310403_INSPECTIONS_20171231

IVUR I H LARULINA
Department of Environmental Qual

Division of Water Resources
Facility NUrn ber - ©Division of Soil and Water Conservation
Q Other Agency
type of Visit: t; Compliance Inspection 0 Operation Review p Structure Evaluation O Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up O Referral O Emergency Q Other O Denied Access
Date of Visit:
11 Z 11111 -) I
Arrival Time:'�`�'�'
Departure Time: County:
Farm Name:
C
1
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
tti
Onsite Representative: Kin
Phone: '110 Z°Q 305L
Integrator:
Phone:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Region:
Design
Swine Capacity
Wean to Finish
Current
Pop.
Design Current
Wet Poultry Capacity Pop. Cattle
Layer Daig Cow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er I
EJ
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current D Cow
D , P,oult , C•_a aci P,o P. Non -Dairy
Farrow to Finish
Layers
Non -Layers
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
eys
Turkey Poults.
Other
Beef Brood Cow
Other
Other
Discharges and Stream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?"
❑ Yes Y No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes `p No
❑ Yes CP No
❑ Yes y No
0 NA ❑ NE
1] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: -L4 Q.3 Date of Inspection: I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
V NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):_
Observed Freeboard (in):{�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
�p No
❑ NA
❑ NE
(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
V 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?
1j Yes
❑ No
[DNA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
T❑ Yes
No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes]
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): (mud t, I LP
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
jk3 No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
.0 No
❑ NA
q3 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No'
❑ NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
❑WUP El Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Q No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 0 No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes jQ No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: - Date of Inspection: I Z
24. D;d the facility fail to calibrate waste application equipment as required by the permit? [:]Yes EA No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 54 No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes 14 No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes V
No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings. -of facility Wo better 'explain situations (use additional pages 'as necessary):
❑ NA ❑ NE
❑NA ❑NE
❑NA ❑NE
q2NA ❑ NE
❑Yes boNo ❑NA ❑NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes �No ❑ NA ❑ NE
(23 10 " 41 -
101-3}11 (2: r\ ALZoa)
�Vj
Cckkl�46%N
NA-C �. __ U� ul� 6a QC.s Q� of AFC 1� I
Revie"/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
w«9s
0V_
Phone: SbMl 13 t4l
Date:
2141201 S

-, _ Di`vi'sion of Water Resources
�. Facility Number - Q 3 © Division of Sail and Water Conservation
®0 Other Agency
Type of Visit: ompliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time:=-J County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: n Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Latitude: Longitude:
Swine
Wean to Finish
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Design Current
Cattle Capacity Pop.
DairyCow
Wean to Feeder
DairyCalf
eeder to Finish
Z. 07
too
Dai Heifer
Farrow to Wean
Farrow to Feeder
Design Current
Dry P,oult , -a aci Pdo
Layers
D Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
l . Is any discharge observed from any part of the operation? ❑ Yes ❑�M5'�D NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑Yes
No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
jrNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

Facili Number: - Date of Inspection:EZU
#Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes
a. If yes, is waste level into the structural freeboard? 0 Yes
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: f
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in): '� 1
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?
Zr No ❑ NA ❑ NE
❑No ❑NA ❑NE
Structure 6
❑ Yes E o ❑ NA ❑ NE
0 Yes 7 ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes C�No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures
require ❑ Yes ❑ f;lo
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes LE[No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes VJNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift
❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes tff No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑IVo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Epo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
VrNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
[i]'No
❑ NA
❑ NE
Required Records & Documents
e
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
Wo
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections [:]Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes dNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fac MV Number: e3l - q q 3 1 Date of Inspection: 1,n T (,
•24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes T[ "No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Po ❑ 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 <o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No [J NA ❑ NE
Other Issues
No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes [] ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes % No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
0 Yes CfNo ❑ NA ❑ NE
permit? (i_e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes [J"No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes dNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ NA ❑ NE
VNo
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�- -rA r
-- SO / / 5u ..,Pre 3 Z.^-
sOo C --,L 2roo (n Jr X.
(eS Cor 4-t e 4-
Y r." a. f Ik, j Aafer\
Reviewer/Inspector Name: [ f IL `
,, Reviewer/Inspector Signature:
6?
Page 3 of 3
vial t c 7�wee %
J l
S'T 4l 4l9 n /h' S { { i — { 1 c
J 1 fo-110. tq 710
n{C-Js 1 5" Ir r-CcrJ0, �' "
Phone: 110 7 b 7j9�
Date: ��4-
21412415

-� iv`ision of Water Resources
Facility Number - 3 M
vision of Soil and Water Conservation
her Agency MLM
rype of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Season for Visit: outine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: j t{ County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: l� J//v.11
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: Z
Certification Number:
Longitude:
Design Current
Swine Capacity Pap. Wet Poultry
Wean to Finish I ILayer
Design Current
Capacity Pop.
Design Current
Cattle 3-0-
P.op.
Dairy Cow
Wean to Feeder
I INon-Layer
Ell
Dairy Calf
�
ceder to Finish 009
JPOp
Dairy Heifer
Farrow to Wean
Design Current
D Cow
Farrow to Feeder
D r P�oult ,
ILayers
Ca �aei P.o .
Non-Dai
Farrow to Finish
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ti ❑ NA ❑ NE
❑ Yes Rzo ❑ NA ❑ NE
Page 1 of 3 21412015 Continued
L�

Facili Number: 1 jDate of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes D-15`o❑ NA ❑ NE
a. if yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): -37
Observed Freeboard (in):
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 ❑ NA ❑ NE
[:]Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
ErNo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
ErNo
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[i No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
D Yes
J No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0 o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
El yes
1J c
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
FfNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
[:]Yes Ej�o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
[DNA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[] Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes No
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

I
Facili Number: jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [ oo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑Yes ❑ No - ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 L Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
[5] No
❑ NA
❑ NE
❑ Yes
L`J No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
ETNo
❑ NA
❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes [] NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Reviewer/Inspector Signature: Date: %
Page 3 of 3 21412015

Itype of visit: Ld-uompttance Inspection U Vperation Review U Ntructure Uvatuanon tJ Iectinical Assistance
Reason for Visit: O_outine O Complaint O Follow-up O Referral O Emergencv O Other O Denied Access
Date of Visit: 20 Arrival Time: Z! 3 6vDeparture Time: County:
Farm Name: &d&A oC k2n Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator: %-n'
60
Region:
Certification Number:
f
Certification Number:
Longitude:
Design Current Design
Swine Capacity Pop. Wet Poultry Capacity
Wean to Finish Layer
Current
Pap.
EEI
Cattle
airy Cow
airy Calf
airy Heifer
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
I
Design
Dry P.oultr. Ca act
ILayers
Current
Po
D Cow
Non -Dairy
I Beef Stocker
Gilts
Non -Layers
jBeef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
❑ Yes Ef No ❑ NA ❑ NE
a. Was the conveyance man-made? ❑ Yes [�TNo ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes ["No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) []Yes 0 No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ZNo ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters [:]Yes &No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued
iI

qwe
mber: - Date of Ins ection: a /
etion & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [-]Yes C3 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes JZ_No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
[]Yes
ONo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�no
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
1;2+No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
P?No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
�} No
❑ NA
❑ NE
maintenance or improvement?
T
Waste Application 011
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes VNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Reauired Records & Documents
❑ Yes a No ❑ NA ❑ NE
❑ Yes la -No ❑ NA ❑ NE
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes WrNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check [:]Yes i�fNo ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑Design ❑ Maps [:]Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JZ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes o No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes L2(No ❑ NA ❑ NE
Page 2 of 3 � y�,,l fL `' e Calaes bale TO o �, /� 1/4/20I1 Continued

Type of Visit .E
Reason for Visit
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Inspection O Operation Review O Structure Evaluation O Technical Assistance
O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Arrival
• Departure Time: County: Region:
Owner Email:
Onsite Representative: P
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:.
;1�u
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 = f = Longitude: = o= 1
Design Current
n
F-ap
C►urrent
Design
Current
apacity Population Wet Poultry
ity
Population
Cattle Capacity
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ DairyCalf
❑ Feeder to Finish
❑ DairyHeifer
❑ Farrow to Wean Dry Poultry
❑ D Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish ❑ La ers
❑ Beef Stocker
❑ Gilts❑Non-La Non -Layers
❑ Beef Feeder
❑ Boars ❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes VNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes
�eNo
❑ NA
—IN
12128104
Contir
IF

Facili Number: - Date of Inspection: g
Waste Gollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [—]Yes �Vo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ERNo ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes '"No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes ;'No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes J2 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 121&o
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 'No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes [;]'No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes E'No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ):�'No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes J[2-14o
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ,E;;Mo
❑ NA
❑ NE
J & Is there a lack of properly operating waste application equipment?
❑ Yes 121ro
❑ NA
❑ NE
Required Records Documents
_&
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes L310
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 0No
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes JET No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking 0 Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ,E3"No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J'N
o
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

FaciliNumber: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Z No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [� o ❑ 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 PrNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes �"No ❑ NA ❑ NE
Other Issues TT
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes �To ❑ NA ❑ NE
and report mortality rates that were higher than normal? T
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 9No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes qfNo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes [jNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWNIP? ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes TT No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or,any other comments'
Use, drawings of facility to better explain situationns (use additional:pages as necessary)..
Reviewer/Inspector Name: Phone: ' / (y 7 c
Reviewer/Inspector Signature: Date: .511'�zL
Page 3 of 3 214,12011

Type of Visit (?Xo'mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance j
Reason for Visit C Woutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access I
Date of Visit: Arrival Time: Departure Time: County:
Farm Name: k 1"
�Irb
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone No:
Integrator•
Operator Certifi tion Number:
Back-up Certification Number:
Region
Location of Farm: Latitude: = c 0 6 = « Longitude: = ° = 6 =
Design
Current
Design Current Design Current
Swine
Capacity
Population
ro
bidet Poultry Capacity Population Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Daia Cow
❑ Wean to Feeder
❑Non -La er
❑ Dai Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry ❑ Dry Cow
❑ Non -Dairy
❑ Layers ❑ Beef Stocker
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers ❑ Beef Feeder
❑ Pullets
❑ Beef Brood Co
❑ Turke s
❑ Boars
Other
❑ Turkey Poults
210 Other Number of Structures:
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2.'' Is there.evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts�or potential adverse impacts to the Waters of the State s
other than from a discharge? t ;
Page I of 3
❑ Yes T o ❑ NA ❑ NE
❑ Yes XfNo
❑ NA
❑ NE
❑ Yes PNo
❑ NA
❑ NE
❑ NA,
❑ NE
❑ Yes ZNo
❑ Yes✓LJ.No
El 'NA
❑ NE
❑ Yes 12N0
❑ NA#
❑ NE
1h8/04
Continued

Fakility Number: ' Date of Inspection
Waste Collection & Treatment ,�
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XJ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes P/No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 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 IVo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes hio ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PNo ❑ NA ❑ NE
maintenance/improvement? //
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ��,,No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or I0 lbs ❑ Total Phosphorus ❑'Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Ao
❑ NA
❑ NE
l5. Does the receiving crop and/or land application site need improvement?
❑ Yes
L3 *No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
�No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
-0No
El NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
YNo
❑ NA
❑ NE
Comments (refer to.question #):`'Explain any YES. answers and/or any`recommendat►ons or°any other comments
Use:drawings of.facility to better. explain situations (pie add�ttonal pages as"necessary),
w
Reviewer/Inspector Name Phone:Xj
Reviewer/Inspector Signature: Date:
Page 2 of 3 I f/28/041 Continued

rFacility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes f No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ,LEI No ❑ NA ❑ NE
the appropriate box. - ❑ WUp ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ko ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and t" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes _0'No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yesj:]-No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes P�Qo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
',O'No
❑ Yes / ;'l-o
El NA
El NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
ElYes No
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes<o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes o
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes.,,�No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
ElYes ZNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes O'No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes PNo ❑ NA ❑ NE
Additional Comments and/or Drawings:
6 CA/
✓ Ya/�n d- /e��o�s /ash
Page 3 of 3 12128104

ision of Water Quality
` Facility Number O Division of Soil and Water Conservation
O Other Agency
Type of Visit (DeC"ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visjt,.4E!rRoutine 0 Complaint 0 Follow up 0 Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival/Time:
ime: �'�1 v eparture Time: County: �n Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: i
0_e/ �'
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Other
❑ Other
Latitude:
0
Owner Email:
Phone:
Phone No. -
Integrator:
Operator Certification Number:
Back-up Certification Number:
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
❑ Non -La ei
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Longitude:
Design Current
Cattle Capacity Population
❑ Daia Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: EJ
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ,ErNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
O'F4o
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes PNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes Vo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 0 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes JZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? Cl Yes [yNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ��,,//
9. Does any part of the waste management system other than the waste structures require ❑ Yes ldNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
W. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ No ❑ NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes q<o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or l0 lbs ❑"total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [:]Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes A❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 10No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes No
g
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: 6 ` Date:
Page 2 of 3 12128104 Continued

• Fariffty Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes �o ❑ NA ❑ NE
❑ Yes o ❑NA El NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 90 ❑ NA ❑ NE
El Waste Application El Weekly Freeboard ❑ Waste Analysis El Soil Analysis El Waste Transfers !❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes _Zo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ENo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑Yes7No
El NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? El Yes ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes O No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes jfNo ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes El o
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes 1QNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes ; No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes .rJ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes dl o
El NA
El NE
33. Does facility require a follow-up visit by same agency?
❑ Yes VNo
❑ NA
❑ NE
Additional and/or Drawings:
�Comments
AL
12128104

'A'bivision of Water Quality
Facility Number O Division of Soil and Water Conservation
0 Other Agency
Type of Visit ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit:
Farm Dame:
Owner Name:
Mailing Address:
Physical Address:
Arrival Time: Departure Time: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Owner Email:
Phone:
Phone No:
Integrator• r�!i
02
Operator Certification Number:
Back-up Certification Number:
Region: 6 1%�
Latitude: 0 0 = 6 ❑ Longitude: = o = d = 4i
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ La er
I❑ Nan -La et
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Pullets
[:]Turkeys
.
❑ Turkey Pouets
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifei
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: =I
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 URo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
P No
❑ Yes
"No
❑ NA
❑ NE
❑ Yes
[3 No
❑ NA
❑ NE
12128104 Continued

Facility ]umber: — Date of inspection
Waste Collection & Treatment /
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [I Yes 2 o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes io ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 'Jallo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes P'No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes P.No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ;2'No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑�l�o ElNA El NE
maintenance or improvement? /
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes V No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.) /
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes eENo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ❑ No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes,
es /, No ❑ NA El NE
17. Does the facility lack adequate acreage for land application? [I Yes No El NA El NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [)io ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: e2-
Reviewer/Inspector Signature: Date: 'L Q
12128104 Continued

Facility Number: 21Z—
Date of Inspection ? �i
Required Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes o
❑ NA
❑ NE
the appropirate box. ❑ WT_JP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes ❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ZNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes E214o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes p3 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes PTo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes P<o
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes Vo
❑ NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [:2 &o ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes qNo ❑ NA ❑ NE
and report the mortality rates that were higher than normal? ((
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes [ Ko ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ;dNo ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes o ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes No ❑ NA ❑ NE
Additional Commeats�and/,or Drawings:
110 3 08 .sly lY s41�1
1
11
q 4-6
e V
�v
11�
� C ��
Coll
f Fa K n-1 J- cc C-C) L
�d )f- C5(7 od -
Page 3 of 3 12/2&04

_&}Hivision of Water Quality w.
Facility Namber G O Division of Soil and Water Conservation
- — - Other Agency'.
Type of Visit lercoompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit,0 Routine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: (/ Arrival Time: �f U Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Ce fication Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: [= o [� d ❑ N Longitude: ❑ o = S = H
Design Current
Swine Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
Feeder to Finishia'�2,461
❑ Farrow to Wean
❑ Farrow to Feeder
w ❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
7r
Design. Current
Wet Poultry Capacity Population
❑ Layer
❑ Nan -La er
---------------
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Co
Number of Structures: .EJ
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes �allo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes ❑ No
❑ Yes 'PNo
El NA
❑NE
❑ Yes .ENO
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection a
'Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes [i�6
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: l
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes J:] No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes [�No
[INA 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?
❑ Yes Q-No
❑ NA ❑ NE
S. Do any of the stuctures lack adequate markers as required by the permit?
[-]Yes p No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes [I -No
❑ NA El NE
maintenance or improvement?
/
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes No
❑ NA ❑ NE
maintenance/improvement?
11. is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes El
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes I No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
'F,1 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2 No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
.�r� fGG S"�Qa C��✓ S �' ''�/
T
Reviewer/Inspector Name Phone:
Reviewer/Inspector Signature: Date:
1212814 C'nnthined

Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [,_JNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropiate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes ;Q No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,,o No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
;j No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
12-No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[2No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
(PNE
Other Issues
/
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes allo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ONo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
J[:�No
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ff No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
��
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
El Yes
eJ Noo
❑ NA
[I NE
33.
Does facility require a follow-up visit by same agency?
El Yes
U<o
❑ NA
❑ NE
Additional Comments and/or Drawings:
jo
/ 61-7. v
//A_
12128104

Type of Visit (D-dompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 'PlAoutine O Complaint O Follow up O Referral O Emergency 0 Other ❑ Denied �r Access//��
Date of Visit: 0 Arris•al Time: Departure Time: County: Region: r✓ jy--�� //?O
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other - -
Owner Email:
Phone:
Phone No
Integrator: Z&0�
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 , „ Longitude: ❑ ° = ,
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer - - -
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes AffNo ❑ NA ❑ NE
❑ Yes ❑ No
❑ NA
❑ NE
❑ Yes [-]No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes LI No
❑ Yes ZNO
❑ NA
❑ NE
❑ Yes �No ❑ NA ❑ NE
12128104 Continued

Facility Number: , — Q� Date of Inspection
Waste Collection & Treatment
4. �'s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [--]Yes KNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 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 VfNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes /No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
VNo ❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
V(No ❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) d %
13. Soil type(s)
14. Do the receiving crops diffe from those designated in the CAWMP?
❑ Yes
El No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ZNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
Ej No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
2rNo ❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
PNo ❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
AL
Reviewer/Inspector Name T Phone:
Reviewer/Inspector Signature: Date: c�
Paee 2 of 12,12 Continued

Facility Number: — C1 Date of inspection �6
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box. ❑ WIJP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Lf No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
❑ Yes U�No ❑ NA ❑ NE
r
❑ Yes No ❑ NA ❑ NE
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
oNo
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
ErNA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
[--]No
,�NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
[:]Yes
,❑ No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NAJNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Z'No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
2rNo
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
51No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes'P'ITo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
.0<o
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
,❑,Wo
❑ NA
❑ NE
Additional Comments and/or Drawings:
cam_ �J
7q�a� 3.3
7 /0 2
l� �2C�
Page 3 of 3 12/28/04

Division of Water Quality
0 =ty ber] Division of Soil and �C A,5ter onservation
Other Agency
Type of Visit Compliance Inspection O Operation Review O Structure Evaluation O Technical=Access
Reason for Visit Routine O Complaint O Foilow up O Referral O Emergency O Other ❑) ,�
Date of Visit:9 � 4 Arrival Time: .sue Q Departure Time: County: Region: L6G�/`C
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator:
Certified Operator: Operator Certification Number:
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: ❑ o = t = Longitude: ❑ o =1 , ❑ "
Design Current.
M Design Current
s: Design Current
Swine
Capacity Population
02❑
Wet i'oultry TCapQsci opuration r
❑ La er
❑Non -La er
Dry Poultry
Cattle it `CapPaacity Population
❑ Daia Cow
❑ Dairy Calf
Daia Heifej
❑ Da Cow
ElNon-Dairy
Wean to Finish
can to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
❑Non -La Non -Layers
El Pullets
❑ Turkeys
El Beef Stocker
❑Beef Feeder
❑ Beef Brood Cowl
❑ Gilts
❑ Boars
Other
El urkey Points
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man -trade?
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?
r-
❑ Yes FfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
2fNo
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

Facility ]Number: —Vo.Date of Inspection oZ
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ❑ No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): l
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 2TNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ONo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �no ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 1
0 ❑ 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 ONo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes eNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 0No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, zn, etc.)
❑ PAN ❑ PAN > 10% or l o lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
.10
gNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[]
Yes
PNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
7No
❑ NA
❑ NE
f �/r !� %� %'C�Q /cS
,���� area
Reviewer/inspector Name c�✓ Q- Phone: a^
Reviewer/Inspector Signature: Date: 12- ,-
12/28/ Continued

Facility_Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes RfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes VNo ❑ NA ❑ NE
the appropirate box.
❑ WUP El Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall []Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 ° Rain Inspections
/ ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? [IYes O No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VfNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA eNE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA XNE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ZNo ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA )eNE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes PNo ElNA El NE
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document ElYes KNo ElNA ❑ 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? ❑ YesNo ElNA ElNE
If yes, contact a regional Air Quality representative immediately !!!!!!
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes teNo ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes PTNo ❑ NA ❑ NE
Additional Comments and/or Drawings
�il/ c� �C GUCIiO
Ile ?no/7
I2128104

Type of Visit XCompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit 94utine Q Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 3 tote of visit: ! Time:
Q Not O erational O Below Threshold
J3�Permitted �Cer[ified © Conditionally CCeertmed j3 Registered Date Last Operated or Above Threshold: --. _._...........
Farm Name: .. .e l*'!'I AP...1.f�.L .t �'�..........��.._.W..... Coumty:......i..� /�f :1.................. ...............
OwnerName: -.M,._ ............................... _ ..... __.... �. ..� - .� — - Phone No: ._.... ._. ..._ ..._......._ ..� .. .
MailingAddress:.......................................................... ...� .................
Facilitv Contact: __._.._. Title: Phone No: .. _.
r ...1.!' l_.
Onsite Representative; r,.�.lZll.... �+�........................................ Integrator: �` W .
Certified Operator:------ .................. ........_ ..............------- _.....---_...... I...... Operator Certification Number:................
Location of Farm:
❑&"wine ❑ Poultry ❑ Cattle ❑ Horse Latitude �• �� 0« Longitude �• �' �s'
Ign ,Current t Desigii Current Design = Current
_ `SWEiiC - _ �/�ow i�..4v : Dnwnlokinw pAtlltrV i _ 1 c f �e�i.i�r , jln�nis�nn�'W C9 • We .� o��mfv�1�ni�I.i4n�s :..,.
❑ Wean to Feeder
eeder to Finish
`=
Farrow to Wean
Farrow to Feeder
Farrow to Finish
-
Gilts
r
❑ Boars
'Number of Lagoa
Discharges & Stream Impacts
MM
Boom
z
1. Is any discharge observed from any part of the operation? ❑ Yes JVNo
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 .E-114o
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes'QNo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 43I o
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .... .... - .................................... ...... ........................ ..I .... ......... ......................... ........... .......
Freeboard (inches):
12112103 Continued

Facility Number: j j— 3 Date of Inspection 7 D
i
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes J?No
i;� seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 2-No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 2M
8. Does any part of the waste management system other than waste structures require maintenancefimprovement? ❑ Yes EI'N0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes _21go
elevation markings?
Waste Aoulicalion
10. Are there any buffers that need maintenance/improvement? ❑ Yes 01TO
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes .2Vo
❑ Excessive Poog ❑ PAN ❑ Hydraulic Overload ❑ Frozen 11Ground�r ❑ Copper and/or Zinc
Al/ �
12. Crop type r/x/r i �f/ra / / , f?' �rl� ..► ) , \ 1
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ,�o
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift daring land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
❑ Yes j2No
❑ Yes 214o
❑ Yes �o
❑ Yes ,! No
❑ Yes �o
❑ Yes ,2190
❑ Yes J1Qo
❑ Yes ❑1C
❑ Yes JP-M'
C.omments (refer q`uesitoa ) Ex& iiijT ES veers and/or at r oar or aaylothei rnn�menrs.
eadat y
Use drawutgs of iaciLty�tn better explain sitaabbns (nseaddtttoaal+pages as necessary) ❑ Fteld Capy ❑ Fxnal Notes
a/re i�t cra �h��i'�
•
Reviewer/Inspmtor Name
Reviewer/Inspector Signature: Date: "7 / ZO
12112103 1 Continued

Facility Number:37 O Date of Inspection ! O
.Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
E11No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
Q'90
23, Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
LNo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Z No
25. Did the facility fail to have a actively certified operator in charge?
❑ Yes
ENo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
2No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
j2No
28. Does facility require a follow-up visit by same agency?
❑ Yes
12'No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
�No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
Ergo
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

r
1�k
r �,-ter _ .�;. a � �. �.:.,.�......�.� �.:.�-�_�•--� -� -:�
1� Type of Visit j8} Compliance Inspection O Operation Review O Lagoon Evaluation
]
Reason for Visit (Routine Q Complaint O Follow up Q Emergency Notification 0 Other ❑ Denied Access
Facility Number Date of Visit: Time:
rO Not Operational 0 Below Threshold
Permitted ®. Ce-r-ti�fieed [3Conditionally Certified ©Registered Date Last Operated or Above/Threshold:
Farm Name:
uPi�i�/ C j7�!X'/ County. A
Owner Name:
Mailing Address:
Facility Contact: %� Title:
Onsite Representative: zt' "%
Certified Operator:
Location of Farm:
Phone No:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' • 0 " Longitude �• 0 0
❑ Wean to Feeder
1'2P&10
I
91 Feeder to Finish
E]
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Discharges & tream impacts
l . Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes. notify DWQ)
c. If discharge is observed.. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): zo
05103101
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
No
❑ Yes
No
❑ Yes �ZNo
Structure 6
Continued

r�
Facility Number: 3/ - ZO Date of inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ,❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ErNo
(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 2rNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ZI No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes PTNo
Waste Aonlication
10. Are there any buffers that need maintenance/improvement? ❑ Yes ZNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑'No
n //
12_ Crop type.�.�1/hu �rL
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONO
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ONo
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
WNo
16.
is there a lack of adequate waste application equipment?
❑ Yes
ZNo
Required Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
ZNo
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
gNo
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
7No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
;ZNo
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
VNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONO
(iel discharge, freeboard problems, over application)
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�o
24.
Does facility require a follow-up visit by same agency?
❑ Yes
�INo
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
W'No
No violations or deficiencies were noted during this visit You will receive no further correspondence about this visit.
;Comments (referto questi;an #): _Explain aay YES aas�ers�artd/ar anv recommeDdadotis or anv otltercomments=� _. _
iise..drawings otfacifity to better ezptatn srttttms._(nseadtit4onalpages as necessary)— �
_ — —
❑Field Copv ❑ Fina] Notes
A6 Corms yl- Zoo A � o
T
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: Z
05103101 1/ Y
Continued

✓i
Facility Number: Q Date of Inspection 2 /�
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanentitemporary cover?
Additir3nal Comments:andlor Drawings: - ;
05103101
❑ Yes Er No
❑ Yes .TNo
❑ Yes eETNo
❑ Yes kffNo
❑ Yes E� No
❑ Yes 2fNo
Cl Yes 2No

Facility Number
Date of visit: 3 ZO Time:
10 3
Not Operational 0 Below Threshold
Permitted ® Certified 13CondittionallyyCertified D Registered Date Last Operated or Above Threshold:
Farm Name: URVY i/ �It?C�a i Ti(/��11 County:
Owner Name: ��ireL Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative: _ZlD` �li )°_
Certified Operator:
Location of Farm:
��,,yyP,,hone No:
Integrator: �^,1— 4s
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 4 Du Longitude 0 6
Design
Current
Design Current Design t*urrent
Swine Ga aei
Eo ula 'on Poultry
Ga achy P,o ulation Cattle Ca acity Ea ulation
❑ La er
= ❑Dai
Finish
❑Non -La er
❑Non-Dai
rFeeder
Wean
o Feeder
Other
o Finish
Total Desin C►►oaci
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ La ooa Area ❑ Spray Field Area
Holding Ponds / Solid I raps
W❑ No
Li uid Waste Mana ement S stem
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes M No
Discharge originated at: ❑ Laizoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ;] No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Freeboard (inches): 3D
05103101 Continued

Facility Number: 3 Date of Inspection o 6L
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,
❑ Yes
�No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
PNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
®No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
®No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
&NO
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
19 No
IL Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
El Yes
09 No
12. Crop type _ fity�.11lrkli (6 � l�� I/t �N&�`Std�C �ke L(TulO ��4
el
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
WNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
ZNo
b) Does the facility need a wettable acre determination?
❑ Yes
R§No
c) This facility is pended for a wettable acre determination?
❑ Yes
JkNo
15. Does the receiving crop need improvement?
❑ Yes
ENNo
16. Is there a lack of adequate waste application equipment?
❑ Yes
[�INO
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
MNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
&No
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
0 No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
RNo
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
[1 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
RNo
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
24. Does facility require a follow-up visit by same agency?
❑ Yes
O No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
O No
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comritents.(refert o que�st�on#,� Exp�a�n�anyfXES_answers_andlor.any recomnr�endattons or any�o#her c nunnents �� " ��"w
Usedraw ngsof�faility to*better e%plain srtuahons(use add�tronalpages s pecessary}
�' �� .�:�.. "` �' q,. � `� . � � �= �. �.. �.;.� F � �� v � �-.�,t ❑Field COpY ❑Final Notes
. .
/.. l'7 " A P64
A5���✓9 d.'Y �.�r��¢ �j �e CO
Aco/A fit I-.n
ReviewerlInspector Name (�
Reviewer/Inspector Signature: Date: Zr6Z
05103101 Continued

's
Facility Number: 31 Date of Inspection Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Jallo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes Ik No
5/00

-
- O Drsion of Soiil and Water Conservation v�
. Q Other Agency, _ _ �
r
f Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation
n for Visit Routine O Complaint O Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number
3% Qi 3 Date of Visit: I Jr , ;)-Zr—)Time. a Printed on: 7/21/2000
O Not Operational O Below Threshold
0 Permitted 0 Certified [3 Conditionally Certified [3 Registered
Farm Name:.........J�e..' d✓ .. ` �............
Owner Name:..................................................................
p( ...........
Facility Contact:
.................................... Title.
Date Last Operated or Above Threshold: ...................."....
County: . uP. �. i'' !.............
Phone No:
Phone No:
MailingAddress..... ..................... ............................................................................ ...... .....
-� fi
Onsite Representative: V e ('f iu✓t Q..l�e }1 .. Integrator:... ..........................................................
Certified Operator:—............................................................. . Operator Certification Number:
Location 'of Farm:
Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • & 44 Longitude • 6 66
Y;-- Design Current
„_. -----------------
Wean to Feeder
Feeder to Finish
20 00
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
"$ Boars
Design Current Design Current
P00try Ca citv Population Cattle. Capacity'Po ulati6n
❑ Layer ❑ Dairy
❑ Non -Layer 1 1 ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present Lag -an Area ❑ Spray Field Area
❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ................ ...... —.......... ........... ......................... ................................ .......................................
Freeboard (inches): 38
S/00
❑ Yes 'P�No
❑ Yes zNo
❑ Yes � No
11 to
❑ Yes 0"No
❑ Yes �Mo
❑ Yes oNo
❑ Yesi No
i
Structure 6
Continued on back

Facility Number: 3 r — Q 3 Date of 111spection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, Yes �No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes �No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement?
❑ Yes JEJNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes ONO
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes Q No
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes ,&No
11, Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes No
12. Crop type Ccv r Q s All 6 r-c #1 e- -c ue
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP).
❑ Yes No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes ONO
b) Does the facility need a wettable acre determination?
❑ Yes VINO
c) This facility is pended for a wettable acre determination?
❑ Yes ;M
15. Does the receiving crop need improvement?
❑ Yes XNo
16. Is there a lack of adequate waste application equipment?
❑ Yes J21No
Re wired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes Jio
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
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
./EfNo
❑ Yes No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes/No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
Eles )No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
24. Does facility require a follow-up visit by same agency?
'�`No
❑ Yes �' o
25, Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes�No
:: INo yWMidfis or 044 ncics were 06- fed• d&ifig this:visit; Y04 Will •tch0ive iio further. • : • : -
caries oridence a�auti this :visit.
Comiuents {refer to question #) ` Explatn'any YES answers and/or any. recommendations or any er po uuuents-
�q -6,- sure 4o u-se a wa-0e Q1) .5,5 at)a-�ed w; k;n 6o �s af' S�,^a�;.�
-�ke �K<-Z �o,��^-��.Z 1`e�or''v""te�0( 'f� 4gke l�✓o�S-�t s,\ ^pjesc\i.p-i
r�CJ days,p r;s �fo ptlrt.�i"9 4o k'' O'-J wtvH161SCIn
o , Rre -5, yr�
Use 0, of =-�Ferc -TICK-Z Ir ear-', Gro p0lq . l
�l .1
-T-Lte fo, c T j t'4 y 15
w e r f j<erj -
Reviewer/Inspector Name O•? e w c, !. . !'t/],gi1t'S : ';
Reviewer/Inspector Signature:.
Date: 5
5100

Facility Number. 3 j i�� Date of Inspection p Printed on: 7/21/2000
Odot.Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes IE!CNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes,,ETNo
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 _0"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.) ❑ Yes01NO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �No
32_ Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
5100

Facility Number Date of Visit: �� Time: � Printed on: 10/2612000
L_ G3
0 Not O erational Q Below Threshold
Permitted 0 Certified (3 Conditionally Certified (] Registered Date Last OperateA or Above Threshold:
Farm Name: W� `� County:..1....................................................
. I................t........................................I........................ ...............G-P 1>�
Owner Name:
........................................
FacilityContact:..............................................................................Title:
MailingAddress: ..........................................................................................
Onsite Representative:... ..1"........................................................................
Certified Operator: ................................................... ..........
Location of Farm:
Phone No:
Phone No:
....................................
................................... ....... ........................................ ............
Integrator:......" ..! `✓J� 4,................
Operator Certification 4N•umber
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 4 14 Longitude a ° «
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish S000 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons
Holding Ponds / Solid Traps
❑ Subsurface Drains Present ❑ Lagoon Area JoSpray Field Area
I-1 No Liouid Waste Manaeement Svstem
Discharges & Stream Im acts
1. Is any discharge observed from any part of the operation?
❑ Yes
VNo
Discharge originated at: [I 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 disc;harize 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
M No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
�iNo
Structure i Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: ........... ---
Freeboard (inches):
5100 Continued
on back

acility Number: 5 � Date of l.nspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes "No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ YesNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenancelimprovement? ❑ Yes ONO
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes XNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ,KYes ❑ No
Waste_ Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over ap Iication? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes 56o
12. Crop typep�
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?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
• : �1o•violaii�ns:or• defeiencies �er� noY:oi, wiil•[reeeiye ttiti further • : •
rresp . •Co ondence: abotif this visit.
❑ Yes UNo
El Yes 19fNo
'Yes ;qN%--:a
❑ Yes CNo
bRcyes ❑ No
❑ Yes )j�No
❑ Yes t�No
❑ Yes );�No
❑ Yes ONO
❑ Yes VNo
❑ Yes 'NfNo
❑ Yes No
❑ Yes EkNo
❑ Yes bOo
❑ Yes I`No
Gominents (refer to question #): -Explain any YES answers:and/oeany recommendations or -any other comments .T
Use drawings'of facility to better explain situations. (use additional pages as necessary) ; .
=1,"4 Y"
�s) s V -]- QLAZIley Y� sE�c+2d ti•e -�t � . �CwQ .G:d-.a.�
i �' �� t► r [Q e�c� ►��� a� �� G �-1 e�,� C�� d t 51.�'-t i5+`�
Reviewer/Inspector Name � "t,
Reviewer/Inspector Signature: Ql Date: 5/00

FaciHty Number: Date of Inspection Printed on: 10/26/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below j Yes ❑ No
liquid level of lagoon or storage pond with no agitation? Y
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �O No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes )�INo
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 /0 No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 10 No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ANo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ANO
Additional Comments and/or Drawrngs: ,.
l C�n.��
J
5100

r
Division of Soil and Water Gonservahon - Operation Review
Division of Soil axed Water Canseryahon „Eompliance Iiispechon ti =s
Division of Water Quality-�Conipllance Inspec4ou
Other Agency„ Operation Review
y , Fr'
L x
IR Routine O Complaint O Follow-up of DWQ inspection Q Follow-up of DSWC review - O Other
Facility Number Q
Date of Inspection
Time of Inspection 24 hr. (hh:mm)
© Permitted Certified [3 Conditionally Certified (] Registered E3 Not Operation—allDate Last Operated:
�[ ,� p ..........................
Farm Name: .... ,t ed.t.�......L.li Aef j�..... FafR?'.1Fafn ................................................. County: ... slJ�lek............ ........................... .......................
Owner Name: ....._....jf irI{..... K"n..................................................•• Phone No: ....q/0..r Z9sf.n..yQQ`.1................_._...............
Facility Contact: ...................................................................... Title: ...... crll}e ............................... Phone No: 11
Mailing Address: ....... 3-5j............ 11.Er1.'ll-'hf.Li.................................. ...-C.............. I.,.......................
OnsiteRepresentative: ........................................................................................................... Integrator: ..... t...1..VX-P.6y........................................ ..............
Certified Operator: ............... , '"xq•...... K". !' el/ .. Operator Certification Number: •• I.I.-Z-5.5 ........
Location of Farm: 7
............................................................................................. . ............................................................................................ ..�_
Latitude Longitude ��• ��«
_..
Design Current "' Design Curren-nt Design Current ••._W.
Swine Capacity Population' Poultry ca acity : Po ulation Cattle Capacity Population
❑ Wean to Feeder ❑ Layer Dairy
Feeder to Finish Q� ❑ Non -Layer ❑Non -Dairy
❑ Farrow to Wean
❑ {
= ❑Farrow to Feeder � Other
❑ Farrow to Finish -. Total Design Capacity
❑ Gilts '
❑ Boars - LL = .. TotaFSSLW
Nuitnber of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
:Holding-Poii& I Solid Traps ❑ No Liquid Waste Management System _
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a- If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: ��
Freeboard(inches): .................:....................................................................................................................... .........
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes VNo
❑ Yes O No
❑ Yes No
0 4-
❑ Yes XNo
❑ Yes � No
❑ Yes IANo
❑ Yes j No
Structure 6
❑ Yes No
Continued on back
3/23/99

IFcility Number. 31 — yo Date of Inspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or.
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type
0
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 determinationT
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records &_Documents
17. Fai I 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?
(iel WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
... . vi. . ..... d fie..... mere . . .. during �h. .v. . . ... . r. p4eiye iiti If tther .
c6rresp6 idence. Aouf this visit..
❑ Yes ®No
❑ Yes )?�No
Yes ❑ No
❑ Yes r�No
❑ Yes b(No
❑ Yes I'No
❑ Yes &rNo
❑ Yes UNo
❑ Yes XNo
❑ Yes VNo
❑ Yes 0 No
❑ Yes • rNo
❑ Yes dNo
❑ Yes [4No
❑ Yes WNo
❑ Yes EZNo
❑ Yes C%No
❑ Yes '(No
❑ Yes YNo
❑ Yes dNo
❑ Yes 0 No
Comments -(refer t6_4uestion #). Ex xFai ny YES answers and/o --any-recommendaiions or:an other eommentsr
r y
,
Use drawings of facility to -Better explain.siivations (use. additional pages as_necessary) =-
�..
ii_---
Reviewer/Inspector NameVV
Reviewer/Inspector Signatures_ ,� /) „ //i W Date:
A.
3/23/99

Facility Number- 31 — 0 31 Date of Inspection Odor Issues
Issues
TI
ces the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below es o
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ["o
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 *o
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes VNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes In(No
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 3Ees�[j'IGo .
Iona ommen an or rawm - .
s
�'s x
i
r
3/23/99

0 Division of Soil and Water Conservation ❑Other Agency
a
Division of Water Quality � . � �; x
Routine O Cum laint Q Follow-u � of DWQ inspection O Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number 3 Time of Inspection 24 hr. (hh:mm)
0 Registered JA Certified © Applied for Permit 13 Permitted 113 Not Opera Date Last Operated: ..........................
FarmName: ............. 1.vtf......y_"n..j.y.....1.-.QLrnn.....-----.......................................... County:... .................................................................
Owner Name. ---.-•----•..-------•-- .- I. --..... L"r.Af,.............................................. Phone No:....�`�dl.R.�.� `1 �-��.�............................................
Facility Contact: Title ...... • Phone No:
Mailing Address:.... ...1......Luxr�4h, ..... L...ri. ......... :............................................... .......
L.............. . ................... .;? ........
....
Onsite Representative:-.-----.. ] �xjl �4.A±1.4k .............................................. Integrahir:......... kku
Certified Operator:............................................................................................................... Operator Certification Number:.............
Location of Farm:
Cketh.........S....... -acts._. ..... a.:...... .............................: �
............. .... ...........................................................I.......................... ......................................
Latitude ��.�� ��� Longitude
General
1'.
Are there any buffers that need maintenancelimprovement?
❑ Yes
No
2.
Is any discharge observed from any part of the operation?
❑ Yes
No
Discharge originated at: ❑ Lagoon' ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
C iNo
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
P No
c. If discharge is observed, what'is the estimated flow in gallntin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
No
3.
Is there evidence of past discharge from any part of the operation?
❑ Yes
(WNo
4.
Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
[pNo
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
qNo
7.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
� No
7/25/97
Continued
on back

Facility lumber: 31 — -1
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes k] No
Structures (Lagoons,tioldinLy Ponds. Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 50 No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure fi
Identifier:
Freeboard(ft): .............. 3,.T............ ........................................ ...........................................................................................................................................
10. Is seepage observed from any of the structures? 0 Yes [ No
11. Is erosion, or any other threats to the integrity bf any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers"
Waste Application
14. Is there physical evidence of over application?
(If in excess of pWMP, or runoff entering waters of the State, notify DWQ)
15. Crop type 1 SAC u.........
Verlwh..................Sn �.....�*t�i�!s........... ...- -....................................................... ..................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20, Does facility require a follow-up visit by same agency?
21. Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0 No.violations or deficiencies were'note'd during this.visit.- Yo'n4ill receive no ftirther
. correspondence about this visit
❑ Yes M No
52 Yes ❑ No
❑ Yes 5M No
❑ Yes ® No
......................................
❑ Yes RNo
❑ Yes P91No
OYes ❑ No
❑ Yes ® No
❑ Yes 8No
❑ Yes Q No
F3 Yes ❑ No
❑ Yes $3 No
❑ Yes [ANo
❑ Yes 0 No
'Comtrients'(refer"to question #): Explain any YES"answers and/or "any recomittendations yr any,, voter conatnents
Use,draw ings Wfaciltiy Vi better explain:situations.' (use'additirinaTpages'as necessary)
y
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7/25/97
Reviewer/Inspector Name Q
Reviewer/Inspector Signature: Date: 7'l�

Routine O Cam taint O Follow-up of DWQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection -lS-
Facility Number 3 3
Time of Inspection.- „� O 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:..... —....
Farm Name:
Land Owner Name: .fir W... _ v� � ....._...._................�
Facility Contact:
Title:
County: ..+'_� +'\ _.... ......., wL Cj
Phone No: ... .........
._....
Phone No:
Mailing Address: 33 !►� 1!1. _.. .....� ._.. ..... �L t ..... �.... �_.., _.
Onsite Representativej wI..1........... t: s �.. __ .. _ .... ....._ Integrator: .1;tom{
" . ....I.... k ....__ .........� �....__.....�.... �_.
Certified Operator:.... Te �� �, :. ...... f1.......... �.. __.. Operator Certification Number:..
Location of Farm:
Il n ,o,�.c .� _ ,s�•a da- �• •--- .9.1-7 ZZ.c .....__......
....s�n..�-.� t�..��.:�......tn�:�.:�-:�._.its"...1.�I..�3�._....__.....�.............._......_......................_.._....�........-..............._......_............-----.._......_ �
Latitude Longitude �• ®u
Type of Operation and Design Capacity
z Design _G�rrent Designs`# De rgnime
T Curtest
Swine Current
4�1. Ca aci Po' Mahon Poultry Ca acitv._ Po Matron _. V ttlefi �_Ca aci AF u ulat]on%
: El Wean to Feeder �� ❑ La °MD;® Feeder to Finish e ❑ Non- er a'
Farrow to Wean Y�3ykzmftogWnn
Farrow to Feeder To'9 1"esign Capacity Z p o is
Farrow to Finish
�. Total `SA p
❑ OtherRic
Nube ofL�agaons /Haldtng P ds ❑ Subsurface Drains Present W
r ❑Lagoon Area Spray Field Area
n ral
I. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenancetimprovement?
❑ Yes ® No
❑ Yes C9 No
❑ Yes ®No
❑ Yes & No
❑ Yes ®.No
❑ Yes qNo
❑ Yes &No
JR Yes ❑ No
Continued on back

J ' Facility Number:.. �,.... *-..,
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes RLNo
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 ago n and/or Holding Ponds
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure 1 Structure 2 Structure 3
Zx,. ... _.. ....2AZ.......... ........ �....
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes 0 No
g' Yes IM No
❑ Yes allo
Structure 5 Structure 6
Waste Application
14. Is there physical evidence of over application?
(If in excess ofWMP, or runoff entering waters of the State, notify DWQ)
15. Crop type $ S t.$c._.... _..._ ...._ ................. ... ................... ....
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?
For Certified Facilitits Only
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
❑ Yes El No
❑ Yes O No
& Yes ❑ No
❑ Yes gNo
❑ Yes I@ No
❑ Yes
KNo
❑ Yes
[a No
V Yes
❑ No
❑ Yes
[RNo
❑ Yes
Fa No
❑ Yes
JELNo
❑ Yes E•No
❑ Yes ®.No
19 Yes ❑ No
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ap�Ii'wtiCt.t i.�r-oY-e. e,r of
Reviewer/Inspector Name.
Reviewer/Inspector Signature:
Date: S
cc. Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

Site Requires Immediate Attention:
Facility No. jV-�D
• DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time: `f Y 5
Farm Name/Owner: Se�cy 1�••�-�4� yT�[`t j�
Mailing Address: � r
County:
Integrator: Phone: o o a 11
On Site Representative: R Ti Phone: U 9 vU
Physical, Address/Location: �4.0- '7 3 Z Aa4
P_ o e�.�G-tv
Type of Operation: Swine ✓ Poultry Cattle
Design Capacity: t ov Number of Animals on Site: O t Oy.
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3 Longitude:Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) . es" No Actual Freeboard: --3-_Ft._ Inches
Was any seepage observed from the lagoon(s)? Yes or& Was any erosion observed? Yes or 6;
7 Is adequate land available for spray? Yes or No Is the cover crop adequate? e or No
Crop(s) being utilized: A-_L Grc-1 (%�nM'1 O(lcly di,
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings?d�br No
100 Feet from Wells? ��or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state -by man-made ditch-, flushing system, or other
similar man-made devices? Yes o&,) If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with.cover crop)? Yes oro
Additional Comments:
Inspector Name
Sign e
cc: Facility Assessment Unit Use Attachments if Needed.