310442_INSPECTIONS_20171231

NORTH CAROLINA
Department of Environmental Qual

Reason for Visit: Gogoutlne D Complaint ❑ Follow-up Q Referral Q Emergency Q Other ❑ Denied Access 4 �'
Date of Visit: Arrival Time: o Departure Time: ! County: �� �� l� Region: VV�
Farm Name: �Ccr mx Owner Email: T
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: aQ R 1 a rn [. y y
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: ) r i 4��
Certification Number:
Longitude:
Design Gurrent
S ne Capacity Pop.
Wean to Finish
Wet Poultry
Layer
Design
Capacity
Current
Pop.
Design Current
Cattle Capacity Pap.
DairyCow
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
D . P,oultr
Layers
Non -Layers
Pullets
Turkeys
TurkeyPoults
Other
Ea aci
P,o
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
Discharges and Stream imrnacts
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 E]' Io�Q NA [] NE
❑ Yes ❑ No ❑ NA] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page I o. f 3
21412015 Continued

V
Facility, Number: -5 l - L jDate of Inspection: i91 ,Q 1 rI I
Waste Collection & Treatment 5 3
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
St M
re 1 Stru�uctturStructure 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 �❑ y❑ 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 reat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
la. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [:3'No ❑ NA ❑ NE
maintenance or improvement?
11. is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ❑ ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
oNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
fn"Po ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
6 NToo NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
[] Yes
No ❑ NA
❑ NE
Required -Records & Documents
19. Did facility fail have Certificate -nit
&o �❑
the to the of Coverage & Pen readily available?
[:]Yes
[: NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes[]
NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
[] Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
No ❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ErNo ❑ NA
❑ NE
Page 2 of 3
21412015 Continued

Facili Number: 3 1 - Date of Inspection:
24, Did the facility fail to calibrate waste Opp iltion equipment as required by the permit?
❑ Yes
EfNo ❑ NA
❑ NE
25, Is 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
ffN. ❑ NA NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No 0 NA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
No ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No ❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes
tiIa ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
aN�o ❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA
❑ NE
Comments;(reter;.tq�4uestion #) 3>uxplatiti anyg$°Y)E;S;answers andlo'ry a y aiiditiorial re±Lommendatidit�4! any- the-corniiient .
g �s.v. i���J.bYi:sd, 1<�t•.r Yd :3�x•a. ����-ii�a'$,.::,t n.4KS.r'�+-7ir:-v�==-,y{v e��i�Glw'•&:.'a°3.�k11ir3'.3:&,�h19a;$
?4
r I
4,0 1) �A - P"111- t±-:r
j I �" L_-.j l C e -05-. C>.,
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 o, f 3
Phone:
Date:
21412015

k"ivision of Water Resources
Facility Number ©- 0 Division of Soil and Water Conservation
r 0 Other Agency
Type of Visit: (a Com ' nee 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 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Nailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Onsite Representative: J9 A ' 'tern Integrator:
Certified Operator: Certification Number:
Back-up Operator:
Location of Farm:
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Non-L
Pullets
Other
Puults
Design Current
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ AppIication 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 I-Ieifer
Dry Cow
Non-Dai
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes P-1,10--❑ NA ❑ NE
❑ Yes [] No
❑ Yes ❑ No
❑ NA ❑ NE
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ N
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 1 of 21412015 Continued

Facllit Number: -kjqTj Date of inspection: (a
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ff No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
St re 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): {� 7__
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes tr ❑ 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 4-5 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes EJ 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 ff No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes EJ'No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes n No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0°/n or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12, Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes ENj�rNo
❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
18. is there a lack of properly operating waste application equipment?
❑ Yes ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes rNo
❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available`? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists D Design ❑ Maps [:]Lease Agreements ❑Other;
21. Does record keeping need improvement'? If yes, chec he appropriate box below. es D 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 LJ N — ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: '3 jDate of inspection. 7 A-2-A&I
.,,`
.24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes 0 No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues �
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes LJ 'NU ❑ 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 Io - ❑ NA C] NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes ErNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes zl o ❑ NA ❑ NE
33. Did the Reviewer/]nspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34, Does the facility require a follow-up visit by the some agency`? ❑ Yes ' ❑ ❑ NA ❑ NE
Cammen" referjoAttestian #):, Explain any YES_answers and/or Any add ltiona] recommendations or any other,comments. .
[bsc drawines•of fae11 tv. to dettar.'exAlain:'situations (use'additiunal pastes as necessary/:
e-U_ 0 /` 5
_4J 9 r� �
�' � 52 3
� � 3 fir" of y Z_
P� t` , r S
C� t r,, 4 S�,L
G� • "Y" �� 7�[
f n �� �7 S k C�
t
O L.[I" Off It e 0- Id, 61 C
coo le", '1j
c& It LAl■'n,,j /�-- 4e1�( 4/_ f�L.121s
Reviewer/Inspector Name: 04- V1,� Pa '-C a1
Reviewer/Inspector Signature:
Page 3 of 3
ie 1 �e c.. R ILL C -
Phone: I t O 77',,/. 7_30 9
Date: Z&zm_ Z16
IF 1
21412015

Orbivision of Water Resources
Facility Number❑ ❑ Division of Soil and Water Conservation
Q Other Agency
f ype of Visit: e3 Com iance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: &Routine Q Complaint 0 Follow-up Q Referral Q Emergency ❑ Other Q Denied Access
Date of Visit: Arrival Time: D Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Onsite Representative: P n ht f r 1l +o.! ^_ R V
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Owner Email:
Phone:
Phone:
Integrator:
Certification Number: I W
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish 2-71 h P 0
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
La er
Nan -La er I 3H]
Pullets
Other
Puults
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Stnicture ❑ 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?
Design Current
Capacity Pop.
Dairy Cow
Do iry Calf
Dairy Heifer
DryCow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ Na ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA [] NE
❑ Yes [:].No ❑ NA ❑ NE
❑ Yes YNo
�o ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412015 Continued

Foci li Nanher: '3 -Ll t4 'L Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [D'Nlo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [:]Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): [ �.
Observed Freeboard (in): 31
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes []�No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan'?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures -need maintenance or improvement? ❑ Yes [ 'No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes [] 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 [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes Ej No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below. ❑ Yes No 0 NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus D 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?
D Yes
N❑
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
15, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ YesFj"No
❑ NA
❑ N.E.
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[] N
'Co❑
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
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? Ifyes, check [] Yes BNo ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check th ,appropriate box below. [�es ❑ No ❑ NA ❑ NE
❑ Waste Application El 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? ❑ �co Yes ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ YesED/No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Fa ilIt N*rriber: 3 1 - 1Y Date of Ins ection: 5 f
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes o ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ 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 E5No ❑ N ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes �o
❑ Yes No
❑ Yes
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? Yes
No
❑NA
❑NE
❑NA
❑NE
❑ NA
❑ NE
❑ NA
❑ NE
"6 [] NA ❑ NE
go ❑ NA ❑ NE
No ❑ NA ❑ NE
Comments (refer.. to. que a don.#); Explain'any YES answers andloir.any; a[ldltianal:recammendations or`any other enniments = t :;' '.:': ,..
Use drawings of.faellt `to better. ex lain'situations[use additional a es as
P Ilya j QI 4'j
M� rC'j VIf
5 kk
Reviewer/Inspector Name: 1/ a
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 110 M
Date: � /Z
Z&f-
21412015

Division of Water Resources
Facility Number '� - ® ❑ Division of Soil and Water Conservation
❑ Other Agency �f
Type of Visit: ompliance inspection n Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Visit: ❑'koutine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit: S Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 'Title:
Onsite Representative: Donut 11 �4r1}t a
Certified Operator:
Back-up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
Wean to Finish
nto Feeder
(.,feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Boars
Other
Other
Latitude:
Phone:
•7 :A
Integrator:
Certification Number:
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Non-L
Pullets
Other
Poults
Discharues 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 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:
W3
Design Current
Cattle Capacity Pop.
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy'
Beef Stocker
Beef Feeder
Beef Brood Cow
❑Yes l5lNy ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes
�N❑
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
Page I of 3
21412015 Continued

r 1 Facili Nuniber: - Date of Inspection: G Z S /
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I
Spillway?:
Designed Freeboard (in): (It 5
Observed Freeboard (in): (4 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.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes D o ❑ 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 UWR
7. Do any of the structures need maintenance or improvement? ❑ Yes E31io ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ErNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes [J'No ❑ NA ❑ N.E.
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes E rNo [] NA [] NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes [!J"No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Co, Zn, etc.)
[] PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Hare 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
E5�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
�o
❑ NA
❑ NE
I6. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[!rNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
EJ�No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
u No
❑ 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
E"No
[] NA
0 NE
the appropriate box.
❑ W UP ❑Checklists [:]Design ❑ Maps ❑ Lease Agreements []vYe—s[:]No
21. Does record keeping need improvement? If yes, check t appropriate box below. [:]NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes [T No%- ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes Fj_'No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

f Faciii Number: - Z Date of inspection: / f
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes E< ❑ 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 PDA 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 6No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [] No NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
Ej 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?
❑ Yes
ffNo
❑ 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
[!5No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below,
❑ Yes
NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
['CNo
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
T No
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer: to question #)::Explain any;YFS a.nsWerkwid/orAny ndditionall recommendations:or� any other cnmmc"rits.;
Use drawings of facili 'to he#ter eii lain situahniris`{use:additianal Fades a"s necessary
P J
4d ah S60 0� jl'��Y � Cl�ViY. �a �7►►a-�fp�
uio tVA #,k�jI () du`j he 4 a 215�/r
An SP 71a/1��R2-e,r,,1:r.C�►��# wl'�
(A 5� 0 "k 'e
t,on V
A 5 �(, M S Z 7 �i %) Va o � r� P� • �" j `
� '4� ' I.'7,4 � inn � �.�-, a� ��. c Ih � � � �' �► a � o��� � ��'��.�. 3A/�yJ.
Reviewer/Inspector Name: R t�k f 9 "
Reviewer/Inspector Signature:
Page 3 of 3
Phone: V -71 Y 73�4
Date: Cr 1 Pe Vi
214/Z015

Type of Visit: Compliance Inspection Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Time: County: r Cat IF1Region:
Farm Name: f 0-0, e T)Or'nt I � Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: D6YIQ j2!� Integrator: 1
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Certification Number:
Longitude:
Design Current
Design
Current
Design Current
Swine Capacity
Pup.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
DairyCow
Wean to Feeder
]Non
-Layer
DairyEl] Calf
Feeder to Finish
Dai Heifer
Farrow to Wean
IFNonj'P�Gauyltrs-Le
Design
Current
D Cow
Farrow to Feeder
D . .
Ca aei
IP,o
Non -Dairy
Farrow to Finish
La ers
Be Stocker
Gilts
Beef Feeder
Boars
pullets
Beef Brood Cow
T10Murkeys
Other
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes P No ❑ NA ❑ NE
❑ Yes
,n No
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
[:]Yes ,I No
❑ Yes No
[:]Yes No
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page 1 o. f 3 21412014 Con#riued

Facili Number: -CAIZ jDate of inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
2] No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑'No
❑ NA
❑ NE
Structuu l Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J2-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
L: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 DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [a No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes E�fNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
4. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ NA ❑ NE
maintenance or improvement? T
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14.
Do the receiving crops differ from those designated in the CAWMP?
❑ Yes ,n No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
[:]Yes
0 No
❑ NA
❑ NE
16.
Did the facility fail to, see ure and/or operate per the irrigation design or wettable
❑ Yes
allo
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
P No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
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,e3 No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ETNo
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes d No
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: - C . Uate of inspection: /
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes � No ❑ NA ❑ NE
■
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes f' No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA 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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
3 1. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
❑ Yes f^No
❑ NA
❑ NE
❑ Yes J^No
❑ NA
❑ NE
❑ Yes neiVo
❑ NA
❑ NE
❑ Yes ;a No
❑ NA
❑ NE
❑ Yes �o ❑ NA E] NE
❑ Yes [�j No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
[] Yes
[:],No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
34, Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #]: Explain any; YES answers;and/or any additional recommendations or any; other comments: ' :r
Use drawings of faclli 'to'better ex lain situatiuns'(use'additional ages as.necessa ]. ; :rc •,
��y t f�S ❑ �
6
2l5�,r iZ,-C a er-ke- Te &_z1/ 1.
may,/
L 1 c•tI �'Yr re �' C2t s I �1 Q � S
Reviewer/Inspector Name:
Reviewer/Inspector signature:
Page 3 of 3
Phone: qB L 7,�� �d
Date: 61.3 d
21417014

0 Division of Water Quality
Facility Number - 0 Division of Soil and Water Conservation V
Q Other Agency VV
Type of Visit: Q Compliance Inspection 0 Operation Review p Structure Evaluation Q Technical Assistance
Reason for Visit: O Routine Q Complaint Q Follow-up O Referral D Emergency Q Other n Denied Access
Date of Visit: Arrival Time: Departure Time: County: La ILI Region:
Farm Name: ��^I sin j�,�� Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: 'title:
Onsite Representative:
E6 EZ1,
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
Latitude:
Phone:
Integrator: M 1.
Certification Number: (26
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Non-L�
Pullets
Other
Poults
Design Current
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:
Design Current
Cattle Capacity Pop.
Dai Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes )ErNo ❑ NA ❑ NE
❑ Yes 4 No
❑ Yes e1no
❑ Yes ONO
❑ Yes No
❑ Yes.No
❑NA ❑NE
[DNA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Faelli Plumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ErNo
a. If yes, is waste level into the structural freeboard? ❑ Yes ZNo
❑ NA ❑ NE
❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway;?:
Designed Freeboard (in):
Observed Freeboard (in):
5, Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc,)
❑ Yes ; 'No ❑ NA ❑ NE
6. Are there structures on -site which are not properly address4and/or managed through a ❑ Yes ffNo ❑ 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 J'N❑ ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 25INo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than tfie 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 ZfN❑
❑ NA
❑ NE
maintenance or improvement?
I L Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes �No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window [] Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2rNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes .TNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes FZ'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes P No
❑ NA
❑ NE
18. Is there a lack of property operating waste application equipment?
❑ Yes O No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes JEJ-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 C] Lease Agreements ❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes E][No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes tNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili Number: - pate of Inspection:
24, Did the facility fail to calibrate waste application equipment as required by the permits
❑ Yes No
'2125.
❑ NA ❑ NE
Is.the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes ,E!jNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey El 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?
❑ YesETNo
❑ NA [] NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[:]Yes P7No
❑ NA ❑ NE
Other Issues -
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes Wr 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?
❑ Yes No
❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes ONo
❑ 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 PNo
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes �N0 ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 4No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
e0 ao#I alul y
�A1A' � I
q 11q) I re Xyo
lr 13 j1 3y
Reviewer/inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 1 71 -
Date: O
214/2 II

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit; 01routine 0 Cam laint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: O County: ^ Region: 4Ir
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: /n Zd
Certification Number:
Certification Number:
Longitude:
Design Current
Capacity Pop.
Wean to Finish
Design Current
WetPoultryPop.
Layer IDairy
Cow
Design I
Wean to Feeder
Non -La er I
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . Aoult Ca welt P,a
Layers
Dry Cow
Non -Dairy
I Beef Stocker
Gilts
Non -Layers
lBeef Feeder
Boars
Other
Other
Pullets
lBeef Brood Cow
Turke s
Turkey Pouits
Other
Discha ses_and Stream Impacts
1. is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made? ❑ Yes ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ) ❑ Yes No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes N ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412011 Continued

Facility Number: - Date of Inspection:
Waste Sollection & Treatment
6,1s storage capacity (structural plus storm storage plus hearty rainfall) less than adequate?
❑ Yes 0No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 53'NFo
[3 NA
C] NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ 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 o
❑ 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 o
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes JTNo
❑ 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
❑ YesP�No
❑ NA
❑ NE
maintenance or improvement?
Waste Annlieation
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ZNo
❑ NA
❑ NE
maintenance or improvement'!
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
[—]Yes a
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes EJ No
0 NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes /�] No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes] No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
[ Yes No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need 'improvement? If yes, check the appropriate box below. [—]Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes XgNo
[] NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 y _ _ 21412011 Continued

Facili Number: - Date of Inspection:
24. Di4 the facility fail to calibrate waste application equipment as required by the pe it? ❑ Yes No ❑ NA ❑ NE
+Y5. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes] No ❑ NA ❑ NE
the appropriate box(es) below,
[] Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes ] No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 16No ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document O Yes FT No ❑ NA ONE
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? ❑ Yesg:fNo ❑ 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 )ZINo ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes /ETNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes /2�'No ❑ NA ❑ NE
33. Did the Reviewerllnspector fail to discuss review/inspection with an on -site representative? ❑ Yes Al
o ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No
[] NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations :or;.any other. comments..
Use drawings of facility to better explain situations use additional pages as:neeessa f� sil y s
y
►� N . �(Qa�e � a e� � aor ;7- pvnelr�
lceyse /e �dr�S .
rayr-q d- /.ecdl-�S
Reviewerllnspector Name:
Phone:
Reviewerllnspector Signature:
Date:
Page 3 o, f 3 l 21412011

Faeili Number: - Date of Ins ection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes [:]No ❑ NA ❑ NE
the appropriate box(es) below.
[]Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
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 ❑ LagoWStorage Pond ❑ Other:
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
�] Yes
❑ No
❑ NA
❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ❑ No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations orany. other. comments
Use `drawings of facility to better explain situations (use additional pages as necessary).
!� �1 �• y •��u/�o . sue] t~Y -{,t'. C� ✓(CLi �5(3 4 C o Q.e�-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�d��•�� urn
�c� . Q sc � [�10
C � a�
� s��sr I
C b
u J31r g4r��� &f q of �Q2 0
6 a ql' o /nS # 0r7L SAIts 9-1
p f- slcc � X4�Vgo 4s hem
N 0 d wou (d ALAX de A to -P
4-C) A_dq'.( tqjclorl
have t:;'ve l fe .z d ,*� mar xs . Aix
r cc e.LGol 47P-^r4o�e /fe "F+
Phone:
Date: a7
4/2011

Faclli Number: - )pate of inspection:
24. Di4 the facility fail to calibrate waste application equipment as required by the pe it? ❑ Yes In No
*25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes it No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ YesA, No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes 4No
❑ NA ❑ NE
[] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes PTNo ❑ 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? ❑ YesJ�J'No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30, Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes 2 No ❑ NA ❑ NE
permit? (i,e„ discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below, ❑ Yes /ETNo ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes A No ❑NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes eNo ❑ NA ❑ NE
Comments (refer. to: question.#)..Explain . any YES, answers :andlor:any�additional recummendationmor,anyl'other,romiiients;-
Llse"drawing: of faeill to.petter..ex lain siituatiovis:(use"addit[niial'a es°ss rieeessaryj
ICe'l se
Reviewer/Inspector Name:
Phone: Y14
Reviewer/Inspector Signature: Date:
Page 3 of 3
I

--G-Division of Water Quality
Facility Number 0 Division of Soil and Water Conservation
_.. Q Other Agency
Type of Visit 9,96mpilance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 45 Routine O Complaint Q Follow up Q Referral Q Emergency I) Other ❑ Denied Access
r Date of Visit: Arrival Time: Departure Time: County: Region:,
Farm Name:�11,,. CL.'t'.C�
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Phone No.
Integrator: /lx;�
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 0 ` 0 " Longitude: = ° = i =
11
Design Current Design Current
Capacity Population WetPoultry Capacity Population
❑ Layer
❑ Non -La er
❑
Wean to Finish
❑
Wean to Feeder
❑
Feeder to Finish
❑
Farrow to Wean.
=
'
❑
Farrow to Feeder
❑
Farrow to Finish
❑
Gilts
❑
Boars
Other
❑ other
_.._..
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ TurkeX Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures: E:11
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 ,ff No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
Page I of 3 12128104 Continued

FaclUty Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? [:]Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ZNo ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'? ❑ Yes 9f4o ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6• Are there structures on -site which are not properly addressed and/or managed ❑ Yes gfNo ❑ 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 DW4
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑pia ❑ NA ❑ NE
8, Do any of the stuctures lack adcquate markers as required by the permit'? ❑ Yes o ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) ��
9. Does any part of the waste management system other than the waste structures require El yes 1'J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10, Are there any required buffers, setbacks, or compliance alternatives that need []Yes ❑ El NA El NE
maintenance/improvement?
1 l . is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �o ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable,Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
r
12, Crop type(s)
13, Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
E
PA, o ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
pKo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
2rNo ❑ NA
❑ NE
17, Does the facility lack adequate acreage for land application?
❑ Yes
�Vo ❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
P4o ❑ NA
❑ NE
F:ei•:'.:`.�a�;a.i•kk�i+= ..;P
Comments. (refer to question #j:: Ex' plain any: YES answer's iindlor<:any�recommendations Aor any. other,camments:. ,
Use drawings of facility to. better explain situations. (use:add itional pages•as necessar l �..: �,. � �". '�`.d��g1�X.;;,
iAit�•
RevicwerlInspector Name ,.t.., .,. : ; = Phone: — I
Reviewerflnspector Signature: If � Date: Q
Page 2 q f 3
I

Facility Number: ' Date of Inspection
• Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )2No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield i 120 Minute Inspections',�Monthly and i" Rain Inspections Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
9No
ElNA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
ElYes
;Io
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
es
ONo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
Yes
❑ No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
VrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
P'No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[;INo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
1PINo
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
JZNo
❑ 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
pa, to
El NA
El NE
33.
Does facility require a follow-up visit by same agency?
[I Yes
2No
❑ NA
❑ NE
k.'.... r.; .
Additional Comments and/or. Drawings:..r.::�...;...:.�-;
a<
�� .T � G� �• { if t �� A '
I
7116
�arn al'-- � 90 b57-C4
Zep 2- Ad,::�7
C4- 1,20
Page 3 of 3
41
1

Type of Visit eC) ,Coom^pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine O Complaint O Follow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: de Departure Time: County:
Farm Name: XOwner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ,�� Title:
!! Onsite Representative: ��%�%%�� I.,
Certified Operator:
Back-up Operator:
Phone:
!h Region:
Phone
No:
Integrator:`
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: O o E=' [= Longitude: =9 =' = «
Design Current
Swine Capacity Population
Design Current
Wct poultry Capacity Population
Resign Current
Cattle Ci ply popuiation
❑ Wean to Finish
10 Layer I
1
❑ Dairy Cow
❑ Wean to Feeder
I
10-Non-Layer 1
❑ Dai Calf
❑ Feeder to Finish
❑ farrow to Wean
❑ Farrow to Feeder
Dry Poultry
El La ers
❑ Dai Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Farrow to Finish
❑ Gilts
❑ Non -Layers
❑Beef Feeder
❑ Boars
Other
❑ Other
❑ Pullets
❑ Turkeys
❑ Turkey Pouets
❑ Other I
❑ Beef Brood Cow
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ONo
❑ 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
ff No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
d
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
Zo
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

`rFacilifa Number: — Date of Inspection
Waste Collection & Treatment �r
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): V
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(iel large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ,;2No ❑ 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 environmentalthr at, notify DWQ
7. Do any of the structures need maintenance or improvement? ElYes 4
No ❑ NA ❑ NE
8. Do any ol'the stuctures lack adequate markers as required by the permit? ❑ Yes ETNo ❑ 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_A2<o ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ NA ❑ NE
El Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [I Heavy Metals (Cu, Zn, etc.) f
[]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 CAWMP2
❑ Yes�No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �' o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes �o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes Iti10
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes y " o
❑ NA
❑ NE
Comments`(refer.'#o questinn #}c `Explain any Y,FS'answerVandlor,any.*&bmmendati or, any other comments.
Use drawings of facility.to better explain situation,S..(use addititinttL'a *es as�ne esi ar' #�� 'c
Reviewerllnspector Name !�1 4, t
�Q ->�: .<h ?:<•r�a,. Phone: Q—
".e=;
=b- __ _
Reviewerllnspector Signature. Date:
1

Facility Number: 'Y-&4 Date of Inspection
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ONo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ONo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps [I Other
21, Does record keeping need improvement? If yes, check the appropriate box below. A Yes JENo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard J6 Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 4fNo ❑ NA ❑ NE
-23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes J2 No ❑ NA ❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
ff No
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
YNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
2(No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ZfNo
❑ NA
❑ NE
and report the mortality rates that were higher than nonnal?
30,
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
-,dNo
❑ 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
2fNo
❑ NA
❑ NE
Genera! Permit? (iel discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
JD'No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
VNo
❑ NA
❑ NE
12128104

Type of Visit 3rcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Aoutine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ denied Access
Date of Visit: !6 e
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Arrival Time; d Departure'I'ime: County:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Region:��
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = O = 4 0 « Longitude: = 0 0 i =
tl
PM1t Design
Current
Design Current
❑esign Current
Sw!He
C parity.
Population
N'et Pmomoultry Capacity Population
Cai#le Capacity
Population
❑ Wean to Finish
❑ Layer
❑Dai Cow
❑ Wean to Feeder
Non -Layer
❑Dai Calf
❑ Feeder to Finish
airy Heifer
❑ Farrow to Wean
pry poultry
D Cow
❑ Farrow to Feeder
Non -Dairy
❑ Farrow to Finish
La ers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
Beef Feeder
❑ Boars
❑ Pullets
❑Beef Brood Ca
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
10 Other
I
Number of structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
PNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
h. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
Cl NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
LI No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12/2M4
Continued

Facility Number: Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ONo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ff No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes pNo [DNA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes FrNo ❑ 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 O'No ❑ NA ❑ NE
8, Do any of the stuctures lack adequate markers as required by the permit'? []Yes gNo ❑ 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 ZJ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [ Mo Cl NA ❑ NE
maintenance/improvement? /
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes RrNo ❑ 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
ONo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
2No
Cl NA
Cl NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
Po
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application? Cl Yes
;2 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
[rNo
❑ NA
❑ NE
Reviewer/inspector Name Y s, °" ,.- 77 t Ph
t .. •
.;� tee... ..N•u Phone:
Reviewer/inspector Signature: Date:
Page 2 of 3 UAINIv4 (-onttnuea

Facility Number: Date of Inspection
Reauired 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 dNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑ Other
21, Does record keeping need improvement`! If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes ,ON❑
❑ NA
❑ NE
23, 1f selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Cl Yes P N❑
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑.No
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes �INo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes �2 No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
'(2-N❑
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
)2rNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
;R'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
ONo
❑ NA
Cl 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
PIN
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
�]`No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E(No
❑ NA
❑ NE
.. SlikGQse SU(J(leec)5
L Imp
t YA c I Wcb- ac���
1C,57671__"
GIooU/.
Page 3 of 3 12/28/04

_ a li:vision of Water Quality
Fadfity Number Q Division of Soil and Water Conservation.
Q Other Agency
Type of Visit C�,�mpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Or*outine Q Complaint Q Follow up Q Referral Q Emergency Q lather ❑ Denied Access
Date of Visit: y Q Arrival Time: Departure Time: I County: Region:
Farm Name: l Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone Na!
Onsite Representative: Integrator: r�
Certified Operator: Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ o = I Q 11
Longitude: = 0 0 1 = ff
Design Current Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle. Capacity Population
10.Wean to Finish _
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
Dry Poultry
Non-L
Pullets
Other
Discharees & Stream lmnacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
1 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 ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
❑NA
❑NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
12128104 Continued

Facility Number: / -- Date of Inspection
baste 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?
St r cture 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C7
5. Are there any immediate threats to the integrity of any of the structures observed'?
(ic/ 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 ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14, Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[] Yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
IZC cotes ll e-a 7�1�
� ,�lf�
t�
Reviewer/Inspector Flame Phone: Or 6 17, —dam` 2-V
Reviewer/Inspector Signature: Date: [�

l.cifity Number. Date of Inspection
Required Records &_ Documents
19. Did the facility fail to have Certificate of Coverage & Pen -nit 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 approprrate box, ❑ WLIP ❑ Checklists ❑ Desig
n ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. .Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Zwaste 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?
Additional Comments and/or Drawings:
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
El Yes El No El NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
12128104

Type of Visit .QfCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit -routine Q Complaint Q Follow up Q Referral Q Emergency Q Other El Denied Access
Departure Time: � County: Region: 4111
Date (of (of Visit., ArrivalTimed�
Farm Name: C ' Owner Email: —i
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 1?_ !J✓GiGltc , ,,, „_,__...._
Certified Operator:
Back-up Operator:
Phone No:
Integrator: 4L6�4
Operator Certification umber:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 0 1 ❑ 1j Longitude: = e = j ❑ jj
Design Current
Resign Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Non -Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Dairy Calf
Feeder to Finish
❑ Dai Heifer
❑ Farrow to Wean 2 7q& .2 d 1
❑ Farrow to Feeder
❑ Farrow to Finish
El Gilts
❑ Boars
Dry Poultry
Layers
❑ Dry Cow
❑ Non -Dairy
El Beef Stocker
El Beef Feeder
❑ Beef Brood Cow
Turkey
Poults
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation? El Yes El No El NA [I NE
Discharge originated at: El Structure El Application Field ❑ Other
a. Was the conveyance man-made? ❑ Yes El No ❑ NA El 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) El Yes El No El NA El NE
2. Is there evidence of a past discharge from any part of the operation`? El Yes El No El NA El 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 12/28104 Continued

Facility Number:32Date of Inspection f1
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?
Struc ure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed'
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes Cl No ❑ NA ❑ NE
Structure 5 Structure 6
❑Yes ❑No ❑NA El NE
❑ Yes ❑ No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes ❑ No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑ No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes ❑ No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑ No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ yes
❑ No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ No
❑ NA
❑ NE
Comments (refer to question ##): Explain any YES answers and/or any recommendations ur•any pther'comments:::.
Use drawings of facility to better explain situations. (use additional pages.as necessary):
Reviewer/Inspector Name I Phone:
Reviewer/Inspector Signature: Date: i3 d
Page 2 of 3 12 8104 Continued

Facility Number: % --� Date of Inspection �-
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes ❑ No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ❑ No ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. Vyes ElN❑ [INA ElNE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ElSoil Analysis ElWaste 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 ❑ No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No ❑ NA ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ❑ No ❑ NA ❑ N
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ❑ No ❑ NA ❑
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern? ❑ Yes ❑ No ❑ NA ❑
If yes, contact a regional Air Quality representative immediately
3 l . Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes ❑ No ❑ NA
General Permit? (iel discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ No ❑ NA
33. Does facility require a follow-up visit by same agency? ❑ Yes ❑ No ❑ NA
Additional Comments and/or Drawings:
a I
Page 3 of 3 12128104

.- .1ti]^. ., I - .: :-, '. " - '.

jType of VisitCo pliance Inspection Q Operation Review Q Structure Evaluation 0 Technical Assistance I
1 Reason for Visit 7Routine Q Complaint Q Foilow up O Referral Q Emergency Q Other ❑ Denied Access
Date of Visit:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Time: : Departure Time: County:
Facility Contact: Title:
Onsite Representative-.
Certified Operator:
Back-up Operator:
Owner Email:
— Phone:
Phone No:
Integrator: A
Operator Certification Number:
Back-up Certification Number:
Region
Location of Farm: Latitude: = o = I = 11 Longitude: =o =1 = 11
Design;
Current.lig
11
Design Current
design Current
Swine
ty
Pp,u..�
etPn
Will
Caci nation
�
atticlon
Ca city PulationP
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er I
DaiEy Calf
12 eederto Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry _
❑ D Cow
Eler
Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
❑ Gilts
❑ Non -Layers
El Beef Feeder
❑ Boars
El Pullets
❑ Beef Brood Co%
❑ Turkeys
Other
❑ Other
❑ Turkey Pouets
❑ Other
Number of Structures:
DisrharQes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State'? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Plqo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
[]Yes. [--]No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes,-Ej`No ❑ NA ❑ NE
❑ Yes RrNo ❑ NA ❑ NE
12128104 Continued

Facility Number: Date of Inspection Q
_ aste (bllection & Treatment ��,,��rr
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes JNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Str7ure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes PNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
b. Are there structures on -site which are not properly addressed and/or managed ❑ Yes 2 No ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes )ZoPo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Mo ❑ 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 PNo ❑ NA ❑ NE
maintenance or improvement'?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes PINo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes /No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ FAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window El Evidence of Wind Drift ❑ Application Outside of Area 1
12. Crop type(s) _&,,Cef. S, C U, _9C✓�J.r,&.& .ter .SC Ar,1,1 _,.,J J
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes 2 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes Z'No
❑ NA
❑ NE
I& Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination
', ❑ Yes Flo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 'No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes O No
❑ NA
❑ NE
Reviewer/Inspector Name f ��-u w `:. ' t■: -.1``: :'%' :'
Reviewer/Inspector Signature:
Phone:
Date: i S
r212810,
Continued

Facility Number: — Date of Inspection
Rsquired Records & Documents
19. Did the facility fail to have Certificate ol'Coverage & Permit readily available? [I Yes '�Mo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;],No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? if yes, check the appropriate box below. eyes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking'Xrop Yield Z20 Minute Inspections Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes O^No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ZNo
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes XNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ❑ Yes ❑ No ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes ❑ No ❑ NA ❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
❑ No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
❑ No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
❑ No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
❑ NA
❑ NE
A[Iiditional G ment a for r w
a._ A�o;`
.2
Qa reca>r�1�
Crap
•����ds
�. mp i n vr 5P�t GtioY1
7 I
lI A S PC C,-VLd Y-N,
r r5-a >r w\ , s L Y\ c6o ed sh\q e, , rc, c o r as
fvpn.�- -k- 4'r Ca{' `I
12128104

IType of Visit 0 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit E
Routine O Complaint O Follow up p Emergency Notification O Other r� ❑ Denied Access
Facility Number :3 Date of Visit: I &:24e Time:
Not Operational O Below Threshold
© Permitted 0 Certified onditionally Certified 0 Registered Date' Last Ope r Ab!Mireshold: ._—
Farm Name: _.. ,f?. ,(..��P!!f!�f�.0 County: �o� �I�L_ _.............. M.__ ..M_............
� r�
Owner Name: _...»....».».» ......»........ » ..........,_....._ . __......» .........._.....w ._ .... 'Phone No:......... ..»...... ».».» ........ _._..»... »» »...._ .... .
MailingAddress:.._ . _........_._............» ..........._.._ » ...»» .» .....».»».».»»..._.... .
Facility Contact: ...... _._.. ___ . .... » .....»_. »» ... Title:.. _. _._..._._...._._ ._..._._ ..... Phone No:
Onslte Representative: .1.� d,�Lll L.l__. r_ _......_.. Integrator:
Certified Operator: .__ . »...»._.... .»......»....» ..___ ._ ___ _ ___ _ . Operator Certification Nuunl�er:
Location of Farm:
IV
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude Longitude "
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes .0-Ko,
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance roan -made? ❑ Yes 0,90
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 MONO
2. Is there evidence of past discharge from any part of the operation? ❑ Yes -91,10
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ lti Q
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ..._._ .». f ... .. .. _..... ..» ._ _ ._ _............_.. »_ ... _.. _.. _ ....... ».... »..».._...»......»..
Freeboard (inches): S
12112103 Continued

Facility Number: 3 — Date of Inspection
5..SVe there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes A:rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or ❑ Yes 10<0
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 ZoRo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ,LkNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ yes O elevation markings?
Waste, Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes �No
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes [TNo
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type
13. Do the receii
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional
Air Quality representative immediately.
S z.qyo�;�r
ReviewerAuspector Name & w
Reviewerllnspector Signature:
Meld
Date:
❑ Yes .HTio
❑ Yes ,eNo
[I Yes ;"No
❑ Yes ,�5No
❑ Yes ZNo
❑ Yes j'fio
❑ Yes 4!(No
❑ Yes 19�0
❑ Yes 0 5o
❑ Final Notes
I�VIKiI.KCK

t
Facility Number: _3 ZaKI Date of inspection
Required Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes 00-90
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WCFP, checklists, design, maps, etc.) ❑ Yes .2vo
23. D;rord keeping need improvement? If yes, check the appropriate box below. �es ❑ No
te Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
2.4. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes ,E]vo
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes ;2�No
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes ,0140
27. Did Reviewer/Inspector fail to discuss review!inspection with on -site representative? ❑ Yes ET&o
28. Does facility require a follow-up visit by same agency? ❑ Yes ,ET`No
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes MONO
Nl'DFSTerinlilted Facilities
30. is the facility covered under a NPDFS Permit? (If no, skip questions 31-35) ;31es ❑ No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No
32. Did the facility fail to install and maintain a rain gauge? ❑ Yes ❑ No
33. Did the facility fail to conduct an annual sludge survey? ETICS ❑ 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. .0Yes ❑ No
,}Mocking Form ecrop Yield Form ❑ Rainfallp4spection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
s3 -
Pleofe /eyk-
G r'n i"
�G`��C� r I �Jl
. .3� Iva '5 Ice e�f' e .s'4�r�
l- �
C3h 1 S el c
WiKPA

jType of Visit 0 Compliance Inspection Q Operation Review Q Lagoon Evaluation
Ij Reason for Visit aiRout'ine Q Complaint 0 Follow up 0 Emergency Notification Q Other ❑ Denied Access
Hacilih, Number Date of Visit: Time:
Not Operational 0 Below Thresbold
® Permitted ISCertified U Conditionally Certified © Registered Date Last Operated or A ve Threshold:
Farm Name: hh YACounty.
Owner Name: _ �►'3 Phone No:
Mailing Address:
Facility Contact: Title:
Onsite Representative:Li1+ED�
Certified Operator:
Location of Farm:
Phone No: .
Integrator: U `+
Operator Certification Number:
❑ Swlna []Poultry ❑ Cattle ❑ Horse Latitude 0 « Longitude ' 0• ��
" Design Current Desigri:':;;;.:Currerrt Design Current
Swine Ca 'aeity Population Po6ltily Ca acitiv 'Po ulattan Cattle . Ca aeitr `:'Po elation
Wean to Feeder Layer i ❑ Dairys
Feeder to Finish'::: ❑ Non -Laver ❑Non -Dairy;
Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish i T.Mal:Design Capacity
❑ Gilts 1
❑ Boars Total' SSM
ki
'Number of Lagoons . Subsurface Drains Present ❑ Lagoon Area S ram Field Area
Holditq 1Ptinds'1ilid Traps' �S'' ❑ No LicLuld Waste Management Svstem i
DSschar= & Stream Impacts
1. is any discharge observed from any pan of the operation? ❑ Yes JK 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 ONO
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes i No
Waste Collection &, Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillwav ❑ Yes MNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier:
Freeboard (inches): 3
05103101 Continued

Facility Number: — Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes U TVo
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 Eo
(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? Cl Yes Eoggo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes M-No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes O�vo
Waste Anulication
10. Are there any buffers that need maintenance/improvement? ❑ Yes , Ko
11. Is there evidence of over application? ❑ Excessive Ponding El PAN ❑ Hydraulic Overload El Yes d No
12. Crop type Corn M&4t' 5U / , "r-i" ItA4 --.. ~ U , �/ Mart
13. Do the receiving crops differ with thoserdesignated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 9�-No
14.
a) Does the facility lack adequate acreage for land application?
❑ Yes
2tvo
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
ado
16.
Is there a lack of adequate waste application equipment?
❑ Yes
tNo
Required
Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
M-No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
U'Iqb
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
® Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
Ro
21.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
>,..!,�rvo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
ES-IQo
(ie/ discharge, freeboard problems, over application)
23,
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ K0
24,
Does facility require a follow-up visit by same agency?
❑ Yes
B�' o
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Rl-?do
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Cornimeiits.(re er, to question #ij: 'Explain any YES answers and/or, airy recomrnendatioie's or.iinyalher comment&
[Ise drsiwings of facility to better explaiin 'sitpatiott :.{usc'additionil pages as petessarv): ❑ Field Copv 0 Final Notes � .. .... :.. E��. ....
r
1 "� EsJI�fTC d S16�C L���it � (+1�RfI� 074 ZAfAG.4 _s;0"�16
99
Z04 /"iC
/'
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
05103101 Continued

Facility lumber: 31 —Ael bate of Inspection 11
dar Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
El Yes
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
❑ Yes
E'!Qo
28. is there any evidence of wind drift during land application? (i.e, residue on neighboring vegetation, asphalt,
❑ Yes
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
9 -No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan biade(s), inoperable shutters, etc.)
❑ Yes
7.No
31. Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
[5-"7b
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
[�-�
Additional Comment+ and/or: Drawings:
f►PFRILIJ

:..• �,,. �-- `;;, '.z
1Vl5io n'of Water Q ' 1,
r.
.,-
,
n of Soil and •Wat Conservation
�. D1VlSio r +
�s
Qr Agency..','.
1
•-}x..�i
.-.
a n.,rL
_ .�% - �F� .�
c.
Type of Visit 0 Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit -0 Routine a Complaint Q Follow up D Emergency Notification Q Other ❑ Denied Access
Facility Numher Date of Visit. L
Pf Permitted I] Certified © Conditionally (Certified ❑ Registered
Fars>a Natnc:n!7ft�!.�. ...........!..
Owner Namc: ....a,1!{.i......�` T r.'�e��i.....
........ `..............................
FacilityContact:..............................................................................Title:..........................
Mailing Address: ........
Onsite Representative:
Certified Operator:
Location of Farm:
i DI '1'ilnr: "I5 Printed on. 7/21/2000
Not Oncrational O Below Threshold
Date Last Operated or Above Threshold:
Countv: Pyrell:.'t
Phone No:
Phone No:
Integrator: .144j ."..''].....................................
Operator Certification lNumber: ..........................................
_ 1T
Swine ❑ Poultry ❑ Cattle ❑ Horse I'<titude ' 0` �" Longitude •
Design Current Design Current Design Current
Swine Capacity.Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer 10 Dairy
Feeder to Finish 2`7 2 ❑ Non -Layer ❑ Non -['airy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Otilcr
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons Subsurface Drains Present l,agL»n Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste i<Ianagement System
Discharges & Stream Impactti
1. Is any discharge observed From any part of the operation? ❑ Yes N No
Discharge originated at: []Lagoon ❑ Spray Field ❑Other
a. If discharge is observed, was the conveyance. nlan-made:' ❑ Yes No
h. If discharge iS Observed. did it reach Water r)f the State:' (if yes, notify DWQ) ❑ Yes No
C. IE' disL:har'a'e is observed, what is the estimated 11my in gallmin? 77 let
d, Doles discharge bypass a lagoon systeni7 (If yes, notify DWQ) ❑ Yes RNo
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste C:olIection & "Treatment
4. Is storage capacity {freeboard plus storm storage) less than adequate' ❑ Spillway ❑ Yes &No
Structure 1 Structure 2 Struc:turc 3 Structure 4 Structure 5 Structure 5
Idcntificr:................................. ...................................................................................................................................................................................
Freeboard (inches): 3y
5100 Continued on hack

Facilityitlumber: •3 I — L14Z Date of Inspection A Printed on: 1/9/2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[] Yes
XNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
RNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
%No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
;S No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
P9 No
Waste Anglication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
O[No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
0 No
12. Crop type Co r V% w h CR -'r &eq Ws)&,""yd,1 ka .S,-4A
13. Do the receiving crops differ with those designated in the Certified Animal aste Management Plan (CAWMP)?
❑ Yes
JR'No
14. a) Does (he facility lack adequate acreage for land application?
❑ Yes
ONo
b) Does the facility need a wettable acre determination?
❑ Yes
5TNo
c) This facility is pended for a wettable acre determination?
❑ Yes
IS No
I5. Does the receiving crop need improvement?
❑ Yes
ONo
16. Is there a lack of adequate waste application equipment?
❑ Yes
�5 No
Required Records & Documents
17. Fail to have Certificate of Coverage & GeneraI Permit readily available?
❑ Yes
IB'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.)
"o Yes
❑ No
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
5No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
E(No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
R•No
22. Fail to notify regional DWp of emergency situations as required by General Permit?
❑ Yes
ff No
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
ETNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
JgNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
FrNo
ISO •Yi#iAtiojis a*' 401e}e00H 40re 0004• 00Af WS'visit; • YOO iv��l1-to$ito 40 WOO :
:....... . ............ .
Comments (refer to question #): Eicplain any:.YES answers and/or any recotnmeindedons,o-eany other e0� haiutf.i .
Use drawn i of facility, to better explain situations. use additional pages as necessary):: ; :,
ri�• C �prn jaDoa'n this ;�h vo j u---te GLed,c )'4o`''f'''l d;v' 1 • 'pull corl ['rr 4&
e t.,,, g,n a
Ghe��Ctr�s,ner_a�^ds-
�a�C ; Hos.1P yydf'�t.+7-I' �—r sp�� �an� �✓Af'VA�e� -kr AGfe[{.�a
iti
ec-Ords ace did� i; rf: �F} ; dk t"+�t SLtot..fs Z�5-k ac,•es' r r¢wW'—
us ; n9 �. 6 'crel -%tr, .� >�3 � � �s
Reviewer/Inspector Name o h. t'►I'a
Reviewer/Inspector Signature: Date: 2_1E810 / Srop

Facility Number: 3C — Z, Date of .Inspection l� (� Printed on: 1 /9/2001
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes WNo
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 No
30. Were any major maintonancc problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes No
Additional Comments an or raw n
,/y 1 J/` �. � �y.. may■ ( + !
O V e ' q(l [ Q�J I� r } a. mtd rG r, o,,d J eAj ee, �/P� f r kfP'l r `
5/00

'DiAA ' '; of Soil and ' Wat- r. Conaeri iition ,- Operation Re►+iew '
Division of Soil'arii13 Water Conservation - ComplIance Inspection.
t; Division of Water, Quality - Compliance Inspection
., r �­ D,Other Agency -Operation: Review
M,
Routine - O Com laint Q Follow-up of DW inspection Q Foll -up of DSWC review Q Other
Facility Number Date of Inspection
Time of Inspection ® 24 hr. (hh:mm)
© Permitted D Certified © Conditionally Certified © Registered 10 Not O erational Date Last Operated: ..........................
County:. ..Il........................ 1C'arin Name .......o!r,,•„..........3r.......................................... ..
OwnerName:... .............................................. ....................... Phone No:.........-.........
Facility Contact:
Title:
Mailing Address: ..............................................
Onsite Representative: ,.D.<. - Y-,s........................................................................
Certifiers Operator:
Location of Farm:
Phone No:
Integrator:......' fr�.................................................
Operator Certification Number:... ......................................
......-....-.......... I....."..,
Latitude ---- • ' « Longitude C�9 ° ="
Design . •;Current- Design. Current' Design Current
Swine CPoultry Cattle .:.;.Ca aci ` Po ulation
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish JEI Non -Layer ❑ Nan -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity; .i
❑ Gilts
❑ Boars Total SSLW
Nuni6er.of I.agooras ❑Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System 1,
Discharges dir Stream Im)acts
1. Is any discharge observed from any part of the operation? []Yes WNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. It'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'? (Il'yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. IS storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes KNo
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure b
Identifier: -ry
Freeboard(inches): ......... !'".............................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion, ❑ Yes �(No
seepage, etc,)
3/23/99 Continued on back

Facility Number: Date of Inspection
b. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
[]Yes
JkNo
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
� No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
�rNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
OM
Waste Armlication
10. Are there any buffers that need maintenance/improvement?
❑ Yes
kNo
11. Is there evidence of over applicatio ? ❑ Excessive Ponding ❑ PAN
ElYes
[XNo
-12. Crop type kalv, )
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
�KNn
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This - facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
ONo
16. Is there a lack of adequate waste application equipment`?
❑ Yes
9No
Required Records & Documents
17, Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
9No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oe/ WUP, checklists, design, maps, etc.)
❑ Yes
0 No
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
KNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
gNo
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
KNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes �'No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes krNo
24. Does facility require a follow-up visit by same agency? ❑ Yes h7fNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes KNo
yibl �i$njs:a �l fie�ertw�ies r��re nr�te� �i�ring #his:v�s�t, • Yatt: iii• ee iye, i#o fu>
carres' orideitce: a 66f this visit:
Comments refer to ues'don Explain any YES answers andldr.any recomtnettdations or any'othercommerits:
Use:drawittgs'of facilityf,ta'better:explain sitiiat�atisi {use additional pages as necessary):'
.. i. ."P .1{ 41 -ei 41 _. F :i.. ,. j k� '.1. -/- •�4k'd . V�•N .d..:{. :'V.... .1 .
r'j
qV
Reviewer/Inspector Name
Reviewer/Inspector Signature: 9 Date; cm

Facility Number: a Date of I n.spection
Odor /sues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes Wo
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ;, fN0
28. Is there any evidence of wind drift during land application'? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ArNo
30, Were any major maintenance problems with the ventilation fans) noted`/ (ix, broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ,No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes el�No
Additionall:.Cornmentsand/or,Drawings: „.. F• _ ,t�•.•. � ... . .
m .. .
J

Cl Division of soil aiid' Water Conservation - Operation�Review
Division of Soil and Water Conserytition,- Compliance Inspection .
G ; Division of Water Quality.: Compliance inspection
Other Agency,- ❑ at o �..
T:e p r i n Review`'' r
Routine OComplaint O Follow-up ofDWQ inspection ❑ Follow -tip of DSWC review Q Other
Facility Number
[late of inspection
Time of Inspection
0=
24 hr. (hh:mm)
Q Permitted A Certified
© Conditionally Certified 0 Registered
Date Last Operated:
113 Not Operational
Farm Name: ........................
.......�... .............................................
County: .........!�/l. .............................. I ...... .... .......... .,
OwnerName:...........................................................................................................................
Phone No:......................................................................................,
FacilityContact : ...........................................
......... ........ .................. .Fitle:........................
.............. ..........................
Phone No:...................................................
Mailing Address:. .................... .. ...... ............................................. .!..1...Onsite Representative: ................
Certified Operator:
Integrator: .... M.Y..'!...............................................
1
Operator Certification Number: ..........................................
L n of F rm•
yr VC, -
......1................... . :.... .. ..... ....................... .�''c.....
..........
Q.�......lr .�-,....:.... ... �..s...�............... Y �r...l.S o.,................
Latitude M 6 •6 Longitude 0 6 «
Design Current' Design Current Design Current
Swine : Ca acit Population Poultry Capacity.Population .: Cattle Capacity Population
:. ❑ Wean to Feeder ❑ Layer I JE1 Dairy
Feeder to Finish '-M 6 ❑ Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder JEI Other
;< s
�] Farrow to Finish 'Y
Total Design Capacity
❑ Gilts,
❑ Boars F `s Total SSLW
Number of Lagoons. ❑ Subsurface Drains Present ❑ Lagoon Area JE1 Spray Field Area
Holding Ponds 1 Solid Traps E== 10 No Liquid Waste Management System
❑ischarses & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance cnan-made?
h. If discharge is observed, did it reach Water of the State'? (If ycs, notify DWQ)
C. ](L discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard(inches): ........5.4........................................................................................ ................................... ...........................
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
seepage, ctc.)
❑ Yes gNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes '� No
❑ Yes �(No
Structure fi
❑ Yes 19No
Continued on back
123199

:t
Facility Number: hate ofinspection
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
NfNo
(If any of questions 4-5 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
KNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
gNo
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
WNo
11. Is [tic re evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
,5 No
12, Crop type C
, L� . 5'a
13. Do the receiving Crops di fe( with those esignated in the Certified Animal Waste Management Plan (CAWMP)?
XYes
Ef No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
Z No
b) Does the facility need a wettable acre determination?
❑ Yes
P No
c) This facility is pended for a wettable acre determination?
❑ Yes
["No
15, Does the receiving crop need improvement'?
❑ Yes
1�No
16. Is there a lack of adequate waste application equipment?
❑ Yes
RfNo
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
ONo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
60 WUP, checklists, design, maps, etc.)
❑ Yes
�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
J;?'No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
( No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
No
(ie/ discharge, freeboard problems, over application)
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
[ No
24. Does facility require a follow-up visit by same Agency?
❑ Yes
NNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
MNo
('Vo WA ignjs •on . cjenc{es •i re pQfepr:ing #. s,v sit; yoo ivil•rt eeiye do i tr
...
carres�onde i 'e. a"baut. this visit.. . . . ' .. .
Comincnts (refer to question*:",Eiipliiin any YES Answers and/or any recommendations or.any ether comments,
„+.
Usc drawings of facility to better explain situations+ (use additional pages as neccmry):
tau %�-,►-r�Y/ 4. �{ >-.�A CAL
y� e� ��. {
� � cam] . � PA � �. 7s Ids -� o�1jZ04 9,124
3/23/99

i
,. -Facility Number: Date ref 1iispection '
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below IXYcs ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 6�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes WNo
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 b�No
30. Were ally major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan bladc(s), inoperable shutters, etc.) ❑ Yes 9No
31, Do the animals feed storage bins fail to have appropriate cover? ❑ Yes N�No
32. Do the flush tanks lack a submerged till pipe or a permanent/temporary cover? KYes ❑ No
[ Addition#il , umrnents'an or. rawings:
3/23/99

i F' ra&. iti?il ':i:- $ "iF `i1Y —... 5 .•'�^� �. ..
Division of Soil and Water Conservation ❑ Other Agency
..„F ?:. Division of Water Quality
s: ; 3' . r TI ;e."' v",..."'"«.,,, �e<<<: !,.^^,,.,^,...'Lt d^.`.,?e�;m",°"'-;'a.�v +^.^�.- .nv»i3„�— ..u..,d.�.>e"i t'Y'• Fn;s:
Fss Fsis '. ::; :Ex :..,:::::::du ^.1':.. .'::f::::;:.:: ... ::�:: ... ..�:53f1'7 3s �i:... ....... ..:?��. � .?.::
HD Routine O Complaint O Follow-uri of llL'L''O inspection O Follow-up of I)SWC review O Other
Date of Inspection �;JD
Facility Number L '
Time of Inspection ID p 24 hr. (hh:mm)
pp E] Not Operational Date Last Operated: • © Registered 0 Certified ©A lied far Permits ©Permitted ..........................
Farm Name:....... t3. . ]��1n,���....... 110644.1....). 11...................•................ County:....;�u. � > r1,.,....,5...................... I .......
...,....,...5.....5....
OwnerName: ................. DOnkl4l..................... Y 4r ............................................. Phone No: ... (.1itJ} 5 :.. ! '...............5...............................
FacilityContact :........................................... 5,.............. 55.................. Title:................................................................ Phone No:...................................................
MailingAddress:.... ........sco I�....s .......................................................... .......... .:.. . +:.1� y......i`................................. .4:`r�.......
Onsite Representative:......t.,1a.T\ .1.!...... .... Integrator:..- of . ................... 1e4...
L'e'rtified Operator:....................•--"----.................................. ......................... ................. I.... Operator Certification+Number, .................... I ........ I...........
Location of harm: -
.ln...d....... .......... 9...... $L.. -c.........................................................................................................
..................... .
Latitude =•'=6 =iL Longitude =' =` =fL
:�:": Cu
Swine : Capacity Pori
H'?
❑ Wean to Feeder
iFE33:
Feeder to Finish
,
"."
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
sign Current ... Design
A.
•Poultry, CapAcity Pppuiation Cattier;Capacity.:;Pni
El Layer I I❑Dairy
❑ Non -Layer I airy
❑ Other
Total Design Capacity:.
F taISSLW:
Number of I:ag aons 1 HoldiingPa'ttds'' ❑ Subsurface Drains Present © lagoon Area ❑ Spray Field Area t.
n?FFS.. .......
:::•::::: �. ,€S{r`i' ;' s•
•`.i,�F'€?1 l;3 ="5'33 ' : No Liquid Waste Management Systen F: ...'
General
L 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 gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in' effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes
EI No
❑ Yes
® No
❑ Yes
[4 No
❑ Yes
[4 No
❑ Yes
® No
❑ Yes
® No
❑ Yes
No
❑ Yes
No
❑ Yes
No
❑ Yes
[0 No
Continued on back

Facility tiumher: —� Z
8. Are there lagoons or storage ponds on site which need to he properly closed'?
Structures tl.agoons.Iinldinp_Pon(N, Flush Pits, eti.l
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes [� No
❑ Yes M) No
Structure l Structure 2 Structure 3 Structure 4 Structure S Structure 6
Identifier
Freeboard(ft):........... ............ ........................................ .................................................... ...................................... .......................................... I..........
10. is seepage observed from any of the: structures;'
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
12. Do any of the structures need maintrnancelimhrovement?
(If any of yuesti❑ns 9-12 was answered yeti, anti the situation lenses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or inaxintum liquid level markers'
Was�lication f
14, Is there physical evidence of over application?
(If in excess of WMP, or !runoff entering waters of the State. notify DWQ)
15. Crop type YYn .usla,................ srla L,..... Y7t,iYL.............. ...... m..... .i a}h -.1 . ...................
16. Do the receiving crops differ with those designated in the Anima] Waste Management Plan (A1' MP)?
r
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewerfinspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Onh
23. Does the facility fail to have a copy of the Animal Waste :Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional prohlems noted which cause noncompliance of the Permit?
�] No. vi0Eations or deficiencies were noted during this. visit. You.wi11 receive no further
Oerespbndenu about this.visit:• , ,' . '
❑ Yes ® No
❑ Yes M No ,
R Yes ❑ Net
❑ Yes 0 No
❑ Yes ® No
❑.Yes CaNo
❑ Yes w4 No
❑ Yes ® No
❑ Yes 9 No
❑ Yes 5aIgo
❑ Yes EgNo
RYes ❑ ,No
❑ Yes to No
❑ Yes Q No
❑ Ycs 59 No
Comments (refer to question #): Explain any YES answers'andlor any recommendations or any other comiments.
CTs drawin s'nf facility to:hetter eii lain :situaticin5, use additional a yes as necessary
Z. t,� &rcw. ot, i ttivrtY 6ok, mm a- to j6c -- 5 ou Iae re v9y
L2, �> �cG{�ar• tore. Potr JPrrn- Skttuld 4 nn Si4-e— • L.a vo 6e i, PL,_- 'Sa:t P�
r0 t� ,r q s �•0�1�1 fie' ae ff MkkL j , C_Vv% o be 1� � � � � {got r� �} b� (t�frd w r
A ��lit'C>+ior, r> . t"L. {C a ,,t s15
rA,Y, #� Oto -204
7/25/97
Reviewer/Inspector Name
rr ..
Reviewer/Inspector Signature: /S.f,�.� `{�, , Date: n14

5.
R DSWC aI9F io few nIm e o r.a e�
k
ii ;.
i, ..........................». ,.- � Fie€. S�.f:.F..`.s ?ftj:. sb�
�3 3 i3B ' .'.M
N...
D nimal' Fee�dIot: erat�t7 'te In `ection
z?. W �A (] n BSI s
... .. ...........• .. - .i. ,. ....,...i.. .. a. 3i ».i:,.. .....? �€:.3i?:i3ii;t��' :i::'::.
i 33 i. i
1,. "Y
ii.
® Routine ❑ Complaint d Follow-u of DW2 Inspection Q Follow-up of DSWC review Q Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: Registered ❑ Applied for Permit (ex:.I.25 for 1 hr .15 min)) Spent on Review
❑ Certified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated: .... . ................. . ...... ..... . .... . ........ . ................ . .... . ...... . . .... . . ....... . .... . ................
Farm Name:..�J ....._.................... County: ».u...11,1111-11,
.....................hn
m......
Land Owner Nae:....FA.x..t.�........ � a r k�}.a�.. Phone No:...LI.1.A..�....L'........a.vap................,
FacilityConctact:...................... .............. ............ itle:................. ...-................ Phone No:.... ...... _._.... ....... ................ ..........
8�9Mailing Address:.. ...... ,P !.1..+. T�3't'.... +e' .»........................ _........ ...... ........ »............................ ...... »........ _...... _._............. ........ .... ............
Onsite Representative:... ,a. ..ra ,�.i,.� .... it.Tx�.x-►.e: .. ........ .!C ........... Integrator: m K.ax .p....... ........ _............. »............
Certified Operator:... Q&Y..1.f!A411........ :......{ ?! ]CL�Ir�_...... ............... Operator Certification Number: ... 4.q '0&'3.._......_...
Location of Farm:
Latitude 13K,J0 J6 « Longitude 4 L$ fi
Type of Operation and Design Capacity
1F,•:Y:si.,. .>a4!...:...t'::,7;:.: -•,�,i3"i;. 'A13... ,.;i:s153331?:3i-s€133f.i
;�U. sin Carrent. ;,; ,;:. €,: Desi nF's.' ..Cu nt'e._:::'..€€Fif'urrent:.
i E , rre �,, p C
A :Swine?; €E'F € �� �..� : _ .�» ,...:.
(f:. i3 , .. Poultr Cattle .
JFHs,isikEFi:FT.SS iA:,,,= €�.�......,€Ii x:ECa us 5'Po ulatron..... <.. _ _ Y.:.:..,::. :Ga `aci �Po "ulat€dn�: ;:Ca'aci ��130buladi;hn
Wean La r€,,. Dai .
El to Feeder ❑
Feeder to Finish fvbU liI0 Nan -Layer ❑ Non -Dairy
i;�;..
� ,€t.; .�,. ... �,.--.. �s'.:•�.3?. ,:3€siis -.i+7 `��ii� �:#€:.?;;�•
F ran 3;"€ ,
allow t Wean
::€ €'s �I?» EE i i .. [•.3»..,3 3t iY.i = �. €' 3 S! . �•s} .s.
3 3: ii Y'.14 € i�F�•e V€'�' ii' i ; it. i..�HF.E H. u3 � � ��?�i € �� '€€)3t
!_!S}� i�..�sr'..t•�ii'1F%; i:F3x§
rl Farrow to Feeder : Ttitai Design CapaciiyE (R�%{,
.
......i.
Fa ow to Finish;
y 3 € CdE,"'- °4Y.:M.':..s°°«° €'. �}'%?e�."d'^. "^"."' ..«n«,,. ': .. .r.,.. w^.. :.:.. ... ..,....e ..=�,bS �€:S$�.€€ 6 ',.a,� �.'; ••.:5;;C:> i fF3ii lcSiC'43i� 3'•. iii?
=T�ta1SS'FL:'
w� i•: s
ler
€. ;e:'F�:�fl�:. r� i a rP {.^: •i:s'%` REF
:F;;t:::::iii!;.i •'.:;�i":
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:??3;H.„ 1►[iji>ilrer pfRi agnanss�I HalslingF;Poisds Subsurface Drains Present
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n Field Area
❑ Lagoon Area Spray
eneral
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
4130197 maintenance/improvement?
❑ Yes ® No
❑ Yes 91 No
❑ Yes q No
❑ Yes RNo
WIA
❑ Yes Ej No
❑ Yes (R No
❑ Yes 14 No
❑ Yes EkNo
Continued on back

Facility Numhcr:., .....—...!&H.
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
C$No
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
❑ No
S& uctufgs_(Lageona_and/or IioUng PpIdSl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
UNo
Freeboard (ft): Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
�1.... 3 ... _.». .... _..... `I.... _....... ......... _................. ...... ­........... .....................
.... _.... _.
10. Is seepage observed from any of the structures?
❑ Yes
® No
It. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
® No
12. Do any of the structures need maintenance/improvement?
Yes
❑ No
(If any of questions 9-I2 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
B No
V_}'aste APPlicat€on
14. Is there physical evidence of over application?
❑ Yes
R No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ». St.!r. 7 .... ....... ............ ... W.�' piaA._............................_4............_........................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
® No
17, Does the facility have a lack of adequate acreage for land application?
❑ Yes
9[ No
18. Does the receiving crop need improvement?
❑ Yes
RNo
19. Is there a lack of available waste application equipment?
❑ Yes
® No
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 Certified ..
❑ Yes
BNo
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
®No
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
24. Does record keeping need improvement?
®-Yes
❑ No
Eamrricnts (refer to quest�on,#l):�Explain'any YES answers andlor;any recummendatiaris or any other ebmmen —
[]se drawings. of facilaty.to better:expIain situations: (use additional pages as.necessary} ; : ' €;
-��
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Reviewer/Inspector Name :A 30'L ' . :::';�� �'�.' �; 1", �.�=iE Fii EIS x :. f:"1'"s, 'i'..' • ','.i:;:i:E: is
Reviewerllnspector Signature: - itz Date: 5
cc. Division of Water Qual tv. Water Oualily Section, Facilitv Assessment U19t 4/30/97