.... _....
�ff
Onsite Representative: --- —---- __...-------- _.... _.
Certified Operator:.. ��.(!�1' ( ....:. ..� �, [ .
Location of Farm:
Phone No: : Z S g- c 3Z/ f
Phone No, .9.. LQ :..Z ,L�_ S 3 D_._.......
... �f..i.lnk.....1� 1.,.... :. :..._ _..__....�s7..
Integrator: �,wY k
Operator Certification Number:3.,,
.[,firs....�a.s.'�.....,�.1.L�.._.._n .._..�..FS..a... ...r....a�.�,�..?�.L�....a.._ .. _ _......xa�s.l.e....a:s..�.r...�.Lti.._
�33--------------------- ._........__------------ -- -_............. __............. .................... _._.....
_ .....__.... _ .... ry
Latitude 35 • 0 0 �" Longitude
Type of Operation and Design Capacity
P �� �Design� Cu a ent ,gin `"..D stg Current D sign kCurrent v
� - Cattle s .sF ' a
PO Mahon a Ca aCt . 'Po ulatlon'
Wean to Feeder ❑ —airy
Feeder to Finish b ❑Non La er �. ❑Non Da
�. _
Farrow to Wean �� ��
Farrow to Feeder Torsi DestgII�Capactty 1 b
71 Farrow to Finish'
❑Other ... ... .. Tot SSLW1 l 2
0x
�uinbe�%Lego n I Ho d g aiads ❑ Subsurface Drains Present
�� ��� . � � ��x " - t`� r _` � f a3 ❑Lagoon Area .(] Spray FieEd Area ✓,3 h
Hera
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/inin?
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
EkYes
❑ No
Continued an back

Facility Number: ... . Z ...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
0 Yes ESNo
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 Pop-dil
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
0 Yes 0 No
0 Yes W No
[I Yes 13 No
Structure 5 Structure 6
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............... ..................... . .....
6.
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?
2 1. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
Fox-Cerfifled Facililies!Qnly
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?
0 Yes [R No
[I Yes W No
Eff Yes 0 No
0 Yes &I No
El Yes 19-No
D Yes 0 No
0 Yes 29 No
0 Yes 0 No
0 Yes RNo
0 Yes 14 No
0 Yes KNo
0 Yes KNo
0 Yes 0 No
13 Yes [I No
9 any, er.66nVnbnts.',;,
Comments'(referto"4, a-,h"y."r'e'6"o'riiffi"ehda"tio,-n- 6th
miplailfiin�y:YES`in�*ers hfidlor'
Use,drawi�j��,��, ac�i tyjo e ion"s;;� tiona p4ges�,
ain sittia. a: -ar a
use a & S Y)
C_O_-jS t_,jL C'dL E-tLR.' C"'� V,
-0
r V-t-v- C--V
0
W &T F
C�- I - -F� t I ef
t2-, v v e- g 1,, 9-,&, -n b-f o-,n i VV,.-4 "j (cowl w-vt(
D_�
V, 0111 6 t A -A
4j�3 -0_ �-a
L 1
2-11 - 6�t 0'3 -L f-t
I
all
.N
Reviewer/Inspector Name
Reviewer/Inspector Signature: rs'_I"a"'� Date: 10j q
cc.* Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention: ____
Facility No- !; 1 3 932,
DrVISION OF ENVIRONMENTAL MANAGENMINT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE-7 1995
, Time:
Farm Name/Owner: C)oO bif- _C) Er_U4�ievlL�'� c.)� c., s 574 r
MaflinE Address:
County: - Du P
Inte---ator. Phone:
On Site Representtardive:�I, O(Ar(' Phone: "147 '1 Z
Physical Address/Location:.E4;j-5,a e `21�41'
14 N
y -5 d I
Type of Operation- S wine Poultry Cattle
Design Capacity: '417(p .. Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Larirude3�__* Ob ' 23 " Longitude.-Z7 * 3;L,," Elevation: —Feet
Circle Yes or No
Does the Animal Waste LaEoon have sufficient fret -board of 1 Foot - 25 year 2A hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard<
9—Fl. Inches
Was any seepage observed from the lagoon(s)? Yes or& Was any erosion observed? Yes or4�O
Is adequate land available for spray? (9!2 o�r No Is thecover crop adequate" 62 or No
Crop(s) being utilized:
Does the facility me--t SCS minimurn setback criteria?. 200 Feet from Dwellings? (Y� or No
100 Feet from Weils? QDe or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stre=. ? Yes or CO/
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or
Is animal waste discharged into waters of the state by man-made ditch, flushini, system, or other
. similar man-made devices? Yes R�r If Yes, Please Explain.
Does the faciEtv maintain adequate waste management records (volurnes of manure, land applied,
e-7
spray irrigated on specific acreage with cove:- cro )? YC_s or No
p
Additional Comments:
I t Vx
ln�spector Name
cc: Facility Assessinent Unit
S ignature
1:se.L\ti_-1c'hmenis if Nel-ded.