310451_INSPECTIONS_20171231

r
NUH I H UAHULINA
Department of Environmental Qual

(Type of Visit: Q Co pliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine Q Complaint Q Follow-up Q Referral Q Emergency ❑ Other 0 Denied Access
Date of Visit: lfo I Arrival Time: Departure Time: ® County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address: __--
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Location of Farm:
aTff g" od
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: (70a k
Certification Number:
Longitude:
llesign Current
Design
Current
Design Current
Swine Capacity Pop.
Wet Poultry
Capacity
Pap.
Cattle Capac[ty Pap.
We o Finish
Layer
DairyCow
o Feeder
Non -La er
DairyCalf
to Finish
6L7
Dai Heifer
to Wean
Design
Current
❑ Cow
to Feeder
Dr. P.oult
Ca aci
P,o .
Non -Dairy
to Finish
La ers
Beef Stocker
Non -La ers
Bee£ Feeder
Pullets
Beef Brood Cow
T urke s
Other
ITurkeyPouets
Other
I Other
Dischar es and Stream Impact
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 front a discharge?
❑ Yes 2rNo ❑ NA ❑ NE
D Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
[]Yes wl�o
o ❑NA ❑NE
❑ Yes ❑ NA ❑ NE
❑ Yes " No ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facial Number: - —k Date of Ins ection: 1la
Waste ollection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ?L _
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
5. 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 iNo ❑ NA ❑ NE
If any of questions 4-5 were answered yes, and the situation poses an immediate public health or environmen l threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes o ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes VNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes JNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
No
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ❑
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
[] Yes Ej No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 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 ❑
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes ZNo
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
❑ NE
Reuuired 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 0 Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
0/Yes ❑ No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard 6cste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes QNo
❑ NA
❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes �fNo
❑ NA
❑ NE
Page 2 of
21412015 Continued

facilit Number: - Date of Inspection: 161
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 ZNo ❑ NA ❑ NE
� the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes EfNo ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 fours and/or document
and report mortality rates that were higher than normal?
29, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31, Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[:]Yes 21'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[] Yes �No ❑ NA ❑ NE
❑ Yes CEI<o ❑ NA . ❑ NE
❑ Yes [2-No ❑ NA ❑ NE
❑ Yes [:],No ❑ NA ❑ NE
❑ Yes N ❑ NA ❑ NE
Comments (refer,to question':d): Explain any. YES,ariswers apd/or:any additional;recommendatlons or any,othi r. commeats..
Use drawinks uf_facllity to better." explafn'sitfiiitions {use additiarial pas es,asmecessary
g k.) (VkSSX () J cJrJC:�Jw� WAS'C� JWALYSrs , arAA TA IL-C-. Coc_ a--V q0 DAYS To
►—CE—C ALLk-,.-�Cx--w.S CoVC.(t-00 .
Reviewer/Inspector Name: f
Reviewer/Inspector Signature: .��lJ►�.{it/[
Page 3 of 3
Phone: `.
Date: to
21412015

a U Division of Water Resources
Facility Number - © 0 Division of Soil and Water Conservation
S- ❑ Other Agency
Type of Visit: 0 ;tRoutine
pliance Inspection Operation Review Q Structure Evaluation Technical Assistance
Reason for Visit: ❑ Complaint Q Follow-up 0 Referral ❑ Emergency Q Other D Denied Access
Date of Visit: Arrival Time: Departure Time: County:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: cyr=5 �i L+i� Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swint
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Region:
Certification Number: - 1201
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La cr
ury rounry
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Design Current
Dischartes 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 roan -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
Dair 1-feifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beel'Brood Cow
❑ Yes UNo [] NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes ❑N ❑NA ❑NE
❑Yes ❑NA ❑NE
❑ Yes yNo ❑ NA ❑ NE
Page I of'3 21412015 Continued

Facili Number: I - k4S71 jDate of Inspection, f414
jK,
Waste Collection & Treatment
4.+Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No [] NA
❑ NE
a, If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Strucctu-re,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
CNo ❑ 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 environmen I threat, notify DWR
7, Do any of the structures need maintenance or improvement? ❑ Yes ❑ ❑ NA [3 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 [2('No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes 2 No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes [/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. Sail Type(s):
14. Do the receiving crops differ from those designated in the CAW MP?
❑ Yes o
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes 2/No
[] NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes [�2(No
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
VN❑
❑ Yeso
❑ 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 CZNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes rNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

F cillt Number: - Uate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit. ❑Yes No ❑ NA El NE
25.hs 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 ❑ NA ❑NE
27, Did the facility fail to secure a phosphorus loss assessments (PLAT') certification? [] Yes gNo
o ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ YesQ< o ❑ 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 [;YIVo ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately. TT
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 the drains exist at the facility? If yes, check the appropriate box below. [] Yes C�J/No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �rVo
o ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes ❑ NA ❑ NE
34, Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments'(refer tbiquestion'#): Eipla[n'any$YES.-answereland/or.�aey: additional:recommendations',?r itnys.btHcr,comments:'
a., .:.ra=Y a. i.a.. spa . :.' 'f 3v. �a i.: ;S:Niaszi�4e�', '.x a6�"•cx �.a :sn...:• i°ls,st .la� r
u e drawings of facili#.y to 6etter�eiip[ain=situatians (usc ai[ditignal pa es,as;neccssaryj:-
ReviewerlInspector Name:
ReviewerlInspector Signatur
Page 3 of 3
Phone�"I o � J
Date: 1
2/4/2015

Type of Visit: Q CCopliance Inspection U Operation Review U Structure Evaluation p Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-u a Referral Q Emergency ❑ Other Q Denied Access
Date of Visit: Arrival Time: L�.� Departure Time: ® County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: OTC 0 - Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Wean to Finish
aor
Wean to Feeder
ELN-oYnTS-LE
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Jag
Dry P,t
Layers
Gilts
Non-L
Boars
Pullets
Other
Latitude:
Poults
Phone:
Certification Number: 0-.
Certification Number:
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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;
yow
Cy alf
y Heifer
Cow
Beef Stocker
Beef Feeder
Beef Brood Cow
❑Yes ❑No ❑NA ❑NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
[] NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No ❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
LA o
Identifier:
Spillway7:
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.)
b. Are there structures on -site which are not properly addressed and/or managed through a,
❑ Yes
ZNo ❑ 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 environmenta 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 [2fNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes ZNo [] NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2 No ❑ NA ❑ NE
❑ 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 ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes L No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes L.d' o ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes VNo
N [3 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
El"No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
[.I] 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
Cg o
❑ NA
❑ NE
❑ Waste Application [] Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections []Monthly and I" Rainfall inspections
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
N
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
[Z
❑ NA
❑ NE
Page 2 of 3 21412014 Continued

Facility Number: -Lis 17 jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
N ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
LQ so ❑ NA
❑ NE
Other Issues
/No
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
2 ❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
0 No [] NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
No
34. Did the facility fail to notify the Regional office of emergency situations as required by the
❑ Yes
[2] ❑ 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 CAWMP7
❑Yes
I�10 ❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/'inspection with an on -site representative?
❑ Yes
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ ❑ NA
❑ NE
Comments (refer: to question #):'Explaln any, YES answers;and/orjnny additional recuininendations:or any, other. comments:. ¢I ' ! _.? .i
:.
�`Y
Y .v:.: °... iS L6 .d s.;3 c°`e F•. •;:
luseArawinp, of facility, tv:hetter. explaiii.Atuations.[use additibrial pages:
�q• y� ,"y
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
G
Phone:kj Ir� 6 ^ 3
Date: i
2/4/2014

r
40 Division of Water Quality
Facility Number � - ' c� � O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 0 CCopllance Inspection Operation Review O Structure Evaluation Technical Assistance
Reason for Visit: Routine O Complaint O Follow-up ❑ Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Time: I inn Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: O7 LS �&2.. ujo Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number: 0
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
]Non -Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Puuets
Other
Discharges and Stream Imgactsand 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,
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑Yes ❑ N
o ❑NA ❑NE
❑Yes �J"4' ❑NA ❑NE
❑ Yes [No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

• ' I II.
Facility Number: - Q �1 Date of InMection: (4 7 _-Zi
Waste Collection & Treatment I I
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?
Structure jj1
Identifier: � h 6,0 IJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):�
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes D No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
D Yes No [DNA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmgxo
threat, notify DWQ
7. Do any of the structures need maintenance or improvement`? ❑ YesNA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit'? ElYes o ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance aIternatives that need ❑ Yes o ❑ 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 Ef o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes �J N
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes V
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ZN
❑ 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
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available'? Ii'yes, check
❑ Yes go
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes o
❑ 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 Inspectiyl�,
❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[:]Yes
❑ NA
❑ NE
Page 2 of 3
21412011 Continued

a A
Facili Number: 21 - Date of Inspection: q lag
24. Did the facility fail to calibrate waste application equipment as required by the permi 'y ❑ Yes N ❑ NA [3 NE
25. is the facility out of compliance with permit conditions related to sludge? if yes, check [] Yes !,d'y0 ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey E] 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 ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT') certification? [:]Yes 90 ❑ 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?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. hoes the facility require a follow-up visit by the same agency?
❑ Yes �No
❑ Yes �(No
❑ Yes No
❑ Yes f No
❑ Yes
❑ Yes la
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
(Comments (refer to question #): Explain any VES answers and/or any additional recommendations or any other. comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�. Phone IU J
q6
Date: V d L
Z/d/ 011

Type of Visit: CYCo pliance Inspection Q Operation Review Q Structure Evaluation ❑ Technical Assistance 1
Reason for Visit: Routine Q Complaint D Follow-up Q Referral Q Emergency 0 Other Q Denied Access I
Date of Visit: 1 3 Arrival Time: ® Departure Time: ® County: ,P Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: _ �5 _ 7K" k tJ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number: 1 $02A
Certification Number:
Longitude:
Design
Current
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pap.
Wean to Finish
Layer
DairyCow
Wean to Feeder
Nan -La er
DairyCalf
Dai Heifer
Feeder to Finish
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr. P,onitr.
Layers
Ea acit
P,o
Non -Dairy
Beef Stocker
Farrow to Finish
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Turke s
Other
Turkey Poults
other
Other
Discharges and Stream Impact
Stream Impacts
I. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
[]Yes Ko [DNA ❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑Yes
No
❑NA
❑NE
❑ Yes ❑ o ❑ NA ❑ NE
❑ Yes o ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page 1 of 3 21412011 Continued

I+acili Number: - s Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
r
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 13"1�
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 [DNA ❑ 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 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 E]/No ❑ NA ❑ NE
maintenance or improvement'!
Waste_ Application
10, Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
[DNA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes CZ/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 o
❑ 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 dNo
❑ NA
0 NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes E3/No
❑ NA
❑ NE
Repulred Records _& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E4 a
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAW -MP readily available? If yes, check
❑ Yes EN o
❑ NA
❑ NE
the appropriate box,
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
[:]Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes dNo
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers
❑ Weather
Code
❑ Sludge Survey
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall inspectioW�to
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes o
❑ NA
❑ NE
Page 2 of 3 21412011 Continued

Facili Number: 31 - Date of Inspection: t
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
[:]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 structures) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
0 Yes
No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
[(No ❑ NA ❑ NE
Other Issues
2$. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
a ❑ 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
MNo ❑ 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
21N o ❑ 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
L�/No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑Yes
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
[� ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No ❑ NA ❑ NE
Comments (refer to question #). Explain.any:YES,answers and/or any additional recommendations,ar any.other;comments:
Usedrawings:of facilityto explain situations (use additional pages as.necessary).
Reviewer/Inspector Name: `}oja k.j
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7 C[ fo - 3 W
Date: tiAEA&
21412011

QO Division of Water Quality
11 Facility Number � - © ❑ Division of Soil and Water Conservation
❑ Other Agency Al
�Typf of Visit: QS Cliance Inspection 0 Operation Review 0 Structure Evaluation Q Technical Assistance V `
Reason for Visit: Routine ❑ Complaint Q Follow-up Q Referral D Emergency D Other 0 Denied Access I
Date of Visit: Arrival Time: S$ Departure Time: D D County: j�C .J Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: �is Q, Wi _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Certification Number:
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
-on-Layer
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharacs and Stream Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other;
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dai Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes No
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes VN
❑ NA ❑ NE
❑ Yes
❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
Page I of 3 21412011 Continued

]Facility Number: - Date of ins ecHon:
Waste Collection & Treatment
4. is storaft capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes O No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LA611"fj
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 WNo ❑ NA ❑ NE
waste management or closure plan?
1f any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmen l threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ YesTNo
o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
o
❑ 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
o
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[Z/No
❑ NA
[] NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[;]/N a
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? `' ❑ Yes Y�o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes [No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ YesrNo
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facility Number: I - Li jDate of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Is the f ility to If
0 Yeso
Yes
NA ❑ NE
No NA N8
out of compliance with permit conditions related sludge? yes, check
❑ ❑
the propriate box(cs) below.
Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge
levels
[] Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
Yes
o NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Yes
2No NA NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
Yes
EZNo 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?
0 Yes
N� 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
N NA NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
Yes
No NA NE
❑ Application Field ❑ Lagoon/Storage Pond [D 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 Io NA NE
34. Does the facility require a follow-up visit by the same agency? Yes o [] 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).
2 i) So CAT'&
Reviewer/Inspector Name;
Reviewer/Inspector Signature:
Page 3 of 3
rt.,, 5t..QP&C SOUE` 'V
Q .,U L" Phone: f 0 1 R ,] 0
Date: Z•
2/4/2 11

Facility Number f 5,
t) division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit (D(mpliance Inspection Q Operation Review 0 Structure Evaluation Q Technical Assistance
C
Reason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: i'] ll Arrival Time: Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone No:
Onsite Representative: 63 G iL wo _. _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Latitude: n0
Operator Certification Number:
Back-up Certification Number:
` Longitude: 0 0 0 & 0 «
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
IbJ Feeder to Finish I lq 16 I t5
LJ Farrow to Finish
❑ Gilts
❑ Boars
O ther
❑ Other
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ urkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a, Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes Ld No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 2 No ❑ NA Cl NE
❑ Yes dNo ❑ NA ❑ NE
Page 1 of 3 12128104 Continued

Facility Number: Si —
Date of Inspection 1
Waste Collection & 'r'reatment
' 4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure I Structure 2 Structure 3
Identifier;
Spillway?:
Designed Freeboard (in);
Observed Freeboard (in); al
Structure 4
❑ Yes V(No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes [ No ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes ZNo ❑ 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? ElYes LEI No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit'? ❑ Yes 0No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes 2No ❑ NA ❑ NE
maintenance or improvement'?
Waste ADplication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance/improvement'? ��
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes 2 No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to incorporate Manure/Studge into Bare Sail
❑ 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
Li/No
El NA
❑ NE
15..Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
,2No
Id No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
�o
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
El Yes
YNo
❑ NA
❑ NE
.. .. :. .... r .....: a .. '
Comments {ret'er :touestton #j::`Explain Tiny YES answers aridlor. any recosrtimendatiotis orany' ot}►erecninmcnts:
Use•drawin s'of Ncilit y.to better explain situntions.,(use'additional' a es.as'necessar x:
.. c.ia :'i.: A:S ." `s: .Sxas•-s::.:;s".. y:r (.a:aa"
Reviewer/Inspector NameTF
- — "r„' :::.. 'r=
Phon 4710
�i 6 —1378
Reviewer/Inspector Signature:
Date: [
-I..-] Ill
Page 2 of 3 1 12128104 Continued

Facility Number: — Date of Inspection i "7
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box, ❑ W UP ❑ Checklists ❑ Design ❑ Maps ❑ Other
❑ Yes E�No ❑ NA ❑ NE
❑ Yes [;lNo ❑ NA ❑ NE
21.
Does record keeping need improvement? if yes, check the appropriate box below.
❑ Yes
EL4
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
E No
El NA
El NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
El Yes
�i No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
EJ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
6 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E� o
❑ NA
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
El Yes
Zo
❑ NA
❑ NE
Other Issues
28,
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
[3/No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
['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
E(No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
ENo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/inspector rail to discuss review/inspection with an on -site representative?
❑ Yes
1 No
❑ NA
❑ NE
33.
Does facility require a i'ollow-up visit by same agency?
❑ Yes
JZ/No
❑ NA
❑ NE
...4 :,.8 t::.r'
Additional Comments and/or Drawin s:
•.�.}.i . li +.:, F. . i:.G.a'. ;i'�. .. :s ?i ;:n:;; �$. k. :.x�. {. e: e.
-�, • .�: .�,yt:.: :.. _
.
t
T
Page 3 of 3 12128104

31 H 45"
Type of Visit eC13aipIlance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 4outine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: a� I� p Arrival Time: _ !� Departure Time: County: Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator: _
Back-up Operator:
Title:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: I.,atitude: = o = ' = « Longitude: = ° = ' 0
Design Current
Design Current Design Current
Swine Eapaciity Population
Wet Poultry
Capacity Population Cattle Capacity Population
U.
❑ Wean to Finish
❑
La er
❑ Dairy Cow
❑ Wean to Feeder
❑Non
-La er
Dairy Calf
Feeder to Finish
❑D
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
Dry Cow
❑ Farrow to Feeder
Non -Dairy
❑
La ers
❑ Farrow to Finish
❑
N ers
Beef Stocker
❑ Gilts
❑ Beef Feeder
❑ Soars
❑Pullets
Nets
❑ Beef Broad Cow
❑
Turkeys
Other
❑
Turkey Points
Other I
Number of Structures:
❑ Other
❑
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ZNo
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
❑ yes
❑ o
[I NA
❑ NE
2. is there evidence of past discharge from any part of the operation?
El Yes
Zo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of'the State
❑ Yes
WN o
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: 3 1 -- s Date of Inspection 7
J Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
dYes No
❑ NA
❑ NE
a. if yes, is waste level into the structural freeboard?
❑ Yes ;No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: C IA6r'= J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1-I
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
Oe/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
,�.f
❑ Yes [ No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental t rent, notify DWQ
7, Do any of the structures need maintenance or improvement? ElYes No ❑ NA ❑ NE
S. 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 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes JNo ❑ NA ❑ NE
maintenance/improvement?
1 l . 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 > lft% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Sail type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
❑
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes
WN o
❑ 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
yp ❑
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment? ❑ Yes
6(J No
❑ NA
❑ NE
4) ?A A RC-A,91V 3 E Erb Sr�T
Reviewer/Inspector Name Y
;�' '= ` Epgi�o ?�' fit• & k
Phone:
3
Reviewer/Inspector Signature:
Date:
1

Facility Number: - Date of Inspection
Required Records & Documents ,�,�
19. Did the facility fail to have Certificate of Coverage & Permit readily available? El Yes [Z No ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes LG No ❑ NA ❑ NE
the appropriate box. ❑ WUP D Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 01�o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain InspectionsJ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ElYes E No ❑ NA ❑ NE
.23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
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?
❑ Yes
o
El NA
El NE
❑ Yes
01/NNo
❑ NA
❑ NE
❑ Yes
L7 No
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
Other Issues
28, Were any additional problems noted which cause non-compliance of the permit or CAWMP7
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33, Does facility require a follow-up visit by same agency?
❑ Yes
El fq`o
❑ NA
ElNE
ElYes
O No
❑ NA
❑ NE
❑ Yes
ff No
❑ NA
❑ NE
❑ Yes
EIo
❑ NA
❑ NE
❑ Yes
Lallo
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
12128104

U�-
Type of Visit 0.Coompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit (d Routine Q Complaint ❑ Fallow up Q Referral O Emergency Q Other ❑ Denied Access
Date of Visit: G io r Arrival Time: l6 Departure Time: County: Uk-)PLM43 Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: OT'r% $ r_o Integrator:
Certified Operator -
Back -up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 o = g =" Longitude: = ° 0' = "
Design Gurt fit
[)csign Current
Design Current
Swine Eapacity 1'opulution
Wet Poultry G pBel ty Population
Cattle Gapj..city Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Nan -La cr
El Dairy Calf
® Feeder to Finish Q
El Dairy Heifer
❑ Farrow to Wean
Dry Poultry
El D Cow
❑ Farrow to Feeder,
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stucker
❑ Gilts
on -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Beef'Brood Co
El Turkeys
Other
❑ Other
alurkey Puults
❑ Other
Number of Structures:
Discharges & Stream Im acts
1. is any discharge observed from any part of the operation?
❑ Yes
LI No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
Yes
❑�No
❑ NA
❑ NE
2. is there evidence of a past discharge from any part of the operation?
El Yes
Q N
El NA
El NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
El Yes
L�'N o
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: Date of Inspection
N_�aste Collection & Treatment
4 Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
0 No ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard?
❑ Yes
❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5 Structure 6
Identifier: LA&c*1J
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 21-7
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
dNo ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
iNo ❑ 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 t rent, notify DWQ
7. Do any of the structures need maintenance or improvement?
[]Yes
o ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
Yes
El,_.J
WNo[I NA NE
❑
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ yes
!J No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
2(No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
ZNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[:]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
[:]Outside of Acceptable Crop Window ❑ Evidence of Wind Drift [:]Application Outside of Area
12. Crop type(s)
13. Sol] type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
FIN
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Ll No
Cl NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
2<o
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
C;Ko
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ErNo
❑ NA
❑ NE
AL
�.,5 �> >~.sC�s✓ ►] To c aW'►�i.ETt. R-la�.x.a Sly L- bT4
Name Reviewer/Ins ector ��
P Phone: b ..00
Reviewer/Inspector Signature: Date:

Facility Number: Date of Inspection
Reaulred
Records & Documents
lit.
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
IJ No
❑ NA
❑ NE
the appropirate box. ❑ WUp ❑ Checklists ❑ Design
g ❑Maps ❑Outer
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
0 Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1"
Rain Inspections ❑
Weather Code
22.
Did the [facility fail to install and maintain a rain gauge?
❑ Yes
�No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
6 No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
6No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
dYes
❑ No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
E�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
nNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
C; 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
G 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
0 No
❑ NA
❑ NE
General Permit? (el discharge, freeboard problems, over application)
�/
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
ICI No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Addutlonal,Catinments iindlor Drawir s� ';+Y
g.. •i #Sa; it � A
Page 3 of 3 12128104
Page 3 of 3 12128104

Division of Water Quality
Facility Number M
4 Division of Soil and Water Conservation
Q Other Agency
Type of Visit mpliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Vislt C Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: 3 '1 Arrival Time: 4 8t7 Departure Time: County: CXRC._;Qh� — Region:
Farm Name:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: ors 9"Op Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = u 0 6 Longitude: 0 0= 1 0
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 14 r)b
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars _ ..
Other
❑ Other -
I❑ Layer
Q Non -La et
Dry Poultry
Non -La
Pullets
Puults
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cowl
Dumber of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ o ❑ NA
El NE
❑ Yes
El Yes
[9 ❑ NA
❑ NE
❑ Yes
7No ❑ NA
❑ NE
12128104 Continued

Facilit = Number: 31=1 Date of inspection '1 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1
Identifier: Lt,(zoo>J
Spillway?:
Designed Freeboard (in):
Observed freeboard (in): 0�5
Structure 2 Structure 3 Structure 4
5. Are there any immediate threats to the integrity of any of the structures observed?
(iel 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
No ❑NA ElNE
❑ Yes ❑ 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 ZNo ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑ ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
g. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Annlication
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes YNo ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes 4o ❑ 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 [Z� o ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:]Yes 1 No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18, Is there a lack of properly operating waste application equipment? ❑ Yes LJ No ❑ NA ❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name k.Jbhk.) FAS20to, Phone:
Reviewer/Inspector Signature: Date:
' 12128104 Continued

Facility Number: — Sj Date of Inspection '1 0
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUp ❑ Checklists ❑ Design ❑Maps ❑ Dtlier
21. Does record keeping need improvement? If yes, check the appropriate box below. LiYes I/ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections Weather Code
22. Did the facilit fail to install and maintain a rain gauge? El El ElNE
❑ Yes [ i No ❑ NA ❑ NE
❑ Yes �No El NA ❑ NE
Y g g
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
73,6❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
ElYes
L ❑ ❑ NA
❑ NE
25.
Did the facility rail to conduct a sludge survey as required by the permit?
❑ Yes
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No ❑ A
❑ NE
27.
Did the facilityfail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No L✓J NA
❑ NE
Other Issues
�
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
ElYes
2 o
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
El"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
2No
❑,NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
❑
❑
❑
32.
Did Reviewer/Inspector rail to discuss review/inspection with an on -site representative?
Yes
o
NA
NE
33.
Does facility require a follow-up visit by same agency'!
❑ Yes
Na
❑ NA
❑ NE
Additional Comments and/or Drawings:
12128104

[Facility Number + C[s
O.Division of Witter Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 6Compliance Inspection D Operation Review O Structure Evaluation d Technical Assistance
Reason for Visit Routine Q Complaint ❑ Follow up 0 Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: 34 Departure Time: County: P Region:
Farm Name:Owner Email:
Owner Name: _
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: ams emowtj
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude: 0 U
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
1 =" Longitude: ❑ ° = ` = "
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish 7) 0 12-00
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layer
❑ Non -La et
Dry Poultry
Non -La
Pullets
Poults
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifez
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cod
I
Number of Structures:
Discharges A 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?
h, 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 Ne ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
❑NE
❑ NA
❑ NE
❑ Yes
D No
❑ Yes
ON o
❑ NA
❑ NE
❑ Yes
0No
❑ NA
❑ NE
12/28/04 Continued

1
Facility Number: 3 —List
Date of inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate'?
a. If yes, is waste level into the structural freeboard?
Structure l Structure 2 Structure 3 Structure 4
Identifier: La b!=1J___
Spillway?:
Designed Freeboard (in): l li• S
Observed Freeboard (in): jc>
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 1J No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes No ❑ NA ❑ NE
❑ Yes 3No ❑ 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 ET/No No ❑ NA ❑ NE
g. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes LJ 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 dNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes IJ No ❑ NA ❑ NE
maintenance/improvement? �
11. Is there evidence of incorrect application? If yes, check the appropriate box below. El0 Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Hcavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidettce 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
Q No
❑ NA
❑ NE
15. hoes 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
Y
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application'?
❑ Yes
i o
ElNA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
IJ iVo
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or Any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: 7 �v - 3
Reviewer/Inspector Signature: Date: b
12128104 Continued

* Facility Number: 3 — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes 0Na ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes UNo ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes D<o ❑ 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
� o
Cl NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
N❑
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
21 o
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Q o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
I2'NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
E 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
Q 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
LJ 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
L. J No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
E No
❑ NA
❑ NE
Comments and/or Drawings:
12128104

w
9
Type of Visit ,C,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit (7 Routine 0 Complaint 0 Fallow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I 210o(o Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:._.
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: Dl= b#4v%Integrator:
Certified Operator:
Back-up Operator:
Phone No:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = ° = ` 0 u Longitude: ❑ ° = ` = "
Design Current
Swine Capacity Population
=C. Tmerkin
Wet Poultry L•"apacity Population
Eattle
Capacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ DairyCow
❑ Wean to Feeder
❑ Non -Layer
❑ Dai Calf
® Feeder to Finish Iy"l D
❑ DairyHeifer
❑ Farrow to Wean
❑ry Pi�ultry
❑ D COS
❑ Farrow to Feeder
❑ Non-Dai
❑ Farrow to Finish
❑ Layers
El Stocker
❑ Gilts
❑Non -La Non -Layers
El
❑ Beef Feeder
❑ Boars
❑ Pullets
❑ Turke s
❑ Beef Brood Cow
Other
❑Turke Poults
❑ Other
❑ Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ld No
❑ NA
❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
❑ Yes
❑ No
❑ NA
❑ NE
b. Did the discharge reach waters of the State'! (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
El 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
MIN c,
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

4
Facility Number: —
Y r Date of Inspection 12.1-1100
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
,�,f
❑ Yes [2 o
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 5
Identifier: L.#0.Uc,.P]
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �a
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
❑ NA
❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
&. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-5 were answered yes, and the situation poses an immediate public health or environmentalthEleat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes 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 2 No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 2 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Lf No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > l0% 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(g) C A>s
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
ZNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
L No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre detennination ?
❑ Yes
[;I/No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
PNo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
2�o
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any :hither. comments,
+r:
Use drawings of facility to better explain situations. use additional pages: asinecessa
��cen,os *- VAV-r►,ti Go1-D SAAPE.
Reviewer/Inspector Name Td14w (AQ, `1. Phone: (�] 714 - 7a(a�
Reviewer/Inspector Signature: Date:
ruge uJ -7 r16/16orv-W l t-MI lllCu

q
Facility Number: — Date of Inspection g !i
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
the appropriate box. ❑ WI]P ❑ Checklists ❑ Desi n g ❑ Maps ❑ other 21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes iJ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
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?
Comments and/or Drawings:
❑ Yes D<o ❑ NA ❑ NE
❑ Yes E No ❑ NA ❑ NE
❑ Yes
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
❑ No
[eNA
❑ NE
❑ Yes
❑ No
a<A
❑ NE
❑ Yes
BT�U
DNA
❑ NE
❑ Yes
❑ No
E11VA
❑ NE
❑ Yes
IJ No
❑ NA
❑ NE
❑ Yes
E5<o
❑ NA
❑ NE
❑ YesCK
❑ NA
❑ NE
❑ Yes
2 o
❑ NA
❑ NE
❑ Yes
E No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
Page 3 of 3 12128104

Type of Visit to Compliance Inspection Q operation Review Q Structure Evaluation ❑ Technical Assistance
Reason for Visit eRoutine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ Denied Access
Date of Visit: Arrival Time: �r-�'-- --' Departure Time: County: Region:
Farm Name: RI'N Owner Email:
�}}
Owner Name: IY? 7,S �,aC0"_j Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:A'Zow'j
Certified Operator:
Back-up Operator:
Phone No:
F
)mod 5
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = ❑ 0 I = 11 Longitude: 0 0 =1 = `l
Swine
Wean to Finish
Wean to feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
II ❑ Layer
�i Non -La_ ct
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey PuuIts
❑ 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 Heifei
❑
Da Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes '0No ❑ NA ❑ NE
❑Yes
El No
El NA
El NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
El Yes
PNo
El NA
El NE
❑ Yes /No ❑ NA ❑ NE
12/28/04 Continued

Facility Number: rij Date of Inspection '7T
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 ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: A,l
Spillway?:
Designed freeboard (in):
Observed Freeboard (in): 4-
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes A N❑ ❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the pen -nit? ❑ Yes m 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 lNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 0 No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes JZ 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 types) L,&0,4 14IA4!�9 �_) 0
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determinations❑ Yes
[XN0
❑ 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
- CrRJ � 2 CaPy Df /�aA�Fz�o ��R�� �,�rr•.
Nf E� Iv Iy]o e,� �•9 F�L A4'K U 1CLZ et - G� STW 541400e65 .
r 0 � s�� .9,cyS�s C'na'�roc. :7065 1Ca4'j
Phone: Reviewer/Inspector Name ' �s7' j�{f..:> s ter: Q—
Reviewer/Inspector Signature: Date:
12128104 Continued

. . 't.
Facility Number: Date of Inspection
Required Records & Documents 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 appropirate box.
❑ Will ❑Checklists ❑Design El Maps ❑ Other
21. Does record keeping need improvement? tf yes, check the appropriate box below. JZ Yes ❑ No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard Z Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ 5tocking Crop Yield + ,fflh2Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes VfN❑ ❑ NA ❑ NE
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 rail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30, At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31, Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33, Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
❑Yes
No
El NA
❑NE
❑ Yes
VrNo
❑ NA
❑ NE
❑ Yes
V No
❑ NA
❑ NE
❑ Yes
❑ No
'A NA
EJNE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes 7 No
❑ NA
❑ NE
❑ Yes / No
❑ NA
❑ NE
❑ Yes P No
❑ NA
❑ NE
❑ Yes PrN❑
❑ NA
❑ NE
F _
Add tional Comments andJur flrawings: .?:;;; e"'
r
00,
12-
12,128/U4

'`=??J; . ::,s•;s:5;y:;.:{ : ra sp s'>� f � „Qi .7 f i i%kq"}S&?d €,j �•€f j,. j
..�'" i" .. pl ,u:i'I%. ! .f€ _� •. - ` 'i,;=,='I kilt
,f 31�,srara,ot Water trait p� r
��.!^';T: I: `• ;�: }3:. i:.. F .°� � .1 iSi,...,���.ie: ai� .s T.. 7 !� �• F{.
`:f:.'k....... s, ;'E'"/��yy,I]1Vt$totttlfSailand`Water:Canser►rati6n'�I � xx�� ,.�I.. :�r:. V .lt . �� 111. s1• :.{ E€ ,' 3 i .�k jjll:t
az•il's{�:�:°� !.Z� ••fx':I'.',• :t�: �i! s euf'.i '€ S:-.>: :... 'k. ,t ',' . iW : I�S :! j
•� f:i"4iiAtk..�ii�'�fi�Lki�a�:l;i'�H�1.1.11Ny1'R�fJSSk:.#slii:::li•s 31�I..!r�.h, :t= r 1 i..-. .�. IiP'EI ! 1 :,I I: yip ,ia-s..,..1, ;`:'§:!;
Type of Visit Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit Routine Q Complaint Q Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number S ❑ate of Visit:
Permitted Certified © Conditionally Certified 0 Registered
Farm Name: ...... Q.T.34 ..0.9—A !: ..... .......................................................
Time: d
Date Last Operated or Above Threshold: ........ ............ ..
County :.....�PL;W .......................................................
OwnerName: ................ »................. ................. ....................................................... Phone No:.......................................................................................
MailingAddress:........,.......................................................»....,.....,.................................................... ..... .............. »........... .................... ....... ... .... ..........................
FacilityContact: ..» .....................................�.................»............ Title:................................................................ Phone No: ..
..
.........................................
Onsite Representative:..7k .. !`.f.................................................................... Integrator:.......... ... ..........................................
CertifiedOperator:.................... .............................
Location of Farm:
Operator Certification Number; ................. . ............... .......
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 4 66 Longitude • 4 «
IR
swine ,
❑ Wean to Feeder
eederto Finish
TI Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
Boars
ryF. .
Design ' 7I Current I " DeSlgii �! Current
,• ;.
Popltry... ;`::... ,. Capacity Populatiori:;:'n Cat
Des. g�pi; '',Curiit
' < CaPacitv;.'rPapulatinri' �;
41.}i`Y •If:( V:� :, �. ii _,� :ri.: •'3';::�.j;f :'..,: ` u Other _
77
- ... ,....; ... ....!: !:. la..:,..! li -f .3 4.:: ." .3� • i5�. �"�fM'i,
De Ca ;. , ' Total' sign pac>tty,
.,11 n;l°i;�• «,* - i!.. .ii i:l . '.;' ter.
Ili .. ty
Nuirttlier.'of Lagoons
�:`. "•�Hnlrlitnu Pnnric l Cnlirt Trarir : �� �!I, 1}a s....„ •!
!: i ` k1 �>H .'r �xlx+I >E, i •r;ii;• : i i''� I
Disebarp—es & Stream Imparts
1. Is any discharge observed from any part of the operation? ❑ Yes o
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ yes ❑ No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes P'No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes gNo
Waste Collection & Treatment `
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes XNo
Swuu'ture 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 5
Identifier: �......... ................................. ..... ...... ............................... ............ ................ ..... ..... _...... ..... ....... ............ ».... ..... ...................................
Freeboard (inches): 2 (p
12112103 Continued

Facility Number: "11-- Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ONo
seepage, etc.)
fi. Are there structures on -site which are not properly addressed and/or managed through a waste management or 0 Yes ❑ No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes UNo
8. Does any part of the waste management system other than waste structures require maintenancelimprovement? ❑ Yes ZND
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes dNo
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes Zx
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes
❑ Excessive Ponding❑ PAN ❑ Hydraulic Overload [I Frozen Ground ❑ Copper and/or Zinc
12, Crop type CSw
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes Ny
14. a) Does the facility lack adequate acreage for land application? El Yes [—�.%
b) Does the facility need a wettable acre determination? ❑ Yes 1N
c) This facility is pended for a wettable acre determination? ❑ Yes VNo
15. Does the receiving crop need improvement? ❑ Yes
16, Is there a lack of adequate waste application equipment? ❑ Yes Zo
Odor Imues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ yes 2/No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
19. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VM100
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes [�/No
Air Quality representative immediately.
. .... :.L� .. _ ....�.. .- .....�.... .. r... '-•.+•:::.._. .....y.r .Y,....... _.. ......= .._.... : n.e,.�. .....,•..«d:cu; ••�:'.:I .K6 - .. F•._: �,:•^T: zt'. •� i l't i.H:.x m+: t3RK..::�n. w
Comments [refer,ta questtnn #)., Explain -any YES.ans►vets aadlor.any.x�ecaarxxrttdatioeas:or.aayotiaer>canamtnts:`'',.:
�:: p
Use drawings af.facility'to Utter. aipla#i�.situatlons. (usc:additiarial pages as > cessaryje ❑Field Copy ❑Final Notes , :
.1�.'!. {Pi�i
;:':
_ ,
+a:
!» u ��qZ +;li! . ^. u" n ]
1��.."� ,�fJ4�u-. �.i' �[r.!::....� ,.i7ii�iF�,�il'f�,k�'.{""iNP`°i!i";:. �I�f�^:"#��IiL�Jii. ii'?1'7� n...n
r
Reviewer/lns Name a, �-�`ry1 ' ::.,
"'"
ector k .
Reviewer/Inspector Signature: Date:
12112103 1 1 `Continued

Facility Number:. — hate of inspection
Rohuired Records & Documents /No
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ElYes
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Oel WUP, checklists, design, maps, etc.) ❑ Yes
23. Does record Keeping need improvement? If yes, check the appropriate box below. ❑ Yes Zo
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes Z/No
25. Did the facility fail to have a actively certified operator in charge? ❑ Yes idlo
26. FaiI to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes Z No
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 2/No
28. Does facility require a follow-up visit by same agency? ❑ Yes d�,-
29. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes L7 Xo
NPUES Permitted Facilities
30. Is facility NPDES
the covered under a Permit? (If no, skip questions 31-35)
❑ Yes
No
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32. Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34. Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit Zrcompliance inspection Q Operation Review Q Lagoon Evaluation
Reason far Visit Z Routine O compiaint O Follow up 0 Emergency Notification 0 Other ❑ Denied Access
Gate of Visit: 3 t Time: 1 � 0
Facility Number 3 { -r {
LOLN-o-1-Operational 0 Below h .hl
0 Permitted 0 Certified [3 Conditionally Certified © Registered Date Last Operated or Above Threshold:
Farm Name: 04 i s 0 W n Far County: _V) V _� +r► ��
Owner Name: oa Phone No:
Mailing Address:
Facility Contact: Title: I Phone No, nn
Onsite Representative: 04 t 3 13e-oiar� Integrator: _6 *Lyn rs *
Certified Operator: Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 0° 46 Longitude a 06 0°k
Design Current Design Current Design Current,
Swine Capac1tv Population Poultry Caparitv Population Cattle capacity Poi ulatiow.
❑ Wean to Feeder I I J[:1 La cr I ❑ Dai y
Feeder to Finish 7 ❑ Non -Layer I I ❑ Non -Dairy
❑ Farrow to Wean -
Farrow to Feeder ❑ Othcr
Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons :.. r� ❑ Subsurface Drains Present Cl La oon Area 10 SpritSprity Field Area
Holding Ponds 15olid Traps :..: No Liquid Waste Management S stem
�I
Discharges & Stream 11219nets
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the Stater? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
2. is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4• is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches); 62-17
05103101
❑ Yes ONo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ONo
❑ Yes JZNo
❑ Yes ZNo
Structure 6
Continued

Facility Number: j — S r Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes ,dNo
❑ Yes XN❑
❑ Yes )2rNo
❑ Yes j2rNo
❑ Yes )dNo
Wage -Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes XNo
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ;?No
12. Crop type CG r " %/ WV'011 Sp �]CCr Y1 f
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONo
14, a) Does the facility lack adequate acreage for land application? ❑ Yes ❑ No
b) Does the facility need a wettable acre determination? ❑ Yes ❑ No
c) This facility is pended for a wettable acre determination? ❑ Yes ❑ No
15. Does the receiving crop need improvement? ❑ Yes �❑
16. Is there a lack of adequate waste application equipment? ❑ Yes ;2rNo
Reguired RgKords
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes eNo
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.) ❑ Yes Cl No
19. Does record keeping need improvement? (icl 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 j2 No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes 12%
22. Fail to notify regional DWQ of cmcrgency situations as required by General Permit?
(ie/ discharge, Freeboard problems, over application) [:]Yes ,ONo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes ZNo
24. Does facility require a follow-up visit by same agency? ❑ Yes �ZNo
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ONo
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comihents (refer: to. question.=,#J:; l;xplaln anyYES unsw sand/or-any reeummeidatit ns ora ny:tithcr comments 3: �
Ilse drawin s of facility to •6eiter ex lain situations use additional ages as necessa '
S. y p �(� p .g ; � -' Field Cop tes v
s �"� ❑ y ❑Final No
,o:.... ...r
spy 41 4hQ vurls bpi 41,e vae4jq6je gcrr5' YvIA3k W-5 46 a
-teG�rfilEdl� S��ei'eil i e'1SvM
A f f A tei f ►n r► vk tv � f n c � be,40 r� � � �l �h�5� u I Il � rya ke,
q� �cce55orr w.OG�,F; cCt4 °fir -rya Gies► tit, Wdt511e ���..�r���.
1�. 3e s,Jre -Few v e .P"Per� bed �.,ni 10 ate►.-171V-z r s - Be s ►��e 4 a �ecarc�
►" ;4,0Se�i I)r l Iicci41 an _'rQP_ 2r5
Reviewer/Inspector Name ��^IpY�E1Nr C T c ki1'_r
Reviewer/Inspector Signature: Date: f�
05103101 Continued

Facility Number: 3► — q 3711 Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes 'ONO
❑ Yes )ZNo
❑ Yes %oNo
❑ Yes 'PrNo
❑ Yes ONO
❑ Yes ❑ No
Additional Comments and/orsDrawings: ' r` ., :: '' ;" z„ ¢%'•; 8: •+y •: F;'• n
1$, G her k w A 'P, ssa r i G4
iraa'9a0v1 desr9Vj ihForr►la�-�; an,
pv,e,-vt 1 he role, �� y�CroPr�� fcr!dr�s Ctwe
05103101

Type of Visit ja'Compliance Inspection Q Operation Review 0 Lagoon Evaluation I
Reason for Visit Routine ❑ Complaint O Follow up ❑ Emergency Notification 0 Other ❑ Oenied Access
Facility Number 3 r Date of Visit:
0 Permitted © Certified 13 Conditionally Certified 0 Registered
Farm Name: ...............04.! S......... V- szn...Fe r`'......................................
OwnerName:............................ rti t v+-.....................................................................
Facility Contact:
ZJ Time: Z l�
Not Overational O Below Threshold
Date Last Operated or Above Threshold: ................... ..
County: :P. V/0L.n .................................. _............... .....
Phone No:
Title:................................................................ Phone No:..................................................
MailingAddress:...............�Q..}................................................................................................................................................................................................................
Onsite Representative:...!-' d v ... ►��' ► �....64 .............................s"/ �......... Integrator: ..................... .............................................................
Certified Operator;
Location of Farm:
Operator Certification Number:
❑ Swine © Poultry ❑ Cattle ❑ Horse Latitude s 4 " Longitude ' 4 «
Design Current Design Current ,.. Detiiga Current
'' Swine , Ca aci Po elation Poul ' a acl . Po ulatlonr Cattle 95 „ '
UY C Ca d 'Po atiari:'c.
❑ Wean to Feeder JEJ Layer ❑ Dairy;
❑ Feeder to Finish ❑ Non -Layer J. . ❑ Non -Dairy
❑ Farrow to Wean `
❑ Farrow to Feeder ❑Other k ;i
❑ Farrow to Finish Tgtai Design Capacity
❑ Gilts a"
❑ Soars Total SSLW:
❑ Subsurface Drains Present ❑ g Spray Number of Lagoons Lagoon Area 5 ra =A';Holding Ponds l 5olid Traps.: ❑ No Li uid Waste Management System I:
Discharees & Stream Impact
1. Is any discharge observed From any part of the operation? ❑ YesZNo
Discharge originated at; ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made.' ❑ Yes 12610
b. IF discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes oNo
c. It' discharge is observed, what is the estimated flaw in galhnin? �j IA
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 ffNo
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes _j=No
Waste Collection & Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier•
...............................................................................................
Freeboard (inches): 37
5/00
❑ Spillway ❑ Yes ONo
- Structure h Structure 5 Structure b
Continued on back

Facility Number: -- Date of Inspection ! 1 11 1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes p.No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes J214o
(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 , 1No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes'ONo
9, Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ YesdNo
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes ONO
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes j2'No
12. Crop type r 1L S + I' l I 501 e A hS
13. Do the receiving crops differ with those desi ated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes,,eNo
14• a) Does the facility lack adequate acreage for land application? ❑ Yes /'No
b) Does the Facility need a wettable acre determination? ❑ Yes"2140
c) This facility is pended for a wettable acre determination? ❑ Yes;dNo
15. Does the receiving crop need improvement? ❑ Yes XNo
16. Is there a lack of adequate waste application equipment? ❑ Yes,,,Efko
Reauired Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yeszj�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 ONo
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) ❑ Yes eNo
20• Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ YesNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes0
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes _dNo
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes XNo
24. Does facility require a follow-up visit by same agency? ❑ Yes _E�No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes _R*o
YIns er- ciejriipte� rr rp p e tog t�js•v�s�t; Yv with �'ec ifa �� #'t
'roues• • deitt;e: abbi6 : this visit • .
Cotti�imeints'(k•4er to.quesdon #)i ;Explain any YES answers "andlor'ainy r�ecommendatlons'or`any otlier"iommeints : 'j; ;:' ; i.UU
i :i:; .;
Use dry of facili to better e.
explain situations: (use additional a es as iseccssa } 'j' ti +. ;a ,::::,_:-;''
�.. tY. p.. p.. lI rs' f t 1l �, u'
T-I1 P re eds A re ri e ctg1 � k e& ,
Reviewer/Inspector Name :i1.,•Z :
ter, EE f}
•` ti. t 1 :. : vie... i; ]l ..5 R-n. ii•
Reviewer/Inspector Signature: Bate: f 11151P 1 5/0

Facility Number: Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ 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? ❑ YesNO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes0
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 ,fNo
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, e(c.) ❑ Yes 'OoNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes gNo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments an or Drawings:
J

40 Division of Water Quality .
0 Division of Soil and Water ConservationflK
Q Other Agency
Type of Visit 0 Compliance Inspection Q Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine 0 Complaint Q Follow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number 31 4g1 irate of Visit: li-tS-ZOOI 'I'imc: iZ:15
ro-Not-0-perational. 0 Below Threshold
® Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold: - -- -- -- -- -- -•
Farm Name: 0.05.Arowtt.fil m.................................................................. County: RUOU .................................... WiRQ.......
Owner Name: Dxi� G..----------------- �ru�A.----•----_._--------•------ Phone No:
MailingAddress: 9,7.6,lixawntAQwz.Rd.................................... ..................................... - wagaolivNc ....................................................... 7.8.453 ..............
FacilityContact: ........................................................... Title: ............................................... Phone No:......................................
Onsite .Representative: iil- Integrator: '
tlub ski?ti,�Rro�rn._._----•---------------------- llxa��� of Gataliata,lt�.--------------•
Certified Operator:QtjA.G..................................... Bt:Qw1A............................................... Operator Certification Number: lal}2.1.............. ...........
....
Location of Farm:
South of Kenansville. On South side of SR 1957 approx. 0.2 mile East of SR 1955.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 66 Longitude ' �� �44
Design Current
Swine Capacity Ponulation
❑ Wean to Feeder
® Feeder to Finish
1470
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry -Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I JE1 Non -Dairy
❑ Other
Total Design Capacity 1,470
Total SSLW 198,450
Number of Lagoons JEI Subsurface Drains Present ❑ Lagoon Area 10 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. if discharge is observed, was the conveyance man-made? ❑ Yes ®No
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ) ❑ Yes ®No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ............. I ............. ..... .--.................. .......................... .................. ......... ........................... ...........................
Freeboard (inches): 37

UNUNvf
"nelnueu
Facility Number: 3]-451 Date of Inspection 11-15-2001
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[] Yes
® No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
Yes
®No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
® No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
® No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
® No
Waste Appliention
10. Are there any buffers that need maintenance/improvement?
❑ Yes
® No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
N No
12. Crop type Corn, Soybeans, Wheat
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
N No
b) Does the facility need a wettable acre determination?
❑ Yes
N No
c) This facility is pended for a wettable acre determination?
❑ Yes
N No
15, Does the receiving crop need improvement?
❑ Yes
N No
16. Is there a lack of adequate waste application equipment?
❑ Yes
N No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
N No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ VrUP, checklists, design, maps, etc.)
❑ Yes
® No
19, Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
N No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
N No
21, Did the facility fail to have a actively certified operator in charge?
❑ Yes
N No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
N No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
N No
24. Does facility require a follow-up visit by same agency?
❑ Yes
®No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes ® No
[] No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question 4): Explain any YES answer§ and/or any recommendations or any other cornments.,,,.
Use drawings of facility to better explain situations. (use additional pages as necessary): Field Copy ❑Final Notes %
the facility and records are neatly kept. +
Reviewer/Inspector Name Stonewall Mathis entered by Bette Rose.. .
Reviewer/Inspector Signature: Date:

r
05103101 Continued
Facility Number: 31-451 Date of Inspection 11-15-2001
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 ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ® No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ®No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or rawmgs.:::'' :::: � ::.:::::.::. . :..- ,..::::::.::... .

ti.
! Division of Water Quality bra
:Division of Soil and Water Conservation
a Other Agency .
r
Type of Visit Q Compliance Inspection O Operation Review 0 Lagoon Evaluation
Raason for Visit 0 Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number 31 451 bate of Visit: 11-15-2Q01 Time: tZ:tS
Not Operational Q Below Threshold
® Permitted ® Certified © Conditionally Certified 0 Registered Date Last Operated or Above Threshold: - -- -- -- -- -- -•
Farm Name: Qua. V.t:owls.FttxM.................................................................. County: DjAplin .................................... WAG.......
Owner Name: O�ia G.------...-._.----- src�►rn---._.»------•-------•------ Phone No; 1J.4�89_�3--•-•---._.-..._._...»._.-.»--
Mai[ing Address: 7.4.OxR.W.jLtpjyA&L...................................»...................................... Magooli t-AC....................................................... Z8.453... .•.........
FacilityContact: ............................................. •............. Title: ............................................... Phone No:......................................
Integrator:�4}Y[l�s_Qt
Certified Operator;Q.U5.Q................................... Brawn ............................................... Operator Certification Numher: l#411.............................
Location of Farm:
South of Kenansville. On South side of SR 1957 approx. 0.2 mile Last of SR 1955.
® Swine ❑ Poultry []Cattle ❑ Horse Latitude • ° « Longitude • 1 «
Design Current
Design
Current
Design Current
Swine Capacity Population
Poultry Capacity
Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
® Feeder to Finish
1470
❑ Non -Layer
ILI Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
1,470
❑ Gilts
Total SSLW
198,450
❑ Boars
Number of Lagoons IE1 Subsurface Drains PresentjjEj Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps JEJ No Liquid Waste Management System
Discharges & Stream impacts
1. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ®No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ®No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Stnicture l Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier1............. ................. .......... .......................... ........................... ........................... ........ -----..............
Freeboard (inches): 37

o-ommueu
uy�ua�u�
Facility Number: 31-45t
Date of inspection 11-15-2QD1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which ate not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
S. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Alpp_lleation
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Corn, Soybeans, Wheat
❑ Yes ® No
❑ Yes ® No
❑ Yes ®No
❑ Yes ®No
❑ Yes ®No
❑ Yes ®No
❑ Yes ®No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ® No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ® No
b) Does the facility need a wettable acre determination? Cl Yes ® No
c) This facility is pended for a wettable acre deternunation? ❑ Yes ® No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did ReviewerlInspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
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): f
tField Copy a ❑Final Notes
�-�.�
I'lie facility and records are neatly kept.
T
Reviewer/Inspector Name Stonewall Mathis entered by Bette Rose .
Reviewer/Inspector signature: Date:

05103101
Continued
haeility Number: 31-4S1 Date of Inspection FT-15-2001
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 ® No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ®No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ®No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ® No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ® No
32. Do the flush tanks lack a submerged fill pipe or a perrnanentltemporary cover? ❑ Yes ❑ No
Additional omments and/or raw ngs:

f .
19 Division of Water Quality
0 Division of Soil and Water Conservation ;
O Other Agency
Type of Visit Q Compliance Inspection 0 Operation Review Q Lagoon Evaluation
Reason for Visit 0 Routine Q Complaint ❑ Follow up Q Emergency Notification Q Other ❑ Denied Access
Facility Number 31 q51 Date of Visit: 11-15-Z04] Time:
Q Not Operational Q Below Threshold
® Permitted ® Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:........
Farm Name: 0.013.00MIAMCM.................................................................. County: DjAplia .................................... WARR.......
Owner Name: Ox1 G.------------------ Sr[A_------------•-------•------ phone No: 9J4-�8g _'T9--•-----•-------•---------•---
Mailing Address: �7. xRWltttx]trrq.Rfd............................................................................ M11911 A.AC......................................................., Z8.453 ..............
Facility Contact: ........................................................... Title: ........................................ Phone No:
.............................................
Onsite Representative: 1lftbtt�t.Qti�Rirvr._._. ----------.---------._--- Integrator:l��Cpyyp�s_Qf
Certified Operator:t?tits.G.....................................0.rO R ............................................... Operator Certification Number: 1R011.............................
Location of Farm -
South of Kenansville. On South side of SR 1957 approx. 0.2 mile East of SR 1955.
® Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • L r �.f Longitude • s «
Design Current
Design Current
Design Current
Swine Capacity Population
Poultry
Capacity Population Cattle
Capacity Population
❑ Wean to Feeder
❑ Layer
❑ Dairy
® Feeder to Finish
1470
JEJ Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
1,470
❑ Gilts
Total SSLW
198,45U
❑ }Soars
Number of Lagoons JE1 Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Imnacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify D WQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (Ifycs, notify DWQ)
[:]Yes ® No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes ® No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ® No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ® No
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ,,,_.........1.,
Freeboard (inches): 37
nl 1'9 0

r
UNUO/ul
Facility Number: 31--451
Date of Inspection 11-15-20�1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation hoses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload
12. Crop type Corn, Soybeans, Wheat
Lunrrnueu
❑ Yes N No
El Yes NNo
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes ® No
❑ Yes N No
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes N No
14. a) Does the facility lack adequate acreage for land applicatiod? ❑ Yes ® No
b) Does the facility need a wettable acre determination? ❑ Yes ® No
c) This facility is pended for a wettable acre determination? ❑ Yes N No
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records_ &_Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
❑ Yes N No
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to question #): Explain any YES answers and/or any recommendations or any, other comntenti:
Use drawings of facility to better explain situations. (use additional pages as necessary): `
❑ Field -Copy ❑ Final Notes l
e facility and records are neatly kept.
r
Reviewer/Inspector Name Stonewall Mathis entered by Bette Rose
Reviewer/Inspector Signature: Date:

05103101 Continued
Facility Number: 31-451 Date of Inspection 11-15-24D1
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
®No
28.
Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
❑ Yes
® No
roads, building structure, and/or public property)
29.
Is the land application spray system intake not located near the liquid surface of the lagoon?
❑ Yes
® No
30.
Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
❑ Yes
® No
31.
Do the animals feed storage bins fail to have appropriate cover?
❑ Yes
®No
32.
Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes
❑ No
Additional omments an or:: Drawings:
......:.. .
J

Diirisioii'oFWii#er Ua t• R� �... .a., �yp�
'y' 'aF 5oit � Di tsion artd•Water.Cotiser►rativri'
Q. g. ,
, .,::d •, . ,. .. - .,.:. _-••- :.:.:.v.:. _ . - Est. �,�..., �.�
�rc x
I....-..i.....:.:....i:?�.,a .-...:.�r ,.a �«.,_:... ..,.... �,:,...,..•.�__ Gam._ .: ,. -._. • .-:.. ._ .. x . -. .. .. .. . _:Y:ir�., .,...... ,.dam.,.... r. 3 , ,.m - . �.-...--..,_� ..,.� ....,+_i;.....�.. ,�[w -.,� • ...�,.. .._.. rtv..•
Type of Visit EDCompliance Inspection Q Operation Review p Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up Q Emergency Notification ❑ Other ❑ Denied Access
Facility Number Elate of Visit: LL''-'L115.dwlJ I..LLt=_J ijne: Printed un: 7/2112000
Q Nnt Operational Q Below Threshold
© Permitted Certified © Conditionally Certified © Registered Date Last Operated or above Threshold:
`j� ....��
FarmName: ...... J................ .1J� ©. .n.......... t1......................... Couttty:.......� .. 1. .........................-
r
Owner Name :.......... +�.�.:.�........ �................. I............... Phone No:..... .1�d..,.►,..�.�.:�i,r,....�,�..........................
Facility Contact:
Mailing Address:
Onsite Representative:..... .,.r &'d C—�
Certified Operator: r�
Location of Farm:
'Title;
Phone No:
Integrator:.., ' Lv �I 5 1 i......
r.4.......................... .......................� .
., Operator Certification Number:
A,
w
Swine ❑ Poultry []Cattle ❑ Horse Latitude 0 C�` �• Longitude •
Resign Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer I ❑ Dairy
Feeder to finish ❑ Non-LayerI 1 ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Fceder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SSLW
Number of Lagoons ❑ Subsurface Brains Present 110 Lawmn Area ❑ Spray Field Area
Holding Ponds/ Solid Traps ❑ No Liquid Waste ;Management System
Discharges & Stream Im acLS
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 Lmnvcyance roan -made`.'
i). if discharge is observed, did it reach Water of the State'? (if yes, notify DWQ)
c. II•dischargc is observed. what is tlx: estiinalcd flow in gal/min?
d, Does discharge bypass a lagoon system? (It'y'es, 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
Stz•uctura I Structure 2 5tructurc ? Structure 4 Structure S
Identifier: .................................. ............................ -...
..... ............... .................... ........ ........ ..................... .............................
Freeboard (inches): 1�
5/00
❑ Yes ,IVo
❑ Yes ❑ No
❑ Yes
t❑ No
�Y
❑ Yes ❑ No
❑ Yes ;�No
o
❑ Yes
❑ Yes o
Structure fi
Continued on back

FacihV Number: y-1j Date of Inspection Printed on: 7/2I/2000
,'5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
o
seepage, etc.)
6. Are (here structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
El Yes
❑
(If any of questions 4-6 was answered yes, and the situation poses an106
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
m'No
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximumand minimum liquid level�KNo
elevation markings?
❑ Yes
o
Waste Application
10. Are there any buffers (hat need maintenance/improvement?
❑ Yes
N
11. Is there evidence of over application? []Excessive Ponding ❑ PAN ❑ Hydraulic Overload
❑ Yes
o
12, Crop type l,/
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
�k o
b) Dues the facility need a wettable acre determination?
❑ Yes
❑ No
e) This facility is pended for a wettable acre determination?
❑ Yes
❑ N
15. Does the receiving crop need improvement?
❑ Yes
No
16. Is there a lack of adequate waste application equipment?
❑ Yes
No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
o
`
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, maps, etc.)
El Yes
�No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
El Yes
�o
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
rNNo
22. Fail to notify regional I)WQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ YesN
o
23, Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'? ❑ Yeso
24, Does facility require a follow-up visit by same agency? ❑ Yes No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes No
Icy latiptis.or-ftiFic�encie5 ry rrr ngted ilirringthis;v�s�tt Yoit}with tteeeiye o futthe'r-. .
cori-es 6ideitce: At)UA this :visit: ...............
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):
rco-jv� /&0 k6 DGLsd.
IV
Reviewer/Inspector Name
Reviewer/Inspector signature: Date: 5100

Fa&ily Number: 3� � Date of Inspection � Printed on: 7121 /2000
�Qdor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or Wow ❑ Yes Io'
liquid level of lagoon or storage pond with no agitation? ff
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �rNo
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 06
0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes XNO
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 and/or Drawings: - =• ;'l
S/00

• ; ©Uivigion of Soil and Water Conservation = Operation Review,.,
0 Division of Soil arid Water'Conservation -'Compliance Inspeetitin
Division of Water Quality - Compliance. Inspection
[� Other Agency - Operation Review
1q) Routine a Complaint Q Follow-up cif DWQ inspection 0 Follwiv-tip of l)S%VC review Q Other
Facility Number
Date cal' inspeclion
F'in►c of lnspection Ia 24 hr. (hh:mm)
© Permitted IP Certified © Conditionally Certified © Registered Q Not O eratiortal Date Last Operate([:
Farm Name: .................. 5.�.........I .iLS►!] ......... gt1Cm ................ Lc�nnty:........I=? 11.�4 ...............................
T'-' ".............................
Owner Name: 0.�1�..... 6...........9<D Ira............................................... Tirane No:.......................................................
FacilityContact: ..............................................................................Title................................................................. Phone No: ........
MaiiingAddress.......... .1e......... ...... V.............................................. ........ V4.cji.ct.... apt.� .......................................... ..4. A ..........
Onsite Representative: ........................................................................................................... Integraator:.................................................................
Certified Operator: ................................................... ............................................................. Operator Certification Number:..........................................
Location of Fartn:
Latitude a ' •6 Longitude • �A "
Design Current
Swine Capacity Population
❑ Wean to Feeder
Weeder to Finish
1+70
Farrow to Wean
❑ farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area I0 Spray Field Area
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discha gLL & Stream Impacts
1. Is any discharge observed from any part of the operation (If yes, notify DWQ)?
- Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. It' discharge is observed, was the ccm.rcyartce roan -made?
h. If discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. if discharge is observed. what is the estimated Ilow in gallmin?
d. Does discharge hylrtss a I:tgornr system?
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any adverse impacts to the waters ol' the State other than from a discharge?
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Strucuire 2 Struclur; 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): .... ......Z-D............... ..............I................
i161J3
AL
❑ Yes M No
❑ Yes ® No
❑ Yes 14 No
[)Yes No
❑ Yes j No
❑ Yes No
❑ Yes M No
Structure 6
Continued on hack

,Facility Number: -S� — c.151 Date of Inspection 3 r;
5. Are there any immediate threats to (tic integrity oi' any of the structures observed? (iel trees, severe crosion, 0 Yes ® No
seepage, ete.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
Closure plan? ❑ Yes ® No
(If any of questions 4-6 was answered yes, and the situation poses an -
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/iin proverncnt? Pd Yes ❑ No
8. Does any pact of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ® No
9. Donny stuctures lack adequate, gauged markers with required lop of dike, maximum and rninimurn
liquid level elevation markings? ❑ Yes ® No
Waste Application
10. Are there any buffers that need maintenance/improvement'? ❑ Yes [A No
11. Is there evidence of over application? ❑ 1'onding ❑ Nitrogen ❑ Yes 50 No
•
12. crap type C. G .1'1............. ...........S11.&±............................................................................................,...........................................................
13. Do the receiving crops differ with those designated in the Ccrtilied Animal Waste, Management Plan (CAWMP)•? ❑ Yes [Z No
14. Does the facility lack wettable acreage for land application? (footprint) ❑ Yes 00 No
15. Does the rcceiving crop need improvement? ❑ Yes % No
16. Is there a lack of adequate waste application equipment? ❑ Yes NNo
Renuired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
[J No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ W[UP, checklists, design, maps, etc:.)
❑ Yes
No
19.
Does record keeping need improvement? (ic/ irrig;ition, 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 oi'design?
❑ Yes
® No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
19 No
22.
Fail to notify regional DWQ of emergency situations as rccluired by General Permit?
(ie/ disc harge, freeboard problems, over application)
❑ Yes
No
23,
Did Reviewer/Inspector mail to discuss reviewlinspecdon with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
FU No
13- N;D.'vioJations :or. derkieride's .were rioted. dtirin� .ttii� visit:. Yeti �vi7l.re�eivc nv further . .
-.
• erjrresPMdertce: t3 661lthis visit.. ......... • ' .... . ... . . .... .. .
Comments:(refe' to question #): Explain any YES answers And/or any recommendat.ions`or any other: commetits.� i;..,
Use drawings of facility to better explain situations. (use additional pages as necessary): f.
i
1. Ca��[r+`uc error�I ►w�e K o ►rlh>Lr �: iotIl of raap+.. +
1V-r „,,,,,. y,,,, t +��ww-� �a �]�t ►�i�i ,� .ti Wds g °�-
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date. S A M 11/6/99

=irr..:sfnma.s,liKw,a..;�:..-..,,..,.....,.,w..--�----•..............n-..,..m..,+?........ie., �.,..5�... ....w..ic�,eii,.�iw...nw.><w,. • �i i �In ,� w°;its»F
a Division of Soil and Water Conservationmm 13 Other Ageney _;R,.;
u
Division of Qua Water lit
. - ----- - x
....
t
e:
Yu
Routine O.Complaint Q Follow-up of DWQ inspection ❑ Follow-up (if DSWC review 0 Other
Facility Number
Date of Inspection
'4S
Time of Inspection _ (D 24 hr. (hh:mm)
D Registered IBCertifiedd © Applied for Permit © Permitted 0 Not O erational Date Last Operated:
FarmName: .................... 5 f .........y301 rti�.}... a,> .x. ............................................... County:........ U�].fora,.....,....,..,.....,......... I .... .......................
Owner Name:..... ........................... S..Cx .. 6[ �,3x.,................................................ Phone No: ...... L1.r i $ .-.q.7a.......,.............................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ............ 92. .......&OWAN...... U........................................... .................. ......................... ... .q „ ....
Onsite Representative: .................. at ...... acaa...................................................... Integrator: ........ &-04A►.S..............................
Certified Operator:............................................................................................................... Operator Certification Number:....................
Location of Farm:
Latitude ' ' " Longitude " ' "
' n ral
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed from any part of the operation?
Discharge originates! at: ❑ Lagoon ❑ Spray Yield ❑ 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
mai ntennnectimprovement?
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'?
7125/97
❑ Yes P No
❑ Yes M No
❑ Yes No
N
❑ Yes C9 No
❑ Yes ® No
❑ Yes QU No
❑ Yes IX No
❑ Yes No
❑ Yes No

Facility Number: _S
8. Are there lagoons or storage ponds on site which need to be properly clotted?
S-hruStur s Lagoons,HQlding fonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2
Identifier:
Freeboard (ft): .............. .............. .......... I ...............
10. Is seepage observed from any of the structures?
Structure 3 Structure 4 Structure 5
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
YVRste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type....................C.O.QN............ W... .................... ............... ........ ............ I........................................
I6. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17. Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permuted facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
C] • No.vinIatians,vr deficiencies. were ntited� during this;visit. • You :~rill 'receive• mi ftirth'er
: c0rre9000debee. Ah'out tjlis:visit:-'-'
❑ Yes V9 No
❑ Yes ® No
Structure 6
❑ Yes CO No
❑ Yes ® No
IN Yes ❑ No
❑ Yes q No
❑ Yes 19 No
❑ Yes Pt No
❑Yes 0No
❑ Yes 00 No
❑ Yes tZ No
❑ Yes fp No
❑ Yes ® No
Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes No
... .�,..," . . .. .............. 3...,:,. ... ... .... ..............
Cntnrnents (fifer to question #):..ExpWin any YES: ansr ers.andlnr any recommendutibns or any othen. cninmeants..,;
S 3. f i gg}
Use dm.win s of �acint � io better ex lain situations (use'�ddidi ; m l " es as neccssa iFF i ' s; _ ; s s i€ _, • ;; ;,
v �p ��/
f t �' p p".FJ ..a ,^ �S �:�¢$F f F;
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12• Qa.rt arms QrL Chvuv. vA�t s6ol0 6e- revcjc-iukd, Giros%Or- OM.4, Or%_ iAvLL4- e);j['_ rde.11 �
56vQ c Fy(tt3 + rtc_vJtdk 'L2.. 000' tr} Sg� l �CAs + 101OCK OCS�C)i' %Wt
7/25/97
ReviewertInspector Name
ReviewerltnspLctor Signature:
ii°...`. is:.
Date:

..:'�; .i.s; A ':. .. ..... .. .... ... .. .....r .... .... .. .......... .......... ........ ... ... .. .. .... :':".I.ij.. .: .... .3i1,3' i:�?sss�1?�r�... .
❑ DSWC Animal Feedlot Operation Review
'zo.t®.
.....
DWQ Animal Feedlot Operation Site Inspection
.......::::.
5 I0utinc 0 Complaint 0 Follow-up (if DWO inspection 0 Follow-n of l)SVVC review 0 Other
Date of Inipe�etita
Facility Number
Time of Inspection Etjij24 hr. (hh:mm)
© Registered ® Certified E3 Applied for Permit E3 Permitted 0 Not O crational I Date Last Operated:
li►
Farm ltiunae:..Q.�t.,�....... .g..sr..a.s.n#.kv....�a:..►r..+r.car.................................................. County: ....�7.u........................... .....................
..iA�.1..�..
Owner Name: ..... JDJ�-iA ....... G......................g !! a ti! f '`............................................. Phone No :.... `i. �.01.. Z . J ,... ......................
Ctiia] 2-99 _34 31
FacilityContact: ..............................................................................Title:................................................................ Phone No:...................................................
Mailing Address: q 746........�.sr7a.rhl.�l.:�►5 val.fry...... Ln..".rL.................... .�1�. �'! a.4..f.G4.�.►......... .C..,. ...................... Z..tl.r.�.
Onsite Representative :.... -D.t.rS..... > .vj........................... .... lntegra(or:..ZJ!_a.�.nk. +..,5.................. .................................
Certified Operatot..................................................... ..................................... .................... ... Operator Certification Number-.
.
Location offarm;
L�jk► .. S.C.st.*....5.[`.e�.l ..., a �'......5..., A7.iF i■rn..s1.... .. .......i�.:..�.....trsn c..i....... .....
tn.......1...1:1.�k..�...................................................... .......... .
Latitude '`6G Longitude ' ' 44
Design Current
Swine Capacity Population
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Design Current Design Current
Poultry Capacity Population Cattle Capacity Population:•
ID E,ayer I I ❑ Dairy
JEJ Non-l-ayer L ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Number of Lagoons 1 Holding Ponds JEI Subsurface Drains Present 10 Lagoon Area FO Spray Field Area
❑ No Liquid Waste Matt:it;ement System
general
1. Are there any buffers that need maintenancelintproveiitcnt? ❑ Yes ® No
2. Is any discharge observed from any part of the operation? ❑ Yes .® No
Discharge Originated at; ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 0 No
b, if dischagge is observed, did it reach Surface Water? [lf yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flew in talhnin? 131A=
d. Does discharge bypass a lagoon system'? (I1' yes, notify ❑WQ) ❑Yes ®No
I Is there evidence of past discharge From any part of the operation? ❑ Yes ® No
4. Were there any adverse impacts to the waters of the State other than from a discharge'? ❑ Yes R No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes KNo
maintenance/i ni l)rovemen t?
6. Is Facility not in compliance with any applicable Setback criteria in effect at the time of design? ❑ Yes ®'No
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes CR No
7125/97 Continued o►t hack

Facility Number:
8. 'Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes (KNo
Structures (Lagoons.ffolding Ponds, Flush 1'its._e_tc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes MNo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure fi
Identifier: I..r. I.
Freeboard(ft):........................ ............ ........ ............................
10. Is seepage observed from any of the: Structures'? ❑ Yes RNo
1 1, 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
(Ir any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13, Do any of the structures lack adequate minintum or maxintum liquid level markers? ❑ Yes ® No
Waste Application
14. • Is there physical evidence of over application? ❑ Yes C&No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ....Ssrl- ....................f. .............. ...........},a. t .--s t.s cA................................................
15. Do the receiving crags 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
® No
18,
Does the receiving crop need improvement?
® Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
RN(')
20.
does facility require a follow-up visit by same agency?
❑ Yes
JKNo
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22.
Does record keeping need improvement'!
21 Yes
❑ No
For Certified or Permitted Facilities Only
23,
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
®'No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
® No
25,
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
JRNo
® No.violations or deficiencies were•n6ted during' this.' visit. .Yoit.will receive no further
coeresOtidence alioitt this:visit:•;
Coiittments (refer to question #): Explain any YES answers. and/or any recommendatinns:or atq otherFcUminents..
Use drawings of facility to'bttter.explum situations. (use additional pages „as necessary)i E F i f'IF'1 ' MV
1-Z. trafC. aojkfsa i i � t-t 4-,a o,,, Wa f i Gut, +
6 , ❑ p i,.r�.. r x-e.. t.-�..v�.tH�, v�-r_c�, v+.eA.43 6 �'4-..V,U.,�.�. q.r yk„r..-.-4'{i'•e--' wo.i p Dom.- f ��
a 1 d car ;i^ a.d r�La. 1 s ue.. + a 4.v 1 i-c r/ I i `rro u t i L r r Q a �-it-t 4, t. ,h
S W I `" ' W ,�rYVV� {t0 [�G Y N V 1L' i `J UL w r t
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2,2 . Cst,k C- u r -4., . f s v 1 .., j w a-. C } i "
S 1n a w S 1 F u l l.
7/25/97
,..... ... •,3i•, �.y;�. .. .... .��... .�� .;..E .�� s"=ity;,.,��,���„i,i,=t' .a ....,€.i!�i��t�I?....44 ...- '.�'i`�S',.'t". .. ..
".... Reviewer/Inspector Name t ....
iReviewer/in.spectorSignatUre: d__ J I J A_ r'. Jl- o r Date:

Site Requires Immediate Attention:
J Facility No. , ,fir
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: � , 1995
Time: a u
Farm Name/Owner: 0 s 640
Ilv�h
Mailing Address: _ -
County:
Integrator: ,Ps2W. CQ930 J Ao r Phone: _ _ On Site Representative: _NJ4 Phone -
Physical Address/Locadon: Ale 4,ja 4TA' Ave f R
idk
Type of Operation: Swine `� Poultry �'t' Cattle
Design Capacity: rfn Number of Animals on Site:
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: " Longitude: Elevation: Feet
N0 F'v 7 `-t
�° Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes 06W Actual Freeboard: Ft. LQ Inches
Was any seepage observed from the lagoons)? Yes or No Was any erosion o served? es' r No
Is adequate land available for spray? Yes or No Is the cover crop adequate? Yes ❑ N
Crop(s) being utilized:
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings?'Yes or No
100 Feet from Wells? Yes or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No
S f
Inspector Name
S Orate
cc: Facility Assessment Unit
Use Attachments if Needed.

v � a i • v +� � +: yvi v�uv�arr LJL.1 .�i\..�
Site Requires Immediate Attention .
Vzj VlI1
Facility Number: r
. SITE VISITATION RECORD
DATE: _ `7 , -� _ 11995
Owner: r_ L _ Farm Naze:
County:
Agent Visiting Site: Phone: 91 d - a LLG _�. 1 X .
Operator: phone:
On Site Representative: 12 h So r Phone: 9/0 r Q51 3 46 0
Physical Address: _Aiw2bt* 1 —4 1 A I ,14 . :5"a �_ S/i 195`7
Mailing Address:
Type of Operation: Swine Poultry Cattle
Design Capacity; I L4 u -0 Number of Animals on Site: _ 114 9_6_ _
Latitude: ° Longitude:
Type of Inspection: Ground Aerial
40 Circle Yes or No
Does the Animal Waste Lagoon have sufficient f eboard of I Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes o No Actual Freeboard: I Feet to Inches
For facilities with more than one lagoon, please address the other lagoons' freeboard under the
co=cnts section.
Was any seepage observed Rom the lagoon(s)7 Yes o No Was there erosion of the dam7: Yes oto
Is adequate land available for land application? Yes or No Is the cover crop adequate? Yes or No
Additional Comments:
M JULo R
Fax to [phone] 114rnature of Agent

Site Requires Immediate Attention:
Facility No. ��x-
'ev t l DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE`VISITATION RECORD
DATE: J-- -A 3 _, 1995
Time: __LLai�
Farm Nr
Mailing
County:
In tegratc
On Site
Physical
Type of
Design Capacity: Number of Animals on Site:
DEM Certification Number: ACE I DEM. Certification Number: ACNEW
Latitude:''" Longitude:Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately l Foot + 7 inches)Ye or No Actual Freeboard: �3 Ft. Incises
Was any seepage observed from the lagoon(s)? Yes o o Was any erosion observed? Yes o o YY__
Is adequate land available for spray? es r No v Is the cover crop adequate? Yes orCW U') i �J
Crop(s) being utilized:
Does the facility meet S CS minimum setback criteria? 200 Feet from Dwellings? 9or No
100 Feet from Wells? or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar, man-made devices? Yes or No If Yes, Please Explain.
Does the facility maintain adequate waste management recoSas (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? esibr No
Additional Comments: 2i . vr �...� __ -Cr�[� I _ �r-,► 'aC`�r�
Vim
Inspector Name �� S ignature
cc: Facility Assessment Unit
Use Attachments if Needed.