310429_INSPECTIONS_20171231

NUH I H LAHULINA
Department of Environmental Qual

Type of Visit: VCor pllance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 6 Routine ❑ Complaint Q Follow-ue Q Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: ��S _! County: (.� Region;
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Owner Email:
Phone:
Title: Phone:
Onsite Representative: �j MET 31—c-2tX.�JCn Integrator:
Certified Operator: Certification Number: G011%
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Swine
Wean to Finish
Design Current
Capacity Pap.
Wet Poultry
Layer
Design Current Deslgn Current
Capacity Pop. Cattle Capacity Pop.
DairyCow
Wean to feeder
5
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Farrow to Feeder
Dr. fault .
Layers
Design Current
Ca aci P,o
❑ Cow
Non -Dairy
Farrow to Finish
Beef Stocker
Gilts
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Dther�=
lro
Turkeys
Turke Faults
Other
Other
Discharees and Stream Imi)acts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
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 L1 No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes eNq
❑NA ❑NE
[:]Yes ❑ NA ❑ NE
❑ Yes Le" &o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facility Number: -4'
Date of Ins ect€ou:I L4 11-7
Waste Collection & Treatment
4. 61storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ET'No
a. Ifyes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑NA ❑NE
❑ NA ❑ NE
Structure I� Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: 61<6
Spillway?:
Designed Freeboard (in):
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 No ❑ NA ❑ NE
❑ Yes 21'No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ 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 n No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes Iti10 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ❑ o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o]
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes �No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes 2"No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
� No
❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
YNo
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
;No
❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
o
❑ NA ❑ NE
Page 2 of 3
21412015 Continued

IFacUlty Number: - ❑ate of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes o ❑ NA ❑ NE
25. It the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes �rNo ❑ 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 Ed o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes fNo ❑ NA ❑ NE
Other Issues
VNo
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 LZJ N0 ❑ NA [] NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
pen -nit'? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other;
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
NA
❑ NE
34. Does the facility require a follow-up visit by the same agency'?
❑ Yes
;No ❑ NA
❑ NE
Comments (refer to q'tiestivn.; j: I; iplain any YES. answers;andlorl.any additlonaI reeommendatlons'oi any,otl er'cutnrtients:'::.
" � fe
i,�
Use.drawings a "C"ility [v'lietiter.explain:situations:.{ use,add'itiono].'pages:us necessary} s'=
=, Ǥ
= z . � _f. ,x' �'.
Reviewer/Inspector Name: w4. k ) 1� Phone t rh'
Reviewer/Inspector Signature:
Date: U
Page 3 o, f 3 1 ' 211112015

r�
(Type of Visit: 5 rRoutine
pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: ❑ Complaint Q Fallow -up ❑ Referral Q Emergency Q Other Q Denied Access
Date of Visit: 3n Arrival Time: Departure Time: QIS County:.l�dfL-z�&) Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: f•► ,StERt�r,f �„ Integrator:
Certified Operator: Certification Number: (19011)
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
fin..
w �x
1
3.
��S
..
....... .� ......
:PG.x `•:i'aei" ::" i.:r'.
..
.. ...
.T 1 C '�i.
^ .. ....
1 •:!.
M..
vS' 1��
-
•::,.. .'E r�� ;� �:'S•;
.`
e�i 1
ry
i!',L .<.;� Ali
:�
Asa
■
--
wo
-a
_.
q
..
555
Discharp-es 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. 1s 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
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �No
❑ Yes allo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I uj•3
21412015 Continued

Facilit Number: [Dateof Inspection: 36
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: LAGasyJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 35
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �6 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 jNo ❑ 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 OWR
7. Do any of the structures need maintenance or improvement? ❑ Yes IL_I o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 2No
❑ NA
[] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes UNo
❑ 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 Dri It ❑ Application Outside of Approved Area
12. Crop Type(s):
13, Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes o
❑ NA
❑ NI?
15. Does the receiving crop and/or land application site need improvement?
0 Yes 2❑
NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
C] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes � o
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes YNNo
❑ NA
❑ NE
Required Records & Documents
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 �No
[] NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [:]Design ❑ Maps [:]Lease Agreements
❑Other:
11
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
VNo
❑ 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?
❑ YesVNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Date of Inspection:
24. Did the facilityfail to calibrate waste application equipment as re required b the ermit7 YesZ"No NANE
Ppq Y p ❑❑ ❑
25; is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes r No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structures) 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 VNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ Yes C./No
❑ Yes 17Io
❑ Yes ZJ/No
❑ Yes No
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
No
No
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments".(referto;questibn,#]:eExplain;any YES arnwers;,and/or,:any -additionalrecornmendationsor..any;other:connments.'.-..
Use drawings of. faCilityfto .f;e`tter,ex liiin:siftietinns: (use.a lditivtiaL, a' es as.riecessar ). �. R • _ ; { �3 A r • t _ t. �' ;;
Reviewer/[nspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:(04(o ' c, 139?
Date:
21412015

i
jp Division of Water Resources
Facility Number ❑ Division of Soil and Water Conservation
L�i z `t� 1 ❑ Other Agency
Type of Visit: C pliance Inspection Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine ❑ Complaint Q Follow-up ❑ Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Entail:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:��
Certified Operator:
Back-up Operator:
Title:
Location of Farm: Latitude:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feedej
Farrow to Finish
Gilts
Boars
Other
]Other
Phone:
Integrator:
Certification Number: I E02
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
b Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
,Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non-Dal
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes O/No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑Yes ❑N ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ YesNo ❑ NA ❑ NI:
Page 1 of 3 21417015 Continued

1Facilit Number: - Date of inspection:
Waste collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
ZZ
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 YNo ❑ 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 E3/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 environments hreat, notify DWR
7. Do any of the structures need maintenance or improvement? [] Ycs No D NA D NE
8. Do any of the structures lack adequate markers as required by the pen -nit?
[] Yes
dNo
❑ 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
trio
❑ 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
ZNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Oround ❑ 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
N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesF7(C
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'?
❑ Yes
L.d o
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes � io
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAW MP readily available? If yes, check
❑ Yes [;.Xo
❑ 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 YNo
❑ 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
❑ NA
❑ NE
23. If selected, did the facility tail to install and maintain rainbreakers on irrigation equipment?
❑ Yes YNo
❑ NA
❑ NE
Page 2 of 21412015 Continued

Facility Number: - Date of Inspection:
14. Did the facility fail to calibrate waste application equipment as required by the permi , ❑ Yes ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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 gNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
24. 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?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34, Does the facility require a follow-up visit by the same agency`?
❑ Yes �No ❑ NA ❑ NE
❑ Yes dNo ❑ NA ❑ NE
❑ Yes ENo ❑ NA [] NE
❑ Yes dNo
❑ Yes rNo
❑
❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to.question #): ,Explain any.,YES answers_abd/or any additional recommendations or anyother comments; ,
Use drawings of facilq to better explain situations. (use `additional -pages as necessary).:' .
LOCA-re Zp i5 o-sr,
Reviewer/Inspector Name:
Reviewer/inspector Signatu
Page 3 of 3
v . Phon(A�
re: Date: G
21412 I5

Svlo�
Type of Visit: (0 Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up a Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: 3 $ County: jP t Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsitc Representative: P'NLT LTC-Li.-so(s' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: M bn l
Certification Number;
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poul#ry
Capacity
Pvp.
Cattle Capacity
Pop.
Finish
]Layer
DairyCow
Feeder
]Non -Layer
DairyCalf
o Finish
Dairylicifer
o Wean
Design
Current
❑ Cow
to Feeder
Dr. P.oultr.
Ga acit
Pop.
Non -Dairy
pto
to Finish
La ers
BeefStocker
Non -La ers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
Poults
Other
Dischartzes and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
[] No
[] NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes V
o❑ NA ❑ NE
Yes o ❑ NA ❑ NE
❑ Yes [ No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

Facilit Number: IDate of Inspection:
Waste Collection &Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: (AC�O
Spillway?: _
Designed Freeboard (in): _
Observed Freeboard (in): 3 _
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
❑ Yes
Structure 5
2r/No ❑ NA ❑ NE
[:]No ❑ NA ❑ NE
Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes dNo [] NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ElYes [FNo [] NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes &No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [3 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
I9. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes Ej No
E(y e s. ❑ No
❑ Yes ►[�N0
❑ Yes M/No
❑ Yes [2fNo
❑ NA ❑ NE
❑ NA ❑ NE
[]NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes �o [] NA ❑ NE
[:]Yes fNo ❑ NA ❑ NE
❑ WUP ❑Checklists [3 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Ycs 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 d ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes VNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

a •
/Facility Number: =��_ - -{�L"j Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permi b ❑Yeso ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Ej/No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N❑ ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes E(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)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes P N❑ ❑ NA [] NE
❑ Yes �No ❑ NA [] NE
❑ Yes Vo ❑ NA ❑ NE
[:]Yes E5"No ❑ NA ❑ NE
❑ Yes d/No ❑ NA ❑ NE
[—]Yes <) ❑ NA ❑ NE
❑ Yes ca<o ❑ NA ❑ NE
.......... 1....,N,.....,...,,,,,... � F-- - ........% I - -
Reviewer/Inspector Signature: Date:
Page 3 of 3 2/4/2011

Type of Visit: Q Cpllance Inspection O Operation Review Q Structure Evaluation a Technical Assistance
Reason for Visit: Routine O Com laint Q Follow-up O Referral O Emergency O Other 0��Denied Access
Date of Visit: Arrival Time: ® Departure Time: ®County: DLJQ L. Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
S-rE►� Dnsite Representative: -__ ��� ¢�IL7 L<` L.�QJ� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: \ a79
Certification Number:
Longitude:
Design. Current
Design
Current
Design Current
Swine
Eapacity
Pap.
Wet=Poultry
Capacity
Pop.
Cattle Capacity
Pop.
Wcan to Finish
Layer
Dairy Cow
Wean to Feeder
Non -La er
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
ll P.ault .
Ga acit
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow --
Turkeys
Other
Turke Poults
tither
Other
1111111
Diseharees and Stream Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
[DNA
❑ NE
❑ Yes ❑ [DNA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 21412011 Continued

Facili Number: .31 - Date of inspection: 2-2.
l'3
Waste Collection & Treatment
44. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Z No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
[] No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3�
5. Are there any immediate threats to the integrity of any of the structures observed?
❑Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
f
6. Are there structures on -site which are not properly addressed and/or managed through a
[3 Yes
[,� No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment 1 threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes�No
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ 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
r x
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
v
❑ 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 Panding ❑ 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. Dv 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
iNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
E(to
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
dNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
E/N o
❑ NA
❑ NE
Required Records & Documents
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
NINo
❑ NA
❑ NE
t h A t b
e app op a e ❑ .
❑WUP []Checklists E] Design ❑ Maps [] Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weckly 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 ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain ra'snbreakers on irrigation equipment? ❑ Yes I rNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

IFacilt Number: 3 - Z Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
<"r5. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes jNo ❑ NA ❑ NE
the appropriate box(es) below.
0 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 fNa ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface t i I c 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
dNo
❑ NA
❑ NE
❑ Yes
EZ/No
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
No
❑ Yes
❑
❑ NA
❑ NE
Yes
�o
❑ NA
❑ NE
Yes
Comments (refer to question .#): Explain any YES answers and/or. any additional recommendations or;any,other comments::i,.ka-¢' s i. `
Use drawings of facility to better explain situations (use additional pages as necessary):... .> _'' _} ; 8 �rE . z
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: r7
Date: L
21412011

Type of Visit: OCorgpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine Q Complaint 0 Follow-up Q Referral a Emergency Q Other Q Denied Access
Date of Visit: sj j S L Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone:
Onsite Representative: } '� S-T(-_LLW4 G Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Wean to Finish
ILa
er
Wean to Feeder
Non-L
Feeder to Finish
Farrow to Wean
D • P,[
Farrow to Feeder
Farrow to Finish
Layers
Gilts
Non-L�
Boars
Pullets
Poults
Other
Certification Number:
Certification Number:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Cy ow
Cy alf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes -r] No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes ❑ o ❑ NA ❑ NE
❑YesVNo
❑NA ❑NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

lFacility Nui'hber: jDate of Inspection: I
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ZNo ❑ 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: LKrO60
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes �IVo [] NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes �(No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes io �] NA ❑ NE
maintenance or improvement? 7
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 2j"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
ENo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
E?/No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[2r"No
❑ NA
❑ NE
Reauired Records & Documents
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
�o
❑ 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 trio ❑ 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 ESNo ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA [] NE
Page 2 of 3 21417011 Continued

Faeilit NuMber: -HLEJ Ds ection:
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes LV
o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [ No ❑ NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document [:]Yes ZNo ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes 0 No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the 0 Yes ❑ 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 ] No
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
[� o ❑ NA ❑ NE
No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/inspector fail to discuss reviewtinspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes
❑ Yes
❑ Yes
Date
❑ NA
❑ NE
It t Z.
21412011

f
Div, islun°of Waler', ualit
'JURY cull- fY W Y
:.a Facilt "N`timber.: 0. a -Soil rid,. ater Co leer utiiin .; = r
n A `enc " =� 3_ g
F {n
Type of Visit Co
Pilance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Q Complaint Q Follow up ()Referral Q Emergency Q Other ❑ Denied Access
pate of Visit: a i► Arrival Time: Departure Time: County' Region:
Farm Name: Owner Email: —----.-.----_--. _..-.
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative:y►A�i ���� �'Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 0 F 0 FF Longitude: = e= t= ff
Uesi Cu r. Uegi �n ,.Gurrcrtt ¢:� . Ilesign� Current ,;v= gnu-:` rrent
t . :.e...
•.�r- •�• "a.... =art=z ��•;�a �F
Swine., a Wet Pout#r fir _..Guttle r - fl ' °
Ci` acli` :I'o ulntion. 3 `>:Ca' self Po ulatiori, sa.:; Ca stciti 4'a ulation
p Y�: R Ya- ,p.. Y: p, � � P..��.Y: , .,-
t.:
❑ Wean to Finish
® Wean to Feeder
5 Z
❑ Feeder to Finish
❑ Farrow to Wean
❑ harrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
ems..
'r sr
Other
❑ Layer
[] Dai Cow
❑ Non -La er
❑Dai
Calf
SF,,:d,,. _ §,
❑ Daia
Heifer
Dry
Cow
_y..x°<
❑
❑ Layers
❑ Non -Layers.
❑ Pullets
❑ Turkeys
El -Turkey Poults
❑ Other
x Non-Dai
❑ Beef Stocker
❑ Beef Feeder F
4 ❑ Beef Brood Cow
[ c• g
!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?
&,0
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ No ❑ NA
❑ NE
❑ Yes
❑ Yes
❑ NA
fN
❑ NE
❑ Yes
❑ NA
❑ NE
Page 1 of 3
12128104 Continued

Facility Number: — Date of Inspection 3
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 2No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
re i Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LStruct
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3R
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.) ,�
6. Are there structures on -site which are not properly addressed and/or managed El Yes L`J N❑ ❑ 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 �N❑ ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? D Yes E3"No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes LJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application ZNc
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 ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydrau lie Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs [:]Total Phosphorus [:]Failure to Incorporate Manure/Sludge into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ENo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
[2'* No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
El Yes
El NA
El NE
18. is there a lack of properly operating waste application equipment?
I
El Yes
,0"No
L No
❑ NA
❑ NE
Reviewer/Inspector Name YJUL t={.j 4,� Piton `� r� (v " 3
Reviewer/Inspector Signature: Date:
Page 2 of 3 12128104 Continued

r
'Facility Number: 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 appropriate box.
❑ WL]P El Checklists El Design El Maps El Other
❑ Yes [ No ❑ NA ❑ NE
❑ Yes DNo ❑ NA ❑ NE
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 l"
Rain Inspections
❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
eNo
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
E�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit`?
❑ Yes
[ZNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
d o
ElNA
ElNE
25.
Did the facility fail to have an actively certified operator in charge?
ElYes
ZN
El NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ NA
❑ NE
Other Issues
/o
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
Zo
❑ NA
❑ NC
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 concerti?
❑ Yes
Lf No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
�No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Ld No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
[21/No
❑ NA
❑ NE
iAddltlPnal Comments and/ Ur Drawings: �• i
'13.
.!£ .R :.•9.:�,..:- £�#'• F$%[.:n•.x�.:. �'�.4'.'-b ki Rid. d.8.
gt.
AL
Page 3 of 3 12178104

k
L
f Visit �Co liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
n for Visit Routine O Complaint ❑ Follow up O Referral Q Emergency O Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:�.,�
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 0 f 0 it Longitude: =° s u
❑esign Cu rent .
Design Current
Design Current
wine
Capacity Papule inn
Wet Poultry Capacity Population
Cattle Capacity Population
f[E]
❑ La er
airy Cow
Wto
��
❑Non -La er
airy Calf
❑Dai Heifer
Dr Poult •
❑ Dry Cow
❑ Farrow to Feeder
"s""�"�"
❑Non-Dai
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -La ers
❑Beef Feeder
❑ Soars
❑ Pullets
❑Beef Brood Cow
❑ Turkeys
Other
❑ TurkeyPoints
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons}?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑
El NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
El Yes
2No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
[ /No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Faci ity Number:
Date of Inspection �$
aste Collection &Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LAQa�-�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): c3
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes a/No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ,No ElNA ElNE
ElYes ICJ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental ti}reat, notify DWQ
7. Do any of the structures need maintenance or improvement? El yes ,YNo
.+(o El NA El NE
8. Do any of the stuctures tack adequate markers as required by the permit? ❑ Yes ❑ 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 TT `` ❑ NA ❑ NE
maintenance or improvement? .
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 5No ❑ NA ❑ NE
maintenance/improvement?
It. Is there evidence of incorrect application? if yes, check the appropriate box below, ❑ Yes [2/No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
El NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
WNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
6o
❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
WNo
❑ NA
❑ NE
Comm nts.'{refer tu.,question #]:a` Explain any kYES„answ.c s agdl�ir anyAIM
gecamm lotions=nr any other comments.
I se drawings of facility to"14tter explain situations. (use, ditionaat pages. as nece�ssar�).-
,.
rxA
Reviewer/Inspector Name'""°�jtj Phone. 6 " 3
Reviewer/Inspector Signature: Date: 3
n Ind n___..•._.-_r
Page 2 aJ 3 l6/Le/v�r L V/iil7iueu

Facility Number: Date of Inspection 1�
Ranuired 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. ❑ WDP ❑Checklists ❑Design ❑Maps ❑Other
El Yes VNo El NA El NE
❑ Waste Transfers ❑ Annual Certification
❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" fain Inspections Weather Code
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El �o El ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? El Yes Fo ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes E N ❑ NA El NE
26, Did the facility fail to have an actively certified operator in charge? El Yes l�N ❑ NA ElNE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes Ld No ❑ NA ❑ NE
21. Does record keeping necd improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Rainfall ❑ Stacking
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air duality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, frceboard problems, over application)
32. Did Reviewer/Inspector fail to discuss re�iewhnspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes 0�(o ❑ NA ❑ NE
❑ Yes % ❑ NA ❑ NE
❑ Yes ON,
❑ Yes E No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
Ekfti10 ❑ NA
❑ NE
❑ Yes
O'No Cl NA
❑ NE
❑ Yes
ON • El NA
❑ NE
❑ Yes
No ❑ NA
❑ NE
Additional Comments'.andlvr Urawtn s: izs '-, °� A�<� r .T..m .�
g� '�aim
Page 3 of 3
12128104
Page 3 of 3
12128104

Type of Visit 0 JRoutlnepliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit O Complaint O Follow up O Referral O Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: SAhg& S-rk& jj C'
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: o [= 9= Longitude: 00=1 0
Design Cutren[
Design Current
Design Current
Swine Capacity Population
Wct Poultry Capacity PopulA ution
Catt{e Eapacity Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
Wean to Feeder
Nan -La er
iry Calf
❑ Feeder to Finish
❑Dairy Heii'er
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
La ers
❑ Reef Stocker
ElPulleetsts Gilts
❑ No crs
❑Beef Feeder
❑ Boars
❑
❑ Beef Brood Co
El Turkeys
Other
❑ Turkey Poults
❑ Other
Number of Structures:
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'1
❑ Yes
n No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
Cl Nil
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
Ld N
❑ NA
❑ NE
3. Were there an adverse impacts or potential adverse impacts to the Waters of the State
Y p
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: — Date of Inspection Z$ d
v
'Waste Collection & Treatment
4, Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: t.R&1000-)
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): S77,
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes 2 No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �Na ❑ NA ❑ NE
❑ Yes L1 No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t7heat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes o ElNA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ElYes 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 strictures require ❑ Yes dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EfNo ❑ NA ❑ NE
maintenance/i m pro verve n t?
11. Is there evidence of incorrect application? If'yes, check the appropriate box below, ❑ Yes ZNo ❑ 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
RfNo
❑ 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
Uf
El NA
El NE
17, Does the facility lack adequate acreage for land application'?
❑ Yes
�No
LI No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
j(N o
❑ NA
❑ NE
f' ., .., 1. S7:'.' :p:s :f f:d4 '..?tiy�:f �4:."fe°.Li3bdt :;:'
fCumments (rcler;to y«estinn #): ; iiplain�atty°gYES:'answers�und/or uny. r commcndationspnr�any other comments.
�nr ..•. k: .. w.y M y .y. i''}•.. Ps ks i,
��[]se1drawin�s of better, � ����j�J�`,yYy��r k$g�:
facili[ylto explain situations.: {use ptlif itltinal pages'iis;necessary]:' >�
-:r .�i`f'S-r •; �,.�q,l•.�..°i. ���, ,.,-..".i..: . ?. `. �.� xF. :.r--: i Of. .,:i:=. •i v.,,,H n..k..A y.;:.i, v a�v� ��F.::.. J�n'F.S%::rk„R' ..'
S . a .t' f;4
A.
ReviewerlInspeetor Name _..`pU _-L - -----� -- Phone: i ~]
ReviewerlInspeetor Signature: Date:
Page 2 of 3 1 12128104 Continued

I
Facility Number: 31 ''f.L'j Date of Inspection
'Required Records & Documents ,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes Lj No ❑ NA ❑ NE
20. Does the facility fail to have all components orthe CAWMP readily available? If yes, check []Yes [ /No ❑ NA ❑ NE
the appropirate box. ❑ WDP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rain fali ❑ 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
ZIN o
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
� o
El
❑ NA
El NE
24.
Did the [facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25,
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
WNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
eNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
Z No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0<0
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 No
❑ NA
El NE
and report the mortality rates that were higher than normal?
'
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
El NA
❑ NE
If yes, contact a regional Air Quality representative immediately
ZN
31.
Did the facility fail to notify the regional office of emergency situations as required by
El Yes
❑ 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
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:7771
Page 3 of 3 12128104

Facility !Humber
0 Division of Water Quality'vj
Q Division of Soil and !Water Conservation
Other Agency � "'':�.'.•.
Type of Visit
pliance Inspection
0 Operation Review Q Structure Evaluation
Q Technical Assistance
Reason for Visit
TRoutine0 Complaint
Q Follow up Q Referral Q Emergency
Q Other ❑ denied Access
Bate of Visit: '>f 8 Arrival Time: Departure Time: County: DjeRLZW Region:
Farm Name: _
Owner Name: _—
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: t= Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c =' 0 Longitude: = 0 ='
= j
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
Z-d ❑ Non -Layer
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Cattle
Design Current` .
Capacity: Population
❑ Dal Cow
❑ Dairy Calf
❑ Dairy Heifej
❑ D Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge'?
M
[]Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
�n
❑ NA
❑ NE
❑ Yes
WNo
❑ NA
❑ NE
121,28/04 Continued

" Facility Number: I — TZ Date of Inspection
. Waste Collection & Treatment
4. Is storage capacity (structural plus stone 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: ( rmft)
Spillway?:
Designed Freeboard (in):
p
Observed Freeboard (in): p
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
E3/No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed anchor managed
❑ Yes
,_,(
IJ No
Cl 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 OWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes i( No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Lfl N❑ ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) �
9. Does any part of the waste management system other than the waste structures require El Yes r: No [] NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 1=1 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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(%)
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
-E:fNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
dNo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
d.,
El NA
El NE
18. is there a lack of properly operating waste application equipment'?
El Yes
,L_�f9oNoo
lsJ
❑ 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):
06C (36XA)G- (ZEAAcl(Eb, SL,vb66 PLaN FlZkSC►,jT.
14 c.A L-tBm r_t o1 v C E4$ r'+ tsE_ o#w� k,,r-r)v rkJ - 3 o'.PA tY "
Reviewer/Inspector Name ,t_j L Phone: ]P�- 7
99
Review�erlinspector Signature: Date: !�4t o
12128104 Continued

Y
Facility Number: — yZ Date of Inspection � +
��R dR d &D m nts
eautre
ecor s acu e
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
B No
❑ NA
❑ NE
20.
Does the facility fail to have all components of the CAWMP readily available? If yes, cheek
❑ Yes
O No
❑ NA
❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design [I Maps ❑ Other
21.
Does record keeping need improvement? I f es check the appropriate box below.
P g P Y�
❑ Yes
L� No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V
Rain Inspections ❑
Weather Code
22,
Did the facility fail to install and maintain a rain gauge?
❑ Yes
N
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
L�J No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
L( Yes
❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ErNo
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
[T'N'� o
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
90
E❑,,D�NA
L3"NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
LJ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
E No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
CJ 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
Cl Yes
CKo
❑ NA
❑ NE
General Permit? (ic/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ETN
El NA
❑ NE
33.
Does facility rcquirc a follow-up visit by same agency?
❑ Yes
❑ NA
❑ NE
Comments and/or Drawings:
12.128104

t
Division of Water [duality
=��dfityumber Q Division of Soil and Water Conservation
Other Agency
Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit &Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: N431 Arrival Time: Q tIt] Departure'I'ime: County: 1_DV?LW Region:
Farm Name: Owner Email:
Owner Name: —
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: T&.Xi Si'mcLon
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: [= a = = « Longitude: = e = t =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
© Wean to Feeder S Z. ly ovv
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
ID Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -La crs
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
Capacity Population
❑
Dairy_Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beet' 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 ld No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
El NE
❑ Yes
[:]No
El Yes
�
Ld"No
❑ NA
El NE
❑ Yes
L' I No
❑ NA
❑ NE
12128104 Continued

}
i
Facility Number: 3 l — Date of Inspection 18 a
4aste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
Zr/No
❑ 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: Lie.-v*Q
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
2(No
❑ NA
❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
2fNo
❑ 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 dNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Hoes any part of the waste management system other than the waste structures require ❑ Yes L7 No ❑ NA ❑ NE
maintenance or improvement`?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes dNo ❑ NA ❑ NE
maintenance/improvement? ,.,�
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El Yes LJ No ❑ NA ❑ NE
❑ Excessive Pond ing ❑ Hydraulic Overload [:]Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 10% or 30 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?
L7 No
El NA
El NE
15. Does the receiving crop and/or land application site need improvement?
,❑/Yes
ld Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure anchor operate per the irrigation design or wettable acre determination?[] Yes
2No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application`?
❑ Yes
E!fNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment'!
❑ Yes
2No
❑ 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):
1<,) Nu.0 Went) t..onrmot_
aq .ct(w �-vh- C LUkAAw rt)1D [APY A►►m SEN b Ca 000-
95.) QV(SU04 .30 swoGE sdukq, RA,-Dy W15 SCAO COPY ra 000, sP RVi Lxy, _oK
�o AOtL f MoJA�. '�� OA,41.
�Al,- W Igo-1061 .
Reviewer// nspector Name J ib � � l _ - Phone: jb ■VO — " 13
Reviewer/inspector Signature: Date: (v

I
i
f
Facility Number: 31 — al Date of Inspection $ o
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 2rNo ❑ NA ❑ NE
the appropirate box.
❑ WUP ❑Checklists El Design ❑Maps ❑Other
21. Does record keeping need improvement? 1f yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
[:]Waste Application [:]Weekly Freeboard ❑ Waste Analysis ❑ Soi] Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Bain Inspections
�❑ Weather Code
22, Did the facility fail to install and maintain a rain gauge? El Yes ,0"No El NA El NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElL�J Yes No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? 001yes ❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? C3' es ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes El"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No 2<A ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 3 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
9 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
3 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
L!I lvo
❑ 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
ZNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
r No
❑ NA
❑ NE
Additional Comments and/or Drawings: I
12128104

3t R. 4 a9
Type of Vlsit 0Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit CJ Routine 0 Complaint Q Follow up Q Referral Q Emergency 0 Other ❑ Denied Access
Date of Visit: a o� Arrival Time: �$ Departure Time: �.J County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: u . Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0= I 0 11 Longitude: = a Q 1=
11
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry f✓apaeity Population Eattle -- gD-S C i !-Yj Population
❑ Wean to Finish
I
I 110 Layer I
I Q Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
El Dry Cow
® Wean to Feeder
I 5SS72.
1 2S6 6
10 Non -La cr I
1
❑ Feeder to Finish
❑ Farrow to Wean
El
Dry Poultry
Farrow to Feeder
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 1 of 3
❑ Yes 6-No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
WNo
❑ NA
❑ NE
❑ Yes dNa ❑ NA ❑ NE
12128104 Continued

Faciiily Number: 3 j — q 2 !
Date of Inspection I SIT
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3 Structure 4
Identifier: LA&*oA) I
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 33
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ZNo ❑ NA ❑ NE
El Yes El No [I NA ❑NE
Structure 5 Structure 6
❑ Yes 7No
[INA ElNE
ElYes ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental thmt, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 0 N ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ yes ;No
N El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9, Does any part of the waste management system other than the waste structures require [I Yes ❑ NA ❑ NE
maintenance or improvement?
Waste Apulication
10.
Are there any required buffers, setbacks, or compliance alternatives that need
Cl Yes
2(No ❑ NA ❑ NE
main to trance/i mp rove in ent?
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 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) 3&fZ f'- t 0A L G, [yQ F6s W(-- Lc,-
13.
Soil type(s) �10 A rc,A
- _-
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement'?
❑ Yes
No ❑ NA ElNE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
No ❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application?
❑ Yes
La No ❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
044o ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any otherleomments..
Use drawings of facility to better explain situations: (use additional pages as necessary):
Vmvv%, ANO I'CACoILD4. (got[. Cr+oo.
AL
Reviewer/Inspector Name F Phone: [`AID} 71hG ..IA45
Reviewer/inspector Signature: Date:
Page 2 of 3 1 12128104 Continued

Facility Number: Date of Inspection lb d tp
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes LEI No Cl NA ❑ NE
24,
Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
ld No
❑ NA
❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑Other
21,
Does record keeping need improvement? If yes, check the appropriate box below.
El Yes
__,,��
LTNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 124 Minute Inspections ❑ Monthly and i"
Rain Inspections❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
ElYes
[3 No
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ yes
D1 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
2"NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
IXNA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
ElYes
D,<
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
[" NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
El Yes
,.,�
IdNo
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
12 No
❑ NA
❑ NE
and report the mortality rates that were higher than normal`?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
E2/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
CXo
❑ 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
El NA
❑ NE
33. Does facility require a follow-up visit by same agency?
El Yes;/No
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit ' 'Compllance Inspection D Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Vlsit',eRoutine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County:
c
Farm Name: CCU . Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title: Phone No:
r J «l
Unsitc Representative:.,t ) Q � � � .- Integrator:,,
Certified Operator:
Hack -up Operator:
Locution of Farm:
Swine
Wean to Finish
can to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Operator Certification Number:
Back-up Certification Number:
Region:l/f3
Latitude: = Q = t Longitude: = ° = 6 =
11
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non Lay er J- J... El
Dry Poultry
Non-L
Pullets
Turke
Other
DischaEgei & 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
❑
Bcef Feeder
❑
Beef Brood Cowl
I
Number of Structures:
b. Did the discharge reach waters of the State? (Byes, 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 (lie operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes L_lNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes ❑No El NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes -ffNo ❑ NA ❑ NE
❑ Yes ,D No ❑ NA ❑ NE
12128104 Continued

Facility Number: f — Date of Inspection 31 a
Waste Collection & Treatment
4.'Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: C
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): CJ
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
El Yes -E]No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes .ONo ❑ NA ❑ NE
❑ Yes -0"No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes `•0 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes .0 No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes Q 1Vo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ro ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes 13'5Io ❑ 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 EFNo ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes 0'No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination,[:] Yes ti!o ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes0-N'o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes I5 No ❑ NA ❑ NE
i'�: �1w:.,iE[.�ri`1i 'c:r`°::.�',<, .:.»�•'.i�:`''4 �:'.��:.; : ::I..:. s:'"y` D-�::'::.:�y:..-':k:.e.': '.--` a.. s..
�Cotnmetits;(t;cfer to;questiun�#j:_��Expl�ln�any:YF5sttnsrvers�andlortany�recammcndatluns or any others,comments.
tlJse`idr wlin''s'nf.�facllit Stu bei'te`i•ex'�i�fnsi[ta[ions. usea�d'ditiorial�'"$ es s nee s Ar .
��s�.:: di'�.�'r�,'4`IS"�;+�(:: �: _.. .. ...'. i�s:.C.nia��' _e:s:. ..-..._��. .. s......,3Cs:'�'u+z:��:�i�..::.r�H.�:F.'d.'17�,�'C-'�'��i�CT.S:�ek',fi� �f _ _1
Reviewer/inspector Name
Phone:
Reviewer/inspector Signature: Date: P
12128104 Continued

Facility Number: — Date of Inspection
Rciuirecl Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes O'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ZYes ❑ No ❑ NA ❑ NE
the appropiiate box. ❑ W Dp ❑ Checklists Design ❑Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. 'o"Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard 12fWaste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25, Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification'?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
❑ Yes
O'No
❑ NA
❑ NE
[--]Yes
Q No
❑ NA
❑ NE
[:]Yes
[--]No
.;D NA
❑ NE
❑ Yes
❑ No
❑'NA
❑ NE
❑ Yes
_0No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ONE
❑ Yes ,ONo ❑ NA [I -NE
❑ Yes , allo ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
2<o
❑ NA
❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
Dq�o
❑ NA
❑ NE
f t� � - .`Y�'..�n ii�l�-: ;��••..:•': .:.i ..�.F .x; �.ti'„.'k... .. �,. .�.•iA.': /��',."e,:� ..I; •.0 lx .�'f ".
��:��� •, ..Ay,.,. •:I�.r�k.�..:r:..��e;; ..s,4 . 4. _ z:';#•'••�y3=_�.,,.��.N:• ".5,a..,.. - y
Addition��;Coirimenfs` �andlor Drawlin ii: ;:;;, �: r�„ v,;,,.•: �...,�
" ea t Y) c c a 1 c� c�oa�t )w()n
I
kA) � on S1l �'eGGC�-s
;0) flea 3e c�av�,s e- 4tf` 1 t L£ 1'Ypi y'LS e U Q Yl-)5
(u5ed C3.
r_Q 00a Go
60s
dq
�, r��C� f2c c or, s
1'2128104

'-• �.�. -�.•: ,-:=n::.:i ��'::�..:. :—�-. ...li .:�•r. i[. _ '�l:: is-:: .agt:.m: rf,['t Is�n=i. ,���.'':%;%;:":£"-:«�:.:;:s --:::14": '�T:... � � :�.. [F}}.:.
.ini:., �1" c.�?':gs-r,- 4r- ., ,'1'i° = s�... , �n7� �.,,, ,r%�, .., �':if' rh"4•-- , r. p; € �:?�:�;�... �f, .!f .::I�,:I,f +. , ! fi`t'jf`!'' ��! , 'f^;" i >€eil€.
•:" s �,� �:;irr: '.,t ; , , r F �;.. ;� n ri1� srr •I�r• : '.:ii.�.f.,. ;3:# !.'
�, ;ia' t. r 1 .:!H;' t, i�k:�•� i�.•rS��.�.,,.� t€� .i.
�1:" 't]`.dl•! d' •9d:""UiYirP '4:'� . �. .!fi�:: �,i ,t � ,. H. (.
f'
.. ....:.... .:.....
�i= I� ')tii �sion:ofSoil' Water ConseErvatioa., !.� '�
..:£it!;+ -. a'�?:Iifa.' � .. �'r.. s� � � /.,{, 1' t. �.;� .r !. s �.•:j.. �: Fa ,. .. r,r ,,,il ' '-��''
.€:€::n'_ ai?:..ail•:.:- i ..`5... �Y�k..:ii}g� p". � .a?
.F„• r
�� , . .,.[',P,:,., �. _.._, � ...:�.��V;��g:,��:�iciIIlfi �:n� � , _�:a::.;,e�'nm�ys .,r9.!,?,�s�. „s:v. r. rr. .. , . ,,. _.:arid. .»,H1.".i}.h ....fd§�. • _...,,< ,_. s, k:a.
Type of Vlsit 0Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ZRoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number t)ate of Visit: Time:
Q Not Operational Below Threshold
Permitted)dC,e`rtified © Conditionally Certified [3 Registered Date Last Operated or Above Threshold: .........................
FarmName: .......... .!{..gust ...... ��i.............................................................................. County:...,:��QL.TP ....... _.................. »...... ........ ..... .......
OwnerName: ... . . ............................................ . ............... . .................................. . ................. Phone No:
MailingAddress: ..... ».......r...................r..........................................................................»......
Facility Contact:...................................................... ._..
., '. Title:............................................................... Phone No:...................................................
1 Q -r ��,
Onsite Representative: •,S �IJ T„�,� l t jS •. � �.••. t..T t1-' . Integrator:...„ .(3"4 J
Certified Operator: .........r...,..._.... ........................................................................................ Operator Certification Number:
Location of Farm -
[:]Swine ❑ Poultry ❑ cattle ❑ horse Latitude F-70
4 " Longitude ' 4 44
Design Current F Design s,i�.:Current , ,:,.� ' :� � rDesig� - Current x �_
SWiEne., .'i. r F : ,. ' . Poul r N fi ., is.y. Cattle S'[;,r', a. ,.
Ca aci Po ulation. Ca ei Po ulation;' :, ;Fr..Ca aci Pa nlatin: •;f;,
Wean to Feeder dd ❑ Layer �� ❑Dairy
❑ Feeder to Finish ❑ Non -Layer ❑ Non -Dairy
Farrow to Wean N ; • " , i ..
Other
Farrow to Feeder l ,i �.i.. 1, f i:.: ;r, w ,•i kids.',
❑ pro' _ — — F,.,.; .,, ;_ ......:,,,,+ i' -i ;.
o t0 S , . ::�C: ;i ;W a.. :;p.,.F'f . ..rr , ` �'
Farr W Plni h ar.. '' : TotW DeAgnicipi8ii,,f
Gilts .;:,,- ,r.. ;a:a r
e . f,. k E ,�
❑ , ;... ' .. ;•'. ° a;:Total Essw `. Boars �a r :;,::.
: Nuionlier of Lagoons
,..Jr.
Discbarses & Strearn Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ;I(No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. If discharge is observed, what is the estimated flow in gaumin?
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 ONo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ;TNo
Waste Collection & Treatment
4. Is storage capacity [freeboard plus storm storage] less than adequate? ❑ Spillway ❑ Yes '2(No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: .............. .............................................................r.................................................................................................................................
Freeboard {inches}: 32
12112103 Continued

Fa ' ity Number: 3 — ZQ
Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes N0
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes ;YNo
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 XN0
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes JEJNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes VNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes XNO
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes '0 No
❑ Excessive Pondiin�g ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type -- U' (71NWVA 6�_ _:5-hAAt1 _ _(QA-Xj D1ca ...
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 21No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes No
b) Does the facility need a wettable acre determination? ❑ Yes No
c) This facility is pended for a wettable acre determination? ❑ Yes XNo
15. Does the receiving crop need improvement? "XYes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes XNO
Odor Itisoes
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes o
liquid level of lagoon or storage pond with no agitation? IN
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes X No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional [:]Yes INo
Air Quality representative immediately.
.. .,....: ....e...:.:..�•: .:: �:- ..::.. .....:: ••: N +. .,_. . .. ..:.. ...x. _; ';r..p;'.::x:: s::.;r:... - ,.,;s•.::.,,.:- --.: a:: - N' ...,r.•rn .a�.:,�::.. .......,�..:�•un���n •;+ns-r.'�h�r1:5•u�,. �. •�r, •-� : ��[' }
Comments (refer.to.questton #}:F.xplaiix'tiiiy answersan YES;d/or aayrecommendations nr oily other.. Comm
�.:.{ :..� .���..�r.� ......:. sif nli....:+1*"."�F'�jH. •... r.'1:t v.�• �:. !tq - .{ • �..
{:.
Usc dr$wiagq of faciltty;ta`bettei':�icplain situations ;(t sG.iaddi#iadak pagCs as:tiecessaryj:
Field Ca Final Notes PY
�.:...�,:�•: •,�,:,+ .: .,. ..,. •. �: P:� ":�'+a�ri' � aC�
Virg t�Qti,� oa Kt:,N6 T�5Gt�E GivaW-r�1
Reviewer/Impactor Name Y.9^..:.,.t.,.r�.7....i.[,
Reviewer/Inspector Signature: Date: 311 0
12112103 1 Continued

Facility Number: Date of Inspection
Reauired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes )6 No
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.) ❑ Yes XNo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes JdNo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes PfNo
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes gfNo
28. Does facility require a follow-up visit by same agency? ❑ Yes XNo
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes P�No
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35) ❑ Yes [XNo
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 V Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit 0 Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit 0 Routine D Complaint Q Follow up ❑ Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
F1 Permitted [3 Certified
© Conditionally Certified D Registered
Farm Name: Y —.L �0,
Owner Name:—,-J14df�r
Mailing Address:
Time: ❑ n
Date Last Operated
dd}or Above Threshold: _
County: _ _LUTA,
Phone No:
Facility Contact: .} Title: Phone No:
Onsite Representative: t L/ifvF�.1____crl 1'}K2 r7��,5 L�}C11 F RIIntegrator:
Certified Operator:
Location of Farm:
Operator Certification Number:
0Swlne ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 06 �6 Longitude ' 4 OG
Design Current Design Current Design .Current
SIvine Capacity Population Poultry Capacity.Population Cattle Capacity Population
Wean to Feeder ❑ Layer QDairy
Feeder to Finish ❑ Nun -La er ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other -
Farrow to Finish Total Design Capacity
Gilts
❑ Boars Total SSLW
Number of.Lagoons ram; ❑ Subsurface Drains Present ❑ La von Area ❑ S ray Ficid Area
HUldin funds I Solid Tra s
g p rw�:: ❑ No Liquid Waste Management System
Discharges — StEcarn Impact
1. Is any discharge observed from any part of the operation? ❑ Yes No
Discharge originated at: ❑ Lagoon ❑ Sprav 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 ZNo
a t �CgI gdofi A, Treatment
4. is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav ❑ Yes XNo
Structure 1 Structure 2 Structure 3 Stnicture 4 Structure 5 Structure 6
Identifier:
Freeboard (inches):
05103101 Continued

Facility Number: — Date of Inspection Printcd on: 712112000
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, Cl Yes No
seepage, etc.) ffll
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes VNo
(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 JzNo
8. Does any part of the waste management system other than waste structures require maintenancclimprovemeut? ❑ Yes 7fNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes P(No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes VNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydrau�c Overload , ❑ Yes �No
i X
12. Crop type Z�W4604 ( CrR�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan
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?
Rectuired Records & Dncumcnts
17. Fail to have Certificate of Coverage & General Permit readily available?
WMP)? ❑ Yes
VfNo
❑ Yes
12fN0
❑ Yes
❑ No
❑ Yes
❑ No
❑ Yes
X No
❑ Yes
No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
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?
(iet 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?
Q f�P1At t45:01- eaeo os wore FtWing t. s'vjslteeei . e ijo fly 't r
CO* rrespo dertce' about
) IWA Ili
rjQZFo l0 r
hexo_S
Il): ExpIi1n'ii ny.'VES answers aadler any, recoiinme ir. ai
;.-�:-:-==:.:. - ... _ :::.-,::.gar.,*-'�:..�,:ws.:...... -^�ja� i ;.;.,,,s • °�+:a:-r;u:�;::;re
t eirplaln situations; (use sidditinnal; pag Pecessa!
�I�►4� 1714P 1/"�
/P
6oID.
❑ Yes 2(No
❑ Yes X"
No
❑ Yes V
No
Yes XNo
❑ Yes XNo
❑ Yes �No
❑ Yes No
❑ Yes Y'No
❑ Yes No
A.
1W
Reviewer/Inspector Name
Reviewer/Inspector Signature: / j /f-,' / Date: Slap

Facility Number: — [late of Inspection I /Z3 119
Odor Issues ` I
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes INO
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 Sand application'! (i.e. residue on neighboring vegetation, asphalt, ❑ Yes x
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 r/
or broken fan bladc(s), inoperable shutters, etc.) ❑ Yes No
31, Do the animals feed storage bins fail to have appropriate cover'? El Yes YNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/tcmporary cover? ❑ Yes ❑ No
Additional omments and/orDrawings:
J

�,.
L r
.7... ,. , ...., , •`� :�:.� _ �Dii+isioti'of Water�Qualit • �;;��:�, �;
mr ..
Yk r
a r . Q Di�is�on o[ it': anil WaterrConseir�afiori'' ,.x ,:' `you..:., 1; ,F
a
g. �... __ e.�..: �:^]d�.i.ri:. _'J..i:r�. ,.:,1.; . [ . m.3 . .: �l...::: ' -: f%!/ �I �• • - __ i.'1��: � Inc :r. rfGa rL.K
�g.
,/� r�,F
.r... i::.l•. i. ...I�..i... �.: �- i .T. :.� .. jiv
...-. .
.V .. - .., r.. ...... -..... �. i .
rl.
:
Type of Visit ACompliance Inspection p Operation Review Q Lagoon Evaluation
Reason for Visit Routine a Complainl O Fallow up ❑ Emergency Notification D Other ❑ Denied Access
Facility Number date of Visit: a— u7 `rime: ® Printed tnr: 7/21/2000
Q Not fi erational Q Below Threshold
O Permitter! OfIcertified © Conditionally Certified 13Registered Date Last Oper'jatted or Above Threshold: ...............
V �CR 1`j .. County:... ....:. �? '--� .....
Farrn Name: L`-`'�
Owner Name:
Facility Contact:
Mailing Address:
Title:
Phone No:
Phone No:
Onsite Representative:... -^sit 5............................................................................. Integrator:.... !,' 4...... .......... r.....................................................
Certified Operator:
Location of Farm:
Operator Certification Number:
AL
17
❑ swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' �L �•� Longitude •
Design Current Design Current Design Current
Swine Ca2acity Population Poultry Capacity Population Cattle Capacity Population
Wean to Feeder p{) ❑ Layer ❑ Dairy
❑ Feeder to Finish ❑ Nun -Layer ❑ Nan -hairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Drains Present ❑ Lag-nn Area ID Spray Field Area
Holding Ponds 1 Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes )I No
Discharge originated at: ❑ Lagoon ❑ Spray Field [:]Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes []No
h. If discharge is'observed. did it reach Water of the State'! (If yes, nolity DWQ) El Yes Cl No
c. II'discharge is observed. what is the csti[nated ilOW in gal/min?
d, Does discharge bypass a lagoon syslem? (if yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? Cl Yes 0 ['No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes XN❑
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Structure i Structura 2 Structurc ; Structure 4 Structure 5 Structure 6
Identificr:.......................................................................................................................................................................................................................
Freeboard (inches): 13
5100 Continued on back

aciilif0umber: -3 _11aLl Vate of Inspection � 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? ❑ Yes *o
(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
bK(No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
14No
9. Do any stuctures lack adequate; gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
Dj'No
Waste Application
I0. Are there any buffers that need maintenance/improvement?
❑ Yes
N(No
11. is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
,WNo
I2. Crop type
13. Do the receiving crops dt fer 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
VNo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
XYes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No.
16. Is there a lack of adequate waste application equipment?
❑ Yes
Wo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
b�No
18. Does the facility fail to have all components of the Certified Animal Waste N'lanagcment Plan readily available?
❑ Yes
(iel WUP, checklists, design, maps, etc.)
XNo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
ZNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
[1 Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ONo
(iel 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
j No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
E�No
yMatioAs,oi- O rjciejppjpS ►lxtrrE-nofpq. 000t)9 0is' visit; - yoo wilI I &dC £ lio; ruetkt�)<' ,
r orresUUn'denCc.abUut.thls.Vlslt.'.•.•. . .'.'.•.•.•.•.-.•. .'.'.•.'.'. .•.-.•.•.-.•. .'
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):
Gie
+.ar��..�
Reviewer/Inspector Name 9 �Q-3700 X— --\
Reviewer/Inspector Signature: Q _ _ Date: QQ Sloo

Fati ity Number: 3i — Date of Inspection �— cly Printed on; 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge Wor below ❑ Yes , j No'
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 4No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the Iagoon? ❑ Yes 0No
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 [9fNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes bM No
Additional - omments and/or, rawin ..
�Ie4 LVQ—k P__o,�& cld��S- ra�__ic&Z,4
I1T
7
5/00

Division of Soil and Water Conservation - O er`ation-Review
L Division of Soil and Water Conservation, t-
- Complliance:Ins pection F a' t,,"f;,r
Division of Water Quality - ComphiAce4nspectiun'
Other Agency - Operation Review l • �;'' €
Routine 0 Complaint Q Follow-up of DWQ inspection Q Follow-up of DSWC review Q Other
Facility Number Date of Inspection
I'inre of Inspeclion 24 hr. (h :mm)
13 Permitted XCertified © Conditionally Certified 13 Registered 0 Not Operational Date Last Operated:
Farin N. —...II...►.. '-.... ....N d .1....................... County:..... � ........................
Owner Name:...-+.L�l -T ..... ..........,&W................................ 1'hrrne No:.... j ...... L1G ............-..........
FacilityContact: ........... �f................................... Title:................................................................ Phone No:...................................................
Mailing Address: ..... .�f. ......C. +f. - ................. ..............
❑nsite Representative: ....... J4.►.,1W. ......je& 1 ��] Integrator:...........)V, �- ...................................
Certified UperatUr:.....,,�'�[,�� ............................ Operator Certification Number:.... 11t%1;W1 ...............
Loc• ion of Farm;
P........ ........... e..... ......... ...O........ ..r AL
.... ... 4.. ll .r... r . ............. -....................................-......
' ..,......1 5........�. 1,�4- P. ....... era. -.......................................................... .. ....-.............-
Latitude 0 ` - Longitude 4 61
Design
Current
Design' Current .
Design Current
Swine ., CapacityPopulation
Poultry
'Capacity Population attle
Capacity Population'
Wean to Feeder
❑Layer
❑ Dairy
❑ Feeder to Finish
10
Non -Layer I
❑ Non -Dairy
4
❑ Farrow to Wean
❑ Farrow to Feeder
❑Other
❑ Farrow to Finish
Total Design Capacity
S Z
❑ Gilts
❑ Boars
Total SSLW
�(pQ
Number of Lagoons. ILI Subsurface Drains Present 110 Lagoon Area 10 Spray Field Area .
Holding Ponds 1 Solid Traps E ❑ No Liquid Waste Management System
Discharges & Stream Impacts
Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. It' discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water (if the State? (If yes, notify DWQ)
c, if discharge is observed, what is the estimated flow in gallrrtin?
d. Dees 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: r{�
Freeboard(inches): ........... !....................................................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/ 9
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes KNo
❑ Yes MNo
❑ Yes KNO
Structure 6
❑ Yes X No
Continued on back

Facility Number: — Date cif Inspection
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/improvetent?
11. Is there evidence ❑f over application? ❑ Excessive Ponding ❑ PAN
12. Crop type ,1),kYC--- l 61 429PL
13. Do the receiving crops differ with those (esignated in the Certified Animal Wade 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?
Re(juired 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/ W UP, check] ists, 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'?
(ic/ 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?
, pia �Yiola�ipn�s •oar- d iFjci0005 -wore 00fed Otwing OW visit; • ;YOO wili•t�eboiye Od ruttit�r
cvrres vu nri�ence.a�>t t�ris visit..... • .. . .
❑ Yes ANo
XYes ❑ No
❑ Yes K No
❑ Yes No
❑ Yes 9No
❑ Yes No
❑ Yes j No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes j No
❑ Yes No
❑ Yes. X No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes 6(No
❑ Yes No
❑ Yes] No
❑ Yes WNo
Comments (refer to question #}: Explain any YES answers and/or any recommendations or;any other comments:.+i '1' `• :i' ;. .'
Use drawings of facility to better explain situations. (use additional pages.as nee .1 . '). !';j; 'i: . u r° '' '' G ii; �' '1'7
7 fir f/ i inn] heam JnIN&JP- U+<rMF'e blot Wk- &
UJ07 t- - � ma c e FDP-. tAJirc. Amp] P. nP
Name Reviewer/Ins ector =r�� :i • !f - :+
P
Reviewer/Inspector Signature: Date: 1 r rG 9 y
3/23/99

Facility Number: Date of Inspection /
rOdor 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? • 1
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 X 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 j�jNo
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 'ANo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes )dNo
3/23/99

N
�w:€Fii€ji'.;�';�E i�Ft `Ei�pi1#.. �':!:'. •S
0 Division of Soil and Water Conservation 0 ❑ther Agency
Division of Water Quality
...�� .s•. '€s .�.-a-.�,.-n,,.,,, e — _ F4i3i1Fte :333•`51j���'a':i1.f: s 13�F i3r 3�
...... -w
gar• e...� eauu
101 Routine Q Complaint ¢ Follow-u of DWQ inspection Q Follow-up of DSWC review D Other
Date of Inspection
Facility Number, _ t.}�
Time of Inspection 24 hr. (hh:mm)
0 Registered [A Certified © Applied for Permit 13 Permitted IQ Not Operational I Date Last Operated:
FarmName: ............V.Q.4-L................. .......................................................................... County:........... 1.i ....... ..................I...................
(P
Owner Name: ............. ......
..�G�►�trk.............. ..........
�c� .................................... ... Phone Na:.,..� °15.R.�.'��� ..�... r.................,....,..............
FacilityContact:.............................................................................. Title:.........................,...................................... Phone No:
Mailing Address: _ Za.,......lC".b_& ........L.,Jxa... U.................................................. C{1 �x�c 1 r.�3x1,,..AEG............................... 1..,,....
Onsite Representative:..........10,t1.1.5..1,.......... . MV,_%rs,............................................... Integrator:..... Mwz..
..................
CertifiedOperator..........................................................................................I.................:... Operator Certification Numbei .........................................
Location of Farm:
Latitude ' ' " Longitude ' ' 4�
f ... ..,3,'.:r:
e5 gn: Current
Swine':44'YCapacity Population
Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Soars
N4niber of Lagoons l Holding Ponds' ❑ Subsurface Drains Present ❑ Lagoon Area JOSprayField Area
.. '':".'ii:'ti'.' 't', !. �, i.:?.?? e'.i '. � .!'r,i:€.i.:3• »e � xs';� ; ... €:...i�; '� ;. �3;; •n€3i�3E���i
❑ No Liquid Waste Management System`:'1sii;:
" ra
1. Are there any buffers that need maintenancetimprovement?
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 lagoonslholding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes t% No
❑ Yes allo
❑ Yes ® No
❑ Yes 1,J No
❑ Yes UNo
❑ Yes ® No
❑ Yes ® No
❑ Yes C9 No
W Yes ❑ No
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes M No
Continued on back

d
8.
Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
No
Structures (Lagoons.Hnlding Ponds,, Plush Pits, etr.) '
9.
Is storage capacity (freeboard plus storm storage) less than adequate`'
❑ Yes
j1 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier:
Freeboard (fly
10,
Is seepage observed from any of the structures''
❑ Yes
No
11.
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
No
12.
Do any of the structures need ntainlcnince/imhrovenient'?
12Yes
❑ No
(if any of questions 9-12 was answered yes, and the situation prises
an itnmediate public health or environmental threat, notify D1WQ) '
13.
Do any of the structures lack adequate mini tnuro or inaxiinum liquid level markers''
❑ Yes
MVO
Waste Application
14,
Is there physical evidence of over application?
❑ Yes
® No
(If in excess of WMP, or runoff entering waters{ the State, notify DWQ)
15.
fof
Crop type .... ........b�!CA] m)cJ .... I ... I .............. �!`�Li...BOLLS...............--.......
.....
Ib.
Do the receiving crops differ with those designates; in the Anintal Waste Management Plan (AWMI')?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
/ No
18,
Does the receiving crop need improvement?
r
Yes
❑ No
19.
Is there a lack of available waste application equipment'?
❑ Yes
P No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
EN No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
J,No
22,
Does record keeping need improvement?
❑ Yes
B No
For Certitied or I'ennitted Facilities Only
23.
Does the facility fail to have a copy of the: Animal Waste :Management Plan readily available?
❑ Yes
1� No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
r4No
25.
Were any additional problems noted which cause noncompliance of the Perinit?
❑ Yes
P No
0 No. vitilations or deficiencies were noted' during this. visit., Yoit.rviII receive no further
eorresp6ndertce about this.visit:
Comtnents (refer to question #): , Explain any. YES answers and/or tiny recominendatinns or any, other Godaments k ......
Usc,drawings of facility to better explain situz}tirins: (use.additirnal pages us. necessary): E; `:'i;i,F ";.'.:
r,�4r Se+boC_F k-ro . +.ce'Jock NkL*ri_ npmyi►k�.
t"? SW3 �a lY►ti�j�lLQ+� -
7/25/97
.� _ ..;,.,,:::,, •,l"
4'
�'.=:11'M ; :"l,
p�� :� _
Reviewer/Inspector Nameam,,,c
Reviewer/Inspeclor Signature: f_ Date: `7.,(P19,. __.. _ . .

� :=u. .;�,.,:d: •'s I ;-::: 3: i:Y:'�;..,..F,.:�„•c. ....€..:»:,:..�;.;��='it?';i:i'i';i;��i .
' .f:;r! •) q. :. €! 7:.I?h •'.: zf., i'F g, ; 3;„ 3 •tiffs.:'
r ..
i.E � :'. ;,1; •::: ;F.i;��1 ss �
r: D nxma ee of atlo►'I@ SWC `
! - r.::.:. [....... .. .. ..: : ::: : '.:.� .. .,•;
�j7'F
fit(€i'.: .:;•F.
• ...,.: 3 F.
nIm cedl t er`atin It se DWQ A al;F a 0 FS• a In ction
Q
. .. .. ... !! �..is, i..:•
>< �. .. ....... ,. .z :... ..- .- .-..-......4>t ... ........::f:ef.. eF..e..».. .....
,
.i': � `..';.;iiiii: •a:�z1FF�.FF:Ii�: •iiFSii
%,s. .Sty r dins
;i€:, ".b?�: ..E:'!13?��. '43:•..?_�
Routine Q Cam taint Q Fellow -up of DWQ Inspection
Q Follow-up of DSWC review Q Other
Date of Inspection R__7d-41
Facility Number
Time of Inspection �24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: [I Registered ❑ Applied for Permit
(ex:.1.25 for I hr 15 min)) Spent on Review
Certified ❑ Permitted
or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:......_.............._................................_............
... ..
.... ......._................-......-................-... .........
.1.r
Farm Name: ......1�....... .Q.Co........»..................»..... »...... _........ .....
...»............ . County:—d.)!:S. vwS.... ........ _.......... �.......]I.Y..--P n
Land Owner Name:.. ,t].1�Ao.... ..._... ..... a. e--hJ� w1.5............_.......................
Phone No:.C]i1....3aq 'L P1.4................_.....................
FacilityConctact:...................../.—..,..._............,.y................................. Title: .................. .................... ..... _.. Phone No: .... »..... ...... ....... ..... .......... ...................
Mailing Address:.. ». .._L..l kL ...�!�! ? r............ _......_............. I.K'1,N 4.. ............................._.......a�45� 1.....
Onsite Representative:...�.l�l l 11. .....3�]f4?1�1�.. ....�2kkr�[. .►.'.�....... Integrator:. '? ....»..... _......................................
Certified Operator: »...._....._ . .... ........... ................... ............. ...... .»................ ....... ...... ......... Operator Certification Number:..... 60.7�..... .............
Location of Form:
Latitude ©' ' ®" Longitude ' ©4 96
Type of Uperatton and Design C:a ncity
E';i.,n ,. i "F3"3i•• '•eE?tt F, �s.si. xE.; ,a..€ y � sF,s�ss,
Des n urgent es n : urrerit�" Design
.�:...
..,.;...;:;::'"'�. , =„ urKent
wined .. ,... Ca aci
..... tt,; �iPnult �?;< s
i'o u[ation ari
;;�,. Cattle C aci `Pa ulatloti:.
Wean to Feeder
x
Feeder to Finish
❑Non -La er❑Non-Dagi
Farr w to W an
..
ssi»i�'i I:'L.. •' 'R"'
,zn ff
sFi F:F::ei £ i� {3'�ii?esiii:`FFFF }�.i a 3,•.�.,SS.li`�.�i�e:.:Fii�e:.
.,.i .fVs s �::y.••F i»i�,� .EF .ieu •i:
j�i�s e.E`f�a:jF!�5eei:. FF
Farrow to FeederTotDesig
n�CapacitY:
i sss ...(S. •.E' ,.:$,..s
''`
�`.».;.' ,
'?g;i�F�u?S�
�f
Farrow to Finis
'-
....�...µ.,..���..�.�.
Omer
:iiY...�..,.�^�w...^•..^.sa...er>w�,. ..�..re.
i, � Tnt>3t1'5SL�W.',•f
s. .. s
s ...
- .. .L .......1.
.. S'
u .....i
� � -�
;F�3�F.: is ry`n'�F �FF.�'iy
,
F .F!?,:;.i"w» di�Fae 3•
i
.
...? ......... �i43
...K S`ry'i!:l:.;..i
.i.. .. .. s t
9
of
"'K' FF Subsurface Drains Present
Ga oons.;lRHaldin Potiids ❑
. ..;.;...>
i? R ,
' nrt' i=:Fn,.:;
x:t?i:
;If ,...,; ; ::::.
a`.;:;,i...;.f..S.:.:.�d. {,.. y�........;,.'v.:: :. �: •xi. ..': ,! .,.
.L.:'. .;. ,. ,i»k:.: i..i ..Ei�;iiii>•i Siiitl'1.• �x'!k!'3;; i;;: Z.','i,;iii, :.a 3
n ;;., ,. ,.;;;:;:: .. ,l.y?i; ;; . Y;.;; :., ;, ;'. ;? ; ; ; ; s.r .s i ❑ Lagoon Area ❑ Spray Field Area
g
fP
�F Ffi
----i-- s,..:::::.......
Ggneral
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
4/30/97
❑ Yes VNo
❑ Yes IR No
❑ Yes No
❑ Yes No
❑ Yes
® No
❑ Yes
No
❑ Yes
No
Yes
❑ No
Continued
on back

Facility Number:..,.l......
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
IRNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
® No
8. Are there lagoons or storage ponds on site which need to be properly closed?
❑ Yes
1K No
Structures fLaguna andlor 11oldias Ponds]
9. Is storage capacity (freeboard plus stonn storage) less than adequate?
❑ Yes
KNo
Freeboard MY Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
....Sa.25..... _.... .......... ............................ ....................... .. .......... ....
........... ..............
10. Is seepage observed from any of the structures?
❑ Yes
ELNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
RNo
12. Do any of the structures need maintenance/improvement?
❑ Yes
H No
(If any of questions 9-12 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
[ZNo
astgAynlication
14. Is there physical evidence of over application?
❑ Yes
10 No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type1.Ara�MV&*A.Jh0............. &".U�D ►- ,.1.:................ ................ .............. ........ ...................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
JK No
17. Does the facility have a lack of adequate acreage for land application?
❑ Yes
BNo
18. Does the receiving crop need improvement?
KYes
❑ No
19. Is there a lack of available waste application equipment?
❑ Yes
EKNo
20. Does facility require a follow-up visit by same agency?
❑ Yes
® No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
For acilities_Only
❑ Yes
9,No
_CEL(Wed_F
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
9No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
JKYes
❑ No
24. Does record keeping need improvement?
❑ Yes
® No
Comments (refer:to question #):''Explain anyY. S answers and/o'r any, recommendations or any other comments:':':;.`.. 'e ;" ";;
[Ise drawings of facility to 1:46 r explain situations: (use additional pages as necessary}'::' ,, ,
$ • w o- u I-d o 0 w . I a e.a 6 to ., ' Ld S w-a l i c� ..�#o ; .., w� r-w� i ts+-+-,1 �V �
t'� �, j X vL► n f- o-t� t� LR,, t � 5 � t e� c �e.i.. TI L ;.t w rz+ ►yC
4 t v, I. L i -t t, ej116
�0 ��Y�' "'�V iv\ art Q+.�} 5 i'i *,4 L i . e . LJ 11 I k 0 ► L.
iZZ . op r_ r 6-'_11 Y i�
I r► c-v-..r j7; ? i col Lw.... T1�.� , vc t — ►A-CLI to �o
.�vw'4fE7et.dC:u......??�Ykvei.:liwviur ..n n.. ... , i•� '1 Revie arII spertar Name ?�1;H.
fi
Reviewer/Inspector Signature: , _ _ _1... _ - IN-'i n Q _ _ _— o A Date:
cc: Division of Water Quality, Water Quality Section, Facility Assessment Unit 4/30/97

•
•
Site Requires Immediate Attention:
Facility No. .9J
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS ITE VISITATION RECORD
DATE: /� , 1995
Time:
Farm Name/Owner:
Mailing Address:
County: r
Integrator: G! y ' Phone:
On Site Representative: J,dli% E1N _ Phone:
Physical Address/Location: fQZLXLV J,a r_ �,2421�-
Type of Operation: Swine _kl Poultry Cattle
Design Capacity: �4)9 Number of Animals on Site: 7 Z6
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: �� ' �8 ' J'J�+" Longitude: —72' '` / ' _ o Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 4 hour storm event
(approximately 1 Foot + 7 inche es r No Actual Freeboard.: Ft. Inches
Was any seepage observed from the lagoons)? Yes <0 Was any erosion observed? Yes �o
Is adequate land available for s ay? Yes or No Is the cover crop adequate? Yes or No
Crop(s) being utilize( g= T L
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellin Yes r No
100 Feet from Wells? e r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on spe
cificreage with cover crop)? Yes or No
Additional Comments:
0 �i�/GG1141K
Inspector Name
Si
cc: Facility Assessment Unit Use Attachments if Needed.