310484_INSPECTIONS_20171231

2 V
NUH I H UAHULINA
Department of Environmental Qual

type of visit: ky2:om iance inspection V uperation [review V structure vvaivatton U technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: : ZO Departure Time: a-Z ', S'4 County: u �� Region: GL/1
Farm Name:-t�fi �'S %�(/� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Phone:
Phone:
Integrator: Q 1
Certification Number: � [ / W��
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
�aSH��1
s �I �' �
� �FHtI
Design Current
Design
Current
Design
Current
Swine Capacity Pop.
Wet Poultry
@apaclty
Pop�i
Ca ity
Plop.
i:attn�e
Wean7Fh
La er
Dai Cow
Wean
Non -La er
Dai Calf
Feede
v4
Dai Heifer
Farro
Design
Current
D Cow
Farro
D Poultr
Ca acit ,
Po
Non -Dairy
Farro
La ers
Beef Stocker
Gilts
Non -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
the
TurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]Yes No ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made? ❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (if yes, notify DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑ Yes No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? Yes lvo NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes �00 NA ❑ NE
of the State other than from a discharge?
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
ff <No❑ NA
❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes
No ❑ NA
❑ NE
Structure I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier: '
Spillway?:
Designed Freeboard (in):
IV
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
2101C ❑ 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? ❑ Yes F2rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 20'NO ❑ NA ❑ NE
maintenance or improvement?
11, Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes �OCINA ❑ 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
E�J'No ❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
- No ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
No ❑ NA
❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
En No❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
No ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
Io ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
El yes
No D NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes [:]No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes ZN ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: '3- Date of Inspection: /
24. Did the facilityfail to calibrate waste application equipment as re required b the permit? Yes N NA NE
ppq Y P � ❑ ❑ ❑
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.
Fl 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 53<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
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:
❑ Yes No ❑ NA ❑ NE
❑ Yes 7No
❑ NA
❑ Yes❑ NA
❑ Yes 21 No ❑ NA
❑ NE
❑ NE
❑ NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? Yes VNo
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes❑ NA ❑ NE
Comments (refer to gpe'stionk<<#): >xpliii a ariy;; YES answers abd/or'a'iny additional,.recommendatians orany othei^ comments �; :,
,. 1
;,.
Use drarvitigs'of:facility�to Better. explain situa Lions' use additional . a es�as necessa `
B
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: IIG --
Date: G C
21412015

Kj
Type of Visit: e'Com ce Inspection O Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: Routine Complaint Follow-up Referral Emergency Other Denied Access
Date of Visit: /bArrival Time: ` % Departure Time: County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: � x it ' ` 2- 1 S�e.
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: a l 3 11
Certification Number:
Longitude:
Design Current
Design
ntm
Design Current
Swine
Capacity Pop.
Wet Poultry
Capacity
Pop.
Cattle Capacity Pop.
Wean to Finish
La er
DairyCow
W n to Feeder
Non -La er
DairyCalf
,-'Feeder to Finish
I Z
Dairy Heifer
Farrow to Wean
Design
Current
D Cow
Farrow to Feeder
Dr, P,oultr
Ca aci
P,o P.
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Turke s
other
TurkeyPaults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes EfNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
[:]Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
[—]Yes 5/No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued
L\'

Facilit Number: 3 y 7 Date of Ind ection: 2 /
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 I Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
No
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
❑'No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health
or environmental
threat, notify 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
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 Aanlication
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
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
rNo ❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
❑?Qo ❑ 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
[DNo ❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes
�—,
L_.Jrc ❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes
❑ NA
❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements
❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Yes
No ❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis
❑ Waste Transfers ❑ Weather
Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V 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❑
VNoNA
❑ NE
Page 2 of 3 21412015 Continued

Facilit Number: ?I Date of inspection: / (p
24, Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No NA ❑ NE
r
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ETNo ❑ 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
28. Did the facility fail to property dispose of dead animals with 24 hours and/or document
❑ Yes
<o
❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
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
;P<o 1:1 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
[2r o
❑ 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
j No
❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
go
❑ NA ❑ NE
Comments,(refer to:queshon,#) „Expl`ain any;Y.ES answers and/or any additional recommendations or any other comments m 4 . .
Used. rawing's;of_faellityao,better explain'situations (use additional. pages,as neeessary)
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: N71
Date: ItA rl
21412015

Type of Visit: (�jCorr anee Inspection U Operation Review Q Structure Evaluation Q Technical Assistance I
Reason for Visit: Routine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: 3 S' Departure Time: l County: Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Title:
Phone:
Onsite Representative: Gt t ' Integrator:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Certification Number:
Certification Number:
Longitude:
1G3If
Design Current
Swine Capacity Pap.
Wean to Finish
Desigrent
n
Wet Poultry Capacity
Layer
Cur
Pop. Cattle
DairyCow
C Design u rent
Capacity Pup.
Wean to Feeder
Non -La er
DairyCalf
ceder to Finish
Z90
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Dr. P,ouItr, Ca acit
I Dry Cow
P,o Non -Dairy
Farrow to Finish
iLayers
I Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Turkeys
TurkeyPoults
Other
Other
Discharges and Stream Impacts ' /
1. is any discharge observed from any part of the operation? [3 Yes ❑�rao ❑ 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 DWR) ❑ Yes ❑ No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)? _
d. Does the discharge bypass the waste management system? (If yes, notify DWR)
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
EJZo
❑ NA
❑ NE
❑ Yes
❑ NA
❑ NE
Page 1 of 3 21412015 Continued

Facili Number: 3 1 Date of Inspection: f
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
Identifier:
Spillway?:
Designed Freeboard (in):
❑ NA ❑ NE
❑NA ❑NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Observed Freeboard (in):1.51
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes E% 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 JE 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 EfNo
D 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 Q No
❑ NA
❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground
❑ Leavy 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?
❑ Y
No
❑ NA
❑ NE
15.
Does the receiving crop and/or land application site need improvement?
Yeses
❑ No
❑ NA
❑ NE
16.
Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes
Io
❑ NA
❑ NE
acres determination?
17.
Does the facility lack adequate acreage for land application?
❑ Yes
Ef No
❑ NA
❑ NE
18.
Is there a lack of properly operating waste application equipment?
❑ Yes
❑11Go
❑ NA
❑ NE
Required
Records & Documents
19.
Did the facility fail to have the Certificate of Coverage & Permit readily available?
facility fail have CAWMP If
❑ Y s"
No
No
❑ NA
NA
❑ NE
NE
20.
Does the to all components of the readily available? yes, check
s
❑
❑
❑
the appropriate box
UP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check t 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 �o ❑ NA ❑ NE
23. if selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑//No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: 113ate of Inspection: n (�
%A. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes FNo
C ❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes E3"No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? []Yes ❑ No Q'lgA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface the drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes Eao ❑ 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 , o ❑ NA ❑ NE
Comments (refer to question ##): Explain any YES answers and/or any additional recommendations or'any other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).: ,
❑ Yes Q'Na ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ NA ❑ NE
❑ Yes [a"No ❑ NA ❑ NE
4rc) U
ZC�� 'Fo( ofi u, 06 Trch SO cfai'S e -141{� ti COO i VA'--' a<t
_1A, 1�(r,j jrrj,7,,k9n Lf/(7
3 �3.e
J
/17 s Gam - "vS' u )c
rx
Reviewer/Inspector Name
Reviewer/Inspector Signature: ✓ter
Page 3 of 3
Phone: fCi 7 P f 7105(
Date: 11 l G S'
2141201 S

Type of Visit: Q 96mpliance Inspection Q Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: 0 Routine O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: t Arrival Time: ® Departure Time: [Z= County: b Region:
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: yk� I` C ('��� —aL
Owner Email:
Phone:
Integrator:
Phone:
Certified Operator: Certification Number: 4c;3 I
Back-up Operator:
Location of Farm:
Certification Number:
Latitude: Longitude:
Design C*urrent
Swine Capacity Pop.
Wean to Finish
Design Current
Wet Poultry Capacity Pop. Cattle
La er DairyCow
Design Current
Capacity Pop.
Wean to Feeder
Non -La er
DairyCalf
Feeder to Finish 2
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current Dry Cow
Dr. P,ouitr. Ca acity Po , Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Qther
Othcr
Turke s
Turkey Poults
Other
Discharges and Stream Impacts
1. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWR)
c. What is the estimated volume that reached waters of the State (gallons)?
❑ Yes n No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
d. Does the discharge bypass the waste management system? (If yes, notify DWR) ❑Yes ❑ ❑ NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page 1 of 3 21412014 Continued

Facili Number: -Li FTI jDate of Inspection: Iti -Lo I
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 �
Identifier: [� : 7y"y►"]
Spillway?:
Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Designed Freeboard (in): t_
Observed Freeboard (in):�
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environment threat, notify DWQ
7. Do any of the structures need maintenance or improvement? [ Yes o ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 214No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below, ❑ Yes ❑ No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? [:]Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes �NO ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes rNo
❑ NA
❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
❑ Yes No
❑ NA
❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
❑ Yes C;r<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 0 Waste Transfers ❑ Weather Code
0 Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes tNo
N ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

1
Facility Number: - Date of Inspection: It ?.a
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [] NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? if yes, check ❑ Yes rNo ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge? ❑ Yes N ' ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes V ❑ NA ❑ NE
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
❑ Yes
o ❑ NA ❑ NE
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
ONo ❑ 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)
XNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
2 ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes❑
NA ❑ NE
VN
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations, or anyother comments.
Use drawings of facilltv to�better'exulain situations (use additional pages as necessarv) `�.
G'j o �
1
,06C_9 I,��S�E,
�1NR��isS-S
(66L, dirt
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
�O i�NC:L PhonEs 1 1V
Date: 11 Z p
114 I4

Type of Visit: Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: eRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: Departure Departure Time: County: yl Region:
Farm Name_. R$q�jyyt Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative: j
Certified Operator:
Back-up Operator:
Location of Farm:
Title:
Latitude:
Phone:
Phone:
Integrator:
Certification Number: jL
Certification Number:
Longitude:
Swine
Wean to Finish
Design
Capacity
Current
Pop.
Design
Wet Poultry Capacity
Layer
Current
Pop.
Cattle
DairyCow
Design Current
C►apacity Pop.
Wean to Feeder
Non -La er
DairyCalf
DairyHeifer
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design
Dt� P,oultr, C•_a aci
Layers
Current
l;o
D Cow
Non -Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turke Poults
Other
Discharees and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of 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 W'No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No
❑ Yes 74NO
❑ Yes ONO
❑ NA ❑ NE
❑NA ❑NE
❑ NA ❑ NE
Page I of 3 21412011 Continued

Facilityumber: - Date of Inspection:
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes XNo ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in): _
Observed Freeboard (in):_
5. Are there any immediate threats to the integrity of any of the structures observed?
(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 VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation Poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes 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 75No ❑ NA ❑ NE
maintenance or improvement?
Waste ADDliCation
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes m No ❑ NA ❑ NE
maintenance or improvement? �''-'
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. [:]Yes [jfNo ❑ 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 Y3 No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes ;E' No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes V5 No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes 0 No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes ;Z No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists []Design []Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ONo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall []Stocking [:]Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes �' No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

/-
Facility Number: - Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ZrNo ❑ NA
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 fait to provide documentation of an actively certified operator in charge?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
❑ NE
❑ NE
❑ Yes 7No ❑ NA [] NE
❑ Yes kfNo ❑ NA [] NE
[] Yes 7No
❑ Yes P'No
❑ Yes �No
❑ Yes V No
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑NA ❑NE
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes �lo ❑ NA ❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ❑ Yes TT No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes ' No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any other comments.
Use drawings of facility to better explain situations (use additional pates as necessary).
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Page 3 of 3
� zr lO�V Phone: -Sw -1 a
Date: ]a— 3
21412011

type of Visit:
Compliance Inspection 0
Operation Review 0 Structure Evaluation
0 Technical Assistance
Reason for Visit:
N6 Routine 0 Complaint
0 Follow-up 0 Referral 0 Emergency
0 Other 0 Denied Access
Date of Visit: I I I Mia Arrival Time: Departure Time: County: ��(a�/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact:
Title: Phone:
Onsite Representative: -kk J 57C,�- Integrator:
Certified Operator: VJ r lit am_6 ,s7Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude:
Longitude:
Design Current
Swine Capacity Pop.
Finish
Design Current
Wet Poultry Capacity Pop.
Layer
Design Current
Cattle Capacity Pop.
DairyCow
Feeder
Non -Layer
DairyCalf
o Finish
b
Design Current
Dr, $aultr Ca aci P,o
DairyHeifer
D Cow
o Wean
F.Gilts
o Feeder
Non -Dairy
o Finish
Layers
Beef Stocker
Nan -La ers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turke s
Turkey Poults
Other
Dischars!es and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes �No
❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes ❑ No
0 NA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes ❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes No
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes No
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 21412011 Continued

Facifl ,Number: - Date of Inspection: j
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: WAI
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.) F
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? W
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 101bs. ❑ 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): J� b f 1(U(
13. Soil Type(s): ��i CGS f cN
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes No ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application?
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.
Q WUP ❑Checklists Q Design ❑ Maps ❑ Lease Agreements
❑ Yes fNo
o
❑ Yeso
❑ Yeso
❑ Yes
❑ Other:
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes VNo ❑ NA ❑ NE
o❑ Waste Application ❑i Weekly Freeboard Q Waste Analysis Q Soil Analysis ❑10aste Transfers 0 Weather Code
e Rainfall ❑ Stocking ❑ Crop Yield 0120 Minute Inspections ❑r Monthly and V Rainfall Inspections 0 Sludge Survey
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 ❑ NA ❑ NE
❑ Yes %] No ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

acitk"uniber: Date of Inspection:
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes ❑ NA [] NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ YesANo
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?
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
❑ Yes V No ❑ NA ❑ NE
❑ Yes ❑ No f NA ❑ NE
❑ Yes No
❑ Yes] No
❑ Yes �LNo
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. ❑ Yes
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes
34. Does the facility require a follow-up visit by the same agency? ❑ Yes
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA [] NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question. #): Explain ony YES answers and/or any additional recommendations or" any-other;comments
Use drawings of facility to better explain situations (use additional pages as necessary).
Cf4bl A -moat �,F_ '�J Li
A? 94 L 901c'�
Reviewer/Inspector Name:
Reviewer/inspector Signature:
Page 3 of 3
Phone: 916(�3�
Date: llalla
21412011

Division of Water Quality
Facility Nntnber - y-j Division of Soil and LW, ater Conscrvation
0 Other Agency
Type of Visit: rcompliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit: ZYCRoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: j + Arrival Time: Departure
Departure Time:I_,1_i� County:
Farm Name: � ILL
_t�](l'� C 1 S t~R �` flR Owner Email:
Owner Name: JJ)/VC'r j 7 6?_ Phone:
Mailing Address: p' r of 1 'S'1 OC.0 /V6 H zA !� { 8 U'j e Hl L/_ , NC__ )QR L1s
Physical Address:
Facility Contact: nn Title:
Onsite Representative: ?S J l
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator:
0011
Certification Number:
Certification Number:
Longitude:
Region:
H 2 31 1
Design Current
Swine Capacity Pop.
Wean to Finish
Design C►urrent
Wet Poultry C►apacity Pop.
I ILaycr I
Design C«urrent
Cattle Capacity Pop.
Dairy Cow
Wean to Feeder
I jNon-Layer I
Dairy Calf
Feeder to Finish
U
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Design Current
Dr, P,oultr. Ca aci P.o ,
Layers
Dry Cow
Non-Dairy
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
Turkeys
Turkey Poults
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
❑ Yes No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
❑ Yes [] No ❑ NA ❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ) ❑ Yes No NA ❑ NE
2. Is there evidence of a past discharge from any part of the operation? ❑ Yes No ❑ NA ❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters ❑ Yes No ❑ NA ❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facility Number: - LISLI Date of Inspection: /
Waste CoHection & '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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: LAQW
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
waste management or closure plan?
❑ Yes No
❑ Yes No
❑ NA ❑ NE
❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 1V I No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? [] Yes Wo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes '�j No ❑ NA ❑ NE
maintenance or improvement? ]]��''
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance or improvement? P
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, et .)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s): !; zczcP� _
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.
OWUP ❑Checklists ODesign [:]maps ❑ Lease Agreements
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Yes
No
❑ NA
❑ NE
❑ Other:
21. Does record keeping need improvement? if yes, check the appropriate box below. ❑ Yes No
ElWaste Application Q Weekly Freeboard Q Waste Analysis Q Soil Analysis [3 Waste Tans ers
0 Rainfall ❑ Stocking Crop Yield [] 120 Minute Inspections 0 Monthly and 1" 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 9No
❑ NA ❑ NE
[] Weather Code
Q Sludge Survey
❑NA ❑NE
❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facili plumber: 1 -LIE Lj Date of Ins ectioa: I
24. Did the,facility fail to calibrate waste application equipment as required by the permit? ❑ Yes No ❑ NA ❑ NE
25. Is -the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes
No ❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail provide documentation of an actively certified operator in charge? ❑ Yes No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes No 1] 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 fait to notify the Regional Office of emergency situations as required by the
❑ Yes
No
❑ NA
❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
[ Yes
1
❑ NA
❑ NE
34. Does the facility require a follow-up visit by the same agency?
❑ Yes
' No
❑ NA
❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recommendations or any, other comments.
Use drawings of facility to better explain situations (use additional pages as necessary).
Lf
NO vt ptAlC SO CC'
Sc�c_Sfl�QCF_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone: 9l()'-�i61�
Date: A 1 U I
21412011

Type of Visit Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure Time: County: Region:
Farm Name: OwnerName: hex _E61 S7G_?_
Mailing Address:
Physical Address:
Owner Email:
Phone:
Facility Contact: Title: Phone No:
OnsiteRepresentative: 15-1Cz?— Integrator:
Certified Operator: LQ 1(21�_} SR- O Brat U Certification Number: /� ��
Back-up Operator:
Back-up Certification Number:
Location of Farm: Latitude: = e = d = N Longitude: = o = i = {1
On Iurrcul Design Current Design Current
Swine Capacity Population Wet Poultry Capy Popu acitlation Cattle Capacity Population
❑ Wean to Finish
IEJ Layer I
I
❑ Dairy Cow
❑ Wean to Feeder
❑ Non -La er
❑ Dairy Calf
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
d
Dry Poultry
❑ Layers
❑Non -Layers
❑ Daia Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑Beef Feeder
ElBeef Brood Cowl
❑ Boars
El Pullets
I
❑ Turkes
Other ❑ Turkey Poults
❑ Other ❑Other
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (if yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (if yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes XNo ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑Yes o El NA El NE
12128104 Continued

Facilkty,Number:3 I — 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: LAQDUN
Spillway?:
Designed Freeboard (in): �.
Observed Freeboard (in): _ 3�
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 k No
ElYes ❑ No
Structure 5
❑ NA ❑ NE
El NA ❑NE
Structure 6
❑ Yes JXNo ❑ 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 . ElNE
8. Do any of the stuctures lack adequate markers as required by the permit?
El
No ❑ NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
kNo ElNA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? if yes, check the appropriate box below.
❑ Yes
No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge
into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of
Area
12. Crop
type(s)(z.`P�
13. Soil type(s) ag s1t:>i /Vaacw<
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
No [I NA El NE
15. Does the receiving crop and/or land application site need improvement?
El Yes
No [I NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ?
El Yes
No [I NA El 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?
El Yes
No ❑ NA [I NE
Comments (refer to questitin #): Explain any YES,,answers and/or any ,recommendations or,,any other 'comments
Use drawings a€.'facility to better explain situations: (use additional`page's.4as,necessary):s
Reviewer/Inspector Name F -� �'�`� s
' �r Phone:
Reviewer/Inspector Signature Date: �U
Page 2 of 3 12128104 Continua

'VachW,; Number: j — Date of Inspection
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 appropriate box. 0 WUP ❑ Checklists ' `
0 Design El Maps [I Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes �No
❑ NA ❑ NE
0 Waste Application 0 Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis ❑Vlaste Transfers ❑ �nual Certification
❑ Rainfall ❑ Stocking ❑/op Yield 0 120 Minute Inspections ❑ Monthly and V Rain Inspections [] Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
No
❑ NA
ElNE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
EljNo
No
❑ NA
El NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
A No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
KNo
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
4 NA
ElNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
No
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
J"No
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes❑
NA
❑ NE
Additional Comments and/or Drawings:
W • I't
3lac�llc� ��
�N r� joeCiFT 10 SolesSAylr"' C
-- GA,>U ASS poQ e, tsm"PS )�✓
Page 3 of 3 12128104

) Hy
Type of Visit OR
Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit \Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: �Arrival Time: Departure Time: County: 1 Region:
Farm Name: \LA_NLLI QM R..E_CtI STER FA(2m Owner Email:
Owner Name: JQNC__'T '►`EC 1 S%2 Phone: )- a$9-
Mailing Address: dog 11 ��� />1/C E�� 1� SC �A I LL �10AIe- R 5a
Physical Address:
Facility Contact:
Title: Phone No:
Onsite Representative:___
Certified Operator: �, t ��"� +' • LEC-,l S TES
Back-up Operator:
Integrator•
Operator Certification Number:
Back-up Certification Number:
Location of Farm: Latitude: 0 0 = = Longitude: = ° ❑ 6 0 "
Design Current
Mapacil:YVIRM55514ition
Design Current
Swine Capacity Population
Wet PoW
Cattle C•apacrty Population
❑ Wean to Finish 1
111 Layer I 1
❑ Dairy Cow
❑ Wean to Feeder
JE1 Non -La er
❑ Dairy Calf
Feeder to Finish
❑ Dairy Heifer
❑ Farrow to Wean
Dry Poultry
❑ Dry Cow
❑ Farrow to Feeder
❑ Non -Dairy
❑ Farrow to Finish
❑ La ers
❑ Beef Stocker
El Gilts
El Non -Layers
❑ Beef Feeder
El Boars
❑Pullets
ElBeef Brood Cow
❑ Turkeys
Other
❑ Other
❑Turke Poults
ILI Other I I
Number of Structures:
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
❑ Yes
k 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
[DNA
❑ NE
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
❑ Yes
❑ No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
No
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
No
❑ NA
❑ NE
other than from a discharge?
12128104
Continued

Facility Number: 31- 60W
Date of Inspection [0 0
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
a. If yes, is waste level into the structural freeboard?
Structure 1 Structure 2 Structure 3 Structure 4
Identified dCi�
Spillway?: QQ
Designed Freeboard (in): -(, as
Observed Freeboard (in): LN
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 D(No ❑ NA ❑ NE
❑ Yes VNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement'? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes { No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks) 1
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes XNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or t0 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) S G zGeI_ p)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP? ❑ Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement? ❑ Yes No ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination ? ❑ Yes No ❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application? ❑ Yes No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes ❑ NA ❑ NE
-:gF£�as€'X
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){{�dd. �r ;r
7
Reviewer/ins ector Name s ;'' ` 9io- 0 �3J
P � t�N+�S: ��_�� ,t �t.�� Phone:
Reviewer/inspector Signature: Date: gn
12128104 Continued

Facility Number: Date of Inspection
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 appropriate box. 0 WUP ❑ Checklists El Design ❑Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes )XNo [I NA ❑ NE
0 Waste Application ❑ Weekly Freeboard 0 Waste Analysis ❑ Soil Analysis El �aste Transfers
✓✓✓✓✓✓❑ �nnual Certification
❑ Rainfall ❑ Stocking ❑ 9fop Yield 0 120 Minute Inspections ❑ Monthly and 1" Rain Inspections 0 Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes 9No ❑ NA ❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes VNo
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
)0 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
o
[I NA
El NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
to
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
V NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
0 No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
ANo
❑ 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
)QNo
El NA
[I NE
If yes, contact a regional Air Quality representative immediately
II
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
KNo
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
No
❑ NA
ElNE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
, No
❑ NA
❑ NE
12128104

Type of Visit 0 Compliance Inspection U Operation Review U Structure Evaluation O Technical Assistance
Reason for Visit A Routine 0 Complaint O Follow up O Referral 0 Emergency O Other ❑ Denied Access
Date of Visit: 6f< Arrival Time(:® Departure Time: County: �-�� Region:
Farm Name:. I C.0 ASYI 1L1EC 1 �,7Tf� - A?= fQ Owner A Email-
Owner
�p 1 -�
eQCQ
Owner Name:, S T r�--ECtS7�� {1 Phone:/910- 0 j-sstD
Mailing Address: .JTC�� �C 1'1 Ef�� - Si`- L �-- + y C n
;L gys
Physical Address:
Facility Contact: n Title:
Onsite Representative: �,� 4l ►`E �15 T 2
Certified Operator: U_) i t--A-t A AA �` • _�`� Cn 1 F 7Tr._2
Phone No. -
Integrator:
Operator Certification Number: 1 &s9/
Back-up Operator: Back-up Certification Number:
Location of Farm: Latitude: ❑ e= 1 = Longitude: = ° = , =
i'
Design
Current Design Current Design Current
Swine
Capacity
Population Wet Poultry Capacity Population Cattle Capacity Population
❑ La er ❑ Dai Cow
on -Layer ❑ Dairy Calf
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish
❑ Dairy Heifer
Dry Poultry ❑ Dry Cow
❑ Farrow to Wean
❑ Farrow to Feeder
ElNon-Dairy
❑ Farrow to Finish
❑ Layers
❑ Beef Stocker
Non -Layers
El Beef Feeder
❑ Gilts
❑ Boars
❑ Pullets
❑ Beef Brood Cow
❑ Turkeys
Other
El Turkey Poults
ElOther Number of Structures:
❑ Other
Discharges & Stream Impacts
1. is any discharge observed from any part of the operation?
❑ Yes
JNo
❑ 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
KNo
❑ NA
❑ NE
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
❑ Yes
NNo
❑ NA
El NE
other than from a discharge?
V
Page 1 of 3
12128104
Continued

Facility Number: — Date of InspectionJQZ
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: LAicoay
Spillway?:
Designed Freeboard (in): 1�
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 )5No
❑ Yes ❑ No
Structure 5
❑ NA ❑ NE
❑NA ❑NE
Structure 6
❑ Yes 44 No ❑ NA ❑ NE
❑ Yes gNo ❑ NA ❑ NE
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes No ❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ElNA ❑ NE
maintenance or improvement? 17
Waste Apmlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes 4 No ❑ NA ❑ NE
maintenance/improvement?
11, Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes �KNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
[]PAN ❑ PAN > 10% or 10 lbs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s)
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination?❑ Yes 9No
❑ NA
❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes 4 No
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes X No
❑ NA
❑ NE
5.-Fr".'3 �+I.R Y� �F.77ii'A
:Comments (r.efer to,gpestiori #) Explain airy YES;answers;andlvsr any,recommendations or�anytother comments e `
Use drawings of facility t6 better explain situations: (use a'dd�tional pages. as necessary), tt c �r':; y.������t�a
f'-44L A& C00i, S _ 0Q I>.
Reviewer/Inspector Name
1 Phone:
Reviewer/Inspector Signature:
Date: Z / d
Page 2 of 3 12128104 Continued

Facility Number: - Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes kNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes gNo ❑ 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 XNo ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and i" Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
O No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
D�No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
2fNo
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
04 No
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
%No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
y(NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
ONo
❑ 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
ANo
❑ 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
ArNo
❑ 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
O No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
NNo
❑ NA
❑ NE
Additional.Comtnents°.and/orDrawinps fk ;e ri� X,=i%s i}{ x o t;r3,'
i ., I? Ti `eL i._ 1' '�i -{1. 9.a.: RI Us .`- k k :a `t w. ,_
Page 3 of 3 12128104

Facility Number (�8�
bivision of.Water Quality.
O Division of Soil and Water Conservation
O Other Agency
Type of Visit ,C,00mpliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance G Reason for Visit Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: I M S a Arrival Time: Departure Time: County: I Region:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: ;� Title:
Onsite Representative: �A I\E C-Ts-re L
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Latitude: = o= 6= Longitude: 0 0= 4 0"
Design Current Design Current
"`Swine,. Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
® Feeder to Finish N -60 I'300
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
Gilts
Boars
Other
❑ Other
❑ Layer
❑ Non -Layer
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
Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Dry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures"
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
Page I of 3
❑ Yes dNo ❑ NA ❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑ Yes
❑ No ❑ NA
❑ NE
❑NA
❑NE
❑Yes
❑Yes
ZN9❑NA
[I NE
El Yes
No ElNA
❑ NE
12128104 Continued

Facility Number: —
Date of Inspection 1 i 15
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?
Structured 1 Structure 2 Structure 3 Structure 4
Identifier: (A 6,wz3-s�
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 3 b
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 2No ❑ NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Structure 5 Structure 6
❑ Yes �No El NA ❑ NE
❑ Yes r_ 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 2 No ❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes Ea 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 ElE Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes J!fNo ❑ 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) �(V-) S 6-0
13. Soil type(s) F6't x--sTo / PJ o 2-jP, i_ic
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
❑ 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes
❑ Yes
Z No
❑ NA
❑ NE
0No
ElNA
ElNE
E No
❑ NA
❑ NE
{�o
El NA
❑NE
[ No
❑ NA
❑ NE
Comments (refer to question ft Explain any YES answers and/or any recommendations'or any other comments.
Use drawings of facility to better explain situations. (use additional;pages as necessary):
NEW CAG�n! l�FSIt;- t] onj E .
'
'kN17 let" 0-DSSWE ,
ReviewerllnspectorName �jvJ L. Phone
Reviewer/Inspector Signature: Date: L t + 5' 0 (o
Page 2 of 3 4 12128104 Continued

• Facility Number: 3 j — Date of Inspection 11
Required Records & Documents /
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes [�LIJ ❑ 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 El Maps El Other
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ld No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and I" Rain Inspections ❑ Weather Code
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes CK El NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? El Yes �No ❑ NA ❑ NE
24. Did the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes [<o ❑ NA ❑ NE
25. Did the facility fail to conduct a sludge survey as required by the permit? ElYes O'NNo ❑ NA ❑ NE
26. Did the facility fail to have an actively certified operator in charge? ❑ Yes E No ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification? ❑ Yes ❑ No dN A ❑ NE
Other Issues
28. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes ZNo ❑ NA ❑ NE
29. Did the facility fail to properly dispose of dead animals within 24 hours and/or document ❑ Yes ZreNo ❑ 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 NNo ❑ 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 Permit? (ie/ discharge, freeboard problems, over application) �f
32. Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative? ElIQ Yes No ❑ NA ❑ NE
33. Does facility require a follow-up visit by same agency? ❑ Yes Ld'No ❑ NA ❑ NE
Additional Comments and/or Drawings:
Page 3 of 3 12128104

Type of Visit Co Hance Inspection O Operation Review O Structure Evaluation O Technical Assistance'
Reason for Visit Routine O Complaint O Follow up O Referral O Emergency O Other ❑ Denied Access
Date of Visit: /t7 i5 Arrival Time: Departure Time: County:
Farm Name: Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
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
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Certification Number:
Region:
Latitude: ❑ 0 0 , Longitude: = ° = 6 ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer i
❑ Non -La er
Other .
i
❑ Other
Dry Poultry
❑
La ers
❑
Non -Layers
❑
Pullets
❑
Turke s
❑
TurkeyPoults
❑
Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑
Dairy Cow
❑
Dairy Calf
❑
Dairy Heifer
❑
Da Cow
❑
Non-Dai
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cow
Number of Structures:
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State
other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes 12< El NA El NE
❑ Yes fo ❑ NA ❑ NE
12128104 Continued

t;
Facility Number: — -! Date of Inspection e~
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 I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 93
5. Are there any immediate threats to the integrity of any of the structures observed?
Cl Yes
LJ No
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes
dNo
❑ 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
notify DWQ
7. Do any of the structures need maintenance or improvement?
Elat,
Yes
No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[I Yes
La `No
El NA El NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require
❑ Yes
Dfo
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes
EfNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below.
❑ Yes
Q"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) Ute-y (f QA CC, S
13. Soil type(s) � bA 17b
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
PNo
❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
El NA El NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination"
Yes
��Vo
la lVo
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes
El —No
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes
ONo
❑ NA ❑ NE
U,) 0EC- A GCT COPY U
(�2r,.- U04i<.s GAD,
LAGOON OESIGN, SAY # CU0 35 a--atcso't
Name Reviewer/Ins ector
p Phone:
T�
Reviewer/Inspector Signature: L Date: o
12128104 Continued

�r
Facility Number: 31 Date of Inspection 11OU96251
Required
Records & Documents
19.
Did the facility fail to have Certificate of Coverage & Permit readily available?
❑ Yes
VNIo
❑ NA
❑ NE
20.
Does the facility fail to have components the CAW If
�Y/es
all of readily available? yes, check
❑ No
El NA
[I NE
the appropirate box.
ElWUP ❑Checklists Design El Maps El Other
21.
Does record keeping need improvement? IF yes, check the appropriate box below.
❑ Yes
No
❑ NA
❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Annual Certification
.❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1 "
Rain Inspections ❑ Weather Code
22.
Did the facility fail to install and maintain a rain gauge?
❑ Yes
IJ No
❑ NA
❑ NE
N
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
21 o
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
L9 No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
N
❑//NA
[I NE
26.
Did the facility fail to have an actively certified operator in charge?
El Yes
�No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
U NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
NNoo
❑ NA
El NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
El Yes
,�
L�"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
L_I Nc
❑ 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?
El Yes
4: N
ElNA
ElNE
33.
Does facility require a follow-up visit by same agency?
ElYes
No
❑ NA
❑ NE
Additional Comments: and/or Drawfn s
12128104
12128104

Type of Visit 0 Compliance inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number t-i $
Date of Visit: is 70 o Time: /moo
O Not Operational Q Below Threshold
Permitted d Certified © Conditionally Certified Q Registered Date Last Operated or Above Threshold:
Farm Name: ..... _.WALUMM_»4 G--15tEn—._ fi; _.»........._ .»........» .....»._ County:...»..tD,-, .`vj.....................»...» ...._.__.» __.
Owner Name: _._».__.__.__._._.__...._. _ _ ._..._ _ ._.____._. _._._.__ __.. _.__.. ' Phone No:
Mailing Address..._.»
FacilityContact:..........__._.._.................»....»_._..»»._.......».» Title:.._.........._._._............_._.__._._._...__. Phone No: „.. „._._.__.... _...... ».»_......
Onsite Representative: RA� `rA rl f __ fx� s.._.......__....__.__.. Integrator:. _,'�S
Certified Operator:.,...„—„,.,.,,.- —.,,__..,.,.... .. _...._ Operator Certification Number:
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' ` " Longitude 0 9 cc
Discharmes & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes [1/NNo
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
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 I Structure 2 Structure 3 Structure 4 Structure 5
Idcntifier: ____ ... .. .. .. ». ..» __ .._ . _.... M_ ......... ___ __..
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes Ld140
❑ Yes Lino
Structure 5
Freeboard (inches): 31
12112103 Continued

Facility Number: 3 ( -- Date of Inspection a
5. .,Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes LEI No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or [] Yes o
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes 0 No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level ❑ Yes �S�O
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes
11. Is there evidence of over application? If yes, check the appropriate box below. ❑ Yes No
❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Frozen Ground ❑ Copper and/or Zinc
12. Crop type ea Q + q I g&0 _
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes CH4
14. a) Does the facility lack adequate acreage for land application? ❑ Yes Flo
b) Does the facility need a wettable acre determination? ❑ Yes Vo
c) This facility is pended for a wettable acre determination? ❑ Yes
15. Does the receiving crop need improvement? ❑ Yes EfNo
16. Is there a lack of adequate waste application equipment? ❑ Yes Ld'No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes N9
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, [I Yes ;90
roads, building structure, and/or public property)
20. At the time of the inspection did the facility pose an odor or air quality concern? If yes, contact a regional ❑ Yes No
Air Quality representative immediately.
Ci t —^-mar rr� a e• s 2�.ar°.r�a ns r rt s, r t�rtt r ur °r �r u r iWN
or eats Qef6r gaest.on4):1 oidwii YES anSWl25 9nd%r,ancy,recam ei datioos os aay�otiter oamments. }f
,¢y�. 7!Y'r''.. i .ii� �4. Wd Ft!tlf}4!P!3t';r r �Yt§ki4ii" N,:E F c aaa;}u�_...u....:-�..:.:��
aUse drawiagstt o IR"A 'tott #ietter6e glawn s�taa��tt tnQs.,E(iase:addiii anal pagrs nsg+necessary? d j Field Co}��/ 11--,1 Final Notes
`€ �0 E i.,d ! # ¢ 3 • ¢a9a , t i I; ' "'e d€¢@ cap t }3 s soa•?'- E; p .� A.
'I�,rL€;t�.;;9E::-x. �i��;l,r. :;��$�t3j1 a ? s� ., i. �.
r w
Hw
i2l
'r'r , �,r�"�r`��;�t S
Reviewer/Inspector Names�K a" €' t �hl E } .1 1! ✓`: r a 7 ° �.,3i�#�j .4 ` "FIrE t ,m
Reviewer/Inspector Signature: Date: rs j1o10 y
IZ/I210.3 Continued

FadUty Number: 31 ..- y j 9 Date of Inspection
Rt~guired Records & Documents
21. Fail to have Certificate of Coverage & General Permit or other Permit readily available?
22. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
23. Does record keeping need improvement? If yes, check the appropriate box below.
❑ Waste Application ❑ Freeboard ❑ Waste Analysis ❑ Soil Sampling
24. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
25. Did the facility fail to have a actively certified operator in charge?
26. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
27. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
28. Does facility require a follow-up visit by same agency?
29. Were any additional problems noted which cause noncompliance of the Certified AWMP?
NPDES Permitted Facilities
30. Is the facility covered under a NPDES Permit? (If no, skip questions 31-35)
31. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
32. Did the facility fail to install and maintain a rain gauge?
33. Did the facility fail to conduct an annual sludge survey?
❑ Yes dNo
❑ Yes ENo
❑ Yes 2lo
❑ Yes
❑ Yes Qel
❑ Yes Eff No
❑ Yes WN
❑ Yes �l
❑ Yes L o
❑ Yes 0 /No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
34. Did the facility fail to calibrate waste application equipment? ❑ Yes ❑ No
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below. ❑ Yes ❑ No
❑ Stocking Form . ❑ Crop Yield Form ❑ Rainfall ❑ Inspection Afar 1" Rain
❑ 120 Minute Inspections ❑ Annual Certification Form
12112103

Type of Visit /" Compliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine O Complaint 0 Follow up 0 Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit:
Permitted ;j C��e�`rfftified 0 Conditionally Certified 0 Registered
Farm Name: ��IIL GLZr�iy1�%(r'•-� 7E/��,
Owner Name: -T
Mailing Address:
Facility Contact: Title:
Onsite Representative: r
Date Last Operated or Above Threshold -
County: ��,/,PGti✓ _ fiyii
Phone No:
Phone No:
Integrator: S
Certified Operator: Operator Certification Number:
Location of Farm:
0 Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude a & it Longitude • 1 66
Design
Swine Ca tacit
❑ Wean to Feeder
Feeder to Finish
Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
�°,•IYumberrofx:Lagoons ��_
Design Current 'Design Current
Poultry Capacitv, Population Cattle Capacity Population
❑ Layer I I ❑ Dairy
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Design Capacity
Total SSLW
Subsurface Drains Present
n Area ILJ Spray Field Area
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. 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 I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches):
05103101
❑ Yes 16No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes No
❑ Yes 'of No
Stnucture 6
Continued

Facility Number: — 8 Date of Inspection `i l
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Anmlication
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic OvellQ�d
l2. Crop type
13. Do the receiving crops differ with those desig ted in the Certified Animal Waste Management Plan (CAWMP)?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement?
16. Is there a lack of adequate waste application equipment?
Renuired Records & Documents
17, Fail to have Certificate of Coverage & General Permit or other Permit readily available?
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
21. Did the facility fail to have a actively certified operator in charge?
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application)
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
24. Does facility require a follow-up visit by same agency?
25. Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes �2(No
❑ Yes YJ No
❑ Yes ONO
❑ Yes gNo
❑ Yes JP No
❑ Yes ONO
,
❑ Yes yJ(No
❑ Yes ANo
❑ Yes XNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes /ElNo
❑ Yes 7rNo
❑ Yes JVNo
❑ Yes )2� No
❑ Yes �No
❑ Yes No
❑ Yes ;Na
❑ Yes 9No
❑ Yes P9No
No
❑ YesNo
❑ Yes
No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
G mtne 4t-(iefer,,to' uestian;# Fx lain an YES answers and/or an` recommeiidationtl nr. an other cotriinents .
�a� c.r� p�< Y Y
ilse drawtn s of facili to better ex lain situations use adN46"'nal pages as necessary)
g ,�
P,- ( T7v ❑Final Notes
Field Co
�€ �Aili A
t 1,20o��yF � / 19
_5r �lnm /v X T �,�i�2, �ooi�-��ff✓� �G it gbh �/��1
n" 5
Reviewerllnspector Name
Reviewer/Inspector Signature: Date: Z
05103101 V 1 Continued

t 'r
Facility Number: — Date of Iuspection 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 at/or below ❑ Yes IJA 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 VNO
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes P�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 /P11
0
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes 7No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes �fNo
32. Do the flush tanks lack a submerged fill pipe or a permanenUtemporary cover? ❑ Yes ❑ No
Additional Comments an orDrawings:
PV 0����
-
I///�6�,z�1Jr �/UED
T
5100

(Type of Visit Compliance Inspection Q Operation Review Q Lagoon Evaluation I
Reason for Visit 9101outine O Complaint, Q Follow up 0 Emergency Notification Q Other ❑ Denied Access
Facility Number Date of Visit:
0 Permitted 13 Certified [3 Conditionally Certified [3 Registered
Farm Name: ............ ll! .!..1..t�.�11!' .....�� r..' .Q ....,� '�'.`. .....................
OwnerName: ............... A!. �. �.I...'.. a....... �.r7 J.....................................
Facility Contact:
Title:
MailingAddress:................../..................................--------.---....................................................
Onsite Representative: .... r„<„---X. ae ;sqej'^
CertifiedOperator: ................................................... ............................................................. Operator Certification Number:
Location of Farm:
KI Time: I WOO
Not Operational 0 Below Threshold
Date Last Operated or /Above Threshold: .........................
County: ...r�... ✓r.. 1.10.........................................................
PhoneNo: ........................................................................................
Phone No:
.......................................................................I.......... ..........................
Integrator: ....S
................................................................................
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 6 64 Longitude ' d 64
Design, , Current,
rianacifv Pnnnlatinn
❑ Wean to Feeder
Feeder to Finish
2
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ GiIts
❑ Boars
Design Current,
Poultry Ca act 1?o ulatioit. Cattle.
[] Layer 1E]
❑ Dairy
❑ Non -Layer Non -Dairy
❑ Other
Total Design Capacity
Total SSLW C
" Subsurface Drains Present ❑ Lagoon Area ❑ Spray Field Am—],.,:E,
Number of Lagoons ; ❑
Holding Ponds, / Solid Traps,. , ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation? ❑ Yes',2�No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes Wo
b. If discharge is observed. did it reach Water of the State? (if yes, notify DWQ) ❑ Yes �'No
c. li' discharge is observed. what is the estimated flow in gal/ruin? h
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes 10 No
2. is there evidence of past discharge from any part of the operation? ❑ Yes 0"No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes A J-No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes-eNo
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................. I ................. .................................... ................................... .................................... .................................... ....................................
Freeboard (inches): �5
5100 Continued on back

Facility Number: 31 Date of Inspection 21 Printed on: 7/21/2000
5. 4re there -any immediate threats to the integrity of any of the structures observe ? (ie/ trees, severe erosion, ❑ Yes fQ 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 �'�10
(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 fXNo
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes /?io
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes XNo
Waste Application '
10. Are there any buffers that need maintenance/improvement"? ❑ Yes KNo
11. Is there evidence of over application? ❑ Excessive Pond/i'�ng ❑ PAN ❑ Hydraulic Overload ❑ Yes�No
12. Crop type aFt'".4o, %PASS �r"tti�! Gra s,A
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes 'EfNo
14. a) Does the facility lack adequate acreage for land application? ❑ Yes/ET]No
b) Does the Facility need a wettable acre determination? ❑ Yes J10
e) This facility is pended for a wettable acre determination? ❑ Yes ;'No
15. Does the receiving crop need improvement'? ❑ Yes ,R�No
16. Is there a lack of adequate waste application equipment? ❑ Yes )'No
Required Records & Documents
17. Fail to have Certificate of Coverage & General Permit readily available? ❑ Yes o
18. Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.) ❑ Yes0`N0
19. Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports) []Yes eNo
20. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes _[�Wo
21. Did the facility fail to have a actively certified operator in charge? ❑ Yes2Io
22. Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes + &No
23. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes;�r&o
24. Does facility require a follow-up visit by same agency? ❑ Yes ,&No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes)�No
�'VQ YiQlatigris o dgticienciej •were noted• d>�`it�g �. s.visiti • ;Y;o� witi•;OOKi 0 fufft>
Corres oncieRce: about this :visit.
Tents (refer to question #): Explain any YES, answers and/or any recommendations or any,other eomtnei
swings of facility to better expla;n situations. (use additional pages as nec`essary): ' » x ,:iir
�1d ee?card i fife well krf�
7 �
r,q
Reviewer/Inspector Name
Reviewer/Inspector Signature:
Date:
I
S/00

F'acility;Number: 3— Date of Inspection ZI )
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ;;rNo
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 fa No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes -0No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional Comments and/or Drawings:
5/00

Division of Water Quality
*Division of Soil and Water Conservation
0 Other Agency
Type of Visit PkIcompliance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit ARoutine O Complaint O Follow up O Emergency Notification O Other ❑ Denied Access
[)ate of Visit: —/ �Dfj 'Cure: % .� Printed (in, 7/21/2000
EFacility Number
0 Not O erational 0 Below Threshold
Permitted Cj Certified [3 Conditio ally Certified Q Registered Date Last Operated or Above Threshold: .........................
Farm Name: ... ..1. f 1 Q%il(.v.... ���,.�1/...........e. ......... C,ounty:...... 1./!s1...................................:.............
Owner N:tme:.... {!!(1.,<��i}II ..7.........`� 4 Phone No:......1...1/.�/�.�Z...'..,.. .....................
. UI .....
Facility Contact: .....�.(% ................ ' itic: ........................................ Phone No:�fll ..75
Address: � �� Mailing r d.............................................................................................................................................................. ,.
Onsite Representative: ... ...
... ... .1(1 .. �'G�'l Integrator: 4..... L......1l.............................................
Certified Operator: .... lvf�/,OIL.................... .. ............................ Operator Certification Number:..........................................
Location 'of Farm:
.l
` &Swine ❑ Poultry ❑ Cattle ❑ Norse Latitude �' �° �•' Longitude �• ��
Design Current
3wme
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Design Current
Poultry Capacity Population
❑ Layer
❑ Non -Layer
❑ Other
Design Current
Cattle Capacity Population
❑ Dairy
❑ Non -Dairy
Total Design Capacity
Total SSLW
Number of Lagoons Subsurface Drains Present 110 Lag --on Area 10 Spray Field Area
I
Holding Ponds 1 Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impact.~
I. Is any discharge observed from any part of the operation? ❑ Yes I, No
Discharge originated at: ❑ Lagoon ❑Spray Field ❑ Other \\
a. If discharge is observed, was the conveyance man-made? ❑Yes ❑ No
h. If discharge is observed. did it reach Water of the State'? (If'yes, notify DWQ) ❑Yes ❑ No
c. If discharge is observed. what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2. Is there evidence of past discharge from any part of the operation'? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes <No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes MNO
Str1.6
I Strutiturc 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: ................................................................................................................................................................................................
Freeboard (inches):
5100 Continued on back

Facility Number: 7,1 — q % Date of inspection Printed on: 7/21/2000
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes MTo
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes KNo
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes DrNo
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes KNO
Waste Application \\
10. Are there any buffers that need maintenance/improvement? ❑ Yes 5-No
11. Is there evidence of over application's ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes AINO
12. Crop type
13. Do the receiving crops dif er with those designated in the Certified Animal Waste Management Plan (CAWMP)'?
14. a) Does the facility lack adequate acreage for land application?
b) Does the facility need a wettable acre determination?
c) This facility is pended for a wettable acre determination?
15. Does the receiving crop need improvement'?
16. Is there a lack of adequate waste application equipment?
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 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?
.. �'.. yiQia . 0t s;ot• ft. ficiencies -*: re noted during this;v. ... . will re. . .Rio. t'.. I ..
correspondence. about. this visit.
❑ Yes kN0
❑ Yes N' 0
❑ Yes R qo
❑ YesRNo
❑ Yes 1�No
❑ Yes R'No
❑ Yes KNo
❑ Yes 15� No
❑ Yes �No
❑ Yes M'No
❑ Yes No
❑ Yes KNo
❑ Yes ro
❑ Yes (ro
❑ Yes IT
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):
df
axw bw
/ n I
1pR'rs ���� �� l��r� a � 6ek,1,t&dA . /'r,r� /yin "11,44
AL
Reviewer/Inspector Namev
Reviewer/Inspector Signature:
Date: 11- J — a0 5100

* 'Facility Number: Date of hispection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes YNO
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours?
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt,
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon?
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.)
31. Do the animals feed storage bins fail to have appropriate cover?
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover?
❑ Yes 0 No
❑ Yes P(No
❑ Yes �lo
❑ Yes *0
❑ Yes allo
❑ Yes XNo
r.J.0..'ona ommea anor ra n Y +�r9'1! r �r„� C{. Iri v� 1pry7•!,'. "!.
` ff
L

f
13 Division of Soil and Water Conservation - Operation Review
Division of Soil and Water Conservation - Compliance Inspection
Division of Water uali Cam fiance Inspection
0 Other Agency - Operation Review * `
Routine Q Complaint O Follow-up of DWQ inspection O Follow-up of USW C review Q Other
Facility Number w- Date of Inspection Z `I1
Time of Inspection 3: 24 hr. (hh:mm)
0 Permitted ® Certified 13 Conditionally Certified ❑ [� Registered Not Operational Date Last Operated:
/ �l� t ' County
Farm Name :.............1�3...1..��,t........ �S:t'Y....... .....k.t'.................. -...f�7.�1.t`....................
Owner Name: ..................... . lLtC1.1...... ........... 06. Phone No: ��IQ.) Z �? �7................ .....
..........................
Facility Contact: ..............................................................................Title:.................... Phone No
MailingAddress: .......2 j.......... :TCC Kh.l t� ....... :............................................I.. ......... l�.y'f....Rilll..i1dC............. ............................. ..r?r$`���........
Onsite Representative: ............ WV6'n . ....... PAt ..... Integrator: n�.1L?r4�j.F....... ............ ............... 4...... 4................
.......................................... .......
Certified Operator: , A; a . ...... .:........................................ Operator Certification Number: j.a A......
Location of Farm:
... ....sLt}c....o..E.....5 ....1)....�..r..Q.'� ...., .i. s....... ....... ......I ............................
....... ............... ...... ................... ................................................
Latitude �• SI I $ Longitude ©' F; <.1' ©"
Design Current Design
Current
Design Current
Swine
Capacity Population Poultry '° Capacity
Population Cattle
Capacity Population
❑ Wean to Feeder
JCI Layer
❑ Dairy
in Feeder to Finish
d
10 Non -Layer
10 Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Other
❑ Farrow to Finish
� 'Total
Design Capacity
1-46
❑ Gilts
❑Boars
Total SSLW
f G 7 (gyp
Nber. of La umDons r
- � g Subsurface Drains Present ❑ Lagoon Area JCDSpray Field Area
i i xl,r
Holdyng,Pon& / Solid Traps 1 �; ❑ No Liquid Waste Management System spa
Discharges & Stream Impacts
L Is any discharge observed from any part of the operation? ❑ Yes j No
Discharte ori-inated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes 1P No
b. If discharge is observed, did it reach Water of the Stale? (If yes, notify DWQ) ❑ Yes jR No
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If vts, notify ifDWQ) Yes No
2. Is there evidence of past discharge from any part of the operation? ❑ Yes No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes No
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes 5INo
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier;
Freeboard(inches); .............3..1......................................................................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
3/23/99
❑ Yes RNo
Continued on back

f Facility Number: — Date of lnspvction
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes �J�j No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? Yes ❑ No
8. Does any pan of the waste management system other than waste structures require maintenance/improvement? ❑ Yes No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes No
Waste Application
10. Are there'any buffers that need maintenance/improvement?
[]Yes
[ONo
It. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
❑ Yes
93No
12. Crop type un�� ►�S�e S"tl..,,j 1 RW0,
_
t
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
allo
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
(P No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
t5. Does the receiving crop need improvement?
❑ Yes
[gNo
t6. Is there a lack of adequate waste application equipment?
❑ Yes
® No
Reauired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit readily available?
❑ Yes
No
18,
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
® No
t9.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
Oe/ discharge, freeboard problems, over application)
ElYes
No
23,
Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
❑ Yes
No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
QQ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
No
violatiQtis;or deficiencies vt�qr. paged during this.visit: Yowill ..to,.,.#'Urthgr.
corres orideirxce. about this visit. • • • • • • • • •
Comments (refer tb: question #) Explain any YES'answers and/or any°recommendations or any other -to' m
Use drawings of facility to better, explain situations (t se additional pages -as
-7• FkA,
IReviewer/Inspector Name _fQr t? w1
Reviewer/Inspector Signature: Date: 12/l 41
3/23/99

" Facility Number: — Datc of lnspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below $4 Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes 1� 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 ,ANo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes �No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes (Q No
itiona omments an or ruw►n s »s
Add
3/23/99
3/23/99

p __t
13 Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
FacilityNumber Date of Inspection ( q
••31
_................. .. Time of Inspection � 24 hr. (hh:mm)
Registered 0 Certified 13 AppliedforPermit 13 Permitted E3 Not Operational Date Last Operated:
Farm Name: ..............�!...�ar+. Qtpi Tk�.........Farn,.......................................... Coanty:.....QU.(��..............................................................
Owner Name: .................W."..MWn......J..............?4f tkkr............................................. Phone No: ....CIAM..2$9. 33G.7...........:................................
FacilityContact: ............................................................................... Title:................................................................ Phone No:...................................................
MailingAddress: .... 241....... S.j6..IG.isn�ntatl........M......................................................Raw......�-Rll... N.G........................................ AA*-
Onsite Representative: ....... W.Ohr n......... tt��S ir................................................ Integrator: ........ C&w.a'.1........................................................
Certified Operator,............................................................................................................... Operator Certification Number:
Location of Farm:
Latitude Longitude
_ -
Design -',Current
Design Current s =; , =
Designs � Current.,
. ,Swine ,
Population
Poultry , < Capacit Po,p alation Cattle2'•,:
y
Capacity Population,
, ,Capacity
❑ Layer I JE1 Dairy
LAO
❑ Non -Layer `' ❑ Non-Dairy
+i�t•
❑ Other h
s
H Farrow [o Finish
Total Design Capac ty',.
^'
z. ,
Total SSLW''.
jNumber of Lagoons / Holding Ponds ® Subsurface Drains Present ❑ Lagoon Area
(, Spray Field Area
�,i ''� , '
` t +
•' No Liquid Waste Management System
❑
W:
,31 - T
❑ Wean to Feeder
® Feeder to Finish
2,
❑ Farrow [o Wean
❑ Farrow [o Feeder
❑
❑ Gilts❑
Boars
General
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: [I Lagoon [I Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
❑ Yes
C9 No
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
❑ Yes
[ No
c. If discharge is observed, what is the estimated Flow in gaVmin?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
I
❑ Yes
No
3. Is there evidence of past discharge from any part of the operation?
❑ Yes
i9 No
4. Were there any adverse impacts to the waters of the State other than from a discharge?
❑ Yes
P No
5. Does any part of the waste management system (other than lagoons/holding ponds) require
El Yes
[P No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
El Yes
No
7. Did the facility fail.to have a certified operator in responsible charge?
❑ Yes
l� No
7/25/97 Continued on back

? .1%
Facility Number: —
8. Are there lagoons or storage ponds on site which need to be properly closed? ❑ Yes [;� No
Structures (Lat-loons.11oldingPonds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Yes 1�3 No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
I'rzehc,a.rd (tt}: ............ -. �................................................. ................................... .................................... .................................... .............. ....................
10. Is seepage observed from any of the structures? ❑ Yes t&No
11. Is erosion, or any other threats to the integrity of any of the structures observed'? ❑ Yes 29 No
12. , Do any of the structures need niairitcnance/iml)roventent? [sYes ❑ No
(If any of questions 9-12 was answered yes, and the situation poses
an immediate public health or environmental threat, notify DWQ) 1
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 1
(If in excess of WMP, or runoff entering waters of the State, notify DWQ) _
15. Crop type ............. 1!�eK.IMJO........................................ ..... ..A Yt7sI J�..............................................................................................I...............................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)? CI -Yes [j No
17, Does the facility have a lack of adequate acreage for land application? ❑ Yes ® No
18. Does the receiving crop need improvement? Yes 19 No
r
19. Is there a lack of available waste application equipment? ❑ Yes ® No
20. Does facility require a follow-up visit by same agency? ❑ Yes t@ No
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative? ❑ Yes (y No
22. Does record keeping need improvement? ® Yes ❑ No
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available? ❑ Yes ® No
24. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes [A No
25. Were any additional problems noted which cause noncompliance of the Permit'? ❑ Yes On No
0 No. violations or deficiencies were noted during this:visit.-:You.will receive no furtlier
cofrespbndence aihoitt this visit.
Comments:(tefer to question:#): Explain any YES answers and/fir any recommendations or. any other co tertts���� V� V
Use.drawtitgs of facility to better e'4 ain'situations.'(use additional pages as nee sstiry), x ,
t6. Cam. Av\ue tc t,�I, or. bkunat�a=,r` t'cee�Cl� S�r���� ti�s. a(� graaiN Slnot)�r} loe' tc1+�oJcrJ
A_Sa V% es4rA f r5)J bermAL ref& . 1 f J
2-L, WO.S4 SaAr-tu- 5�'WJ�d �t u�do ed. Con JoSi�ti S`ne�[} mot, i � ti.
7/25/97
J
t
Reviewer/Ins ector Name
p
Reviewer/Inspector Signature: ` Date:

A,
U Division of Soil and Water Conservation Other Agency Noss:
' Division of Water Quality
MW
Routine 0 Cont laint 0 Follo-w-up of DNVQ inspection 0 Follow-up of DSWC review 0 Other
Date of Inspection
Facility Number
Time of Inspection 24 hr. (hh:mm)
E3 Registered 13 Certified [3 Applied for Permit © Permitted 1 Not Operation Date Last Operated: .............
Farm Nance: County
...,.�%[[i...� Mahn.......,��.X{'�GI'...�itif..tr.................................................................,...Npk!:1,..................................... .......................
Owner Name:..,......I!!l,I.1. ,ticsp,........,Nc1hr..................................... ..... Phone No: la� �i- 3.3y ?........,
Title: Phone No: ► Facility Contact: .... 1i5.�.i.�...!.Fir:.....,..'I}�t�!......................... ....11�?.kart,tr..................,.......,,.......,..........,�.°�..ka,�R9.r..3.�(v..7............
MailingAddress:...Z �........ S1Xkfxl�:L-j..... Pi .............................................. I............ ......�L........................................... ..U..` .....
.
Onsite Representative:..�."W..1.���►,atn...... Z '......................................................... Integrator: ......... carircn..'s................ ........... I...........................
Certified Operator:........Y.�i..1..it�lc' ........ L...... ... 3..................................... Operator Certification Number,......... . Z .. ......
Location of Farm:
...+ ..... .i.l . ...�a ........ m...: .....r�rrrs ....... .kfi.tl..cic; ..... rtttr,.... � .........an...5K.Iito.k...:. Tum..l.e........t?.(.......... .
.........[... .x..-rur .....r..i- ...a.►....a.I.1.�.1�...��rn�....�.s..........r��.i.s.....�n...��^k�.1���...���.�....��.�..F��.:.....
Latitude =• 6 16 Longitude • =1 =11
De * k., Current,
'z
;^?Design` Current
Designs Currents
Swmne'Capac!tyPoptalatton
Poultry
Capgcyty {PopulattonK Cattle „ a ,Capgc3ty
PtipPlatYna
❑Wean to Feeder
❑ Layer
❑Dairy
j] Feeder to Finish
JZ40
JE1 Non Layer
I
Non Dalry
❑Farrow to Wean
:.
& > �,;�
rYk ;
[] Farrow to Feeder
❑Other
`
i
❑ Farrow to Finish
d To DCsign Capacity"
O`
❑ Gitts
Boars
.._ _ __.
.' Total SSLW
._
z
(1�
3
Number f La Ponys' f Hotdtn ;Ponds'•
�y
l9 Spray Field A rea
Subsurface Drains Present
❑ Lagoon Area
d.
b 0
.. ...... .... .......
No Liquid Waste Management System
.
)❑
General
1. Are there any buffers that need maintenance/improvement? ❑ Yes X) No
2. Is any discharge observed from any part of the operation? ❑ Yes ® No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man -[Wade? ❑ Yes ® No
b. if discharge is observed, did it reach Surface Water? (If yes, notify DWQ) ❑ Yes ® No
c. If discharge is observed, what is the estimated flow in gaUmin?tiA
,d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ® No
3. Is there evidence of past discharge from any part of the operation? ❑ Yes (I No
4. Were there any adverse impacts to the waters of the State other than from a discharge? ❑ Yes M No
5. Does any part of the waste management system (other than lagoons/holding ponds) require ® Yes ❑ No
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design? ❑ Yes tallo
7. Did the facility fail to have a certified operator in responsible charge? ❑ Yes 0 No
7/25/97 Continued on back

Facility Number: 1
8. Are there lagoons or storage ponds on site which need to be property closed?
❑ Yes
9 No
Structures (Lap-oons.Holdine Ponds Flush Pits etc.
9. Is storage capacity (Freeboard plus storm storage) less than adequate?
❑ Yes
® No
Structure l Structure. 2 Structure 3 Structure 4
Structure 5 Structure 6
Identifier:
Freeboard(ft):........... .........................................................................
10. Is seepage observed from any of the structures?
❑ Yes
QNo
11. Is erosion, or any other threats to the integrity of any of the structures observed?
❑ Yes
I' No
12. Do any of the structures need maintenance/improvement?
ES 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
IQ 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 Cro t e )tor tjk lLftli aftr-,
.........
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?
18. Does the receiving crop need improvement?
19. Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does record keeping need improvement?
For Certified or Permitted Facilities Only
23. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
24. Were any additional problems noted which cause noncompliance of the Certified AWMP?
25. Were any additional problems noted which cause noncompliance of the Permit?
0•No',violations-or. defciencie's.were-noted during this. -visit'., Y,ou.wili.receive•i1o•further-:-
: OerespQndepce Ah:out tbis.visif.:
❑ Yes 12 No
❑ Yes ® No
❑ Yes EI No
Yes ❑ No
❑ Yes No
Yes ❑ No
❑ Yes ® No
® Yes [I No
❑ Yes QNo
. - R - i', EE 4 'h 'F - -.. _-� m t, 7.
otntanettts refer tolyueshon #). `,Explaen any7'$ gnsrvers and/or any t ecarua�ttendattans orxsny other corttKttexats ;�
Use drawrng5 of facthty better�expla�ttt
to situations Muse addittonah ages asagece$Sary)
�,eij. `
Ze Cart ftI Wkv,, s�Vmy;vt) 'use aveaS i* avoit} 2)QeS5jve �Oyjil .
i2• &zee a2cy 04 +tm- �cLycl J,Lt i4kll ,�vUjj be (,Gseejej. Eros)oh otrta5 or. Ovkr OiL wc.11 56uld
EAi.ft, ctoj ay. rese•,deJ.
pp
16. 1ZIe iS �i�tj ih C�� �01S V CT 4r ?<S4UO,-
1a. So: i ksr s�ouid b� ��• c,rri-i die, plcv�- A� 1RR.-Z (out„ s�'tou�ti ��. used �- eQc�. cvt�
j
�
1`t• FOyrnur V"1 0_4e� U>AS +0 CrG�.$ aj G.t e, "f i✓� � 61. All CIro�S W_1 QCreFc t0�
'o- 4
rev W s ouid Z r�dur; z rr 4ev � Pied 1w. � v+` *,C Sat a� We.6r Ar ets je,7/25/9�
ffg ?�� t,, g �
ReviewerAll
/InspectorNarne iftful '�. f
Reviewer/Inspector Signature: 4 _ Date: /Q ~7

•
Site Requires Immediate Attention:
Facility No. -3 !'y ktj rR
DIVISION OF ENVIRONMENTAL MANAGEMENT.
ANE\4AL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 3 r , 1995
Time: Of 3 5-_
Farm Na
Mailing,
County:
Integrata.. 9_fn- I . • L 11v«,.. — r -, ,
On Site Representative: r-� Hih sax, Phone: k..l 3' �
Physical Address/Location: - Vf S R_ 1141 0. 5-- rh i l f f tZt!J5
Type of Operation: Swine ' ✓ Poultry Cattle
Design Capacity: Number of Animals on Site: 1a y6
DEM Certification Number: ACE DEM Cerdfication'Number: ACNEW
r
Latitude: 3f ° S�' V" Longitude: '-7 -° {��-f " Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately I Foot + 7 inches) & — Z or No Actual Freeboard:_Ft. b Inches
Was any seepage observed from the lagoon(s)? Yes or� Was any erosion observed? Yes or No
Is adequate land available for spray Yes�or No 'Is the cover crop adequate? es r No
Crop(s) being utilized: 1� j� % /�c�rfc� --- t L I/ P,(* GAI
Does the facility meet SCS minimum setback criteria? 200 Feet from D�llings? e or No
100 Feet from Wells? es-ar No
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or No
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes or No
Is animal waste discharged into waters of the state by man-made ditch, flushing system, or other
similar man-made devices? Yes orb 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
Additional Comments: _ w 3 j1 vp < 1270k-, Z I 1�i e&
• - -T. . CgEkog C.- - -
Inspector Name .
Signature
cc: Facility Assessment Unit Use attachments if Needed.