310455_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: JD Once Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine Q Complaint 0 Follow-up O Referral 0 Emergency a Other Q Denied Access
Date of Visit: I -2 Arrival Time: =6 Departure Time: County:
Farm Name: 94,1) d u 66-► a'( I Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Jo tgt7 f Z'r- _ Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Design
Current
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
an to Finish
La er
DairyCow
an to Feeder
Nan -La er
DairyCalf
der to Finish
DairyHeifer
❑w to Wean
Design
Current
❑ Cow
ow to Feeder
D P,oult .
Ca aci
I'.o
Non -Dairy
ow to Finish
!Boars
Layers
Beef Stucker
s
Non -Layers
Beef Feeder
Pullets
Beef Brood Cow
Turke s
er
Turke Adults
er
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made`? ❑ Yes ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) [] Yes ' No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes PNo
❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412015 Continued

lFacility Number: - Date of Ins ectiont -2-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
[] Yes
❑ 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 5
Identifier:
Spillway'?:
Designed Freeboard (in):
Observed Freeboard (in):3
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No ❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
0"No ❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑YesVo
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
E(N 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
ZNo ❑ NA
❑ NE
maintenance or improvement?
Waste ADvIleation
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 7 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): t ] r #7 a -►94` J h'► `�l t ��! i ..
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
[2rNo
❑ NA
[] NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
E"No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
0-'No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
VNo
❑ NA
❑ NE
Reauired 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
❑ Yes
L No
[] NA
❑ NE
the appropriate box.
❑ WUP [:]Checklists ❑ Design [] Maps ❑ Lease Agreements ❑Other: 21
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 [3 Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfal I Inspections Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes allo [] NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

[Facility Number: S i - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes VID
No ❑ NA ❑ NE
25. is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ 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 NoZ 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 the drains exist at the facility? If yes, check the appropriate box below,
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes [] No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Evrriniegts ,(referi to question #}: Explain an YESi$nswersi3ndloir'any addltionalreeommendittions tir an `otlier: coii<imenti +. .:
Use;dr�winga:�uf}facility;tokiefte��explaln;si[u�ation`s'{use'additlanal:pale`sas�necessar'•.y}::.�;,;��-.��?�����;;��EtlF���;����R������
1h d) P su_rl/er 3-it-(?
4-o 4 c-2 y' a)4 N' r
-Tor- c,) e reau,,. 4-c s4,,6.nJ 4-o
r
kd r I�F0V4 I
Reviewer/Inspector Name: �1
Reviewer/Inspector Signature: Lt J7 Cf
1
Page 3 of 3
Phone.: q(J 71t t( Znt
Date: 1 2. - Z 0 ~I •
21412015

Type of Visit: _Q-ebmplinnce Inspection 0 Operation Review 0 Structure Evaluation 3 Technical Assistance
Reason for Visit:—@-Xbutine Q Complaint Q Follow-up ❑ Referral ❑ Emergency 0 Other Q Denied Access
Date of Visit: I Arrival Time: , j - Departure Time: County: Region: fir_
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: J�p uwe. e"Integrator: ,�q
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm: Latitude: Longitude:
Design Crrent u
Swine Capacity Pop.
Wean to Finish
Wean to Feeder LNon-La
Wet Poultry
Layer
er
Design
Capacity
Current
Pnp.
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
Feeder to Finish
DairyHeifer
Farrow to Wean
Dr P,oultt
ILayers
Pullets
Design
Ca aci
Current
P,a
I
I
I
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
113eef Brood Cow
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes�'�°No" ❑ NA'`'❑°NE='
❑ Yes
[;14o
❑ NA
❑ NE
❑ Yes
ENo
❑ NA
❑ NE
❑ Yes
EINo
❑ NA
❑ NE
[—]Yes
❑'No
❑ NA
❑ NE
❑ Yes
❑<o
❑ NA
❑ NE
Page I of 3 21412015 Continued

Faciilt Number: - Date of inspection:
Waste Collection & Treatment
4. Is storage capacityjstructural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes J'No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �2Vo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): ;U
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an Immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes
J2 No
❑ 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)
'[2
9. Does any part of the waste management system other than the waste structures require
❑ Yes
J2 No
❑ NA
❑ NE
maintenance or improvement?
Waste AP Ucation
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
E-No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
[:-No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved
Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
❑' No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
❑' No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
[No
[] NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
Q No
❑ NA
❑ NE
Reauired 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
E] Yes
J�J'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 12-No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute inspections ❑ Monthly and 1" Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge?
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
Page 2 of 3
❑ Yes jc - o
[:]Yes [2-No
❑NA []NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
21412015 Continued

Facili Number: - — Date of Inspection:
24. Did the facilitytfail to calibrate waste application equipment as required by the permit? ❑ Yes �No ❑ NA ❑ NE
I
25. Is the facility outbf compliance with permit conditions related to sludge? If yes, check ❑ Yes [ErNo [] NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structures) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor o 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
E2-No
❑ NA
❑ NE
❑ Yes
2] No
❑ NA
❑ NE
[] Yes
.t=! No
❑ NA
❑ NE
❑ Yes �' o ❑ NA ❑ NE
❑ Yes [:]. o ❑ NA ❑ NE
❑ Yes _QON0
❑ NA
❑ NE
❑ Yes []-i<o
❑ NA
❑ NE
❑ Yes Eff 'N"o
[] NA
❑ NE
❑Yes C2--Xo
❑NA
❑NE
Comments (refer. to question #)::Explain any, YES answemind/or any additional. recommendations or any.other. comments:::
Use drnwin s:uf facilit ' sto 6etfer ex ` latin'.situations (use additional ages as necessary
rac0C 4e'e'4'&j a 4C", 6L
Al-
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 7,3'�
Date: Z A
141201

Type of Visit: ompliance Inspection 0 Operation Review 0 Structure Evaluation p Technical Assistance
Reason for Visit: 22outine Q Complaint p Follow-up Q Referral Q Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: t� Departure Time: County: U-nn Region:;'
Farm Name: Owner Email:
Owner Name:
Mulling Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator: i Jrey
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: a 4
Certification Number: L y
Longitude:
Design Current
Qesign
CurrenE
Resign Current
SWine
Capacity Pop:
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
❑airyCow
Wean to Feeder
Non -La er
I
airy Calf
Feeder to Finish
Dairy heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Qr P,oultr.
Ca acit
1'0
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Othe
urkey Poults
Other
ether
Dischart=_es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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 ;ZrNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes [] No [] NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes XNo ❑ NA ❑ NE
Page 1 of 3 2.1412011 Continued

Facilit Dumber: 11- Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes jE'No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes ❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
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 4No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWR
7. Do any of the structures need maintenance or improvement?
❑ Yes dNo
❑ NA
❑ NE
S. Do any of the structures lack adequate markers as required by the permit?
❑ Yes [ Ko
❑ NA
[] NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
TT
9. Does any part of the waste management system other than the waste structures require
❑ Yes [:�'No
❑ NA
[] NE
maintenance or improvement?
Waste Aeplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes .,j No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? if yes, check the appropriate box below.
❑ Yes eNo
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground [] Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application
Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
[D NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
[:]Yes P2rNo
❑ NA
[] NE
16. Did the facility fail to secure and/or operate per the irrigation design at wettable
❑ Yes No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes [dNo
T
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes o
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes tpNo
❑ 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
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis [] Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes XNo
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes [?rNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Facility Number: MJ6JUate of inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �TNo
"w
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZNo
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 XNo
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes [XNo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
{] NA ❑ NE
❑ Yes WfNo ❑ NA ❑ NE
❑ Yes
7No
❑ NA
❑ NE
❑ Yes
EfNo
❑ NA
❑ NE
❑ Yes 7 No ❑ NA ❑ NE
❑ Yes W No ❑ NA ❑ NE
❑ Yes ZNo ❑ NA ❑ NE
Reviewer/Inspector Name: Uv� - - Phone:
.�-
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412014

Division of Water Quality
Facility Number 1 411 - ® O Division of Soil and Water Conservation
Q Other Agency
Type of Visit: 4K Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: ORoutine a Complaint Q Follow-up ❑ Referral Q Emergency ❑ Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: I XS 0 Aq 1 County:
Farm Name: v �► j� E 1/If� Owner Ema€l:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Phone:
Region:
Onsite Representative: �} I�l�1�i i1y integrator:
I a, qgfr g2 V�o
Certified Operator: 6 Certification Number:
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
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
Layer
Non -La er
Design Current
Dry Poultry Capacity Pop.
Layers
Non -Layers
Pullets
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify 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)
z. 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 �6 No ❑ NA ❑ NE
❑ Yes ❑ No
Yes [:]No
❑ Yes ❑ No
❑ Yes 0—
❑ Yes �no
�] NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
Page 1 of-3 21412011 Continued

/Facility Number: ] - Lptb 5 jDate of Inspection: W:)ll
Waste Collection & Treatment
4. 1s storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes j6No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? [] Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes �[] No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes KNo ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Zr 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 ZfNo ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 7No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes effNo [DNA ❑ 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?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fait to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
No
❑ NA
❑ NE
❑ Yes
PT, No
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑ Yes
RTNo
❑ NA
❑ NE
❑ Yes
�TNo
[] NA
❑ NE
❑ Yes 7
No ❑ NA ❑ NE
❑ YesPT"o ❑ NA ❑ NE
❑WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ZfNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall [:]Stocking [—]Crop Yield ❑ l20 Minute Inspections ❑ Monthly and V Rainfall Inspections
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes X No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? 0 Yes VfNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ONE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

� h
Facili Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes WNo ❑ 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
❑ Nan -compliant sludge levels in any lagoon
List strue ture(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes No ❑ NA ❑ NE
Other Issues
28, Did the facility fail to properly dispose of dead animals with 24 hours and/or document
[:]Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
❑ Yes No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ZNo Q• NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of Facili to better explain situations (use additional pages as necessary).
O ■1[ e,r Y)"p1V
PXIQ�&
kctp
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date.
21412011

Type of Visit: Compliance Inspection 0 Operation Review p Structure Evaluation 0 Technical Assistance
Reason for Visit: Routine 0 Complaint Q Follow-up ❑ Referral n Emergency Q Other 0 Denied Access
Date of Visit: Arrival Time: ® Departure Time: 1=0= County: Cl�
Farm Name: ❑ C&N A MIVk r-_ L L- Owner Email:
Owner Name: A of -N f) �A-41F-EU- Phone:
Mailing Address: p. Lp� 1 _ _ NL_SF� ul C-L xc �a if L(SIP
Physical Address:
Facility Contact:
Onsite Representative:14N LQNI [-9-
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Integrator:
Certification Number:
Certification Number:
Longitude:
Region:
Design Current
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry CapacityM Pap.
I ILayer I
Design Curren#
Cattle Capaclty Pop.
i Cow
Wean to Feeder
I INon-Layer
I
i Calf
Feeder to Finish
iry Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
D . P,oultr. Ca aci P,o
Layers
Non -Layers
D Caw
Non -Dairy
Beef Stocker
Beef Feeder
Gilts
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes ❑ No ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes J;�No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ YesANo ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

1
Facilit Nhmber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes )t 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: LA-GaW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes 0 No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No [] NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes [] No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require [] Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
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): '?r—_AjLL lA 1 L[ 6
13. Soil Type(s): f' UG0 L
14. Do the receiving crops differ from ose designate to the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
)Yes0VVVV����"``
tX
No
0 NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
J&o
❑ NA
❑ NE
Reauired 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.
Cj WUP ❑ Checklists Q Design ❑ Maps ❑ Lease Agreements []Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
[] Waste Application Q Weekly Freeboard Q Waste Analysis Soil Analysis ❑ ste Transfers
[] Rainfall ❑ Stocking E] Crop Yield ❑ 120 Minute Inspections 0 Monthly and 1 " Rain all Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
Page 2 of 3
❑ NA ❑ NE
❑ Weather Code
E] Sludge Survey
❑NA ❑NE
❑NA ❑NE
21412011 Continued

l�
Facili tuber: - 4521 Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes PNe
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes )4 No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a PDA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately,
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? if yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
e
❑ NA ❑ NE
❑ NA [] NE
Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
NA
❑ NE
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
❑ Yes No
IKI Yes i(No
❑NA ❑NE
❑ NA ❑ NE
[ ] NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #):'Explain.any YES Answers. and/or, any additional recommendations or any; other..comment&,
use drawings:of ficillty. to better ex lain'situations (use additional pages as necessar :
C) .9 q>Q,0<zLG55 GXf cA-C'oo)l �Ny*-
D6 . ca Q
� o NiA r- �'- 5 1A-
zro,V emu` �1 � c�7A UHF r��� p>1�eE
50l4 a T o�►� ' 'g,DS I W1 5 T 5
* 5M ALL Ta.FGS �S
wl� SSt�D
5 Cs> 6e
i5 . IF16LDS
Reviewer/Inspector Name: rI 64*0174 (S Phone: tG'+760 430�
14
d
Reviewer/Inspector Signature:. Date: ]
Page 3 of 3 21412011

Division of Water Quality
Facility Number 0 - 4 5 � a Division of Soil and Water Conservation
p Other Agency
type of Visit: Compliance Inspection Operation Review Q Structure Evaluation O Technical Assistance
Zeason for Visit: OLRoutine Q Complaint Q Follow-up 0 Referral a Emergency 0 Other Q Denied Access
Date of Visit: z 1 Arrival Time: Departure Time: County: 11+1 Region:
Farm Name: e gNoc,,,+ AHIyA [AA( ac y- Owner Email:
Owner Name: ,] n(ze Q G- WLLL Phone: f IV -D g?I?— �SD Q
Mailing Address: �) 1 C l I v6 CS E Hr LL,iVC_
Physical Address:
Facility Contact:
Title:
Onsite Representative: 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
Non -Layer
Design Current
Dr.v Poultry Capacity Pop.
La ers
Non-Laye
Pullets
Turkeys
Turkey Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pap,
Dairy Cow
Daia Calf
Daia Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes lNo [[] NA ❑ NE
❑ Yes ❑ No
❑ Yes [-]No
[DNA ❑ NE
❑ NA ❑ NE
[]Yes [] No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
No
❑ Y es ❑ NA ❑ NE
Page I Of 3 21412011 Continued

acill Number: Date of Inspection:
Waste Collection & Treatment
4. is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes o ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: L92wt
Spillway?:
Designed Freeboard (in): - f
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes 0 No
[] Yes tNo
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? Yes ❑ No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? Yes [ No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes j No ❑ NA ❑ NE
maintenance or improvement? 1 .
11. Is there evidence of incorrect land application? If yes, cheek the appropriate box below. ❑ Yes o ❑ NA E] NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zri, etc.)
❑ PAN ❑ PAN > 10% or l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): C—4 C r I I t CLf_TT
13. Soil Type(s): _L&C 1 (,Le_
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes kNo
❑ NA
❑ NE
Required Records & Documents 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 avaiiable? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
QWUP OChecklists Q Design [] Maps ❑ Lease Agreements ❑Other:
21 • Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes
[l Waste Application [] Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ jYaste Yrran�sfers
Q Rainfall ❑ Stocking Q Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l " Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
❑ NA ❑ NE
0 Weather Code
Q Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

>l:'acili Number: 11 - t. 5 Date of Inspection: &I3
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes rNo
o ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ["] Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
Yes [] No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes �] No
❑ Yes �No
❑ NA ❑ NE
�NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
32, Were any additional problems noted which cause non-compliance of the permit or CAWMP7 ❑ Yes No ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
�Sca l (_ er=yci7_r n jqV-_--, + 15 Fo (L �/o - 5 T Lc N6 r j 0,
RER-se mot.v ActC D u�roQN
I,t.}. N F�� n '� �►PP�-Es5 �G�c�s tc A 2oUXI c,46ocYu 'r3A )X
/o )cE L XN oEi�L- CO/v 7-a4C.] L.
LA [ A &A5H+ 14QC-, r F 140T ?t a14 T&b 6i49-L AA ILLEri
Grn7-f1n C3 �5
(-)r,-,l �
pip. PUA-sE C4 G >' ct�
Q F o t)1 C. c A mqL�--��o� p 5
�;laMsv�Q1GO-C-T)ve
rr✓G u 1pt c L_DS 49-c I m p R-oo i l►1 c�
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone:
Date:� -
21412011

Division of Water Quality
Facility Number "3 �55 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit AlOompliance Inspection Q Operation Review Q Structure Evaluation ❑ Technical Assistance
Reason for Visit Routine Q Complaint Q follow up O Referral Q Emergency D Other ❑ Denied Access
Date of Visit: I-6 Arrival Time: L� Departure Time: County: .A/ Region:
Farm Name: Nt�+MF LL Owner Email:
I!AMC Name: N�� aQUL_ Pho}ne:r 1ja J 9�_300a p
Mailing Address: � Iq S / e S� 5� !rye ► / X C.. Ci-� `V S
Physical Address:
Facility Contact:
Title:
Onsite Representative:
LA/VIC-F-
car
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = c 0 I= 11 Longitude: O n= 4 0
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
Layer
_ ❑ Non -La er
Dry Poultry
❑ Layers
El Non -Layers
Lj Pullets
Turke s
❑ Turkey Pouets
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
Design Current
Cattle Capacity Population
Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ DrY Cow
Non -Dairy
El Beef Stocker
Beef Feeder
El Beef Brood CovA
c. What is the estimated volume that reached waters of the State (gallons)?
Number of Structures:
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
XNo
❑ NA
❑ N E
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes �No ❑ NA ❑ NE
[Dyes 6o ❑ NA ❑ NE
12128104 Continued

racility.Number: ? ) —YS5 Date of Inspection
Waste Collection & Treatment X_No
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ElYes ❑ 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: LAr002►
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental
threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
)(No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
No
❑ NA
❑ NE
maintenance or improvement?
Waste ARplication
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
4No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 101bs ❑ 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) ���u� SCS
13. Soil type(s) &,Ofi f-kA l _
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
5No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
kNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ Yes
F No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
`.� ... ::... .... �:• �: .•�, ..� '�" ..�... .;.:...'...(.:'isi,•.yt....,,.,.:•�.'��:.��sY;;;:z•;.r.��i�
Cumments4refee,:iii` uestiun #}r Explain any: YES;ans►yers and/or. any; recommcndatlons vr• any nther::cvmmcnts.' ; &:q ; o r ; ` .' t
r i f f ilgit •t tt r p use aiiditionai a es �' ne ` Used aw ngs u ac y u be c explain.slfuatians.,( p g as necessaryj:
s .
�: �.. ..,.. .. 't ��.. •:" �.. ..... _..s �.. .. .. i."r, .� .�.f icf'.... ..�a i7-.R.v...._�.��a'�.�z::Y.d ����.��9'S•���.i .t s: �:�'�i �'a�r �.75x.x....�. .:i 2�: �,.. ;;�:;k
91
Reviewer/inspector Name' `T. .r '..::.` Phone:
Reviewer/Inspector Signature: Date: CD
Page 2 of 3 12128104 Continued
`'r

I
AlaciiltyNumber: —y Date of inspection
Re
aired Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
No
❑ NA
El NE
20.
Does the facility fail to have all components of the CAWMP readiiy available? If yes, check
❑ Yes
No
❑ NA
❑ NE
the appropriate box.
[l Wl]P El Checklists 0 Design 0 Maps El Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
*o
❑ NA
[I NE
0 Waste Application El Weekly Freeboard El Waste Analysis 0 Soil Analysis ❑ /ste Transfers���////// ��,��,❑Xual Certification
Cl Rainfall ❑ Stocking El Crop Yield [] 120 Minute Inspections [l Monthly and 1"
Rain Inspections 3
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
No
Cl NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
)kNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification`?
❑ Yes
❑ No
�(NA
ElNE
Other Issues
28.
Were any additional problems noted which cause noncompliance of the permit or CAWMP?
❑ Yes
[ No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
(� No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes}k
o
[:1 NA
❑ NE
Additional Comments and/or Drawings:
C. Q t t 6914'f 10/V
cc uD r'e CouJ F>AOL&1�14 To A SNC F01- exE Mpri
w.A ,
-�rllcllo
a�-
l�4�ry
1. �
QD076- ?kAWLFIN6 QECabS - 6457 rUG^if /(A:7kt�,
Coeds/ ' 'C - ! L C��-0 I� F L Fy}T M �1 !J� G U EN 1
LA/1 -4f /0 • BA5&t-s CW 04600A1
J
OF ftoo IC off] C� jar LA.31 q_ccow]'�' - Crb & M 5 d!C AG71 Ue
70wo V-r- To 6 ET 8 S 776 � C-GO KA"
g lq tyelvril &r w&6b5 io 66- Dcyfc Td r HC- a_ F tE c b R&4,rijoc460dV
Page 3 of 3 12128104

Division of Water Quality
Facility Number�2 �� Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit ACompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 'A Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: L.ZL.I�I Arriivaal ,rime: Departure Time: County: Region:
farm Name: �?�QLi F HM9 �kPU-ELL Owner Email: c�cs n
Owner Name: �nJ1� G gMeu_ j� Phone: Qr 1+� ate"' r g v�
Mailing Address: 0`y`1{ J� G � 11LL H
Physical Address:
Facility Contact: Title:
Onsite Representative: ]�+�N"� LR>n►lEfL'i7c1� b''l42ft�LL
Certified Operator:
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: = e 0 I =is Longitude: 0 0 = i = «
Design Current
Swine Capacity Population
❑ 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
Wet Poultry Capacity Population Cattle Capacity Population
❑ Layer
❑ Non -Layer
Dry Poultry
Discharp-es & Stream Imoacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made'?
❑
Dairy Cow
❑
Daia Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:EJ
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c, What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El Yes
El No
El NA
El NE
El NA
El NE
El Yes
El No
❑ Yes
NNo
❑ NA
❑ NE
❑ Yes
NiNo
❑ NA
❑ NE
12/28/04 Continued

)Facility Number: ] -»
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 t Structure 2 Structure 3 Structure 4
Identifier: 4AZOW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes ) 1No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes )4 No ❑ NA ❑ NE
❑ Yes 1A No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes] No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? if yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes
�dNo
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement? X.Yes
❑ No
❑ NA
❑ NE
lb. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes
❑ No
❑ NA
XNE
17. Does the facility lack adequate acreage for land application? ❑ Yes
❑ No
❑ NA
�rNE
18. Is there a lack of properly operating waste application equipment? ❑ Yes
❑ No
❑ NA
ANE
lit -'�° '�..: ,� .. toobw .
mments (referff�questlonlq# :, :Expls}in any YES answers andlnr any recommendationsror any other comments.
Jlr �„t"9 i ' �;i1� i�h i. iW. .
use drawings of�t'acilityAto better explain ituations: (useaaddi#ipnal pages as necessary):
Y k+e i n�3 i7ss
i ro-14,-c.L -7t* OLEC 10NAQ AG iROM04,11 ! ST
,')::)_9NN Ls -Al rC-1— H Qo� -Tc) DC- it- MI/VE cCK-k �LsE (3 F )4C7-/ &4
r✓l F- A L L W l LL_ wS t 1 C Lk Q M 1 I
T
ReviewerAnspector Name - N A .� j - .
Phone: 56-VT �6-1 3 94
Reviewer/Inspector Signature:
Date: `1 d
Page 2 of 3 12128104 Continued

Facility Number: Date of Inspection [�
Re
wired 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, cheek
❑ Yes
❑ No
❑ NA
�NE
the appropiiate box. ElWUp [l Checklists El Design ❑Maps [I Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ NA
} NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and l"
Rain Inspections ❑
Weather
Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
❑ NA
NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
❑ NA
NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
❑ NA
KNE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
❑ NA
gq NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
❑ No
❑ NA
4 NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA
D NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes]
No
[I NA
[] NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
Ayes
❑ No
❑ NA
❑ NE
- .:; {,. f:Y.��.j..�:� `�: '�q.{'.y1 -'�- ��C �. rn.4:� �i-.�:(��.,�.i"�I::kF�d :���9'�.
Additlonal�Ctimirierifs1an. 6 D'rawiriQs a z .. .4g 4: £ . .';'.�. i..S.
g. .� ?�i.R.':�G �:�.�.�-4��1� ��.���6'���. •i N�R�
ok A mA wf,-�+ 64ovr-5 A co
cam/ fhb-��,— [.ocar�l� 7c�� Q ACIC
�[P'LD J/►! ??-fqvpS �t Gv�►9 C 4 55 t 9LL w AN A-r n k AC C R a
&-*A TS KQ- - �+4Q �� C L X�) 14L 14 yCa n Sf-SN City G,¢a4F
Q�E►45w c.HkQ lE Nd �&(_AAWpl� 7 H e (LA7 W7 L__ 9 f- t'V 7-t+e w(Lt -r
c►J><C.�- ����aw]�� L� i ��- Tt11 S CIF. I-Q -K3 a-05 S
Page 3 of 3 12128104

Type of Visit 94ompliance Inspection a Operation Review 0 Structure Evaluation Q Technical Assistance
Reason for Visit �Ooutlne D Complaint D Follow up Q Referral Q Emergency Q Other ❑ denied Access
Date of Visit: (Q�]�al
Arri(val Time: L,® Departure Time. � County: Region:
Farm Name: ZANf)(A 4-1` IVNjq H gRRE U_ -_ Owner Email: r�
Owner Name: _), Eize L A�LAN Dot 1Ai4�Rl=LL _ Phone:
�rPhone:
Mailing Address: '=j)Q 1q S / y C 50 zcs
Physical Address:
Facility Contact: Title:
Onsite Representative: �N/ ^ I?.- -w
Certified Operator: U- )jA1 FRC_Q LA 1AtQ(zRGLL__
Back-up Operator:
Phone No:
Integrator:
Operator Certification Number: 4
Back-up Certification Number:
Location of Farm: Latitude: = v 0 I 0 11 Longitude: = 0 0 6 = «
Design Current
Design Current
Design Current
Swine Eapacity
Population
Wet Poultry Capacity Population
Eattle Capacity
Population
❑ Wean to Finish
❑ La er
❑ Dairy Cow
❑ Wean to Feeder
-Layer
❑ Dairy Calf
Feeder to Finish
(j
❑ Dairy Heifer
Farrow to Wean
Dry Poultry
❑ Da Cow
❑ Farrow to Feeder
❑ Non -Dairy
Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Non -Layers
❑ Gilts
❑Beef' Feeder
❑ Boars
❑ Pullets
❑ Beef Brood Co
❑ Turkeys
Other
❑ Other
❑ Turkey Points
❑ Other
Number of Structures:
Discharges & Stream Impacts
Is any discharge observed from any part of the operation? ❑ Yes 't(N❑ ❑ 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?
❑ Yes
9No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
D(No
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number:? t -- y5S Date of inspection
Waste Collection & Treatment
4. Is storage capacity {struc(ural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural frceboard?
Structure 1
Identifier: _ 4.A5& Q'M
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
Structure 2 Structure 3 Structure 4
❑ Yes A No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
El NA ❑NE
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
No
❑ NA
❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes
No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
11
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11.
Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes
ANo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy 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 [I Evidence of Wind Drift [I Application Outside of Area
12.
Crop typece
s) 1
13.
Soil type(s) Lu A A t,t l 7
14.
Do the receiving crops differ from those designated in the CAW MP? ❑ Yes
[$No
❑ NA ❑ NE
15.
Does the receiving crop and/or land application site need improvement? X Yes
❑ No
❑ NA ❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination? ❑ Yes
54 No
❑ NA ❑ NE
17.
Does the facility lack adequate acreage for land application? ❑ Yes
% No
❑ NA ❑ NE
18.
Is there a lack of properly operating waste application equipment? ❑ Yes
'XNo
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recotnmendatians orany other comments.
Use drawings afRfac[lity tv better explain situations. (use additional pages as necessary);
F77]�7,►N3`j,
C¢��j�� �.�o
1i ]c�� �• S
tr trflHl-�Gao�►! 15 1N WI�Q -REDS TCi i3
mAt�rraLH�p J tTIs mo57Lr� FILL wEED'5
-�H� 07HF9- eAdt=7V FLG0- ) �4AS 59A9-3p Gevw"DA GaUtr F
wX z-L S c0n1TAC*r0*WC "f m PALL- -r # e A G9QNGj t5 T iU C-O tAC-
cuj -170 14F_ FA(W a t-4SLP w1IJ1 A9L19N Tv r+ttP4Ua 13C-(V%&kAW
�.._ -
Reviewer/inspector Name Phone:
Reviewer/inspector Signature: Date -
Page 2 of 3 12128104 Continued

Facility Number: — Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes )q No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes XNo ❑ NA ❑ NE
the appropirate box, 0 WDP [1 Checklists ❑ Design 0 Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No ❑ NA ❑ NE
[:]Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑ /aste Transfers ❑Pinual Certification
0 Rainfall 0 Stocking 0 Crop Yield 0 120 Minute Inspections 0 Monthly and V Rain inspections [] Weather Code
22. Did the facility fail to install and maintain a rain gauge?
23. 1fselected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit''
26. Did the facility fail to have an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern'?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Additional Comments and/or Drawings:
�c.�ASE F
❑ Yes
0No
❑ NA
❑ NE
❑ Yes
C.No
❑ NA
❑ NE
❑ Yes
A No
❑ NA
❑ NE
El Yes
�No
❑ NA
❑ NE
❑ Yes
Jplil No
❑ NA
❑ NE
❑ Yes
❑ No
kNA
❑ NE
❑ Yes
%No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
P .No
❑ NA
❑ NE
'Yes
❑ No
❑ NA
❑ NE
FAmmeR- 'A A s m 6,4s u>L& is 44 1 E f=(L e E 130 a MA cz)J E R qr F lzd m
-T-op D F ffNgi GR_ TO l= t CZ S -r S T o6 1 a' 1
LACROC3 DP-526Af A GEZjS i_0 Z� u")1 R oq_Z s
Page 3 of 3 12128104

Type of Visit compliance Inspection 0 Operation Review 0 Structure Evaluation ❑ Technical Assistance
Reason for Visit ]0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ denied Access
Date of Visit: Arrival Time: ® Departure Time: County: U A/ Region:
Farm Name:
Owner Name: ND�I _ AUE-L:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: f
Certifies! Operator: w �QQ� LL
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number: dW
Back-up Certification Number:
Location of Farm: Latitude: = e = I ❑ 11 Longitude: = e ❑ 6 ❑ s6
Design Current
Swine Eapari Population
Design Current
Wet Poultry Capacity Population
Design Current
Cattle Eapa�ity Population
❑ Wean to Finish
ID Laver
❑ Dairy Cow
❑ Wean to Feeder
Non -Layer
ElDai Calf
Feeder to Finish jLjtf6
❑ Dairy licifcr
❑ Farrow to Wean
pry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ Layers
❑Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Boars
❑ Pullets
El Beef Brood Co
Turkeys
Other
❑ Turkey Poults
❑Other
Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
A 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?
❑ Yes
OkNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
O(No
❑ NA
❑ NE
other than from a discharge?
I
page 1 of 3
12128104
Continued

Facility Number: 3 — yj Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes ANo
❑ NA ❑ NE
a. If yes, is waste Ievel into the structural freeboard?
❑ Yes ❑ No
❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: 1"4EonY►1
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
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
Yes ❑ No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes rNo
❑ NA [IN E
(Nat 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
y�
❑ yes oe No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes kNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes 0 No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside
of Area
12. Crop type(s) M- A
13. Soil type(s) L.0
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
Q%No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
Yes
❑ No
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?
❑ Yes
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question 4):: Explain any YES..answers and/or any recommendations .ior any other comments.
Use drawings of facility. to better explain situations. (use additional pagewas necessary): ,
�7. "0Zr-V ' and FW AK b"/N P1Pc- -ALL W A576
ccw7A11crF.10 P_,ACP I
`
LA-CaaA� N071F [ED Wlr/�( a,­t he-5
15, uszq_r-' A w/ AcC c-X7 (A+woo) A v-o - C-0/vI4cT
A GRAM i� r 1r ,t►fc+i SMFS
l-f A-- g>E6ht teaRr/NL;' u.]1 34 L►`] 4SF E Lb-�
Reviewer/Inspector Name M ti !N 6
Phone: 963
Reviewer/Inspector Signature:
Date: Q
Page 2 of 3 12128104 Continued

Ak! 61
Facility Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes "tg 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.
❑ WL]P ❑Checklists M Design ❑Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
XNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
0No
❑ NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
VNo
❑ NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
Z No
❑ NA
Cl NE
26, Did the facility fail to have an actively certified operator in charge?
❑ Yes
`U Na
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
A NA
❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes b5 No ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document []Yes )PNo ❑ 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 ]ym No ❑ NA ❑ NE
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by ❑ Yes No ❑ NA ❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes] No ❑ NA ❑ NE
Page 3 of'3 12128104

Type of Visit Q�Cbmpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit -Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ denied Access
Date of Visit: =Arrival Time: V•r
Farm Name:
Owner Name:
Mailing Address:
physical Address:
rtureTime: County: k_ Region:w�
Owner Email:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Phone:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: [= o =, = Longitude: = o =1 =
Design Current
benign Current
Design Current
Swine Capacity Population
Wet Poultry Capacity Population
Cattle Capacity Population
❑ Wean to Finish
❑ La er
❑ Wean to Feeder
❑ Non -Layer
Feeder to finish
Dry Poultry
❑ La ern
❑ Non -La ern
ry
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
poGilts
Boars
El Pullets
❑ Turke s
Other
❑ Other
TurkeyPoults
Other
Number of Structures:
❑ Dairy Cow
❑ Dairy Calf'
❑ Dairy Heifer
[]_Dry Cow
❑ Non -Doi
❑ Beef Stacker
❑ Seel Feeder
❑ Beef Brood Cow
Discharges & Stream Impact
1. Is any discharge observed from any part of the operation?
❑ Yes
P 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 ol'a past discharge from any part of the operation?
❑ Yes
Xj No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
J6 No
❑ NA
❑ NE
other than from a discharge?
Page 1 of 3
12128104
Continued

Facility Number: '3 —7 Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
J2 No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure
5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
J2 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
;2TNo
❑ 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
21 No
❑ NA
❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes
0 No
❑ NA
❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
,RNo
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ No
❑ NA
❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes Vi No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Fleavy 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 typc(s) r [�ae
13. Soil type(s) L46Z / 14A?
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
40 Yes
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
[OIo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
[
❑ NA
❑ NE
Comments (refer to question 4): 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
Reviewer/Inspector Signature: % Date: t� Q
Page 2 of 3 17128104 Continued

Facility Plumber: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes gNo ❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ZNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑ Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes V) No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
[B No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
W No
O NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ No
[;j NA
❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
❑ No
INA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
EINo
❑ 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
El NA
El NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
ElL�.I Yes
,VNo
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?
ElYes
LI 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
JffNo
❑ 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
E!rNo
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency'?
❑ Yes
eNo
❑ NA
❑ NE
Additional; Comments and/or Drawings:
0 j�'///"� �s
`'
llo�v a� 04
"ke ca_04 al-e /1&?-/
Page 3 of 3 12128104

(Type of Visit P Compliance Inspection Q Operation Review p Lagoon Evaluation j
Reason for Visit JD Routine Q Complaint D Follow up 4 Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit: L
0 Permitted ❑ Certified © Conditionally Certified ❑ Registered
Farm Name:
Time: _ /tea c
Date'Last Operated or Above Threshold:
County:,ia,?.L.l.t
Owner Name: _. »......__.. ._..... »». ».» ...».»»»... .....»».»»..».. ».». .. • Phone No: ... »..........
MailingAddress:...__ _...... _._..... _ _. .... _ __... ___...._ ._ .. _._._ . _ __ ___._ ._ . __ ..... _.__ ..._.__ ....._.».........»...» ... ....,_
Facilitv Contact: »_. »» . _...»»».»».....». »....» .»....».»+» Title:...».» . _...»»..,
Onsite Representative: „ 4 ..tAL � ..t 4f l' . .........
Certified Operator%_.........._-_._ .» ..»».»» ...»»....» ..»_ ».»»..»..»»..» .._...... »».».»».
Location of Farm:
Phone No:
Integrator:.-0rl
Operator Certification Number:-_—....-__-_,.
AL
__IV
❑ Swine ❑ Poultry ❑ Cattle © Horse Latitude �• LJ` C]�s Longitude �' ��.�«
... �`' t * . ttt�tt :.
.. ...
Swine Ca
y F„.
pool,
ti7':. N Ca'
M1p... n: ;;;Cattle
tia
Ca "Pv' lotion
,Po t:a = ..
Q :.
13 Wean to Feeder
❑Layer
❑ Datry
ceder to Finish
Y ❑ Non -Layer
'' ` ❑ Non-D
-,
Farrow to Wean
. Farrow to Feeder
1 Other
.M
"
Farrow to Finish
;a .... •. _...
_
; P9
❑ Gilts
VMY
g��
Boars:....
{i=! i i,
. .:,
;.
Number, oI =
-:
�'
ii.'. k'y`f3y b
]:.'.�:�� ..� �;r�i'::; �s:<�-•;i��'
q%�agooas
ni�� ."_';"l[rayr•_n`}7�:[.:.. .i..�
DischaMes & Stream1mvacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & T ent
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier: .............�»... — » .... _.....», »._.w_ _.M_w ......... _. _ ....... _....»....ww __..... _..
Freeboard (inches): 33
❑ Yes ,ffNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑Yes [;�o
❑ Yes ;dNo
❑ Yes ;�No
Structure 6
121I2103 Continued

Facility Number: — Date of Inspection �f
S. 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 maintenancelimprovement?
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
10. Are there any buffers that need maintenanceJimprovement?
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground Copper and/or Zinc
12. Crop type �{ �� [�:�' el
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWW)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attar below
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours?
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? if yes, contact a regional
Air Quality representative immediately.
❑ Yes .,A No
❑ Yes Pq"No
❑ Yes 0�o
❑ Yes 9No
❑ Yes ff No
❑ Yes EfNo
❑ Yes C�No
❑ Yes eNo
❑ Yes PI'No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 0 No
❑ Yes 21 No
❑ Yes 0"No
❑ Yes ONo
❑ Yes No
❑ Yes P No
_._.__. .,,..,... ,,..._. .,....+4 ^.?"+7.il k!4Y4;•Y":'3:!mI` •.»,....... :;M"',y..+r„ tsxxxu... _. •_' :�s'N+kls�-.Ltv:'§tii€....... 13k+r'::.: ,.,.,;�+^x ':-�u�" 11r...:. It7clr.":xf'i'm: s—N.- caHei:•.Tri--r�."1-'-'A 5 'i-A'-,;, RM•11T
: Ctttnu ai 6./l dif,to, esteofi #jJ ':7_in YES a W*ers iWME an o er, eon�tnen '` i? �'L =
u'i"i5e' "awCMh.�"�"'Y A7€ii� �i:?'Ih!�' Ni�iM.!f!Y.:�N�iRS??',+ i:::. ':1n
r,ea:pla% tua {ase additiotta! as aeeesaty;jfe ❑ Field Copy ❑ Final Notes
iis'irewings vfl�aeiitly=;o Bette si tiaax. pages,
..n:�. ._ �:�k.:..uibi i.u... �i 4 d i. .3 rx KY �x :. � ;�, � :..'?.°'..,�.e"'•'i
IkA
�Cfs � � a �w Ga c✓ c� �e� s . - f
i lw��E�'���T tiP�%7
-e �a 7'
Reviewer/Inspector Name 22
Reviewer/Inspector Signature:
Dane:
12112103 Continued

Facility Number: 3 Date of Inspection
Reauired lA=rds & 17ocuments
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
tie! WUP, checklists, design, maps, etc.}
23. Does record keeping need 'improvement? If yes, check the appropriate box below.
❑ 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?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss reviewrmspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Rennifted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes ❑ No
❑ Yes ❑090
❑ Yes 7110
❑ Yes Xo
❑ Yes ;2fNo
❑ Yes No
❑ Yes No
❑ Yes ff No
❑ Yes �fNo
❑ Yes No
❑ Yes ❑ No
❑ Yes ❑ No
❑ 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 Farm ❑ Crop Yield Form ❑ Rainfall ❑ Inspection After I" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
I2112103

C1%4e�elc4 6--__
Type of Visit )aCompliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit Routine ❑ Complaint () Fallow up D Emergency Notification D Other ❑ Denied Access
FaciIitr• Number
Hate or visit.- DZ Time: I
� S
Oi3crati2nal 0 Belog�.Ureshold
0 Permitted © Certified [3Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: A vt 4.1 -� ►"1 11 %'1 �► +�-s'_' e e County: Dui 1' , --
Owner Name: R n e 1'r0.� .. N 4.011CI I Phone No:
Mailing Address:
Facility Contact: jj 1 /Title: J� Phone No: r
Onsite Representative: R 4 nOL
7 -_ i` gezel� r Ayng �;( � /ec O integrator: �^"Q!_✓ h5 AT e4_f a 1 ; n
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a �• 041 Longitude 0' 1
Design -Current . Design.;i.Current, °.Design ''Current',
Swine Capacity Po ulation Poultry �' Ca 'acity 'Po ulation Cattle Ca} acih Pn uigtlori
❑ Wean to Feeder ❑ Layer Dairy
Feeder to Finish 1' ❑Nun -La er on -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ Other
r
❑ Farrow to Finish m tsU D NI .,
Td Csizn-Caps� lh''
❑ Giits
❑ soars Total SS L W
Number of Lagoons. .. 1 Subsurface Drains Present Lagoon Area S rav Field Area
Holdin Pon& Solid Traps QiSystem
g, P � No Li uid Waste Mana ement
Discharges ¢& Siream impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. if discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min'
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Cgllecti2n & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Freeboard (inches):
Structure 5
❑ Yes ZNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �No
❑ Yes ❑ No
❑ Yes 11RfNo
Structure 6
05103101 Continued

Facility Number- 3 —
Date of Inspection 1
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
d. 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
immedlate 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 maintenancelimprovement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Annlication
❑ Yes Z�No
❑ Yes 2 No
Yes ❑ No
❑ Yes ONO
❑ Yes 'ZNo
10. Are there any buffers that need maintenance/improvement? ❑ Yes 2f No
11. Is there evidence of over application? ❑ Excessive �Pronding ❑ PAN ❑ Hydraulic Overload El Yes ,�No
12. Crop type F� �^^� �R tJrr ►'� �t�r1 C� 1'R ► n,,, .ye►�S�
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 ,ZNo
b) Does the facility need a wettable acre determination? ❑ Yes ,12"No
c) This facility is pended for a wettable acre determination? ❑ Yes 2No
15. Does the receiving crop need improvement? aYes ❑ No
Ib. Is there a lack of adequate waste application equipment? ❑ Yes ZNo
Required Recoras & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes -&No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes 2!rNo
19. Does record keeping need improvement? (iel 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 ZrNo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes _Lallo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes ZNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes E30No
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
0 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer -to que'stlon #)i ' Explain an'YE5 answers'and/or. any.recornmendations or: n y: o`a co a an thermm nti`
"' ' - • ul.-` '`
Use drawings of facility, to better explain situations; (ase addilianaE pages as ne e;sa
.,. w° Field Cony ❑Final Notes
17.-The 1)tj4s;0(e rVAO o�C 41,e Joa►n nee'#s MevlvlJ
i,<} 4AGt� �qs ,met,141y deems Guy -i?eedJ k b,e boded
V e dc:I�/ S er 44l4R !�!`n re, -'no r/Cd �r a1" 1 41 r e 4'e, j4i - �C. 0 4
�aer•�,udif�l
needs 4e cor.4;•7tie 7o be do�"} TD e]i,.r};r}(� e r1or, (,rF90a+ iL i-r
e,4 a t��'S�a�lrsZ, I�dG�S�G� ove'> 44e en-]�-re f Fetal.
Gan ] in ue��
P �.T d 1�1f� yy��..�
ReviewerlIns actor ]tame �� �`�� 1 '��°� -'� � � 'T7
Reviewer/Inspector Signature: Date: D?-
05/03/0I Continued

Facility Number. Date of Inspection p2
dor 122 S
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, 1s 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 fans) 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?
xYcs ❑ No
❑ Yes -O No
❑ Yes ZNo
❑ Yes J'No
❑ Yes �1Io
❑ Yes No
❑ Yes ❑ No
Additional Comments and/or Drawings: "
-��, e 2nC� ! q I� cad►per � �o ���, td��; ��a�`r , .r �n cxce�s ��'
p�
�hs�a� cr p�r;Fr�-�;o►-� even-�S .
�6a�ra! reGdrds o►►'� n� �c2 � er� �� -A wee 6,5is
i r .
Need -fie b-- sv rc �o 6-1 ve q '-, iy U-re &I
�cL
� rra Can a�f fit, corn 44e ),7ee4 4a go 6Aek
a �d �ecr l c c►l�� e ,rdw,c Zav � be►'•� uol� a�l�'c�x �•c�n� Upoh
rece,v'sj aPP It' ible w4.r�le a►�al�.��s ��pq�n�1 s�M� %s�az.
Need 40 A74e -Ar G4✓r'�C� A7Ew76ey Ole
ee- t 1, LI 1 � 1 �r Ae,,e gfe 44 55�►"a �� r nSJ
-54Tr - is -Ao be vs ed ;n 54ee, d e r ; ele I:,krv:Je
to v- el 1,g4efer f S.
05'. r�lat?� oe4 aht s4,W 7La
)rnffodv"; n9 Zl4 ]eAq m y -/wo �reviaks .!�f)45�4"n os.
-rl7c S r%-Nq ll � r�[ r"r, eras 1 so wed s a vs�d ;,, A,'.s a n�
-�G,e r. l� P' �',��G� - �,� ��'C�t►� S �1,� `f �' IG T71e✓e ma ply
�7e t 4r,reef i &n f �' �!o[ -1 j [�ell SAOtI 16( �� 4&,-i7 1, 6 a ] I
Cissi��anCP 4,9,e- Sa 4;t4 111r ve t,) Gee-{ shoe) 17 Ae
�'► � Id - C�cf � sc�; � .sa,.l�la -F�r s >c`: �Id 1 � "� �'►'e��
eAc yew r . R� roja:►,'c c 1 P¢I�r gnor* �r��areerL►en� a c�a'a ti
ell coz,�'
�etvi + dz> al
Z

_ Division of Water Quality
tft Q Division of Soil and Water Conservation
D Other Agency
Type of Visit ,Compliance Inspection ❑ Operation Review O Lagoon Evaluation
Reason for Visit Okoutine O Complaint Q Follow up O Emergency Notification Q Other ❑ Denied Access
Facility Number 3 Datc of Visit: `-`= Tiirm: ► 31 Printed on: 7/21/2000
Q Not Operational a Below Threshold
13 Permitted 0 Certified 1+ Conditionally Certifffied 0 Registered Date Last Operated or Above Threshold: .........................
Farm Name: q'�dt' Ja ►-lvet. rlaf'al--(....... county:...4�-.... �r✓1....................................................
.. j rr W......
OwnerName:............ '� `t ..rl rl e.r............................................. Phone No:......................................................................................
FacilityContact:.............................................................................. Title:................................................................ Phone No:...................................................
MailingAddress: ..................................................................�.ff................r..r................................................................................................-...............-- •-.........................
Onsite Representative:.. !.n .. .! . ,I rl r .� i 1 ................................ Integrator: r� '�. . d �� [..!.`l ¢I ................
Certified Operator:................................................................................................................ Operator Certification Number:..........................................
Loeation'of Farm:
!, ._ ... _ _ I.T.
CKwine Cl Poultry ❑ Cattle ❑ Horse Latitude C • �� �« Longitude �' �� �«
Design Current
...:_ ' .. 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
❑ Layer I I Dairy
❑ Non -Layer I I iry
❑ Other
Total Design Capacity
Totai sure
Nurttiber,of Lagoons ❑ Subsurface Drains Present 0 Lagnun Area
'.Hokling Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharaes & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water of the State? (It'yes, notify DWQ)
c, lf' discharge is observed, what is the estimaled flaw in gal/min'?
d. Does discharge bypass a lagoon system? (if yes, notify DWQ)
Spray Field Area
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
5trycturc 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier; .......................................................-..........-............................-.........................................................................
Freeboard (inches): 23
5100
❑ YesXJ`No
❑ Yes dNo
❑ Yes g'No
❑ Yes No
❑ Yes 2fNo
❑ Yes 0 No
❑ YesJ3'No
Structure b
Continued on buck

Facility Number: 3) -- y 5�5 Dale of Inspection Printed on: 7/2112170d
rj 5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes �J lsio
seepage, etc.) pp
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes XNo
(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 j2fNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes eNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes �No
Waste Application
10. Are there any buffers that need maintenancelimprovement'? ❑ Yes �No
11, Is there evidence of over application? ❑ Excessive Ponding. ❑ PAN ❑ Hydraulic Overload ❑ Yes �No
12. Crop type �e f'rRv rt I /
13. Do the receiving crops differ with those d signated in the Certified Animal Waste Management Plan (CAWMP)? El Yes No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes�No
b) Does the facility need a wettable acre determination'? ❑ Yes 12NO
c) This facility is pended for a wettable acre determination? ❑ Yes RrNo
15. Does the receiving crap need improvement? 'Yes ❑ No
16. Is there a lack of adequate waste application equipment? ❑ Yes )�fNo
Renuinud Records & Documents
17• Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes 0No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.) ❑ Yes )ZrNo
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports) .,;a Yes ❑ No
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes A No
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes /E(No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes IdNo
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes 'O"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,,E�No
:'N4**10'1�41'0 4s*:a;3' 0i0#jcje�00's ��0re 0,���� 0*iH°1,ng i�js:v1sat!' You wilI*>Kee�iye 0o i4ib'6r :. .
co resporidehr e: ahvtat tkIS visit: : :
Cammeats (refer. to question #):'Ex plaia any YES answers and/or any:recommeridations or. any,otlier}eopimentg
Use�drawin of facili �:to better ex lain situation§;` use additiinnal a es as necessa Nt ':_`..: ' 7 } 1; r `
:.:
_. r ry��:
lrj. �G90,
r mL,4-ri rhPeD(S . o de ;M.pr'aved +" a
aern. rJde, Aa td. 13ack-bc,,,ue4A -1",elo( nee�ys 5,~yn 'E'�a+� ;ri,P �n�e►M�n��
do not rp,1 -a1�1okt 4eh,G`s("un4;1 ;s
'ore�eo►S� ��el°°G.0
e�
►�1���
sure 10 kCe -'reeba ard r'eor'ds on A week/ b�tr'S
Reviewer/Inspector Name S-ll d�E fnla if h ; J
Reviewer/Inspector Signature: _ Date: of sroo

Haeility Number: 3 ] - SS Uatc of Inspection Printer/ on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ 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_j 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,,,,Z 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 /2,No
31. Do the animals feed storage bins fail to have appropriate cover'? ❑ Yes )2"No
32. Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover? ❑ Yes ❑ No
Additional .Comments and/or rawmgs: r r;I1 T ,
5/00

Division of Water Quality. b
Q Division of Soil and Water Conservation f�
0 Other Agency
Type of Visit 76 Compliance Inspection a Operation Review Q Lagoon Evaluation
Reason tar Visit $Routine O Complaint O Follow up D Emergency Notification Q Other ❑ Denied Access
F- I3ati of Visit:
Facility Number s"'J 5
,'Permitted [3Certified 0 Conditionally Certified [Registered
Farm Name: ........... Q'...r...1..'..?.1111....A..................................................
Owner Name:............ I� q!���„^�..q}1.' �°�......!7•°!�I' i r 1 .................
.......................
Facility Contact:
Mailing Address:
Title:
J� OO 'nine: I fl:-riT I Printed on: 10/26/2000
Q Not Operational 0 Below Threshold
Date Last Operated or Above Threshold: .........................
County:...i�..l.trr .l�"�....................................I........I........
Phone No:
Phone No:
Onsite Representative:.... I!?..............19G1.....'.R.g�rc �r...................... Integrator: 4VLf,v,I,f, dh,.Lfi''a..+"LC'7.....................
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude �� C�' �•� Longitude '
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ID Laycr ❑ Dairy
%Feeder to Finish Cl I0 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts + I
❑ Boars i
Total SSLW
Number of Lagoons I ❑ Subsurface Drains Present ❑ Lagoon Area ID Spray Field Arc:i
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact~
1. Is any discharge observed from any part of the operation?
Discharge origimited at: ❑ Lagoon ❑ Spray Field ❑ Other
a. li' discharge is observed, was the conveyance man-made?
b. If discharge is observed. did it reach Water ofthe State? (if yes, notify DWQ)
c. II'discharge is observed, what is the cstimaled flew in gallinin?
d, Does discharge bypass a lagoon system? (Ifyes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structurc 2 Structure 3 Structure 4 Structurr 5
Identifier................ r...................................................... ................................... .............. I.....................
Frceboard (inches): �r
5100
❑ Yes 9No
❑ Yes ,` No
❑ Yes No
h1Q
❑ Yes $ No
❑ Yes ONo
❑ Yes 9No
❑ Yes K No
Structure 6
Continued on back

Facility Number: Date of Inspection Printed on: 10/26/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
❑ Yes
3f 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
JR No
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7, Do any of the structures need maintenancelimprovement?
❑ Yes
ff No
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
❑ Yes
No
Waste Application
10. Are there any buffers that need maintenancelimprovement?
❑ Yes
Ej No
1 t . Is there evidence of over application'? ❑ Excessive Po�rnding ❑ PAN ❑ Hydraulic Overload
❑ Yes
gf No
f r
12. Crop type . far-r"�VdIA, f7k i ! •fw+ill 6 et lis.
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP) •
❑ Yes
tgNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
M No
b) Does the facility need a wettable acre (Ietermination?
❑ Yes
.91 No
c) This facility is pended for a wettable acre determination?
❑ Yes
No
15. Does the receiving crop need improvement?
❑ Yes
No
lb. Is there a lack of adequate waste application cquipment?
❑ Yes
ff No
Rcauired Records & DocumenLs
17. Fail to have Certificate of Coverage & General Permit readily available'?
❑ Yes
;N No
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(iel WUP, checklists, design, maps, etc.)
❑ Yes
IgNo
19. Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
R"Yes
❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
f No
21. Did the facility fail to have a actively certified operator in charge?
❑ Yes
19 No
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(iel discharge, freeboard problems, over application) ❑ Yes No
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative? ❑ Yes No
24. Does facility require a follow-up visit by same agency'? ❑ Yes 7E§ No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP•? ❑ Yes JgNo
yiiQlafriQtqs;oi" d ##epetic{es ► ire Qteo00irig this'vjsjt! fuft� '
• corres• on' dense: aboutw this visit.
Comments (refer to question #): Explain any YES answers and/or any'reconimendations or any other coretments: _ A.
Use drawings of facility to Netter explain situations. (use additional pages as necessary):
^.
fcT. Prfeirt+ .rn-tin}+! of ra 41 ih 1-ic}d 1 �Jsoph . rri� bermVdo 11•t veld I
Ih s ewvp 4v�Jd use ra int ') J
�° ..,) � +'V't d L.P!►'1g �d � e �� C d r1 � 7 I an OfaW +h • A.Wp Il
J* } ; n•.e acbar4d ,-�)r 46 so it AM resv f¢ f.
}� So Sure 4o kc!r �reet laird r"eGd r�„r 4Y1 � iJe�tc[ � �jt„5iS }3c tire -�d
6Al CUItdc- __T►ee-2.'-f c.0rret41l�.
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date: 12 5 bf0 5100

Facility Number: 3 I Date of Inspection p p Printed on: 10126/2000
0ddr 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 driftduring land application? (i.e. residue on neighboring vegetation, asphalt, ElYes 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 ONO
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 ONO
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ONo
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes 0No
Ndditionall Comments an or raw ngs: ,.
5/00

Lagoon Dike Inspection Report
3 1- 115 S
Name of Farm/Facility ITN (4Vr'e-( gvowey .
Location of Farm/Facility
Owner's Name, Address
and Telephone Number
Date of Inspection
Structural Height, Feet
Lagoon Surface Area, Acres
Upstream S1ope,xH:1V
�3 r
iffoLaw-
A9 9F
Names of Inspectors A • fitg N J11
Freeboard, Feet
C_ Top Width, Feet J
• t Downstream Slope, xH:1V . 2 1 .
Embankment Sliding? Yes No
(Check One, Describe if Yes)
Seepage?
(Check One, Describe if Yes)
Erosion?
(Check One, Describe if Yes)
Condition of
Vegetative Cover
(Grass, Trees)
Did Dike Overtop?
Follow -Up Inspection Needed?
Engineering Study Needed?
Yes No
Yes No
155
Yes �L_ No If Yes, Depth of Overtopping, Feet
Yes No
Yes 'lL No
Is Dam Jurisdictional to the Dam Safety Law of 1967? Yes No
Other Comments dJfe-d 1/t 4 a_U•.:i

Facility Nurtthcr. [late of InslteGtic,n
'rime of Inspection � 24 hr. (hh:mm)
M Permitted M Certified p Conditionally Certified p Registered p of Operational Date Last Operated:
Fa,"„r Name: Handy..&.Arwa.kla.t:rel,l............................................................................. Carroty: Uuplin W1R0
Owncr Name: Ra.ndy..&.Auma................. Harrill....................................................... Phone No: 9.10-289-3822 .........................................
FacilityContact:................................................................................rille:................................I.............................. Phone No:
MailingAddress: r'ess: ... .......................................................................................... Rosra. N.ill.. N C......................................................... 2845f i..............
Onshe Itepr•esentative:.......................................................................................................... Intcgratur:.lir.o.:nr'.S.,uf.Caralina,,Jjar..................................
Certified Operator: .................................................. ...................................................... Operator Cerlif'ication Number:
Lucalion of farm:
Latitude ®r ©� ®•6 Longitude ©. ©6 ®11
Design Current ..
Swine Capacity Population:
p Wean to Feeder
® Feeder to rn,s
0 Farrow to Wean
Farrow to Fee3er
0 Farrow to Finis
0 Gilts
p Boars
Design Current Design .Current:,
Poultry ; Capacity Population Cattle Ca#acity Population
0 ayer
0 on- ayer
0 Other
Total Design Capacity 1,440
Total SSLW 194,4U�
Number of Lagoons 0 0Subsurface Drains Present ❑ Lagoon rea p Spray rc reu
Holding Ponds./ Solid Traps 0 o Liquid Waste Management Sy
�; ... _.... ...... . M.
I. Is any discharge observed from any part of the operation? 0 Yes 0 No
Discharge originated at: 0 Lagoon 0 Spray Field 0 Other
a. If discharge is observed, was the conveyance Irian -made? 0 Yes 0 No
b. if discharge is observed, did it react, Water of the State? (II'yes, notify DWQ) 0 Yes 0 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) p Yes 0 No
2. is there evidence of past discharge from any part of the operation? []Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [:]No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway 0 Yes []No
StrrrCtt,l'e I Structure 2 Structure 3 Structure d Structure 5 Structure C
Identifier:
Freeboard (inches): ...............2.4...............
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
3/23/99 seepage, etc.)
0 Yes C3 No
9128/99
Cnnlihued on bark
Design Current Design .Current:,
Poultry ; Capacity Population Cattle Ca#acity Population
0 ayer
0 on- ayer
0 Other
Total Design Capacity 1,440
Total SSLW 194,4U�
Number of Lagoons 0 0Subsurface Drains Present ❑ Lagoon rea p Spray rc reu
Holding Ponds./ Solid Traps 0 o Liquid Waste Management Sy
�; ... _.... ...... . M.
I. Is any discharge observed from any part of the operation? 0 Yes 0 No
Discharge originated at: 0 Lagoon 0 Spray Field 0 Other
a. If discharge is observed, was the conveyance Irian -made? 0 Yes 0 No
b. if discharge is observed, did it react, Water of the State? (II'yes, notify DWQ) 0 Yes 0 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) p Yes 0 No
2. is there evidence of past discharge from any part of the operation? []Yes 0 No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes [:]No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? 0 Spillway 0 Yes []No
StrrrCtt,l'e I Structure 2 Structure 3 Structure d Structure 5 Structure C
Identifier:
Freeboard (inches): ...............2.4...............
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
3/23/99 seepage, etc.)
0 Yes C3 No
9128/99
Cnnlihued on bark

facility Number: 31-455 Date of Inspection 9/28/99
6, Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes p No
of 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/improverent7 p Yes []No
9. Do any stuctures lack adequate, gauged markers with required maximum and rninimutn liquid level
elevation markings? p Yes p No
Waste Application
la. Are there any buffers that need maintenance/improvement? ❑ Yes p No
11. Is there evidence of over application? ❑ Excessive Ponding p PAN [:]Yes []No
12. Crop type
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? ❑ Yes []No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15.
Does the receiving crop need improvement?
❑ Yes
p 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
❑ 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
❑ No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
p No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22,
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
❑ Yes
❑ No
23.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
p No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance ofthe Certified AWMP?
p Yes
❑ No
IY - K4'.Vitita 1Ons,ax:-defi'd'9n' c's•werehated during. this 'An't. ; You' - wviii'receivly tia further. ;
•.cvrrespondei►ee:Qb Wir is:Wisat:•................•.•.•.•.•.•.•.•.•.-,•...-.-....... . -]
Comments'lrefer�to'auestisnl#il:ilflaxnlain�anvYL•'Slanswers�rrndtor�anv]rectimtnendations"vr'artviofhern'comments!{l��t€i?�d�iili=�:>rf��i��r��
dequate freeboard available,
o lagoon seepage, no erosion, no embankment sliding was observed during dam safety inspection. Condition of grass cover
i dike wall is in poor condition (dike did not overtop during storm) and a permanent ground cover should be established. Slight
osion gulley at toe of lagoon. Dike needs to be mowed when dries out.
Reviewer/Ins ector Name
p .A .
Reviewer/Inspector Signature: Date:

© Division of Soil and Water Conservation - Operation. Review "' + •4 '- !
0 Division of'Soil and Water Conservation - Compliance Inspection:
Division of Water Quality - Compliance Inspection.
Other Agency - Operation Review
191 € outine_ 0_Cornplaint 0 follow-up of DWQ inspection 0 Follow -tip of DSWC review 0 Other j
Facility Number- Date of Inspection
Ti tile of Inspection �D 24 hr. (hh:mm)
0 Permitted M Certified ❑ AConditliolnallly Certified ❑ Registered JE3 Not (] eratitmal I Date Last Operated:
ti,rr►C..:....I�Y1l,..lt.�.�. ................... Cittirity:....... �^
Farm Name: ............ .1 tt +f- rr.......... �!i.....
Owner Namt.:.......gau. ,r� .... :....ItlrfCG.. k�sYkS.�.1...... Phone No:
FacilityContact:..............................................................................Title:................................................................ Phone No:...................................................
MailingAddress: ....... zz.lq........ ...14W.. {{ ....'Sid ........................................ ... IRJI...i.N.E............................................... 4.M-T ...........
Onsite Representative: ........ 1 94,...... x1Ci.lsA...................... ....................................... Integrator: ......... &.Dun,s ...........................................................
Certified Operator: ................................................................................................................ Operator Certification Number:..........................................
Location offarm:
........................... An ..... k st......I.i G...... P....... RkV.) W.)......rn.;Ln..... .........C.f.....I ..14...,.................... .... .............. .............. ............... ........
.��
............................................................................ . .. .......... ...........
Latilude 0 ` .4 Longitude 0 6 rc
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
Feeder to Finish )L440 L4w JE1 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Fccdcr ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts °
❑ Boars- Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lagoon Area ❑ Spray Field Area
Holding Ponds 1 Solid Traps JE1 No Liquid Waste Management System
Discharges & Stream Impacts
I. Is any discharge observed front any part of the operation (If yes, notify DWQ)'? ❑ Yes Eb No
Discharge originalcd at: ❑ Lagoon ❑ Spray Field ❑ Other
it, €f discharge is observed, was the conveyance man -inane:' ❑ Yes ® No
h. II' discharge is observed, did it reach: ❑ Surface Waters ❑ Waters of the State ❑ Yes (A No
c. [f' discharge is observed, what is ncc estimated flow in gal/Will'!
d. Mies discharge: hypass a Ingutui system? ❑ Yes ® No
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes ® No
3. Were there any adverse impacts to the waters of the State other than frorn a discharge? ❑ Yes No
Waste Collection & Treatment
4, Is storage capacity (freeboard plus storm storage) less than adequate'? PYes No
structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure G
Identifier:
Frcchoard (inches,): ...............it
I It5199 Continued on buck

Facility Number: 31 — � s Date of Inspection
—'Yes
5. Are there any immediate threats to the integrity of any of the structures observed? (ic/ trees, severe erosion,❑`
�jj No
seepage, etc.)
6. Are there structures on -site which arc not properly addressed and/or managed through a waste management or
closure plan?
❑ Yes
R 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 ol'the structures need maintenance/improvement?
Yes
❑ No
8. Does any pact of the waste management system other than waste structures require maintenance/improvement?
Yes
O No
9. Do any stuctures lack adequate, gauged markers with required top ot'dike, maximum and minimum
liquid level elevation markings?
❑ Yes
j 7 No
Waste Application
10. Are there any buffers that need maintcnanc clintprovemcnt?
❑ Yes
No
11. Is (here evidence of over application? ❑ Ponding ❑ Nitrogen
❑Yes
No
12. Crop type .........6".Y.MuIO ................... smj s...... ,rf_h...................... ........................ ..................................,...........................................................
13, Do the receiving crops differ with those designated in the Certified Animal Waste Management flan (CAWMP)?
❑ Yes
® No
14. Does the facility lack wettable acreage for Iand applicalion? (footprint)
❑ Yes
® No
15. Does the receiving crap need improvement?
❑ Yes
® No
16. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Iteguired Records & Documents
I7. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes NJ No
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ic/ WUP, checklists, design, chaps, etc.) ❑ Yes ® No
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) L] Yes ElNo
20. Is facility not in compliance with any applicable setback crilerin in effect at the time of design? ❑ Yes ® No
21 • Did the facility fail to have a certified operator in responsible charge`? ❑ Yes ® No
22, Fail to notify regional DWQ of emergency situations as required by General Permit?
(ict discharge, f•rceboard problems, over application) ❑ Yes t5No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative`? ❑ Yes No
24. Does facility require a follow-up visit by same agency? [P Yes ❑ No
El
N�AWH'tions.ar. derkieiicles .were rioted. detain.Hiis;visii.' You vill.reeeive nu further
'earresporideirrce''a6ouf:this;visi#.:.::.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:... ... .. ...
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): �' • ,' it.,
I it r
In3U {LI Y f j 1 I e , 01 - A�Da�• (J�►� Snot/fU Ia1� fr• c ( Sj]onsth A
I-t c�NkIiAUC
tinr+4�w t�r ] eA-WASno V C�> t�� I0GrC Ctrs >:.5 . ll
$- S[�w� S�LndtU � �- i rt5�lle..� a•- (rr[ ��Q,r. ! i n.R airD3'i ►;`� � t tiss,. 1
t ,,cA- QA s6IIJ lac 1+tbR � o�• 5P r`�eoyd tP Gas 5h��� rev:atd ctn�
9 tot
M0.� �C!} '� � C � h-•r�� bt''`��- • 4 rr: A0.TiCv� i'�CD�'r�S S �,Dt�� �i jU-(]l kA s{ +�+-tni TrrYge�'� �` �81 iqV+.
d rr,5a`[or- ,nab �a�s]ja�.,� S�Tl o ]w slnra�`�} �� c t• rrr� �1cor�S �I j .]
Reviewer/inspector Name Erct,,, L •I.',
Reviewer/Inspector Signature: '.6a'c.4_1 Date: 11/6/99
ti

s ,' Division of Soil and Water Conservation Other Agency
_ n 4.
ptaDivision
of Water Quality
16kRoutine t&Complaint V Follow-up of ❑W `inspection V Follow-up of DSWC review Q Qther
Date of Inspection ER�1'24
Facility NumberTime of Inspection hr. (hh:mm)
❑ Registered 10 Certified © Applied for Permit ❑ Permitted � Not () cratwnat Date Last Operated:
Y'. +tk Farm Name: ............., ry �...�:..�kY�r.�....,�t�.i''�.��................................................. Count .......�ui���,..,....................................................,...
Owner Name :.............•• mll�.... .....A rma ...... or rr..t ........................................... Phone No:... `�iA�l..x .-• r..............................................
Facility Contact:
Title:
Phone No:
MailingAddress: ...... 2-4 E.,.... -a> ...................................... ........... ..,................................. ... , .V.S:v .....
Onsite Re resentative:.......... AM.V...... .. Integrator: ........ s ..............
Certified Operator;............................................................................................................... Operator Certification Number:
Location of Farm:
Latitude " Longitude 0• ���'•
Desfgri Current Design 'urrent Design ".,.Current"'
Swine. Capacity Population Poultry Capacity Population Cattle Capacity'Papultian
❑ Wean to Feeder ID Layer ❑ ❑airy
Feeder to Finish IL4qo ID Non -Layer I 1 ❑ Non-Dairy
Farrow to Wean
❑ Farrow to Feeder ❑ ether
❑ Farrow to Finish ' Total Design Capacity
❑ Gilts
❑ Boars ::, Total SSLW :.
Number oP itagtiors 1:.Hofding Panels' ❑ 5ubsurfacc Urains Present ME agoan Area I[] Spray Field Area
.n,"1�..fs.f:•�3F.:. .e.i .. ❑
i
No Liquid Waste Management System
"en al
1. Are there any buffers that need maintenancelimprovement? ❑ Yes 5d No
2. Is any discharge observed from any part of the operation? ❑ Yes 0 No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes No
b. If discharge is observed, did it reach Surface Water? (11'yes, notify DWQ) ❑ Yes No
c. If discharge is observed, what is the estimated flow in gaVmin? tj
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
IM No
4, Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
❑ Yes
No
maintenance/improvement?
6. is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EA No
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
P No
7/25/97

iF acility Number: 3 —
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (LagoonsJIolding Ponds, Flush Pits, e1r.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3
Identifier:
Freeboard (tt):............�.�A................
10. is seepage observed from any of the structures?
Structure 4
11'. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
❑ Yes P No
19 Yes ❑ No
Structure 5 Structure G
❑ Yes IM No
❑ Yes 10 No
Yes ❑ No
13, Do any of the structures lack adequate minimum or maximum liquid level markers? ❑ Yes No
Waste Application
14. Is there physical evidence of over application? ❑ Yes No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15. Crop type ............. ?e�:7Ml.tt��a................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes PD No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
No
18.
Does the receiving crop need improvement?
IN Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
M No
20.
Does facility require a follow-up visit by same agency?
® Yes
❑ No
21.
Did Reviewer/Inspector Fail to discuss reviewlinspection with on -site representative?
❑ Yes
M No
22.
Does record keeping need improvement?
1% 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
tM No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
W No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
® No
0 • No.vlolifltins. or. deficiencies. were noted during this'visit.: Yo'dwill re'eii�e: no.ftirther
::-cyrr�spuitde�tceatic�ufthis'visit:::�::�:::::.:�. .�:. .•:•.-:�..�.�:-�•:- •.:�::�; .-: .•
... ...................... �:::::.. .. .. ... .....•ctsi�:wN:..:..;::::'::'::!`F
tI . i '�i omitsIref+�r; �: vestrnn. # .: E Iair�.a�y. ;YES answers ctndlor iiny ;reCoxnmendalio'ns or: �n aihet' eomitxt'euts,:
Ja d` twit�gs of l [it y to bettetr explain sttuatii��.s, ns additWfi pages as necessary
1.i,b [ ,;:. fi sF s f«F`F F' FY I(it IIt:tIlItttt !;i.tt x
ns�i�Gi E�JI �ve�h ;rti � (1�q�on • f�-dL4f4a�� �.V!` S F'1au � •]r� �Oc.l:.i-iC � h b. Yt51or►Sipfc. (°� �i'r+tit�y� +r'a�ti�; �
i I. L_o. dcr. b i iLr_ u oA t g�((oc�V l� t ++ i•Wrjt3 .
�g. &rmde- tr- Wjh - ?retd5 -,y�W Lie r`M�YCtIFU.
�erN%AJ 44.'% 5rrc j Mar 'I-) , j I
�e" ��rb,►y +rtcaffrt}s 1), r6L kk b� i�Y*l �vt I 4 �`rt� ns�6.er V s i ry 4kt we �[.r} a cv'&.5f ° F
�►�i wFw-+-'c�IWIA'[-Fn� }ai-� Voj' �dw'rs. t{ pJoW kv-v C se^�L ps�oA be.Y'tCA5. t-a O" Jar,1 N S611) hf- i}� rrK. rtCork. `rr w��OY� �LCt rw ioV {d!�`[� 44� ysT.
b'L;� 1,8 n.1':� l LIOc?e �] r<s�t�J.�"� 4 .�'` '�C�� sl�vv s1 i'� l '^Js. ��- �aYrn. Ltm 5hc�M/97
Reviewer/Inspector Name ,, .,, .:;::...: F:.:,.. iiii `i,: :i :.::eFSi..
p i i�'Fi. s. .,ti:�I. ... .. t�: ii�i.�».: ,: sl. •s'3 ;3; 'e s:..:: ..f ..
... � l 1� 71A�%i ! •�.. ...�: -� .. F «... .. .. ... ..33.�i..��. �3.33.4...... �..... .........i ...... .. e..f.e .eF&......e..,u,.....F.F.
Reviewer/Inspector Signature: Date:

Facility Number: --- L! .... . .... Date of Inspection:1
Additional Comments and/or
6.4 te V16Q + was
4130/97

. ............................................................................................ (
`
DSWC Animal Feedlot Operation Review '
10DWQ Animal Feedlot Operation Site inspection .....
:.�:.:.:
E k!e:
..::::::...::. ?!'S
0 Routine Q Con laint O Follow-u {1f [)NVt iits cxti(m Q Follow-up of DMVC review Q Qther
Facility Number Date of Inspection
Time of lnspectic�n 24 hr. (hh:mm)
Registered ® Certified © Applied for Permit 17 Permitted 113 Not Operational Date Last Operated:
Farm Name: ... .
....�.....t°t�..��......l:�:a..�r.,�.�..1.1....... ....... C��unty:..�..u..�..t,.�.r.,...................................
f I t Z>
Owner Name:...�..�s+.�.�...�,.,..e....- .........C�G�:!r.-xr....�.................................... >i hone No: �. �..Jt....... �....3.t�..................
FacilityContact: ................................,............................................. Title:................................. Phone itio:...................................................
,Nlailittg Addt ess:.. .[..... .:.... ]. :. Q............................................ ,s.�.. - ..1.�.. C— ....�3-4.51
t_ _ r...........'..............
Onsite Representative: ....................i�t-'!�:r.tn.�.�........... ................................. .......,............................-
Certified Operator11............................................................................................................... Operator Certification Number ....................................
Location of Farm:
Q%�.....1►.s[1.�C........��lCL3.�....5..�..�..�...0....... .w, r....s�. SL. ..... - Ukl, ..L ....5.1'1.Y.�.....R ..: � y.....L.7�.. .....................
...............................................................................................................................................................
Latitude = • ' ki Longitude • ' 06g
Design Current Design Current Design Current
Swine Capacity Population Poultry Capacity Population Cattle Capacity,;. Population
❑ Wean to Feeder I.ayer ❑ Dairy
ElFeeder to Finish 10 Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder 10 Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
El Boars Total SSLW
Number of Lagoons 1 Holding Ponds ❑ Subsurface Drains Pmsentj Area Spray Field Area
❑ Nt� LiquidWaste�Iatrat;ement System
General
1. Are there any buffers that need ittairitenancclimprovenient? 19Yes ❑ No
2. Is any discharge observed !Torn any part of the operation? ❑ Yes No
Discharge orillinated at; ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, Was the con%reyance man-tnade? ❑ Yes ® No
b, If discharge is observed, dial it reach Surface Water? (If yeti. notify DWQ) ❑ Yes ® No
c. if discharge is observed, what is the estimated flaw ing:sllntin?
d. Does discharge bypass a lagoon system:? (lt yes, notify DWQ) ❑ Yes ® No
3. is there evidence of past discharge from any part cif the operation? ❑ Yes 52 No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes .® No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ❑ Yes KNo
mai ntenanceli mproventent?
5. is facility not in compliance with any applicable setback criteria in effect at the tinte ot'design'? ❑ Yes JR No
7. Did the facility tail to have a certified operator in responsible charge? ❑ Yes 19 No
7/25/97 Continued on back

Facility Number: 3- $ 5
8.
Are there lagoons or storage ponds on site which need to be properly clotted?
❑ Yes
® No
Structures La goons lioldin Ponds Flush Pits etc.
9.
Is storage capacity (freeboard plus storm storage) less than adequate?
❑ Yes
® No
Structure l Structure 2 Structure 3 Structure 4 Structure 5
Structure 6
Identifier: .......1..:...............
Freeboard(ft):...................................... .................................................................................................................................................................................
10.
Is seepage observed from any of the structures?
❑ Yes
&No
11,
Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
®'No
12,
Do any of the structures need maintenance/improvement?
® Yes
❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimurn or maximum liquid level markers?
❑ Yes
No
Waste Application
14,
Is there physical evidence of over application'?
❑ Yes
®,No
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
15.
Crop type ...�p„1t�C.. v..t.+4................................................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management flan (AWMP)'?
❑ Yes
Ed No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
IN No
18.
Does the receiving crop need improvement?
B Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20.
Does facility require a follow-up visit by same agency?
❑ Yes
IN No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
®No
22.
Does record keeping need improvement?
® Yes
❑ No
For Certified or 11'ermitted Facilities Onl
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
H.No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
JK No
25,
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
1 No
No violations or deficiencies were noted, during' this'visit.Aou:rvi11 receive no further
cvrrespntrtdence about this:visit
Comments (refer to question #): Explain any.'YES answers and/or any recommendations "or„any other comments. ; E;
Use: drawings of facility to better explutn sttuat[r:ns. {use additional pages as n��essarv);;,;; ; , ,; ,,; ,; ;;`'", "'''
' ...e.:. Fig - .5.... ,... ..F: , f :.. T.
.. .. •:
eu+el_ w~£-sL 0�.+^ �_ Q/� �r6^��t�rS w.+
2 • %,t v. r t-r t.. w f w► a,, Lo. R a o v, w,� 1. I r,l r-a-,..-i v�-u-t , uo v tL. e
it va Lu n �r S j �t i 3 iH LwY �.. •4�a .
Ll • Crg•t cL Z^-. t-t� n. L--" t -S f v*-j �t AA d C , OL L l ► i #-S >�-+-u c. F
o-� V� ►.t t� q t* i �Q 4 0 ►rl p 4 vx. � � W% So � k}• � "A, 11 G tc o Q- "
L ] LJ 7/25/97
w..... ..w- ...... ........
ReviewerllnspMor Name A,. f :m
Reviewer/Inspector Signature: r _�J,, ,�,�t- W [4,q_ _ Date.

•
0 ?
Site Requires Immediate Attention:
Facility No. Tr -
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE. _ -23 _, 1995
.r Time: - -13 D —
Farm N
Mailing
County
Integral
■
M. P1%zFW_Q'WAKZ..L_ WWD'-=,z _ - I
Type of Operation: Swine `� Poultry Cattle �s i�t kV-S'
Design Capacity: ,ICI U Number of Animals on Site:
DEM Certification Number: ACE . DEM Certification Number: ACNEW
Latitude: ? Y ° 5_a' _,Z-6 " ' Longitude: _22�° �_ ' 26 " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) 6 or No Actual Freeboard: Ft. . Inches
Was any seepage observed from the lagoon(s)? Yes or No Was any erosion observed? Yes or No
Is adequate land availabl for spray? e or No Is the cover crop adequate? Yes o No
Crop(s) being utilized: Vniu {
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwellings`D or No
100 Feet from Wells?6 or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes onT v
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Nlap Blue Line? Yes q0
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man -trade devices? Yes or(g 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 oe``
Additional Comments: _ _.�►� 0�iCAN CA_,N_ _ v�__ V6 d � �� �' Y
0
.-
Z�a2 az_-
Inspector Name
S ignature
cc: Facility Assessment Unit
Use Attachments if Needed.