310464_INSPECTIONS_20171231

NORTH CAROLINA .�
Department of Environmental Qua!

Type of Visit: CQ Copoff
ance Inspection U Operation Review U Structure Evaluation CJ Technical Assistance
Reason for Visit: Q Routine Q Complaint 0 Follow-up ❑ Referral ❑ Emergency Q Other 0 Denied Access
Date of Visit:Arrival Time: r ] Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Pt e,4-r c e - l - t ►--p - -_
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
Certification Number: f 1
Certification Number:
Longitude:
Design
Current
Design
Current
Design Eurrent
Swine
Gapuclty
Pap.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
Layer
airy Cow
can to Feeder
n o
3 if
Nan -La er
airy Calf
Feeder to Finish
airy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
❑ Poult
Ca aci
P,a P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turkeys
Other
Turkey Poults
ether
Dther
DischaEges 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?
h. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of'the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes No ❑ NA ❑ NE
❑Yes []No ❑NA ❑NE
❑ Yes ❑ No ❑ NA [] NE
[:]Yes
❑ No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facility Number: 3 - Date of Inspection: 2
►'
Waste Collection & Treatment
4. Ist storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. Ifyes, is waste level into the structural freeboard? [] Yes ❑ No ❑ NA ONE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: I Z
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): �_ L
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 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 o NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yesgzo❑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 E rNo❑ 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?
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?
❑ Yes
No
[] Yes
[:I No
❑ Yes
alKo
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[:]Yes ErNo ❑ NA ❑ NE
❑ Yes Ea�o` �❑ NA [_]NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes E2-No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes 2-N—o
❑ NA
❑ NE
the appropriate box.
❑ WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
[—]Yes No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis [:)Soil Analysis
❑ Waste Transfers
[] Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
[] Yes
❑ NA
❑ NE
23, If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[—]Yes rNo
❑ NA
❑ NE
Page 2 of 3 21412015 Continued

Facility Number: 31-GA jDate of Inspection: Z If 1 &:7]
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes Ho ❑ 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 concem?
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/lnspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes ET No
❑ Yes ❑ No
ff
❑ NA ❑ NF'.
NA ❑ NE
❑ Yes C]15o ❑ NA ❑ NE
❑ Yes P'No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
es� ❑NA ❑NE
❑Yes ❑NA ❑NE
❑ Yes NA ❑ NE
❑ Yes��No[o:] NA ❑ NE
Reviewer/Inspector Signature: yl =
Page 3 of 3
Date: ! 1 / r
21412015

l
Division of Water Resources
Facility Number ❑ Division of Soil and Water Conservation
❑ Other Agency
Type of Visit: ompl' Inspection 0 Operation Review ❑ Structure Evaluation ❑ Technical Assistance
Reason for Visit: outine ❑ Complaint ❑ Follow-up ❑ Referral ❑ Emergency ❑ Other ❑ Denied Access
Date of Visit:
Arrival Time: It=
Departure Time: S County: Region:
Farm Name:
Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Phone:
Facility Contact: Title:
Onsite Representative: �r C n 4.c c "4ee r i r-
Certified Operator -
Back -up Operator:
Location of Farm:
Design Current
Swine Capacity Pop.
W an to Finish
can to Feeder o Jjfrjj
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Latitude:
Phone:
Integrator:
Certification Number:
q
I
r
Certification Number:
Design Current
Wet Poultry Capacity Pop.
Layer
Non -Layer
Design Current
pry ro
Non-L
Pullets
Turkey Poults
Other
Discbarees and Stream Impacts
1. Is any discharge observed from any part of the operation'?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf'
Dairy Heifer
Dry Cow
,Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes [�No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑Yes
❑No
❑NA
❑NE
❑ Yes Vl�o
[3NA [3NE
Yes ❑ NA ❑ NC
❑ Yes F3/No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

' I
Facility Number: `71 - V&7 jDate of Inspection: 1 7
r
Waste Collection & Treatment ��
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [2 iYo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ Na ❑ 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 Q, ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes No NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 E3No ❑ NA ❑ NE
maintenance or improvement?
Waste Agullcation
10. Are there any required buffers, setbacks, or compliance aItematives 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 > l 0% 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 fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
�o
❑ NA
❑ NE
❑ Yes
1 ] No
❑ NA
❑ NE
❑ Yes
EE�No
❑ NA
❑ NE
[] Yes E NZo ❑ NA ❑ NE
❑ Yes rNo❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
[] Yes F2fNo [] NA ❑ NE
❑WUP ❑Checklists [] Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [] N
El Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections El Monthly and I " 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?
❑ Yes �N
o
Page 2 of 3 21412015 Continued

Facifi Number: - ❑ate of Inspection: J
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [r]'Tro ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes Q" ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26, Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No A .❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No aNA ❑ NE
Other Issues
28. Did the faciIity fail to properly dispose of dead animals with 24 hours and/or document [:]Yes No 0 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 Ko ❑ 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
ZeNeo ❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below,
❑ Yes
CNo ❑ 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
]3 ❑ NA
[] NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
F rNo ❑ NA
❑ NE
Ir oa
(D d, L &,,
We S r )a f
(✓(� S�J� f SSr� fffk'0 ""-441"IJ
f �s
doter �{`
Reviewer/Inspector Name: Rev e � (' 9'
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 114 7`f 6 %.)BSI
Date: )'-7 J
21412015

Division of Water Resources
Facility Number - ❑ Division of Soil and Water Conservation
Q Other Agency
type of visit: Grtomwiance inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: 0 Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name:
Owner Name:
!Nailing Address:
Physical Address:
Facility Contact:
Onsite Representative: e cr i
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Owner Email:
Phone:
Title:
Latitude:
Phone:
Integrator:
Certification Number: f 7,
Certification Number:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
1 9b Non -Layer
er
Wean to Finish
W 'n to Feeder
-
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
Pullets
Puults
Design Current
Discharae_s 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?
h. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (if yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Design Current
Cattle Capacity Pop.
DairyCow
DairyCalf
DairyHeifer
D Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes to ❑ NA ❑ NF
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes FrN9❑ NA ❑ NE
❑ Yes No o NA ❑ NE
Page 1 of 3 21412015 Continued

Facility Number: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. I f yes, is waste level into the structural freeboard? ❑ Yes ❑ No
❑ NA ❑ NE
❑ NA [] NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): R r 5 T. 5 j I? - s
Observed Freeboard (in): 4 *5 7 _ 2j�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes �No[:] ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
G. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes Z 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 envirenmenta .threat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes [' 'y ❑ 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
ZNo
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below,
❑ Yes No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals
(Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% ❑r 1 d lbs. E] Total Phosphorus ❑ Failure to Incorporate
Manure/Sludge into
Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Dri ft ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soi I Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes N
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ YesrNo
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes ❑
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No.
❑ NA
❑ NE
Required Records & Documents
14. Did the facility ail 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 �No
❑ NA
❑ NE
the appropriate box,
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements [3 Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crap Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �o ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes fNo ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: Date of inspection:
34.'Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2 No
❑ NA
❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
17<0
❑ 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 structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge?
❑ Yes
No
A
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No
eNA
❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
ZNo
❑ NA
❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
0 Yes
ffNo
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
VNo
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
o
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
o
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
No
❑ NA
❑ NE
Comments (refer'tri,question4)::Explain any.Y)~S;hhswers and/or.Hny endat,i
Uaedrawings of facility to defter, explain situations;{itxe ii`dditioniilpagaesd;adsitnioencaels;sraercyo)mm,
xonsor�any.athemtrnns:.
oo
pCat e S�+'1J s con es
« ll A•f__ O i�: a D►
119 7P6 73 y
Reviewer/Inspector Name; L14--
Phone: 7In 79 G 23 o,
Reviewer/Inspector Signature:
Page 3 of 3
Date:
2141015

1� , a ``7 1/IYl.71V1! V! ►\ isitU {►GAVRI L%;3 Y
Facility Number ] - 0 Division of Soil and Water Conservation
Q Other Agency
Type of Visit: Q Compliance Inspection 0 Operation Review Q Structure Evaluation 07echnical Assistance
Reason for Visit: Q Routine Q Complaint 0 Follow-up Q Referral D Emergency a Other Q Denied Access
Date of Visit: 3 Arrival Time: Departure Time:-f-�--� County: Region:
Farm Name:
Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: e rf ; t— 7 Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
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:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
La er
Non -La er
Non-L�
Pullets
Other
Pou Its
Design Current
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ ❑ther:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWR)
c, What is the estimated volume that reached waters of the State (gallons)?
d, Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge'?
Longitude:
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy heifer
Dry Cow
.Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 6"No ❑ NA ❑ NE
❑ Yes
No
E] NA
❑ NE
Yes
No
❑NA
❑NE
❑Yes []No ❑NA ❑NE
❑ Yes [D",No ❑ NA [] NE
❑ Yes r No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

1
Faciliti,Number: - Date of Inspection; -2
'Jr
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
3-No
❑ NA
❑ NE
a, I f 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): `] 2- 4
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
Ci oo
❑ 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
[3'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?
❑r Yes
❑ No
❑ NA
❑ NE
8. Do any of the structures lack adequate markers as required by the permit?
❑ Yes
[7] No
❑ NA
❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
[2'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
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
PN
16, Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ No
❑ NA
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
❑ No
❑ NA
dNE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
❑ No
❑ NA
0 NE
20. Does the facility fail to have all components of the CAWMP readily available'! If yes, check
❑ Yes
❑ No
❑ NA
F(N E
the appropriate box,
❑ WUP ❑Checklists 0 Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Iryes, check the appropriate box below. ❑ Yes ❑ No
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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'?
❑ Yes []No
❑ Yes ❑ No
❑ NA [3"NE
❑ Weather Code
❑ Sludge Sui�;E
,
❑ NAffNE
❑ NA
Page 2 of3 21412015 Continued

facilitjNumber: � [ - �{ �_ Date of Inspection: a -If � S
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ No
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ No
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26.. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes ❑ No
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes ❑ No
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface 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?
❑ NA 0`9E
❑ NA ❑ NE
❑ NA []-NE
C�r'NA ❑ NE
❑ Yes Q No ❑ NA ❑ NE
❑ Yes ❑'f4o ❑ NA ❑ NE
❑ Yes to [DNA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No
❑ Yes �No
Yes dNo
0 NA D NE
DNA []NE
❑NA ❑NE
Comments?(refer-to.Fq 6tiori #);kExpl tin, any�YES answers and/or, Any. additional. recommendations or any other comments:.:
616 drawin slt ;of facilit >ita:better-ex fain uations'(use:.additiunal. nges.as neeesssry):
I ter`►^- ao k- a¢
�, lr� �� +s• So•1 ,n e et
rL,P-
ke 4°,..`.l 4-Q 4 �— i,­ i` taw, � 304 i1
R, 5cti55cj#6:6nS C'_4 �VOK P+c4_4"r5
Reviewer/Inspector Name: 0VV-
Reviewer/Inspector Signature:
Page 3 of 3
Phone: T I () 7P6 r
Date: 1( I�_ Y L,
21412015

Reason for Visit: & Routine Q Complaint Q Follow-up Q Referral Q Emergency Q Other Q Denied Access
Date of Visit: Ifjjj!t#Lj I Arrival Time:0 Departure Time: County:
Farm Name: (?_�411JCD
(XLK { 1 OZAAC C RS Owner Email:
Owner Name: Q rl.TiG� M , 1�e(L4W/ , T Phone:
Mailing Address: JQ $ 1 U,) H ! _TC PLASt,F 4 AWM T-6 Li U1c ./Y ( 6,3(o's
Physical Address:
Facility Contact:
Title:
Onsite Representative:
Certified Operator; 9.1c+h4q:t�eq-(u 6V
Back-up Operator:
Location of Farm:
Latitude:
Phone:
ante razor:
I[[,,
Corti catia Number:
Certification Number:
Longitude:
Region:
I�139)9
M��P-esl'"gnLSurr'
Swine
Wean to Finish
Wean to Feeder
e- nt
Capacity Pop.
i !%#Q
Wet Poultry
I JLayer
Non -La cr
Design
Capacity
I
I
Current
Pop.
Design Current
Cattle Capacity Fop.
Dairy Cow
Dairy Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
D . P,anIt .
Lavers
Design
Ca aeit
Current
P,a
Dry Cow
Non-Dairy
Beef Stocker
Farrow to Finish
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkc Poults
Other
D_ischarzes_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 I ]C1 No
❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Page I of 3 21412014 Continued

Facili Number: - JD Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
No
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
❑ No
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): 1 J9. S 19, S
Observed Freeboard (in):T
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
No
[] NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWR
7. Do any of the structures need maintenance or improvement? [] Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 4No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes X No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land 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 Approved Area
ta
12. Crop Type(s): ZE 1`
13. Soil Type(s): �i [j 1 i..I.�L
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No
❑ NA
❑ NE
15. hoes the receiving crop and/or land application site need improvement?
❑ YesiNo
No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
No
❑ NA
❑ NE
19. Is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Reaulred 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.
0 WUP []Checklists ❑ Design 0 Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. [] Yes X No
0 Waste Application ❑ Weekly Freeboard Q Waste Analysis 0 Soil Analysis E] Waste Transfers
❑ Rainfall Q Stocking 0 Crop Yield Q 120 Minute Inspections ❑ Monthly and I " 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
Q Weather Code
0 Sludge Survey
[] NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412014 Continued

Faclli Number: j - Date of inspection: t-{
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA ❑ NE
25, Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail 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
0 No
[DNA
❑ 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
t4No
❑ 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
V
❑ 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
allo
❑ 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 ReviewerlInspector 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
t,No
❑ NA
❑ NE
Comments (refer to question #); Explain any YES answers and/or: any additional recommendations. or any.otber.comment& ;. :
Use drawings of facility to better explain situations (use additional a es.as,necessa ):
w. A
jLIJ, , -
�131�
Lj1 �)JLI
ow
lq'RC-
Sal L (:I'
tan i4 i 1 eW p01 H
&x UN 7-1 L aN__J'
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
J�fn4NQ(4 Q S Phone: /V ` T % '_� 5 4"
Una-A-L
Z2'
Date: Lih C{
21412014

0 Division of Water Quality
11 Facility Number - ® ❑ Division of Soil and Water Conservation
a Other Agency 11
Type of Visit: Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Qf Routine Q Complaint D Follow-up D Referral O Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: ; jj Departure Time: � County:
Farm Name: ? ►rY � lj'�' ] }+� pvTAAXI(K Owner Email:
Owner Name: ,e' Phone:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Title:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Region:
Integrator:
Certification Number:
Certification Number:
Longitude:
Design Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
Other
"Layer _:�� I :�]
Nan -La er
Poults
Design Current
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?
Design Current
Capacity Pop.
Dairy Cow
Dairy Calf
D4Ey Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes No
[:]Yes No
[:]Yes �TNo
[—]Yes a] No
❑ Yes Zj No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

1
1
Facility Number: - Lk jDate of Inspection-
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes
;ErNo
❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
, FefrNo
❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure
6
Identifier: 1
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
jEr 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
P No
❑ 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
Fe'No
❑ NA
❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
ff No
❑ NA
❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below.
❑ Yes
WNo
❑ 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
Z'No
❑ NA
❑ NE
15, Does the receiving crop and/or land application site need improvement?
❑ Yes
;21No
❑ NA
- ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
;2�No
❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
[ZNo
❑ NA
❑ NE
18, Is there a lack of properly operating waste application equipment?
❑ Yes
dNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Zf No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? if yes, check
❑ Yes
0No
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design [:]Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below, ❑ Yes ,ErNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I " Rainfall inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes in No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes eNo
❑ NA ❑ NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1
[Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
ZNo
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
ZrNo
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
Z 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
ZNo
❑ 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
EfNo
❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
17No
❑ NA ❑ NE
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
75No
❑ 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
Reviewer/Inspector Signature:
Page 3 of 3
Phone: cO3 's b 1
Date: !�_! o L3
21412011

type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation 0 Technical Assistance
[Reason for Visi : YLRoutine Q Complaint Q Follow-up () Referral a Emergency Q Other O Denied Access
Date of Visit: Arrival Time: �] _ Departure Time: ® County: �� Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: [ 'i S e Integrator:
�] 1 gol n
Certified Operator: ]-lGagQ.r�) q4A6, Certification Number: p' L
Back-up Operator:
Location of Farm:
Latitude:
Certification Number:
Longitude:
Design Current Design Current tffq;;3%IJMLCUj rent
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pap.
Wean to Finish
La er
Dai Cow
Dairy Calf
Wean to Feeder
15=
Layer
Feeder to Finish
Dairy Heifer
1Dry Cow
Non-Dai
Farrow to Wean
Farrow to Feeder
Design Gurrcnt
D Poult Ea acit Po
Farrow to Finish
La ers
Beef Stocker
Gilts
Non -Layers
Pullets
Beef Feeder
Boars
Beef Broad Cow
Other
Other
Turkeys
TurkeyPoults
Other
Discharees and Stream_lmpacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes �No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
[] No
❑ NA
❑ NE
❑ Yes
% No
❑ NA
❑ NE
❑ Yes
`KNo
❑ NA
❑ NE
Page 1 of 3 21412011 Continued

Fackty Number: ! - Ds ection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
Yes
No
777""❑���
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?:
Q
Designed Freeboard (in):
Observed Freeboard (in): OQ 45
5. Are there any immediate threats to the integrity of any of the structures observed?
Yes
I ](1 No
NA
NE
(i,e., large trees, severe erosion, seepage, etc.)
T[
6. Are there structures on -site which are not properly addressed and/or managed through a
E:] 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 [DNA [] 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 Anplication
10. Are there any required buffers, setbacks, or compliance alternatives that need Yes No NA NE
maintenance or improvement?
1 l . Is there evidence of incorrect land application? If yes, check the appropriate box below. Yes No NA NE
[] Excessive Pending ❑ 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): t4 L] LLF-
14. Da the receiving crops differ from those designated in the CAWMP?
Yes 1
NA
[3 NE
15. Does the receiving crop and/or land application site need improvement?
[] Yes No
[3 NA
[3 NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
[] Yes No
E] NA
NE
acres determination?
17. Does the facility lack adequate acreage for land application?
Yes o
❑ NA
NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes No
❑ NA
[] NE
Re uired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
Yes No
NA
NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
[] Yes No
NA
NE
the appropriate box.
[] WUP 2Checklists Q Design [j] Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
Yes No
NA
NE
0 Waste Application [] Weekly Freeboard 0 Waste Analysis 0 Soil Analysis
[] Waste Transfers
+[], Weather Code
Q Rainfall [i Stocking © Crop Yield Q 120 Minute Inspections❑ Monthly and 1 " Rainfall Inspections 0 Sludge Survey
22. Did the facility fail to install and maintain a rain gauge?
Yes + No
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
[] Yes
No
[] NA
[] NE
Page 2 of 3
21412011 Continued

lFacMty Number: 31 - Date of inspection: '
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey [:]Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes)kNo ❑ 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 reviewlinspection 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 ors any.other comments,E.N �" t*,4p:l"r
Use, .drawin s nf' faeilit . to' better. explain,situatians (use additional ages ail , -
b))q119 6 Ur
� 11]�� 1• �
n�551634,G
ReviewerlInspector Name;
ReviewerlInspector Signature:
Page 3 of 3
Phone: 9 j[]41 (,0-4?0�
Date:
21412011

ADivision of Water Quality
Facility Number - y ❑ Division of Soil and Water Conservation
Q Other Agency 11
jType of Visit: AC' ompliance Inspection O Operation Review l) Structure Evaluation 0 Technical Assistance
(Reason for Visit: outine 0 Complaint Q Follow-up Q Referral Q Emergency 4 Other Q Denied Access
Date of Visit: j 1 i Arrival Time: � Departure Time: County: 4]V
Farm Name: 1 Q (uG { RGDACi9 S Owner Email:
Owner Name: [ a,&�KJ71GJ_1 M J�EPt111 G Phone:
Mailing Address: 1 aw— I u'�01 Tlr FLg! o R-8 /YLAM VC', Ugg , /V C CO
Physical Address:
Facility Contact: (] Title: Phone:
Onsite Representative:? $ '�' 'l`_ _(L_ 6W11 CG ��Gt lute rator:
Certified Operator: 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
1. ether
Certification Number:
Latitude:
Design Current Design Current
Capacity Pop. Wet Poultry Capacity Pop.
I I E La er
55 t-I1 Non -La er
Poults
Design Current
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
Longitude:
Region:
-3(0S
q Pq1' 1 I
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Beef Feeder
Beef Brood Cow
❑ Yes 0 No ❑ NA ❑ NE
❑ Yes [:]No ❑ NA ❑ NE
[] Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Page 1 of 3 21412011 Continued

IFec9ty Number: -Ll41 Date of Inspection: 1 1
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No
Structure 1 Structure 2
Structure 3
Identifier:
3
Spillway?:
n
Designed Freeboard (in):
Observed Freeboard (in): L49
❑NA ❑NE
❑NA ❑NE
Structure 4 Structure 5 Structure 6
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No ❑ NA ❑ NE
❑ Yes 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 b6 No ❑ NA ❑ NE
S. Do any of the structures lack adequate markers as required by the permit? ❑ Yes &0 ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? 0
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 �LNo ❑ 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):SG r=(L C. '
13. Soil Type(s): -_&ILA }I LLE,
14. Do the receiving crops differ fr'dlfi 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?
Reauired Re_cords_& Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
0 WUP ❑Checklists ❑ Design [] Maps ❑ Lease Agreements
❑ Yes No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes No
❑ NA
❑ NE
❑ Yes eNo
❑ NA
❑ NE
❑ Yes
�No
❑ NA
❑ NE
❑Yes kNo ❑NA ❑NE
❑ Yes No ❑ NA ❑ NE
❑ Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No
D Waste Application 0 Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑ Waste Tran fers
Q Rainfall ❑ Stacking 0 Crop Yield Q 120 Minute Inspections [] Monthly and 1" Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes TA
� No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No
[DNA ❑ NE
0 Weather Code
[] Sludge Survey
❑NA ❑NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

IFaci9ty Number: I - W&q Date of Inspection: —4 1 IfIll
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No [DNA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes �No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes ❑ No �NA ❑ NE
Other Issues
29. Did the facility fail to properly dispose of dead animals with 24 hours and/or document ❑ Yes No ❑ NA ❑ NE
and report mortality rates that were higher than normal? 0
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 14No ❑ 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
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: gia'7+7�
Date: 1 h
21412011

Type of Visit o.Compliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint Q Follow up Q Referral Q Emergency 0 Other ❑Denied Access
Date of Visit: Arrival a
® l Time: Q['� Departure Time: County: 1 Region:
Farm Name:��t1� Owner EmnEL•
g i9 - r95P S7 oti
Owner Name: Phone:—S�3aSCC�
Mailing Address: Si i! � FC► 15 -- � oulvT (3C.i o r , ! jtiK�65
Physical Address: _
Facility Contact: _
Onsite Representati
Certified Operator:
Sack -up Operator:
Title:
Phone No:
ve:S PcLe) Integrator:
• i, q-04 Al Op rater Pertification
Number: f-I a 19
Back-up Certification Number:
Location of Farm: Latitude: = O 0 4 = Longitude: = e = i =
11
Design Current
Swine capacity Population
urrent
Design01191
Wet Poultry Capacityulatlau
Design
Cattle C:tpacity
Current
Population
❑ Wean to Finish
❑ Layer
❑ DairyCaw
❑ Dai Calf
❑ DairyHeifer
❑ D Cow
❑ Non-DaiTy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
Number of Structures:
Wean to Feeder
C]
❑ Non -Layer
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
Dry Poultry
❑ Farrow to Finish
❑ Gilts
❑ Boars
Other
❑ Other
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ Turkey Faults
❑ Other
Discharges & Stream imnacts
1. is any discharge observed from any part of the operation?
❑ Yes
x 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
Cl 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`?
❑ YeskN
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yeso
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Dumber: 3f — y
Date of Inspection SM __
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Stru►�tt re 3 Structure 4
Identifier; +
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): LID L4 �{
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 XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8, Do any of the stuctures lack adequate markers as required by the pennit? ❑ 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 • ElNE
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 WindoYv ❑ Evidence of Wind Drift ❑ Application Outside of Area
12, Crop type(s)
13. Soil type(s)
tyLE_
14. Do the receiving crops differ f-rom those designated in the CAWMP?
❑ Yes
No ❑ NA
ElNE
15, Does the receiving crop and/or land application site need improvement?
ElYes
No ElNA
ElNE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
ElYes
No ❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
No ❑ NA
ElNE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
� �:�:�_.: €.��: M : � r�� ��:�:�;: � :,�:; s�i'��� .:.�� fit:?��•w,. � "��."
'cumments (refer [a questiiiri #j: ;Fxplaln;any,.YES answers'andlor: any other, comments:;
Use,drawin , of facilsfy to better explain situations: (use additional a y) pages a"s neeess
. .. - . s.. :1 z•. - . , y ...:.� ..... .:. 2?? �:m".-',r;:s •:xw'x�.�r's h.t4$.mS':.H..f"'.. �.' S:s.•;'�' ..... >k1�xA
Reviewer/Ins ector Name "` `.t..: r
p s.:,. 5:; i Phone: �iC]— �i� ?
Reviewer/inspector Signature: Date:
Page 2 of 3 12128104 Continued

PaeilityNumber:--� Date of Inspection 5 ro
Reauired Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available'? ❑ Yes X. 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. 0 WUP ❑ Checklists 0 Design 0 Maps ❑ ether
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes X No ❑ NA ❑ NE
❑ Waste Application 0 Weekly Freeboard ❑ Waste Analysis [] Soil Analysis ❑ Vste Transfers ❑/nual Certification
El Rainfall 0 Stocking [l Crop Yield C] 120 Minute Inspections C] 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?
ElYes
No
El NA
❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
XNo
❑ NA
❑ NE
25. Did the facility Fail to conduct a sludge survey as required by the permit?
❑ Yes
)ANo
❑ NA
❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
*o
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
XNA
❑ NE '
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document
[] Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31, Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/]nspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Additional Comments and/or Drawings:
r�+�l�V J • W
9133II6 O• t]
C L G"71 6/� dK G
� C f P A xl c y-_ on A FE D 5 } 5
`10 AT A 94E: 51 AGE T t,V6 -ro Lk-) A45 �-1 w-F V- aDF-
Page 3 q f3 12128104

Type of Visit ' gCompliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit ),Routine Q Complaint Q Follow up Q Referral 0 Emergency Q Other ❑ Denied Access
Date of Visit: 1 Arrival Time: ® Departure Time: u County: IV Region:
Farm Name: 1� �-¢ [ Nt �C"i ��A�CrIC��S _ Owner Email:
4�1Z �V�ICr �Q� C. „ .,._,..,...- ---
Owner Name: __ Phone: CC.915'- ��►"-53a5
Mailing Address: Ir;12S 1 l l Tf� rLASI� 1 ' lC�.f N _ UE AC
Physical Address:
Facility Contact: Title:
Onsite Representative: _ �_"Nr1GE JA_q ji A(7
Certified Operator: Ea- CJ �� �RR_tAJ6
Sack -up Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: 0 �" Longitude- = o = ` = `1
Design Current
Design
Current )Design
Current
Swine CapaPoultry �ci Population Vet
Capacity
Yopulatlnn Cattle Capacity
❑ Dairy Cow
aDairy Calf
Population
❑ Wean to Finish
1
❑ Layer
IN Wean to Feeder
j 5 UO
❑ Non -Layer
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
FoBoars
Dry Poultry
❑ La ers
❑ Non -Layers
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
Beef Feeder
❑ Beef Brood Cow
❑El
Pullets
❑ Turkeys
Other ❑ Turkey Poults
❑ Other ❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
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 KNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ANo Cl NA ❑ NE
❑ Yes No ❑ NA ❑ NE
12178104 Continued

Faciiity Number: �j — Date of inspection
Waste Collection & TreatmentANo
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes [INA [INE
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: �7
Spillway?:
Designed Freeboard (in): �} • ri� • 5 7,
Observed Freeboard (in): 30
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes X No ❑ NA Cl NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed ❑ Yes XNo ❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 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 ElNA ❑ NE
maintenance or improvement? K
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
maintenance/improvement?
❑Yes N No El NA El NE
11. Is there evidence of incorrect application? If yes, check the appropriate box below, ❑ Yes ANo ❑ NA ElNE
ElExcessive Ponding ❑ Hydraulic Overload ElFrozen Ground ElHeavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or ld lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Winslow ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) '�3 C1
13. Soil type(s)
14. Do the receiving crops diffelr4rom those designated in the CAWMP?
❑ Yes
A4 No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
10 No
❑ NA
[INE
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
KNo
❑ NA
❑ NE
;Gonimeq[s (refer tn.' quest on, lEx .lain any. answers iin�i'lur an recbmmendations,or: an rother:camments.'a. .'
p.... Y . y.;.... Y.....;..:::..,, :
a •:a,3a'..::�:•,..u.•4..E:....`.:;L;;.a.�...'�•.f..�.A1: ,. a
Use. drawings, af; faiility to,
better ex Itiin sifuations;'{use:additianA{' Pages neceasa .r? .� . „ ..;�_ _` -..,a *::;:, iY
p,
Fi 1U L7 t.A CiCON A►+tEND MErN7 t~o (L rctEL-'� t-4 GaUu y pw7 w I he3t6NS �
V�C� 7ci 5 QR S#c1if F iGLi] Fog 1TigLl AN
CA Lj6it-Ar Ti 6 W Ya G E t"I OLd 10
Reviewer/Ins ector Name — — l
p Phone: jo- t,76 3�
Reviewer/Inspector Signature: Date: 1
12128104 Continued

Facility Number: — Date of Inspection
Reauired
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
[] yes
No
❑ NA
El NE
24.
Does the facility fail to have all components of the CAWMP readily available? If yes, check
El Yes
o
❑ NA
❑ NE
the appropriate box. 0 WUP ❑ Checklists 0 Design 0 Maps ❑Other
21.
Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
l.](1 No
❑ NA
❑ NE
0 Waste Application E) Weekly Freeboard 0 Waste Analysis 0 Soil Analysis 0 Yoste Transfers l❑/ennual Certification
❑ Rainfall O Stocking ❑ Crop Yield 0 120 Minute Inspections 0 Monthly and 1"
Rain Inspections (]
Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
0 No
❑ NA
❑ NE
.23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ 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
o
❑ NA
❑ NE
2b.
Did the facility fail to have an actively certified operator in charge?
ElYes
JrNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29,
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ yes
fM No
Vy
❑ 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?
Cl Yes
No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Mditiana>��umnneritx+andlor 17 awiti' s:
109 I I
121,29104

Type of Visit 0 Compliance Inspection 0 Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit X) Routine Q Complaint Q Follow up Q Referral Q Emergency Q Other ❑ denied Access
Date of Visit: Arrival Time: ® Departure Time: County:
Farm Name: Owner Name: 1 [-�
MN71CC^+CL6M'S HG?_QN6;
Mailing Address:
Physical Address:
Facility Contact: Title:
SENTICE HEL-TWwaS CHRD1-IEst.Rtnr�
Onsite Representative: C►+-R-T 1 S N ER¢ tN f
Certified Operator:
Back-up Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Location of Farm: Latitude: [� D [� 101i Longitude: [= 0 0 i =
Ig
Design Gurrent
Design Current
Design Current
Swine Capacity Population
Wet Poultry Capacity PA.opulation
Cattle Capacity Population
❑ Wean to Finish
❑ Layer
❑ Dairy Cow
® Wean to Feeder 1co 3
❑ Non -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to feeder
❑ Non -Dairy
El Farrow to Finish
❑ Layers
❑ Beef Stocker
Gilts
on -Layers
❑Beef Feeder
FIED Boars
❑Pllets
u
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Poults
❑ Other
I ❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
ko
❑ 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
P(No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
IX
El NA
El NE
other than from a discharge?
Page 1 of 3
12128104
Continued

a T
Facility Number:
Date of Inspection ( d
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. if yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier:
Spillway?: Designed Freeboard (in): ! �. 19.5 7a
. 4
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.)
b. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes jX No
❑ Yes ❑ No
Structure 5
El NA ❑NE
❑ NA ❑ NE
Structure 6
❑ Yes M No ❑ NA ❑ NE
❑ Yes IX 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 Od No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes EXNo ❑ 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 Qq No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes [X No ❑ 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)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
N No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
A No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
❑ YesrVi
No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
]� No
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments..:..:::;
Use drawings of facility to better explain situations. (use. additional pages as necessary):'
Ai
Reviewer/Inspector Name Phone: C)16 '_j _4 39
Reviewer/Inspector Signature: Date: 9
Page 2 of 3 12128104 Continued

1
Facllity Number: Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes A No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;dNo ❑ NA ❑ NE
the appropriate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 0 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
g No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
gNo
rM
❑ NA
ElNE
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
�jNo
❑ NA
❑ NE
26,
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ONo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
�XQNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
O[No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
21No
❑ 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
O 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
1;�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
kNo
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
XNo
❑ NA
❑ NE
Comments and/or Drawings:
Page 3 of 3 IZ128104

IF
Facility Number
I(Diyision of Water Quality
0 Division of Soil and Water Conservation"
Q Other Agency
Type of Visit 6 C mpliance Inspection D Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit Routine Q Complaint a Follow up Q Referral Q Emergency a Other ❑ Denied Access
Date of Visit: ® Arrival Time: Departure'fime: County: DVf I,_2tJ Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Owner Email:
Phone:
Onsite Representative: . B( #,jT,,� U ee C&x 3Cn Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Other
❑ Other
Phone No:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o = 1 = " Longitude: = o = ' =
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
[ 5 4o J j1104o_ i ❑ Non -La et
Dry Poultry
Layers
Non -Layers
El Pullets
❑ Turkeys
❑ Turkey Poults
❑ other
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance roan -made?
Design Current:
Cattle Capacity Population'.
❑
Dairy Cow
❑
Daia Calf
❑
Dairy Heifei
E]Dry
Cow
❑
Non -Dairy
❑
Beef Stocket
❑
Beef Feeder
❑
Beef Brood Co
Number of Structures:
h, Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes /No ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
El Yes
VX101, ❑ NA
❑ NE
El Yes
❑ NA
❑ NE
1212"4 Continued

Facility Number: 31— 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 I Structure 2 Structure 3 Structure 4
Identifier: u&rooAJ r WrwO 2— (&qaN 'L
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):^-
5. Are there any immediate threats to the integrity of any of the structures observed?
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
through a waste management or closure plan?
❑ Yes �No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
[]Yes No ❑ NA ❑ NE
❑ Yes E5 o ❑ NA FINE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaWNo
eat, notify DWQ
`? ❑
7. Do any of the structures need maintenance or improvementYes ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes [ZfNo ❑ 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 L7No ❑ NA ❑ NE
maintenance or improvement?
Waste_ Application
10. Are there any required buffers, setbacks, or compliance alternatives that need 0 Yes [:Ao ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes ETNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc,)
❑ PAN ❑ PAN > I0-X, or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ Application Outside of Area
12. Crop type(q)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
LYNNo
ElNA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
ElYes
[7 o
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?[:] Yes
ONo
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
[�o
❑ NA
❑ NE
18. is there a lack of properly operating waste application equipment?
❑ Yes
[No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
i AY6 A WCA R E C.TALU r 5190+r Fe LN6 L a& LA Gova►J j , SE r 4`r as,f U Af ,
CRr✓ dA►f& d-L--V LA&mrj rVmm AA, �P(Cr DaN� ro SEt '4r t�,s
Reviewer/Inspector Name �o f,J �jd��{� r..�_ Phone: 9J,)
Reviewer/Inspector Signature:
Date: 4 yl a
rricorvY %,Ur//srr"U"

4
i
Facility Number: — [{{, Date of Inspection a
Required Records &_Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑'Yes ❑ No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps ❑ Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes L7 No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Cade
22. Did the facility fail to install and maintain a rain gauge? ElYes E No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2 No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit?
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
2 No
❑ NA
❑ NE
❑ Yes
E NNo
❑ NA
ElNE
❑ Yes
9 No
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
29, Did the facility fail to properly dispose of dead animals within 24 hours and/or document
and report the mortality rates that were higher than normal?.
30. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately
31. Did the facility fail to notify the regional office of emergency situations as required by
General Permit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
33. Does facility require a follow-up visit by same agency?
Comments and/or Drawings:
Cl Yes
❑ No ONA
❑ NE
❑ Yes
0 <No❑ NA
❑ NE
❑ Yes
;/No ❑ NA
❑ NE
No
❑ Yes
5 ❑ NA
❑ NE
❑ Yes
El"No
❑ NA
❑ NE
❑ Yes
LJ N
❑ NA
❑ NE
[]Yes
'� Nn
❑ NA
❑ NE
12128104

Type of Visit Q'Compliance Inspection Q Operation Review D Structure Evaluation ❑ Technlcal Assistance
Reason for Visit 0 Routine Q Complaint Q Follow up Q Referral n Emergency n Other ❑ aenled Access
Date of Visit: Arrival Time: Departure Time: County: ❑UP«I Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: ?".PI I cusjz. 0_k tj 6-
Certified Operator:
Back-up Operator:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 U = ` =" Longitude: = o = ` 0 `l
Design Current
Swine Capacity Population
Design Current
Wet Poultry Capacity Population
sign
Cattle acity
Sap
Current
Population
❑ can to Finish
❑ La er
❑ Dairy Cow
® can to Feeder IrS,60 I yr�0
on -Layer
❑ Dairy Calf
❑ Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
ElNon-Dairy
El Farrow to' Finish
❑ Layers
El Beef Stocker
❑ Gilts
Non -Layers
❑ Beef Feeder
❑ Soars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
❑ Turkey Puuets
❑ Other
❑ Other
Number of Structures:
Discharees & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
Ej<o
❑ 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
2rNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
�2N
❑ NA
❑ NE
other than from a discharge?
Page I of 3
12128104
Continued

Facility Number: 31 Date of Inspection G
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: I -A 6-=AJ 1 LA6rjq I Z LA 6-Z01V
Spillway?:
Designed Freeboard (in): .,�� ! �� I7 •,
Observed Freeboard (in): `] 17
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 UKo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes Ly No ❑ NA ❑ NE
❑ Yes Ld No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmentaith7at, 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 dNo ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) J
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 Jd N ' ❑ 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) 560.M&N ( /l) J ( d
13. Soil type(s)
V-74-
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
Cl Yes
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes
17. Does the facility lack adequate acreage for land application? ❑ Yes
18. is there a lack of properly operating waste application equipment? ❑ Yes
ETNo ❑ NA
❑No El NA
❑ NE
ONE
0 No ❑ NA
❑ NE
EKo ❑NA
ONE
`X"' El NA
❑NE
Comments (refer to question #): Explain any YES answers and/or any.: recommendations or. - any other comments:;
Use drawings of -facility to.better explain situations. (use additional pages. as necessary);;
FAtL.A"' Apo (?-G C4fl- V4 rk/ 6-1� D
&)xTN (.AGffo-1j pr_zr4,1 ro&, # T) FA,6666 ^AP t4 Vs -!L, aF , S` � °"vim` t SF AIArAq
L_60- MCUS Aldtz'F Or xaxl� 7b1 041/6 r?fValEp,
CAL-ZVAWV-J DvE 6y r-ru o or' i'Mf, .
Reviewer/Inspector Name bj'j(-A,Phone:
Reviewer/Inspector Signature:
. »8..... ! .,
Date: tT/Date: �3 ,00
12129104 Continued

Facility Number. — Date of Inspection II a131.7G
� r
ReQuired Records & Documents
19. Did the facility fail to have 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 El Yes NoN ❑ NA ❑ NE
the appropriate box.
❑ WUP El Checklists [I Design ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes Ck<o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑
❑ NA
❑ NE
23,
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
El Yes
VN
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
El Yes
El NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
ETNo
El NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
[I Yes
El No
VNA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ZI No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
(] Yes
iV❑
❑ 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?
ElB 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
El Yes
//
2'N' o
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, aver application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
Z No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
ONo
❑ NA
❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 I Z128104

Type of Visit j0 Compliance inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit 95Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date Uf Visit: Arri,,l 'time: ; []e urture Time: i aunty: Up Region:
Farm Name: 0 Owner Email:
Owner Name:&ntnz'm9 Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: � �� f. tdr­
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: [= o ❑ i Q Longitude: = ° =1
Design Current Design Current
Capacity Population Wet Poultry Ctapacity. Population
❑ Layer
❑ Non -La er
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turke s
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population.
❑
Daia Cow
❑
Dai Calf
❑
Dairy Heifei
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Broad Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notil'y 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 X No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
El NA
El NE
El Yes
El No
❑ Yes
Wf No
❑ NA
❑ NE
❑ Yes
XNo
❑ NA
❑ NE
12128104 Continued

r
Facility Number: — Date of Inspection
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes yrNo
❑ 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: A15
Spillway?:
Designed Freeboard (in):
J.
Observed Freeboard (in): +341 .31
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes No
ElNA ElNE
(ie/ large trees, severe erosion, seepage, etc.)
10
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes ;ZNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes A No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
❑ Yes ONo
❑ 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?
It. 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 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) G` 662(QL)Aa,5-6-42�
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 andJor 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
r .
Gnmmentsr3fer:to gnestion�#}�?Explaln anyYESanwers,pndlor�ny recomretendatigns or any other commenta.
Use drawings of�facility:to better�explaln aituations[uac additianalges as necessary
2 �F �, 5' �9•�0 �s-. .-���i•t� �s�;
�G`C2.9-ca.��
Reviewer/inspector Name-'. _; a °t,:; Phone:
Reviewer/Inspector Signature: Date:
12/28/0 Continued

Facility Number. Date of inspection /o
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes / No
❑ NA ❑ NE
20, Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes No
❑ NA El NI,
the approprrate box. ElWUP ❑ Checklists El Design ❑ Desi g Maps El Other
/91
21. Does record keeping need improvement? If yes, check the appropriate box below.
ZYes ❑ No
❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis OWaste Transfers ❑ Annual
Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield 9120 Minute Inspections ❑ Monthly and i" Rain
Inspections 0
Weather Code
22. Did the facility fail to install and maintain a rain gauge'?
❑ Yes JZ No
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes 0 No
❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes No
❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes No
❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes No
❑ NA ❑ NE
27. Did the [facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes III❑ No
❑ NA X NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes YfNo
❑ 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 0No
❑ 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 ONo
❑ NA ❑ NE
General Pennit? (ie/ discharge, freeboard problems, over application)
32. Did Reviewer/inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency?
❑ Yes No
❑ NA ❑ NE
Adilitltinal Coitiments unill0 r,-
� C04/0
G�J �s►-f � -
oo.
I ti�
4A �rf C'rQvPf r�vvr�
A,
IV� •
0 c _, ❑ l.��a �`"����GD om/ �it'G'��cfi
e,_4 /9 &.7 C-,
opL
G� �o
12128104

Type of Visit A5 Compliance Inspection p Operation Review a Lagoon Evaluation
Reason for Visit . ' Outine D Complaint 0 Follow up D Emergency [Notification Q Other ❑ Denied Access
Facility Number II)ateorvisit:
AVermitted,;Certified ©Co�n]ditionally Certified [3 Registered
Farm Name: .... l:.I.e�'r:j k�,.. ....I 0- .k.... •
OwnerName :.. ... ........................................ ...... ...... ................ ............ ........................ .... ..
Mailing Address:
Time:
IO Not Overational O Below Threshold
Date Last Operated or Above Threshold: .........................
Counts': �.�!!.1..knx...........................................
Phone No:
Facility Contact : ..... ........... ....................................................... ....
�Title: ... .......... .............................. .................... Phone No: ...... ... ........... ... ........ .................
�j,,,� Onsite Representative: t.r•},� !!li ...; erls...... Integrator:Rg.1rn1ae-n-...S G,.i.lj..... .....
Certified Operator:
Location of Farm:
Operator Certification Number: ................................. . .......
wine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 it 9 " Longitude ' ' �«
_. ,fir ....�-1'-... .-,.,_.. ., .. .i •;:I-,.
'Design,. Current! j j
Swine ­V5. �: _ 4i
Ca aei :, Populadon
can to Feeder %
"OTeeder to Finish
u ❑ Farrow to Wean
a
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
I.�:, �'�`>2 �'•i, f:!�.�isii. i���l �il.
r" Ali NiirnW, of Lagoons
pj ; F ; ;4 U.....4 4.. K Design ` : s' Cuirrent Current '
t # '�� .
Poult ya ; { Ca a¢i i; Po 'elation: •,Catdc ` x € Ca aci . Po uIadon
ri ❑Layer -1; ❑ Dairy
❑ Non -Layer -][]No -Dairy
10
Other
s 'i z •� ' i;it ;i,`'r: ,' s
Total44
i n `ticiti 1
-Delsnl' 41
r }:
V
J � � F
a. I
{ : *661 ssL
Discharges & Stream IM12acts
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?
❑ Yes 'ErNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes Z'Ro
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes Lilo
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ONO
Stru ,ture 1 Structure 2 Sture 3 Structure 4 Structure 5 Structure 6
Identifier: ......... .................. ........... ............................................................. ..„................... ............ .......................
...a.... .......... ... ........
Frechoard (inches): J •�
12112103 Continued

Facility Number: 3 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (iel trees, severe erosion,
❑ Yes
''ltiio
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
❑ Yes
[IQo
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?
❑ Yes
.QNo
8• Does any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
0 No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
j2NO
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
J20No
11. Is there evidence of over application? If yes, check the appropriate box below.
❑ Yes
�a
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop
type Cj Qe<
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
fd'Fio
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
RTNo
b) Does the facility need a wettable acre determination?
❑ Yes
ONO
c) This facility is pended for a wettable acre determination?
❑ Yes
.ONo
15. Does the receiving crop need improvement?
❑ Yes
PNO
16. Is there a lack of adequate waste application equipment?
❑ Yes
ZNo
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge atlor below ❑ Yes ,two
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes �No
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ;;Vno
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes PNO
Air Quality representative immediately.
...-;�'i��.as.�tt..i,.ar:•�u:.,mr�._re,y_...m .�:,��G�,i�...�..:5:r ��.�:. •ttr.r_.�c.._�r�=��y.rs :...-.. ..�, ..,:._:�nr.�::;, u. �ia:�,ra•:a..��i.��....: .-. ..
Corinmegts;(ret'er= to quasttaa #}: �. Explain anygYES ariswcrs aaiilor,.any� recosn�adatioiris or: aoy other comments. ����� V
� .w..::l " ' �.i!a�ngp'!''.. ' �{gs .� w�gy.r:u�.•€s:� � fin'2 :'_!.:.,, . :.� • s:.:sim., :r-enis:#? if..:aE4l,;;tS�€.'..,<..:s�.::;ri•.:.517::...<.��.Il:�:?SP.?': .:::z':::': + �:...,��..�;.� ...t,.."..a� . ux.....�.�,.'�..,�...�.�.t�ad'..
-7)
ilJse'drawings oi`fadlityta:better:explain`sit�uations�(useadditianal pages asra�cessary}:� Field Co Final Notes
7 � �' �g:' � r;ar?� � asp}� }L . :•�5;�: ,. iII,: p ' :�� � ",i � , 4 <ii!: § ` "';�`r
o Yt e s*o a_ re c,,. S of
-C e- � CA oa 2 �-
- �'Re co r d neQ-� rzrAerk)
" T:�-ar rr, i 5
3hcye, .
Reviewer/Inspector Name s
Reviewer/Inspector Signature:
Well I'YTai✓l+a,n_ed -�_ 'i,n 300c�
Date:
r�a►Fa/rxl

Facility Number: 3 : — Date of Inspection
Reauired Records & Documents
21. FaiI to have Certificate of Coverage & General Permit or other Permit readily available? ❑ Yes )no
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
Ocl WUP, checklists, design, maps, etc.) ❑ Yes ;IWo
23. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes .Er&o
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 2r!ko
25.
Did the facility fail to have a actively certified operator in charge?
❑ Yes
.0No
26.
Fail to notify regional DWQ of emergency situations as required by General Permit?
No
(iel discharge, freeboard problems, over application)
❑ Yes
8
27.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
�o
28.
Does facility require a follow-up visit by same agency?
❑ Yes
F.,Wo
29.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
Rio
NPDES permitted Facilities
30.
Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
❑ Yes
ZNo
31.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑ No
32.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
❑ No
33.
Did the facility fail to conduct an annual sludge survey?
❑ Yes
❑ No
34.
Did the facility fail to calibrate waste application equipment?
❑ Yes
❑ No
35.
Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
❑ Yes
❑ No
❑ Stocking Form ❑ Crag Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 124 Minute Inspections ❑ Annual Certification Form
12112103

j Type of Visit 4 Compliance Inspection ❑ Operation Review 0 Lagoon Evaluation
IReason for Visit J6Routine ❑ Complaint Q Follow up ❑ Emergency Notification D Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted 0 Ztlfled U ConPOA
ally Certi © Registered
Farm Name:
Owner Name: /jC`'
Mailing Address:
Time. -
Date Last OperateoMr Above Threshold: ..
County: GZ�
Phone No:
Facility Contact: Title: hone No:
Onsite Representative: lEkezee �+ � Integrator:
Certified Operator; Operator Certification Number:
Location of Farm:
eswine ❑ Poultry ❑ Cattle ❑ Horse latitude �_J e 6 ! _J °° Longitude 0' 0& Q
Design Current Resign Current Design Current
Swine Ca aci Population Poultry Capacltv Population Cattle Capacitv Population
❑ Wean to Feeder ❑ Layer ❑ Dairy
❑ Feeder to Finish JE1 Non -Layer I ID Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑ Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
Boars Total SSLW
Number iif Lagoons .: © ❑ Subsurface Drains Present 10 Lagoon Area Spray Field Area
_.,.
�,t�I•iolding Ponds 1 Solid Traps .. ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1, Is any discharge observed from any part of the operation:?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made`?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Dees discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
❑ Yes RfNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? Cl Yes No
Waste Collection & 'Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate:? ❑ Spillway ❑ Yes ZNa
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Stnicture 6
Idenlifier:
Freeboard (inches):
05103101 Continued

Facility Number: 3— Date of Inspection
S. Are there any immediate threats to the integrity of any of the structures observed? (ic) trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
W-aste-Application
10. Are there any buffers that need maintenance/improvement?
11, Is there evidence of over application? / % ❑ Excessive lei
12, Crop type 1j 1 �J
13. Do the receiving crops differ with 'those designated in the Certi
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15, Does the receiving crop need improvement?
16. is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ic/ irrigation, freeboard, waste analysis & soil sample reports)
20. is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes �No
Cl Yes No
❑ Yes 0 No
❑ Yes No
❑Yes IIIIIIXNO
❑ Yes 4No
❑ Yes No
U Yes No
❑ YesPO
No
❑ Yes No
❑ Yes ❑ No
❑ Yes P�No
Cl Yes �No
❑ Yes �No
❑ Yes )dNo
❑ Yes XNo
❑ Yes o
ElYes fNO
❑ Yes A
No
Yes No
El Yes IIIIII o
El Yes No
© No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit,
_........,.: _.:� w: r..<.c,�;;�.: ;�aa:.,, sw;,• , .. - � .�: r•:�...:p „S.'s`,q• .ss, .:.;�. , i...
'Cpmmeiits (refer to questlon'#): Explain any YES answers undlar any, recommendation R any nt er;.comments,;. ; .,...: . -.:• ......•.
I]se'ilruwings of facility to better explain situutions�.{use�additlanal pages a necessar`yj '' Field Copy ❑ Final Notes t:t
rod Ue— J K ON
�. `l D�CI�i 6 �' f C-00 r�`r 77V6,L_
�A,I
.
4 ,e S �a /�/fEr r �,� � 02� 4N
6 S154,04-F
0 I99
10Iv &21-0 vz/t/,:Z. 4jjX-C_",2Fo' � Ua�
fitb�v e,�Z
4//J�5 4VI-5 1-4 ��y AaA&Wp
-
Reviewer/Inspector Name
='
Reviewer/Inspector Signature:
Date:
05103101 LIf v r r Continued

Facility Number: —i Date of Inspection
Odnr Issues
26. 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?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vege(ation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fans belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes ❑ No
❑ Yes JZ(No
ElYes 1 t Na
❑ Yes No
❑ Yes
❑ Ye No
❑ Yes []No
:Additional Comments and/or Drawings.•::i..:: i.: �a�;:�•�a. � r; :i� a;:�
15 611 �= ���� �'��DS �� G r�r�•���,l� f �,'
� , 5
05103101

;Pry;j
[F[�i�' fi:; ::::&F VI6�OII,O�WatCTsQpA}{j i` ''"
lit
'.
Kelm
1q
41'.
1 y" i
I! � ; ; ,.. ,.�, ..,:. ,,,i'.�•��: �� �.::k�•..., .� .:.�. -i :: .. ....;1�9,. , _., ., .- ... r _., 1PI kI. �:s�2'�ii�.;:.'.....�..�.....�.._, �.... � . •g•�,� .. fV;¢..... ,. ..... r.., w,�l I�
IType of Visit OCompliance Inspection O Operation Review O Lagoon Evaluation j
n for Visit oRoutine O Complaint O Follow up O Emergency Notification Q Other ❑ denied Access
Date of Visit: Time:
Facility Number 3 J
0 Permitted 0 Certified 0 Conditionally Certified 0 Registered
Farm Name: ...... .gErn,l .... ..................................
Owner Name: ..... ......... 19.r'<;41're...... i. ............. �.....................................
Facility Contact: ........................................... .................................... Title...........................
Date Last Operated or Above Threshold: .........................
County:.D.1/0-11.'H........................................................
Phone No:.....................................,....................................
Phone No:
MailingAddress:.............................................................1., ......, ......................................................................................................... ..........................
Onsite Representative: !c+z'i.'.�G r...rl� r f �a!'; ,C / rCf... z 1 �.. Integrator: ' r!'T�.!� "G . .'.qm................
Certified Operator:
Location of Farm:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 06 46 Longitude " 4 66
Design Current Design Current Design Current ,'
Cipacilty. Population Poultry , Capacity Population Cattle Capacity Pa .. ul&tian
Wean to Feeder t71I ❑ Layer I I Dairy
eeder to Finish If rl 6,2 JEJ Non -Layer I I JEJ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
❑ Farrow to Finish Total Design Capacity
❑ Gilts
❑ Boars Total SS
' I +j Number of Legootta ❑ 1.
❑Subsurface Drains Present MagoonArea 10Spray Field A—m—al.
Holding Ponds 1 Salid•Traps ❑ No Liquid Waste Management System
Dischar es & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure S
Identifier: :................................................ �.........................��.....................................................................................
Freeboard (inches): 9s Z
S/00
❑ Yes WNO
❑ Yes oNo
❑ Yes o
11171
❑ Yes'ONo
❑ Yes/ETNo
❑ Yes j1No
❑ Yes
o
Structure
Continued on back

Faculty Number: — Date of Inspection►f o
5. Are there any immediate threats to the integrity of any of the structures observed? (ie1 trees, severe erosion, ❑ Yes 2rNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes�"No
(If any of questions 4.6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes )2m0
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ;ETNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes JR No
Waste Application
10. Are there any buffers that need maintenancelimprovement? ❑ Yes EMo
SH'1
11. Is there evidence of over application? ❑ Excessive Ponding 'AN ❑ Hydraulic Overload es E[�1o■'1a,(
12. Crop type 13e�" r-,. uG�� C'�, n-}►'t r� !� r~n 2� •Si'' 1 i'! 1 T L7�"�t t
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes ONo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes PNO
b) Does the facility need a wettable acre determination? ❑ Yes '001N0
c) This facility is pended for a wettable acre determination? ❑ Yes'12NO
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ,
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss reviewlinspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
�VQ Yi#1 t ��:el� � ��ae� r� i�#t • ........ �...... ..... '. #Q .....:: .
6rres o idence: ab6u' this visit:
❑ Yes ONo
❑ Yes '-p7Vo
❑ Yes �No
❑ Yes
�No
(/Yes ❑ No
❑ Yes •,ETNo
❑ Yes Mio
❑ Yes ; &No
❑ Yes ETNo
❑ Yes eNo
❑ Yes ,fNo
Cuatments (refer tn'qustlon #}: Explain any YES answers artd/tit any rcctsuincxtdations or any ocher comments..
[lae'drawinp of lli0 to better explain situations: (use additional: pages as necessary):
r.
r ,
r N ��� '
a o �t�e � wc��-� any � `�s i1 �1��� � ►-��r; � (tea dais a�'
� �1�'c.�,-� a-► eV6�-�s oN 4he�49-2-►5. Veeel 4o h4ve A vo%l.k waS4c-
61n 1YSl-s;O°► y �'� f-fa k r sn ►��1 e1 ev' c •� � �- m�►�+ � .
•t QCAA4W
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date: r711110 / sloo

Faeility Number. ❑ate of Inspection fQJ�
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 fours? ❑ Yes _,ErNo
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 _PNo
30, Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ,'No
3I. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes-A!fNo
32, Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? 0 Yes ❑ No
AddlUonal Lommentsas or ra ap: +
1-44 e of ` Z 35. c ids ►-e c t/4 ro ►^ �r � �'o t.►. c ,r t J V s ► `)
-Zi7,s �N �l rf �w��,trr �h � ►e 2 is. 14•XV 7 AK me�Xr-tek- �dfA
n r a.
/Iced �dl elcz-red ; f Maril zoo/ Apf cJ+-&,'J w�'t�►
1 1
5100

i�
Division of Water Quality
Q Division of Soil and Water Conservation
Q Other Agency
Type of Visit 0 Compliance Inspection Q Operation Review ❑ Lagoon Evaluation I
Reason for Visit ,Q Routine Q Complaint D Fallow up Q Emergency Notification a Other ❑ Denied Access
date of Visit: Timi: Q G Prinled on. 7/21/2000
Facility Number
Q Not Operational Q Below'rhreshold
APermitted © Certified 0 Conditionally Certified © Registered Date Fast Operated or Above Threshold: .........................
r�
Farm Name: .................'r...'............................................................... County :..... �1..1.`............................... ....................
...
OwnerName:........................................................................................................................... Phone No:
FacilityContact: ..............................................................................'I'itle:................................................................ Phone No:
MailingAddress:................................................................. .................. ........................ .......... ..................................................................................... ..........................
Onsite Representative- .O.L, ........ Integrator: ........DQ fr.C>tl.............................................
.......
Certified Operator: ................................................... ............... __ ......................................... Operator Certification Number:..........................................
Location cif Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude �' �� �•° Longitude
............. ................. ......
Design Current
................. ....... ....... .......... _.
Design Current Design Current
Swine
Capacity Population
Poultry
Capacity population Cattle Capacity Population
Wean to Feeder
"7
❑ Layer
❑ Dairy
gi Feeder to Finish
ngo
JE1 Non -Layer
❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
Total Design Capacity
❑ Gilts.
❑ Boars
Total SSLW
Number of Lagoons ❑ Subsurface Drains Present 110 Lug .... n Area 10 Spray Field Arco
Holding Ponds 1 Solid Traps ❑ No Liquid Waste :Management System
Discharees & Stream Imuactti
1. Is any discharge observed from any part of the operation'?
❑ Yes
�rNo
Discharge originated at. ElLagoon ❑ Spray Field ❑ Other
a. II discharge is observed, WkIN the eonveyanec man-made?
❑ Yes
❑ No
h. If discharge is ohserved. did it reach Water of the State? (It' Yes, nutit'y DWQ)
❑ Yes
❑ No
c. ll'clischarge is ohscrved. what is the ctitimatcd Ilow in gal/min'?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
❑ Yes
❑ No
2. Is there evidence of past discharge from any part of the operation'?
❑ Yes
N No
3. Were there any adversa impacts or Potential adverse impacts to the Waters of the State other than from a discharge?
❑ Yes
ONO
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
❑ Yes
_kNo
Structure i Structure 2 Structure 3 Structure 4 Structurc 5
Structure 6
Identifier: ..................... :.............................. ..... ........................ .......... ............ ......... .......... .. ....................................
....................................
Freehoard (inches): 20 qaL qmxq
5/00
Continued on hack

Facility Number:' � — Datc of Inspection . 0 11'rintcd on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (icl trees, severe erosion, D Yes KNo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes WNo
(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?
X'es
❑ No
8. Doc% any part of the waste management system other than waste structures require maintenance/improvement?
❑ Yes
*0
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings'?
❑ Yes
C<No
Waste application
10. Are there any buffers that need maintenance/improvement'?
❑ Yes
&1N0
11, is there evidence of over application? ❑ Excessive Pcmding ❑ PAN Wydraulic Overload
Xyes
[]'No
12. Crop type 44 F!�
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
kNo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
NTNo
h) 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
15 No
lb. Is there a lack of adequate waste application equipment?
❑ Yes
0 No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
IMNo
18, Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available'?
(ie/ WUP, chccklists, design, maps, etc.)
❑ Yes
ONo
19. Does record keeping need improvement? (icl irrigation, freeboard, waste analysis & soil sample reports)
KYes
❑ No
20, Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
JjrNo
21, Did the facility fail to have a actively certified operator in charge'?
❑ Yes
XNo
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
VNo
Oc/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative'?
❑ Yes
�ZNo
24. Does facility require a follow-up visit by same agency?
❑ Yes
) No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
a'Yes
❑ No
yi¢tations 'or ciencips -wire 040. ilodog Ms;visitt • Y:oo wilt •teeoi*o fjo rui-tho
carrel' oridet ce: about. this visit. ........... .
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
�%�, L,;-� �
5 ` z-e } L,4ilk
�-�e t..► yes ��e
+J'^c� l�•L� �,r�'P� �5.� � � l�� GAS t b1 ��b�— '� �LG `�` C''t
Reviewer/Inspector Name
ReviewerlInspector Signature:
Date: G--aj slo0

Facility Number: —L Date of Inspection G G a Printed on: 7/21/2000
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge �Uor Nlow kes ❑ 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 EyNo
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ,f No
reads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes Rio
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 �rNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes 1;�No
32. Do the Flush tanks lack a submerged fill pipe or a permanent/temporary Cover? ❑ Yes XNO
Additional omments and/orDrawings:
C3Cd11.
U lJ,e�-v> LG- ps�lr 11 C- 44 CIL7r Cn� d-r L �5 C�1 ❑ Jlc.���C
7
5/00

C;Dirrision of Soil and Water ConscrvMinn'- Ope-ration:Revicw -
©.Division of Soil and Waiter Conservation -Compliance Inspection !
Division of Water Quality - Compliance Inspection "
Other Agency - Operation Review
V Routine ❑ Complaint Q Follow-up of 1AVQ inspection 0 Follow -up of I swc review D Other
Facility Number 1)atc of Inspectlon 3 2- q1
Timt: Of Inspection ;{)Q 24 hr. (hh:mm)
0 Permitted loCertified [3 Conditionally ,Certified C] Registered 0 Not Open, Date Last Operated:
Farin Name: .qwt '�..... �ar.. - Nm�}J1uv,. ............................................ 0,11nly:...... �t►�...................
❑►veer Name:......[M.'',[.5...................1 f3fi.i�................. Phone No:.�p�...�P�-. ja.!�...........................................
Facility Contact: Title: Pboue No: ...................................................
MailingAddress :........ .L �.......�1!} i�G.... R [ti........... 9.Cl.................................. ...... gt..... Q.11m.7 ......j................................ 1'PS.........
Onsitc Representative: ............... BAf u . .........J1.................................................... Integrator: ...... �Qr�Fs1f��?..........
..................
Certified Operator: ............. .I14...... ........... ......................... Operator Certification Number: .... 1 Z..z-•11t....................
Location of Farm:
D,ti kn car.
.................................................... .MAL
Latitude Longitude �■ �° ���
Swine Capacity Population
Wean to Feeder
Dv
Dt)
Feeder to Finish
142,0
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Poultry Capacity Population Cattle Capacity Population
❑ Layer ❑ Dairy
❑ Non -Layer I jr-1 Non -Dairy
❑ Qiht:r
Total Design Capacity
Total SSLW
Number of Lagnons Subsurface Drains Present JJ❑ Lagoon Area JVSprayFieldArea J
Holding Ponds 1 Solid Traps ❑ Na liquid Waste Management System
Discharge- & Stream Immicts
1. Is any discharge observed from any part of the operation (If' yes, notify DWQ)?
Discharge originalcd at: ❑ Lagoon ❑ Spray Field ❑ Other
a. [I'discharge is observed, was [lie conveyance man-rnadcY
h. If elischargc is observed, did it reach: ❑ Surface Waters ❑ Waters of the State
c. lf' dischargc is ohserved. what is the estimated flow in gal/mill?
d.. Does discharge hypass a lagoon system?
2. Is there evidence of past discharge from any part of the operation'?
3. Were there any 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?
Structure 1 Structure 2 SlruCtL11C 3 Structure 4 Structure 5
kiem.ifier: OW A&tA Jcw
Frechoard (inches): ............ Z$ .2 ti
❑ Yes 5Q No
❑ Yes 10 No
❑ Yes 0 No
❑ Yes ®No
❑ Yes C4 No
❑ Yes M No
❑ Yes M No
Slreu:[urc 0
Continued air back

Heility r4umber: 3t — (�� Date of inspection .j z
5. Are there any immediate threats to the integrity of any of the strictures observed? (ic/ trees, severe erosion, ❑ Yes Qd 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 ZNo
(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 maintenancelintprovctnent? Yes ❑ No
8. Does any pat of the waste management system other than waste structures require maintenance/improvement? ❑ Yes P) No
9. Do any stuctures lack adequate, gauged markers with required top of (like, maximum and minimum
liquid level elevation markings? ❑ Yes [VNo
Waste Application
10. Are there any buffers that need nutin(enahcelimprc)voment'? ❑ Yes No
11. Is there evidence of Over application'? ❑ Ponding ❑ Nitrogen ❑ Yes ® No
..skbhU........ Y ►.r.....................
13. Do the receiving crops differ with those designated in the Certifies] Animal Waste Management Plan (CAWMP)? ❑ Yes 10 No
14. Does the facility lack wettable acreage for land application'? (footprint) ❑ Yes No
15, Does (lie receiving crop need improvement'? ❑ Yes No
16. Is there a lack of adequate waste application equipment? ❑ Yes No
Reouired Records & Docu(nents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
PONo
18.
Does the facility fail to have all components of the Certified Animal Wastc Management Plan readily available?
(iel WUP, checklists, design, maps; etc.)
❑ Yes
® No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
ElYes
CDNo
20.
Is facility not in compliance with any applicable setback criteria in effect at the tithe of design'?
❑ Yes
® No
21.
Did the facility fail to have a certified operator in responsible charge?
❑ Yes
j 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 review/inspection with con -site representative? ❑ Yes R No
24. Does facility require a follow-up visit by same agency? ❑ Yes PNo
a
NO' of itions'Ut' deficiend s .were noted. rfurin this;visit:. Y'ou wi I.retcetve nor further ,
eorrespot}deOee: 6biD6t' this 'visit... ..:.:.:. :..::.:.:: .
Comments (refer to question #): Explain any YES answers.andlor any recommendatioas'or any other comments. i, t
Use drawings of facility to better explain situations. (use additional pages as necessary):
11 .k
dw o}:
Wail c vuw L t?.�tl,,ti S �►ou [t} 1e e uw� : Alt r0
�Cwt 4 }fie m: �' btw� Irt�t.tVuJ t i N6 U0 toe, Utts W " � t - �r.Yv►�
yq-covoS.
Reviewer/Inspector Name '
Reviewerllnspector Signature:
Date: 11/6/99

[� Division aF soil and Water Conservation D er Agency
:. ;;
of Water P,Division Quality
... .. Ei'. .. ..
I& Routine O Complaint O Follow-on of ❑WO inspection O Fallow-un or DSWC review O Other I
Date of Inspection I
Facility Number Time of Inspection � 24 hr. (hh:mm)
0 Registered CfCertified 0 Applied for Permit © Permitted 113 Not O erational Date Last Operated: .............. „
Farm Name:......`.).` lrtr�...... .. !r.........1...................................... County:............... .......................
OwnerName:....... ?' �.4� ......................................................................... Phone No: La,T.................................................... ,..............
FacilityContact: ......................,......I................................... .... Title:................................................................ Phone No:...................................................
Mailing Address:... �gl.... i l`'s�. ['�'...... Mk GVo-,-- .��C..... _ ............... .......................... ....... ...... ........
Onsite Representative: }" I,
C-►�-
. . ..... . 4..�?............................................................ Inte mats}r:............, s
Certified Operator;............................................................................................................... Operator Certification Number;.........................................
Locat"on of i [
. ....... ...... CCkkl ..f t.... . ... 1jA2<,.. s ..... S.t. ..... 5- ....1 ....................... .. �.!,.v -... .
Qw,...a.a...4rr>................. .... ............ .......
....
Latitude ' 4 " Longitude 4 c6
De .
s gn.:,,,' ..Current
S►vine' ;;'i Capacity..;Population
Wean to Feeder
�)LGd
Feeder to Finish
-;-196
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
.
sign urrent Design urrent
Puitlify Capacity Population Cattle Capacity:: Population
❑ Layer ❑ Dairy
❑ Non -Layer I0 Non -Dairy
❑ Other
Total Design Capacity
Total SSLw
Number of Lagoons I Holding.Poinds . © ❑ Subsurface Drains Present ❑ Magoon Area ❑ Spray Field Area
❑ No Liquid Waste Management System
=eneral
1. Are there any buffers that need maintenance/improvement? ❑ Yes dNo
2. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. Ifdischarge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
b. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes 4No
❑ Yes tgNo
[I Yes allo
NN
❑ Yes ]% No
❑ Yes D4 No
❑ Yes V�No
❑ Yes 0 No
❑ Yes [2fNo
7. Did the facility fail to have a certified operator in responsible charge?
7/25/97
❑ Yes i4 Na

Facility Number:--
8. Are there lagoons or storage ponds on -site which need to be properly closed?
❑ Yes C.No
Struc(pM ("goon.01olding Ponds. Flush Fits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 0 No
Structure I. Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: �...............„__..,..................................,........................,................................................................,..
Freeboard(ft): ............. ....,..., ..........: .....................,.`.:.......................................................,,.,......,,,....,..........,......................................
10.
Is seepage observed from any of the structures?
❑ Yes
Z.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?
9Yes
❑ No
(If any of questions 9.12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ)
13.
Do any of the structures lack adequate minimum or maximum liquid level markers?
❑ Yes
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)
6�......
15,
Crop type ..... .......................................................................................................................................................................................................
16.
Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
❑ Yes
No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
9 Yes
❑ No
19.
Is there a lack of available waste application equipment?
❑ Yes
IZNo
20.
Does facility require a follow-up visit by same agency?
❑ Yes
allo
21.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
Cl Yes
MNo
22.
Does record keeping need improvement?
Oyes
❑ No
For
Certified or Permits Facilities Only
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
l No
24,
Were any additional problems noted which cause noncompliance of the Certified AWMP?
UYes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
0 No
0' No.violations,ar. deficiencies: were ttoted-during this.visit.- You:will receive,iro f irthier ..
correspbtideince d oitt this; visit:
uest on #): E lain' ari' ' 1�ES answers aadfi" �n : recoipamendatians oir. ur ` ptlter c�mnaents; ' g; ' ' . pnlet�:. 'Ce �G;iQ }� . r::;' : ::;, Y tF�I;•....F F. &:.
Vito
... '
IJse- triittgs;otatity in fetter ciplalnituaEtt�ns: use additianal p necessary);;;i
K:e •t:y: r � : .t3:3 . .. __,. .F�SI:C a ,sj.i... _... t- .�'. 1�5f s � i � ii `. ? i% ��i-eEE� • i- �s u ��., s�sF3::s�'s� ���is' �.: �.. ,.; �: �:�..i�i:: i�.:..
,�::E:., - '....�... ....:i:', ........,: �.,� .. .............. ... ....... .. ..... ......... . a£. ..�... S1.?Y�..S.ii iiS.F1 i.3.i..F.e [ .I... s ��
St�+@S �.ti
6rr', II � j {{
. W �'t r.s, 5►C� ""v F�`� dam. ej�-
<b- o� Lie►- a'IGS-, 44�s LI �.� �,� e�.��- wex� rpm `t r ��t.
lS7 �4i +
� 1.�1 �� �1 �`7� �=.s ��. -�. �• �� r��, t,.u.r k �a +-cam-� �� :�. 3,�-;►�j.
zn -
7125197
Reviewer/Ins ector Name
P � .) � . . .::. . ' .. �F -;� Y •. =(iFiS '..s�.:1SIIi].�.'.,.. ,. Mi%%YFS?i. ... ...... .....:: � ... :�•...e��: �..:" 'i:i'_�� .i..i::i:":� iiit. °'
Reviewer/Inspector Signature: Date: G[ a�-
r ,

r
'�'� �i;;��-- ,;;;; `__ ;jj ❑Division aF Sail and Water Conservation 0 Other Agency ' � " ' '�'�' _
is
n�
=;f .� , ' •®Division of Water Quality
A
•.. �'.t.. :. .ass :::::. S°�,3'."'e'°n-^'.�'i'°°°ir'�:F�°^-s: :""33s.swww,.s«, nr'�!p,� sw..ef...,, ewuw..�fe«a.'.^x^...x+^nir3—+...�.—.,�., w x: re...v� .. .. - � ... .. i
I4b Routine O Complaint O Follow-up of I)8V0 inspection O Follow-up of i)swc review O Other
Facility Number
[X Registered 10 Certified 0 Applied for Permit [i Permitted
Date of Inspection
Time of Inspection I LQ 06 74 hr. (hlt-mm)
i 3 Not C7 erational Date Last Operated:
Farm Nante:......kY.7[:ik,�i ....�i&.t...1.!7tT�l tAl............................................................. County:...... , l n,.................................................• ...........
Owner Name: ...... P.?�!r!1?CiL{{ ............. �:t�.r.1 l►................................................................... Phone No: ..,.�� 0-, o.Si'in-.t. zoa............
Facility Contact: ... P(zg b.I;R. ........... w;q.......................... Title: ...... &OKLt.-........................................ Phone No: , 19� (a$ '.�1�1�,?...............
Mailing Address:...... j........wk.... ¢ s. -......'....................................................[(1-,..5�..Y.G...... ..................................., 'rr......
Onsite Representative:.,.... 4}{ g Q .........
�71tf'�,.�....... r1:lrt�............................•---...------.................... Integrator: �ctta.-....-..............................................
Certified Operator ;..........P , ' r "
.k...i!�.T...CtSd�1Cs� Operator Certification Number: .........................................
Location of Farm:
1�.iw ......... °3.... hu ............. rx,,..... ..rtC.vi1.�t :..,.� ct~.,... l'. �ln.......,..f.Sl�l.........K.n......
.>~.....,.cz;rs ....R.179........
.........................................
Latitude EXEI' ©1 69 Longitude • L f�"
Des n arrant , _ Design, : Cur"rent..
swlrieV'iiCa soli P.1 ulation : , `Pnu1t "CA aCit Pti ulation Cattle C
fit y= p ry.' P y: p
Wean to Feeder
❑ Feeder to Finish
p
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
[] Gilts
❑ Boars
❑ Layerff Dairy
❑ Non -Layer „❑Non-Dair}
❑ Other
Total°Desigin,;Ca pacity.
.:F•[ �' ;.F:�' •Total SSLW
s
n `_. Current...",
M
M
i - Number of Lagoons l Holding Ponds 3 ®Subsurfaee Drains Present ❑ Lagoon Area Spray Field Area
s €,
� E1 No Liq uid Waste Management S!ste,
---
Getieryd
1. Are there any buffers that need maintenance/improvement? ❑ Yes ® No
2. Is any discharge observed From any part of the operation? ❑ Yes ® No
Discharge originated at: El Lagoon [I 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? (if yes, notify DWQ)
❑ Yes
CO No
c. If discharge is observed, what is the estimated flow in gaVmin?
A. Does discharge bypass a lagoon system'! (If yes, notify DWQ)
❑ Yes
[A No
3. Is there evidence of past discharge from any part of the operation'?
❑ Yes
W No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
57No
S. Does any part of the waste management system (other than lagoon4holding ponds) require
❑ Yes
H No
mai ntenanceli mprovement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
EfNo
7. Did the facility fail to have a certified operator in responsible charge?
❑ Yes
K No
7/25/97 Continued opt buck

Facility Number: 3 t — +(
S. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes [% N❑
Structures fLagoons.liolding Pou(is,Flush Pits. etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? Yes ❑ No
Structure 1 Structure 2 Structure :3 Structure 4 Structure 5 Structure 6
Identifier: li Z 4 3 -
.................. ..........................................................................................................................................................................
Freeboard(ft):..............Z............... ,............ .... ,r................... ......�r..�................................................. .................................... .......................
.............
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 10 No
12. Do any of the structures need maintenance/improvement? 5,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 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 ........... earrx d..4;.................................................................... .................................................................................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? ❑ Yes ® No
17.
Does the facility have a lack of adequate acreage for land application?
❑ Yes
® No
18.
Does the receiving crop need improvement?
❑ Yes
09 No
19.
Is there a lack of available waste application equipment?
❑ Yes
® No
20,
Does facility require a follow-up visit by same agency?
29 Yes
❑ No
21.
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
® No
22,
Does record keeping need improvement?
IQ Yes
❑ No
jEor Certified or Permitted Facilities On1w
23.
Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
❑ Yes
No
24.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
25.
Were any additional problems noted which cause noncompliance of the Permit?
❑ Yes
No
13: No.viola' dons or deiideneies were nated_d'dng this:visit.:.You .'rvill receive, nn,ftirtlier ' ,
- ctirrespotTdehce ab"out this' visit:• : . � :... � � . • � . . � .. � . . � - ... . � ... - . • :: � : � : _ � .
.....:..;p::u:s::: .ye:• . :: ::. .. ::.:.... question
...::». ...... .::.. , .: s: '=,=1: 5....:•..-... .. :s::-..�•. :av»:..». •�.n.. m,Es=�! :....:,:3..: ...;..-- �'..d,:: .F..:.: �'e.'.s: idi:s.it•...; is"::ia:' •:....: ,:.�,s1.,F: ....�
CAtrtatents{refer to question #}:` 1Fxplain°any YES an ers'andloir any, recomntensiattnna or any atlter cummetsts: iF € i
•F i's� " 33"1. 's. J b !Fj rys• :3 33 ` •[., 4 3s' F' 3i3 S€"s d
Use drawings of l'ueiltty"to„better`, explain sit6;' 66 as`, tusa additional pales as"necessaryj;
s ..•3's: P:e4I'..: i :.-€E€€i:. .e€t 3 � :: :'n ._ :.. f:3C �... ...� .s. �. i M?i :s. '.��... ;3h s: ,,y �_1` •: t: .ia F
�.. �.:??i:::::::.. _.. eft .:..:..' a .... .. .... .,.. ss: .... .., v. :..e. �.
v t z . out'- 'J [l s off- I019oa„$-* z sh❑dld be mujj, Weejs tf41*VJ OAJ 3+Vss _4-A f i"• 80re- Spf�
oft t ayot-s . # I %►L 47, ',�noJl� 4e Meejec1. I -AU ytd, dr• I a ra+ +# i sl �� be t pa.y�I
t3. Akt 4•k+rvt tat Xh;. s�a�7�t] bl► have' it urd le.€,jt �vwrl�rS. Gr�v1 . pr+�e sr�av�d bL, eCL0"�.
zz. so:l o,4 w�;k, so mLis Sl1Q�I� �e 'kk4k- Mj OL4tityxvr , "ya �csir�ns (6- III �t
(a.1mm ikdj be, :A e_er ,'A' d PIAn-
7/25/97
Reviewer/Ins Pam" for ]Name
•- K ;:.
�}ys
�.,
�
.. ...... .,x �.n::: ... ..�=i1
ti��` sty
3rs:i• �=�'n
ReviewerlInspector Signature:
Date:

Site Requires Immediate Attention:
FacilityNo. 3 1g(,�
DIVISION OF ENVIRONMENTAL MANAGEV. ENT
ANIMAL FEEDLOT OPERATIONS S= VISITATION RECORD
DATE: 7 I , 1995
Time:
Farm Name/Owner: r .Ja G �7 5 r►�t�► +Y4 ��'�l�le+���l• r- FAO IRK aoo.
Nrlailing Address: _I 2- l - �, ,� _f1�-S k � , ,1'1�� Q ►ter_ z ro
County: J
Integrator: 2�04..Lkreoe k Phone: 0
On Site Representative: eCo 7"r cF H � e Q ,'AJ&, Phone: `' 6 7 a
Physical Address/Lccation:..S PSIS— IS, 't �-� �s� �� ' �', _� '_ . SRL 1306
Type of Operation: Swine Poultry Cattle
Design Capacity: rq Z" S Number of Animals on Site: _ 7 a C:;,
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: 3S 0 2- Longitude: 3 Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot ;� �5 yeyr 24 hoLeorm event
(approximately I Foot + 7 inches) d7;;%r No Actual Freebo aro� _ Ft. 2_ Inches
Was any seepage observed from the lagoon(s)? Yes or(D Was any erasion observed nor No
ti" •. a
Is adequate land available for spray?jpor No Is the cover crop adequate? es r No
Crop(s) being udlized:_Zvr
Does the facility meet SCS minimum setback criteria?. 200 Feet from Dwe'.lings? �r No
1 100 Feet from Wells?(1;7�6r No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream?0or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Nlap Blue Line? Yes or?4
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o i o -If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrig.ated on specific acreage with cover crop)? e for No
Additional Comments: _4 ! e;
e r� r _ �� J ,` d 12� sd� !�
[• r . is
I sp�cior ame Siana=e
``cc:'Facility Assessment Linn if Needed.

a
is
Site Requires Immediate Attention:
Facility No. -----.
DIVISION OF ENVIRONMENTAL MANAGEMENT
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: , 1995
Time:r�`Z}_
Farm
Mailil
County:
Integrator: LJ- vxet . a a4 , py!nz Phone: _
r-
On Site Representative: �{�.v. C;.� � , C %r t vt-r Phone:�-
Physical Address/Location:
v"� r
Type of Operation: Swine Poultry Cattle - {0"j
Design Capacity: _ �U Sy Number of Animals on Site: _5,7e)n
DEM Certification Number: ACE DEM Certification Number: ACNEW
Latitude: ' �_" Longitude: 27 ;5x,' _13
Circle Yes or No
Elevation: Feet
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) Yes or No Actual Freeboard: --?---Ft. Inches �f
Was any seepage observed from the lagoons)? Yes or No Was any erosion served? es or No /Gl
Is adequate land available for spray? Yes or No Is the cover crop adeq' teT Yes or`NF
Crop(s) being utilized: 3 9 er i_0 fd LJ1 ���
Does the facility meet SCS minimum setback criteria? 200 Feet from Dwellings`? or No
100 Feet from Wells? (s or No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes o
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or0o
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes o No r If Yes, Please Explain.
Does the facility maintain adequate waste management records (volumes of manure, land applied,
spray irrigated on specific acreage with cover crop)? Yes or No t hS 9 r-e Pa�
Additional Comments: �Q� 00,Dln
4,-) C° s0
_ s
a +� ern
Inspector Name �_ign�ature
cc: Facility Assessment Unit Use Attachments if Needed.