310507_INSPECTIONS_20171231

NUH I H UAHULINA
Department of Environmental Qual

Type of Visit: -.07Routine
liance Inspection O Operation Review O Structure Evaluation O Technical Assistance
sit:
Reason for Vi0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: ��I Arrival Time: L_I L_LJ Departure Time: 2 County: Region:
Farm Name: NL S i Tl Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title-
Onsite Representative: (,� Waalo kWe tl
Certified Operator:
Back-up Operator:
Phone:
Phone:
Integrator:
Certification Number:
Certification Number:
Location of Farm: Latitude: Longitude:
Design C►urrent Deslgn Current Design Current
Swine Capacity Pop. Wet Poultry Capacity Pop. Cattle Capacity Pop.
Wean to Finish Layer Dai Cow
Wean to Feeder
I INon-Layer
I
E�]
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Farrow to Feeder
Design Current
De, P,Oaltr, Ca acl P,n P.
Dry Cow
Non -Dairy
Farrow to Finish
Layers
I
113eef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
I
113eef Brood Cow
Other
Other
Turke s
Turke Poults
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)
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 ❑ ❑ NA ❑ NE
❑ Yes NA ❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

rl
Facili Number: - Date of Inspection: rt 7pi
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): 1}�
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes ]�No ❑ NA ❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a ❑ Yes ❑/ /No ❑ NA ❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmenta hreat, notify DWR
7. Do any of the structures need maintenance or improvement? ❑ Yes ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes rNo ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes No ❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes No ❑ NA D 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 l0 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
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 ❑ NA ❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable ❑ Yes eN ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes o ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ YesE!5No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 1" Rainfall Inspections ❑ Sludge Survey
22, Did the facility fail to install and maintain a rain gauge? ❑ Yes � ❑ NA ❑ NE
rr 23. If selected, did the facility fail to install and maintain rainbreakers on iigation equipment? ❑ Yes Z No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facili Number: - bDrl Date of Ins ection:
.4. 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 o ' ❑ 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:
25. 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 Q lg �❑ 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,
34. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below
❑ Application Field ❑ Lagoon/storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[] Yes No ❑ NA ❑ NE
❑ Yes [?/<0- ❑ NA ❑ NE
❑ Yes 2 1`'o ❑ NA ❑ NE
❑ Yes [ZNo ❑ NA ❑ NE
❑ Yes E! o ❑ NA
❑ Yes ❑,IQo NA
❑ Yes ❑-Qo Lj NA
Comments.(refer to question.#) Explain sny.Y)ES'answers and/or,any�additional' recommendationszor.any'other comments.
Use drawings of facility to,hetter e4l'alii sltuations.(use addifionsl, ages:as "necessary).;
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ NE
❑ NE
❑ NE
Phone: o �7 3, y
Date: (d\`1
21412015

rol
Type of Visit: �O 7ROutine
pliance Inspection Q Operation Review O Structure Evaluation p Technical Assistance
Reason for Visit: O Complaint O Follow-up O Referral O Emergency O Other O Denied Access
Date of Visit: Arrival Timer Departure Time: I f County: ))U�Pa A/ Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative:y0p6mp"J Integrator:
Certified Operator: Certification Number: '
Back-up Operator:
Location of Farm: Latitude:
Certification Number:
Longitude:
Swine
to Finish
Design
Capacity
C►urrent
P.
Design Current
Wet Fonitry Capacity Pop. Cattle
er DairyCow
Design,.-
Capacity.
Current
P p.
PWean
Wean to Feeder
ELa
Non -La er
DairyCalf
Feeder to Finish
Farrow to Wean
Dai Heifer
Design Ourrent Dry Cow
Farrow to Feeder
D ry, P,,5 u I t ry, Ca acit P.o , Non -Dairy
Layers Beef Stocker
Non -Layers Beef Feeder
Pullets Beef Brood Cow
Turkeys
Turkey Poults
Other
Farrow to Finish
Gilts
Boars
Other.
Other
Discharp,es and Stream Impacts f
1. Is any discharge observed from any part of the operation? ❑ Yes rNo ❑ 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) D 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 Z No; ❑ NA ❑ NE
❑ Yes a—N/o ❑ NA ❑ NE
Page I of 3 21412015 Continued

Facilit Number: 75 -1 Date of Inspection:
/Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes �No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes ❑ No ❑ NA ❑ NE
Structure I Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier: lJ'1&s-,-, tJ
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
I&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 environm71,11'
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
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 40 ❑ NA ❑ NE
maintenance or improvement?
Waste Application �/
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes I k o ❑ NA ❑ NE
maintenance or improvement? 7"
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes 2:�No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
15. Does the receiving crop and/or land application site need improvement?
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
acres determination?
17. Does the facility lack adequate acreage for land application?
18. Is there a lack of properly operating waste application equipment?
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropriate box.
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
U No
No
L.Q ivo
2�No
ZNo
❑ Yes k No
❑ Yes El"No'
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
[]NA []NE
[]NA ❑NE
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? Ifyes, check the appropriate box below. ❑ Yes o ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall [:]Stocking ❑ Crop Yield ❑ 120 Minute Inspections ❑ Monthly and 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 F31No ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: JDate of Inspection:
a 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 YNo ❑ 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 o ❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? ❑ Yes YNo ❑ 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
[] Yes �No ❑ NA ❑ NE
❑ Yes 25"No ❑ NA ❑ NE
❑ Yes Z/No ❑ NA ❑ NE
❑ Yes 21"No ❑ NA ❑ NE
❑ Yes E No
❑ Yes Ej`No,
❑ Yes �o
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
Comments (refer to question #) Explain any;YES answers.: and/or any addiitional,recommendations.orFanyaother comments.,
Use drawings of facility'tokbetter.ei'via►n'situationsf(use additional pages as necessary).'.
ReviewerlInspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
Phone-_ l (� `_3 re
Date: � I+
21412015

G
Type of Visit: &Compliance Inspection O Operation Review Q Structure Evaluation Q Technical Assistance
Reason for Visit: Routine 0 Complaint 0 Follow-up O Referral 0 Emergency O Other O Denied Access
Date of Visit: Arrival Time: 0 Departure Time: O County: Region:
Farm Name: Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title: Phone:
Onsite Representative: SC (7L V /-/ L Integrator:
Certified Operator: Certification Number:
Back-up Operator: Certification Number:
Location of Farm:
Latitude: Longitude:
Design Current
Swine Capacity Pop.
Wean to Finish
W n to Feeder
eeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Wet Poultry
La er
I INon-Layer
Dr. P,oultr,
Layers
Design
Capacity
Design
Ca p.Aacit
Current
Pop.
Current
P■o
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Dry Cow
Non -Dairy
Beef Stocker
Gilts
Boars
Non -Layers
Pullets
Beef Feeder
Beef Brood Cow
Qther
Other
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)?
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 L"J No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes ❑ No ❑ NA ❑ NE
❑ Yes C3 o ❑ NA ❑ NE
0 Yes &No ❑ NA ❑ NE
Page 1 of 3 21412015 Continued

Facili Number: - Q Date of Inspection:
Waste Colbection & 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?:
l
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
Z rNo
❑ 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 Z--Nc' ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes Z No ❑ NA ONE
(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 ] NNo ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes EJ'No ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP? 0 Yes No ❑ NA ❑ NE
15. Does the receiving crop and/or land application site need improvement'? ❑ Yes ��No
o ❑ NA ❑ NE
16. Did the facilityfail to secure and/or operate per the irrigation design or wettable ❑ Yes ❑ NA ❑ NE
acres determination?
17. Does the facility lack adequate acreage for land application? ❑ Yes [' No ❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment? ❑ Yes [Ef No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? Yes ❑ o ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑ WUP ❑Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Oth
21. Does record keeping need improvement? If yes, check t appropriate box below. Wes ❑ No ❑ NA 0 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 too
❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ElYes ❑ NA ❑ NE
Page 2 of 3 21412015 Continued

Facility Number: - Q Date of Inspection:
24. Did thc+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
E"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?
EYes
o ❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
❑ Yes
❑ No n 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:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP?
33. Did the Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
34. Does the facility require a follow-up visit by the same agency?
❑ Yes []-No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
❑ Yes []No ❑ NA ❑ NE
❑Yes ❑No ❑NA ❑NE
❑ Yes
❑ Yes
❑ Yes
❑NA ❑NE
❑ NA ❑ NE
❑NA ❑NE
Reviewer/Inspector Signature: Date:
Page 3 of 3 21412015

Type of Visit: Compliance Inspection 0 Operation Review Q Structure Evaluation O Technical Assistance
Reason for Visit: QRoutine O Complaint O Follow-up Q Referral Q Emergency O Other O Denied Access
Date of Visit: Arrival Time-, Departure Time: County: � ,v Region:
Farm Name: a / Owner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative: 5co /-�_ & �
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: 4,1
Certification Number:
Certification Number:
Longitude:
Design C►urrent
Design
Current
Design Current
Swine Capacity
Pop.
Wet Poultry
Capacity
Pop.
C+attle Capacity Pop.
Wean to Finish
La er
Dai Cow
Wean to Feeder
Non -La er
Dai Calf
Feeder to Finish
Dairy Heifer
Farrow to Wean
Design
Current
Dry Cow
Farrow to Feeder
Dr. P,oultr
Ca sei
P,o
Non -Dairy
Farrow to Finish
Layers
Beef Stocker
Gilts
Non -Layers
Beef feeder
Boars
Pullets
Beef Brood Cow
Turke s
OtherI
ITurkeyPoults
Other
Other
Discharges and Stream Impacts
1. Is any discharge observed from any part of the operation? [—]Yes [:VKo ❑ NA ❑ NE
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other:
a. Was the conveyance man-made?
❑ Yes 'P�No
❑ NA
❑ NE
b. Did the discharge reach waters of the State? (If yes, notify DWQ).—,._.
❑ Yes
VNo
❑ NA
❑ NE
c. What is the estimated volume that reached waters o f the State (gallons)?
d. Does the discharge bypass the waste man gerrient system? (If yes, notify DWQ)
❑ Yes
�No
❑ NA
❑ NE
2. Is there evidence of a past discharge from any part of the operation?
❑ Yes
E!fNo
❑ NA
❑ NE
3. Were there any observable adverse impacts or potential adverse impacts to the waters
❑ Yes
ZrNo
❑ NA
❑ NE
of the State other than from a discharge?
Page I of 3 21412011 Continued

Facili Number: - Date of Inspection: a-19
IN
!;'aste 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
5XNo
❑ NA
❑ NE
Structure 1 Structure 2 Structure 3 Structure 4
Structure 5
Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed?
❑ Yes
ONo
❑ NA
❑ NE
(i.e., large trees, severe erosion, seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a
❑ Yes
�No
❑ NA
❑ NE
waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes ;?r No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes FNo ❑ 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 F
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? 7�
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes ro ❑ NA ❑ NE
Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, et
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Approved Area
12. Crop Type(s):
13. Soil Type(s):
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yet No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes ,0 No
❑ NA
❑ NE
16. Did the facility fail to secure and/or operate per the irrigation design or wettable
❑ Yes No
;2
❑ NA
[] NE
acres determination?
17. Does the facility lack adequate acreage for land application?
❑ Yes Jallo
❑ NA
❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes J�j No
❑ NA
❑ NE
Reauired Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes_;;TNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes E�r No ❑ NA ❑ NE
the appropriate box.
❑WUP []Checklists ❑ Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes ;'No ❑ NA ❑ NE
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers ❑ Weather Code
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections ❑ Sludge Survey
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes'4 No ❑ NA ❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes .�f`NNo ❑ NA ❑ NE
Page 2 of 3 21412011 Continued

Facilit,y Number: Date of Inspection:
�4. Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes
o
❑ NA ❑ NE
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check
❑ Yes
No
❑ NA ❑ NE
the appropriate box(es) below.
❑ Failure to complete annual sludge survey ❑ Failure to develop a POA for sludge levels
❑ Non -compliant sludge levels in any lagoon
List structure(s) and date of first survey indicating non-compliance:
26. Did the facility fail to provide documentation of an actively certified operator in charge?
❑ Yes
[ o
❑ NA ❑ NE
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification?
[] Yes
No
❑ NA 0 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 0 NA ONE
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the ❑ Yes [ No ❑ NA ❑ NE
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below. [] Yes [] No ❑ NA ❑ NE
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes [] No ❑ NA ❑ NE
33. Did the Reviewer/inspector fail to discuss review/inspection with an on -site representative? ❑ Yes No ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 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).
13� 0
crrl�/yS,sJ
60 rctl C o
Ayr at C'40Q rp'_
Reviewer/Inspector Name:
r� Corc�.s lGol��Yia�`
Phone:
Reviewer/Inspector Signature:
Page 3 of 3
Date: ?s 1d 6 //

a
Type of Visit: AE�rCompliancc Inspection. O Operation Review 0 Structure Evaluation 0 Technical Assistance I
Reason for Visit: _C>Aoutine 0 Complaint 0 Follow-up 0 Referral 0 Emergency 0 Other 0 Denied Access
Date of Visit: Arrival Time: eparture Time: County : Region. Tl�
Farm Name:�S wner Email:
Owner Name: Phone:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Latitude:
Phone:
Integrator: j .
Certification Number:
Certification Number:
Longitude:
Design Current
Swine Capacity Pop:
Wean to Finish
Wean to Feeder
Feeder to Finish
Wet Poultry
Layer
Non -Layer
Design
Capacity
Current
Pop.
EE
Design Current
Cattle Capacity Pop.
Dairy Cow
Dairy Calf
Dairy Heifer
Farrow to Wean
D > PpU-ltr,
Layers
Design
Ca aci
.
Current
l:o ,
Dry Cow
Farrow to Feeder
Farrow to Finish
Non -Daily
Beef Stocker
Gilts
Non -Layers
Beef Feeder
Boars
Pullets
Beef Brood Cow
Other
Other
LlOther
Turkeys
-Turkey Poults
Dischar es and Stream Impact
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other: _
a. Was the conveyance man-made?
b. Did the discharge reach waters of the State? (If yes, notify DWQ)
c. What is the estimated volume that reached waters of the State (gallons)?
d. Does the discharge bypass the waste management system? (If yes, notify DWQ)
2. Is there evidence of a past discharge from any part of the operation?
3. Were there any observable adverse impacts or potential adverse impacts to the waters
of the State other than from a discharge?
❑ Yes ZNo ❑ NA ❑ NE
❑ Yes
P No
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
VNo
❑ NA
❑ NE
❑ Yes
ONo
❑ NA
❑ NE
❑ Yes
7No
❑ NA
❑ NE
Page 1 of 3
21412011 Continued

[Facility Number: Date of inspection: 7
Waste. Collection & Treatment
4' Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes 0 No ❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard? ❑ Yes �:fNo ❑ NA ❑ NE
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
Identifier:
Spillway?:
Designed Freeboard (in):
Observed Freeboard (in): C
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 5No ❑ 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 2-No ❑ NA ❑ NE
8. Do any of the structures lack adequate markers as required by the permit? ❑ Yes j� No ❑ NA ❑ NE
(not applicable to roofed pits, dry stacks, and/or wet stacks) T
9. Does any part of the waste management system other than the waste structures require ❑ Yes '?-No ❑ NA ❑ NE
maintenance or improvement? T
Waste ApDlication
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes P
No ❑ NA ❑ NE
maintenance or improvement?
11. Is there evidence of incorrect land application? If yes, check the appropriate box below. ❑ Yes zNo ❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 lbs. ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of 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?
18. Is there a lack of properly operating waste application equipment?
❑ Yes No ❑ NA ❑ NE
❑ Yes No ❑ NA ❑ NE
Required Records & Documents
19. Did the facility fail to have the Certificate of Coverage & Permit readily available? ❑ Yes �'No ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes No ❑ NA ❑ NE
the appropriate box.
❑WUP ❑Checklists []Design ❑ Maps ❑ Lease Agreements ❑Other:
21. Does record keeping need improvement? If yes, check the appropriate box below. ❑ Yes 'PrNo
❑ Waste Application ❑ Weekly Freeboard ❑ Waste Analysis ❑ Soil Analysis ❑ Waste Transfers
❑ Rainfall ❑ Stocking [] Crop Yield ❑ 120 Minute Inspections ❑ Monthly and V Rainfall Inspections
22. Did the facility fail to install and maintain a rain gauge? ❑ Yes �No
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment? ❑ Yes 2j No
❑NA ❑NE
❑ Weather Code
❑ Sludge Survey
❑ NA ❑ NE
❑NA ❑NE
Page 2 of 3 21412011 Continued

Facility Number: - Date of Inspection: 9-
24.pid the facility fail to calibrate waste application equipment as required by the permit? ❑ Yes �ffNo
25. Is the facility out of compliance with permit conditions related to sludge? If yes, check ❑ Yes ONO
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 ONO
27. Did the facility fail to secure a phosphorus loss assessments (PLAT) certification? [:]Yes allo
Other Issues
28. Did the facility fail to properly dispose of dead animals with 24 hours and/or document
and report mortality rates that were higher than normal?
29. At the time of the inspection did the facility pose an odor or air quality concern?
If yes, contact a regional Air Quality representative immediately.
30. Did the facility fail to notify the Regional Office of emergency situations as required by the
permit? (i.e., discharge, freeboard problems, over -application)
31. Do subsurface tile drains exist at the facility? If yes, check the appropriate box below.
❑ Application Field ❑ Lagoon/Storage Pond ❑ Other:
32. Were any additional problems noted which cause non-compliance of the permit or CAWMP? ❑ Yes 'E2"No ❑ NA ❑ NE
33. Did the ReviewerlInspector--fail to discuss review/inspection with an on -site representative? ❑ Yes gNo ❑ NA ❑ NE
34. Does the facility require a follow-up visit by the same agency? ❑ Yes 'P No ❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any additional recomrnendatipns.or any_ other comments:; `
.Use drawings of facility to better explain situations (use additional pates as necessary).
❑NA ❑NE
❑ NA ❑ NE
❑ NA ❑ NE
❑ NA ❑ NE
1,G-2
!, Z_
Reviewer/Inspector Name:
Reviewer/Inspector Signature:
Page 3 of 3
❑ Yes No [] NA ❑ NE
❑ Yes ONO ❑ NA ❑ NE
❑ Yes J2'No ❑ NA ❑ NE
❑ Yes ,fNo ❑ NA ❑ NE
�'ecarc� � lo�,�a�'.
Phone: G— b - 79�
Date: q, 7
214 OII

Type of Visit (Dr -compliance Inspection O Operation Review O Structure Evaluation O Technical Assistance
Reason for Visit'GlAoutine O Complaint 0 Follow up O Referral O Emergency 0 Other ❑ Denied Access
Date of Visit: G ` Arrival Time: Departure Time: County:
Farm Name: 1 Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact:
Onsite Representative:
Certified Operator:
Back-up Operator:
Title:
Phone:
Phone No:
Integrator: I/ /'4�
Operator Certification Number:
Sack -up Certification Number:
Region:
Location of Farm: Latitude: =' =' =" Longitude: = ° =' =
Design
Current
Dqe esign Current
Design Current
Swine Capacity
Population
Wet Poultry Capacity Popation
Cagle Capacity Population
❑ Wean to Finish
❑ La er
n-La er
Dry Poultry
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
ElNon-Dairy
❑ Wean to Feeder
❑ Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
El Farrow to Finish
❑ Layers
El Beef Stocker
Gilts
Non -Layers
❑ Pullets
❑ Turkeys
ElBeef Feeder
❑ Beef Brood Cow
P0Boars
Other
❑ Turkey Poults
❑ Other
Number of Structures: a
• ❑ Other
Discharges & Stream Impacts
1, 1s any discharge observed from any part of the operation?
❑ Yes
�kNo
❑ 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
Zo
❑ 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?
Page 1 of 3
12/28/04
Continued

Facility Number: — G Date of Inspection , /
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available?
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check
the appropirate box. ❑ WUP ❑ Checklists ❑ Design El Maps [:3 Other
❑ Yes Q'�4o ❑ NA ❑ NE
[]Yes j3No ❑ NA ❑ NE
21. Does record keeping need improvement? If yes, check the appropriate bo below.
❑Yes
❑ No
❑ NA
❑ NE
[:]Waste Application El Weekly Freeboard ❑ Waste Analysi ❑ S'�I Analysis [:]Waste Transfers
❑ Annual Certification
❑ Rainfall ❑ Stocking ❑ Crop Yield ❑ 120 Minute Inspec ions ❑ Monthly and 1"
Rain Inspections
❑
Weather Code
22. Did the facility fail to install and maintain a rain gauge?
❑ Yes
A
No
'
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
ONo
❑ NA
❑ NE
4. id the facility fail to calibrate waste application equipment as required by the permit?
25. Did the facility fail to conduct a sludge survey as required by the permit.
` ❑ Y s
Yes
El No
�No
❑ NA
❑ NA
[I NE
El NE
26. Did the facility fail to have an actively certified operator in charge?
❑ Yes
PNo
❑ NA
❑ NE
27. Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
[(No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
No
❑ NA
❑ NE
and report the mortality rates that were higher than normal?
30.
At the time of the inspection did the facility pose an odor or air quality concern?
❑ Yes
No
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
rr
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
1No
❑ 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
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency?
❑ Yes
No
❑ NA
❑ NE
Addational�Cninmentsanfd/or�Dra�wings; w,
i
i
Page 3 of 3 12128104

[F�a'cifity
0 Division of Water Quality
Number , f� rf 0 Division of Soil and Water Conservation k�
Q Other Agency
Type of Visit 0 Compliance Inspection 0 Operation Review 0 Structure Evaluation 0 Technical Assistance
Reason for Visit 0 Routine 0 Complaint 0 Follow up 0 Referral 0 Emergency 0 Other ❑ Denied Access
Date of Visit: Arrival Time: Departure 'Time: County: Region:-----�C/
Farm Name:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: Title:
Onsite Representative:
Certified Operator:
Owner Email:
Phone:
Phone No:
Integrator:
Operator Certification Number:
Back-up Operator: Back-up Certification Number:
Location of Farm:
Swine
Wean to Finish
Wean to Feeder
Feeder to Finish
Farrow to Wean
Farrow to Feeder
Farrow to Finish
Gilts
Boars
Latitude: ❑ O 0 6 Longitude: = ° = ` ❑
Design Current Design Current
Capacity Population Wet Poultry Capacity Population
❑ Layer
❑ Non -Layer
Other
❑ Other _....
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
D. Turkeys
❑ Turkey Poults
❑ Other
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Structure ❑ Application Field ❑ Other
a. Was the conveyance man-made?
Design Current
Cattle Capacity Population
❑ Dairy Cow
❑ Dairy Calf
❑ Dairy Heifer
❑ Dry Cow
❑ Non -Dairy
❑ Beef Stocker
❑ Beef Feeder
❑ Beef Brood Cow
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)?
Number of Structures: E'
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
J'No
❑ NA
❑ NE
❑ Yes
21"No
❑ NA
❑ NE
12128104 Continued

Facility Number: Date of Inspection t7
Waste Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate?
❑ Yes 2rNo
❑ NA ❑ NE
a. If yes, is waste level into the structural freeboard?
❑ Yes 2No
❑ 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
❑ NA ❑ NE
(ie/ large trees, severe erosion, seepage, etc.)
J[R'No
6. Are there structures on -site which are not properly addressed and/or managed
❑ Yes IR"No
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or
environmental threat, notify DWQ
7. Do any of the structures need maintenance or improvement?
❑ Yes _C2'No
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit?
[-]Yes ff 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 J' No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need
❑ Yes ffNo
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate below.
❑ Yes ❑ No
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic OvQrJoad ❑ Frozen Gro d ❑ He vy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs tal Phosphorus ❑ Fa cure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drifl ❑ 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 QWo
❑ 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 8 No
❑ NA ❑ NE
17. Does the facility lack adequate acreage for land application?
❑ Yes ENo
❑ NA ❑ NE
18. Is there a lack of properly operating waste application equipment?
❑ Yes P-190
❑ NA ❑ NE
Comments (refer to question #): Explain any YES answers and/or any recommendations or any other comments.
Use drawings of facility to better explain situations. (use additional pages as necessary):
Reviewer/Inspector Name Phone: - Z
Reviewer/inspector Signature: Date: d
12128104 - Continued

Facility Number: ! `� Date of Inspection
Required Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes .ETNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes 0 No ❑ NA ❑ NE
the appropirate box. ❑ WUP ❑ Checklists ❑ Design
g ❑Maps ❑Other
21. Does record keeping need improvement? If yes, check the appropriate box ow. ❑ Yes JQ No ❑ NA ❑ NE
ElWaste Application ❑ Weekly Freeboard ❑ Waste Analysis El So' 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 ,ErNo
❑ NA
❑ NE
23. If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes ,2No
❑ NA
❑ NE
24
Bid the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes ❑ No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes Q-No
❑ NA
❑ NE
25.
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 2No
❑ NA
❑ NE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes 2No
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes 2No
❑ 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 FFNo
❑ NA
❑ NE
If yes, contact a regional Air Quality representative immediately
3 I.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes 15No
❑ 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 ❑-Wo
❑ NA
❑ NE
Additional Comments and/or Drawings:
if 1171a6
a rlVeWZri
71-
Y ri?X
C'C���G�r��'��s _910- �3J/
�/lit
/7Tr�'�
Uhl Gt�CGvcev/
12128104

(Type of Visit 9 Compliance Inspection O Operation Review O Structure Evaivatlon O Technical Assistance I
Reason for Visit O ❑ Routine O Complaint O Follow up O Referral O Emergency O Other Denied Access
Date of Visit:
(%6 Arrival Time:
9%.
Departure Time: County:
Farm Dame:
/U/ �/
�y�%
� Owner Email:
Owner Name:
Mailing Address:
Physical Address:
Facility Contact: / / L Title:
Onsite Representative:
Certified Operator:
Back-up Operator:
Location of Farm:
Phone:
l Pt-. Region:
Phone No:
1 nteerator•
Operator Certification Number:
Back-up Certification Number:
Latitude: = 0 [= i Longitude: 0 ° = ' =
Design Current Design Current
Swine Capacity Population Wet Poultry Capacity Population Cattle
❑ Wean to Finish
❑ Wean to Feeder
❑ Feeder to Finish 4M ILot
❑ Farrow to Wean
❑ Farrow to Feeder
i
❑ Farrow to Finish
❑ Gilts
❑ Boars—_--
Other.
❑ Other - ---- - -- - - .�
❑ Layer Ii
❑ Non -La et
Dry Poultry
❑ Layers
❑ Non -Layers
❑ Pullets
❑ Turkeys
❑ 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
aDairy
Heifer
❑
Pry Cow
❑
Non -Dairy
❑
Beef Stocker
❑
Beef Feeder
❑
Beef Brood Cowl
I
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 ❑'No ❑ NA ❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ Yes
❑ No
❑ NA
❑ NE
❑ NA
❑ NE
❑ Yes
❑ No
❑ Yes
{'No
❑ NA
❑ NE
❑ Yes
;No
❑ NA
❑ NE
12128104 Continued

Facility Number: — Date of Inspection
-,r
WAte Collection & Treatment
4. Is storage capacity (structural plus storm storage plus heavy rainfall) less than adequate? ❑ Yes ,[TNo ❑ 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): r�
Observed Freeboard (in):
5. Are there any immediate threats to the integrity of any of the structures observed? ❑ Yes .2 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 ETNo
❑ NA ❑ NE
through a waste management or closure plan?
If any of questions 4-6 were answered yes, and the situation poses an immediate public health or environmental threat,
notify DWQ
7. Do any of the structures need maintenance or improvement? ❑ Yes 11allo
❑ NA ❑ NE
8. Do any of the stuctures lack adequate markers as required by the permit? ❑ Yes ❑'No
❑ NA ❑ NE
(Not applicable to roofed pits, dry stacks and/or wet stacks)
9. Does any part of the waste management system other than the waste structures require ❑ Yes ❑'No
❑ NA ❑ NE
maintenance or improvement?
Waste Application
10. Are there any required buffers, setbacks, or compliance alternatives that need ❑ Yes �' o
❑ NA ❑ NE
maintenance/improvement?
11. Is there evidence of incorrect application? If yes, check the appropriate box below. ❑ Yes PNo
❑ NA ❑ NE
❑ Excessive Ponding ❑ Hydraulic Overload ❑ Frozen Ground ❑ Heavy Metals (Cu, Zn, etc.)
❑ PAN ❑ PAN > 10% or 10 Ibs ❑ Total Phosphorus ❑ Failure to Incorporate Manure/Sludge into Bare Soil
❑ Outside of Acceptable Crop Window ❑ Evidence of Wind Drift ❑ Application Outside of Area
12. Crop type(s) r 6/ ')
13. Soil type(s)
14. Do the receiving crops differ from those designated in the CAWMP?
❑ Yes
2-No
❑ NA
❑ NE
15. Does the receiving crop and/or land application site need improvement?
❑ Yes
ETNo
❑ NA
❑ NE
16, Did the facility fail to secure and/or operate per the irrigation design or wettable acre determination'[]
Yes
J!j 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?
El Yes
,Z
D No
❑ NA
❑ NE
Reviewer/Inspector Name ,$ Phone: 9121 T
ReviewerlInspector Signature: Date: e
121281 Continued

Facility Number: -2 Date of Inspection l 6
Re uiied Records & Documents
19. Did the facility fail to have Certificate of Coverage & Permit readily available? ❑ Yes /EfNo ❑ NA ❑ NE
20. Does the facility fail to have all components of the CAWMP readily available? If yes, check ❑ Yes J2'No ❑ NA ❑ NE
the approprrate box. ❑ WUP ❑ Checklists ❑ Design ❑Maps El Other
21. Does record keeping; need improvement? If yes, check the appropriate box below. ❑ Yes J2 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
2 No
❑ NA
❑ NE
23.
If selected, did the facility fail to install and maintain rainbreakers on irrigation equipment?
❑ Yes
❑'No
❑ NA
❑ NE
24.
Did the facility fail to calibrate waste application equipment as required by the permit?
❑ Yes.
J:R"No
❑ NA
❑ NE
25.
Did the facility fail to conduct a sludge survey as required by the permit?
❑ Yes
�i o
❑ NA
❑ NE
26.
Did the facility fail to have an actively certified operator in charge?
❑ Yes
12""No
❑ NA
❑ NE
27.
Did the facility fail to secure a phosphorus loss assessment (PLAT) certification?
❑ Yes
❑ No
❑ NA )ZNE
Other Issues
28.
Were any additional problems noted which cause non-compliance of the permit or CAWMP?
❑ Yes
. F,,jNo
❑ NA
❑ NE
29.
Did the facility fail to properly dispose of dead animals within 24 hours and/or document
❑ Yes
0 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
'J2
31.
Did the facility fail to notify the regional office of emergency situations as required by
❑ Yes
❑ NA
❑ NE
General Permit? (ie/ discharge, freeboard problems, over application)
'P'No
32.
Did Reviewer/Inspector fail to discuss review/inspection with an on -site representative?
❑ Yes
D-No
❑ NA
❑ NE
33.
Does facility require a follow-up visit by same agency:?
❑ Yes
Q-No
❑ NA
❑ NE
Addirtibnal Comments and/or Drawings:.,
9-7 G i to rotes
6e.�
S �d wokf
e U
9' 1A c )-c-s ,
} kc4'. "_�e Cords
'
rleldu CA C C"I I PCX
�J
oea� ';�_ Q ( &r 4/ c
12128104

(Type of Visit 6 CorQpiiance Inspection O Operation Review O Lagoon Evaluation
Reason for Visit Routine p Complaint p Follow up O Emergency Notification O Other ❑ Denied Access
Facility Number Date of Visit: Time: 1 b
{a Not Operational C Below Threshold
MlPfermitted CCertffled © Conditionally Certified 0 Registered Date Last Operated or Above Threshold:. .._» .... _..
Farm Name: _------- _...._....--- ----- ---------- County. - I'L)Pa.� ...»»...»»
OwnerName:. .. ._._..........._............ _... W_....._._._....__.._.w_....».__....._....... ' Phone No:».».».»................_...........................»....._......._
MailingAddress: .....».... »....... ...»......... .....»............................_................................ ....» ......»...........__... »..».............._._._...._... .........................
FacilitvContact: ... _ .. ..».....». ».» . _ .. ____ ._ Tide: ._--- ------------- » ».»» __. Phone No:
Onsite Representative: ,._N1 �R5. ,�� _ ��» » .. »» » »...... Integrator"
Certified Operator:........» ....»..............».» _ . »...._. » _......___.................... Operator Certification Number:....._._..»_._ ........_......
Location of Farm:
© Swine ❑ Poultry © Cattle ❑ Morse Latitude Longitude �• �' �"
ID • Curren � . gag
'Current
Swine Ca 'Po irlaitian w,iPonitry3 ,s
._.
aci �Po" iaQan Cattle Ca
Po tion
Wean to Feeder ';. ❑Layer
❑Dairy
;
''
eeder to Finish p ❑Non -Layer
❑Non -Dairy
,
Farrow to Wean`i
Farrow to Feeder Other
r
: +
Farrow to Finish ''';i 4 % "
y ' Tatar D@57gI1lSClty f
t
Byars'►�L
.
Namber,Of.L�agooas�i .CYO , 3i�},'2 ��.{
lr
Discharges & Stream Impacts
I. 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 l Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): 40
❑ Yes ER/No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes
❑ No
❑ Yes
[KNo
❑ Yes
R<o
❑ Yes ❑IA
.01
Structure 6
12112103 Continued

Facility Number: 3 j -- Slo Date of Inspection
S. Aret here any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
[j yes
No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
El Yes
0 No
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes
,,......,,��
La'4o
8. Does any part of the waste management system other than waste structures require maintenancelimprovement?
❑ Yes
To
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
❑ Yes
No
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
❑ Yes
Q No
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 tyre (-So
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
N
14. a) Does the facility lack adequate acreage for land application?
❑ YesVNo
b) Does the facility need a wettable acre determination?
❑ Yes
c) This facility is pended for a wettable acre determination?
❑ Yes
ETIZ
15. Does the receiving crop need improvement?
❑ Yes
0,10"
16. Is there a lack of adequate waste application equipment?
❑ Yes
[d'No
Odor Issues
17. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge attor below ❑ Yes Q-N-o
liquid level of lagoon or storage pond with no agitation?
18. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes 040
19. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes �Wo
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 .T3No
Air Quality representative immediately.
Field Copy ❑ Final Notes
NEw 4.shic-o c�1&�ao-J sO PGAC.4. -TvAff ZOOL/
a ,� IC.eEP C°Py' ar �t iG�►'C� 4Coub� 14C,� ar+ i�C-RW►ii wSTu c*-D
ot3TAz:�j copy of pCt,J t_A&oarr ocs'.r&N *11) PLAC�- wetn 1zEtow0J,
3S) 1/9OA-16 cRaP yzi>(_a r'0
6..rn
k.C,&P Cope alb ANOJUAL C"t'TXf-rCAT'L5Q
a3,) iJs� � r4�
ReviewerRaspector Name
Reviewer/Inspector Signature:
b.1 ASTE 1►r►r AL Y-S LS T;rnnC_- SPIN) ,. r/o aVk
Date: 6
12112103 Cowed

Facilfty Number: 31 _ 5a7 Date of Inspecction
Requited 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. Doe record keeping need improvement? If yes, check the appropriate box below.
Waste Application ❑ Freeboard 0 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?
25. 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?
34. Did the facility fail to calibrate waste application equipment?
35. Does record keeping for NPDES required forms need improvement? If yes, check the appropriate box below.
Stocking Form 1�Crop Yield Form ❑ Rainfall ❑ Inspection After 1" Rain
❑ 120 Minute Inspections &Annual Certification Form
dYes ❑ No
❑ Y s /NNo
Yes ❑ No
❑ Yes 3 NNo
❑ Yes [3 No
❑ Yes ±No
❑ Yes Ef No
❑ Yes [ o
❑ Yes NNo
[/Yes ❑
❑ Yes
❑ Yes
❑ Yes
❑res
VNo
❑ No
12112103

c
Type of Visit (%Compliance Inspection Q Operation Review O Lagoon Evaluation
Reason for Visit O Routine O Complaint O Follow up O Emergency Notification QfOther ❑ Denied Access
Facility Number Date of Visit: i 'Zl Time: I JU 3L�
10 Not Operational Below Threshold
Permitted R Certified 0 Conditionally Certified [3 Registered Date Last Operated or Above Threshold:
1
Farm Name: _. ��ri f f A�_ ✓"., ,T County: V. a ,,a
Owner Name: SG/fry-, , Phone No:
Mailing Address:
Facility Contact: Title: Phone No:
Onsite Representative: Integrator.
Certified Operator: Operator Certification Number:
Location of Farm:
[:]Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude ' 01 0 " Longitude 0' 0
Design" � +Current' .Design ;:;Current:' ;`''Design . '�Currept'
Swine Ca aciri Po ulation k Pouitr ".'.Ca a_ tv.IPo" ulation Cattle ;e ; .1, ., Cit acttv',11?o wliition
E E. ❑ Wean to Feeder # ❑ La er i' ❑ DaiTY
eeder to Finish 7 ❑ Non -La er ❑ Non -Dairy
Farrow to Wean
❑ Farrow to Feeder ❑other
'
t € f
' Farrow to Finish €.;' „ ,` ' E Totaesign Cap
1 D acfty'"''
Gilts
Boars
Number of Lagoons ❑Subsurface Drains Presept ❑ Lagoon Area ❑ S rav Field Area ' ',:
.B ezE 3i3 �! 1 , ....
Holding Ponds'/'Solid 3 raps ° ❑ No Liquid Waste Mana ement System
Discharges 8& Stream Impacts
1. Is any discharge observed from any part of the operation?
El Yes ❑ No
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made? ❑ Yes ❑ No
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ) ❑ Yes ❑ No
c. if discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ) ❑ Yes ❑ No
2, is there evidence of past discharge from any part of the operation? ❑ Yes ❑ No
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge? ❑ Yes ❑ No
Waste Collection & Treatment
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway ❑ Yes ❑ No
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5 Structure 6
identifier: /
Freeboard (inches): 3 G G 17
05103101 Continued

P �0 l
ri

Facility Number: Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? ❑ Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes [:]No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)?
❑ Yes
❑ No
14. a) Does the facility lack adequate acreage for land application?
❑ Yes
❑ No
b) Does the facility need a wettable acre determination?
❑ Yes
❑ No
c) This facility is pended for a wettable acre determination?
❑ Yes
❑ No
15. Does the receiving crop need improvement?
❑ Yes
❑ No
16. Is there a lack of adequate waste application equipment?
❑ Yes
❑ No
Reauired Records_&_Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
❑ No
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
❑ No
19.
Does record keeping need improvement? (iel irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
❑ No
20.
Is facility not in compliance with any applicable setback criteria in effect at the time of design?
❑ Yes
❑ No
21,
Did the facility fail to have a actively certified operator in charge?
❑ Yes
❑ No
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
❑ Yes
❑ No
(ie/ discharge, freeboard problems, over application)
23.
Did Reviewer/inspector fail to discuss review/inspection with on -site representative?
❑ Yes
❑ No
24.
Does facility require a follow-up visit by same agency?
❑ Yes
❑ No
25.
Were any additional problems noted which cause noncompliance of the Certified AWMP?
❑ Yes
❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments refer.to; uest►on # Ex lain an l'ES Qnswet`s andlor an recpmtaten�kationx or an other cditiiments.' E o ,� l , } `'
Use drawings of factltty to better explam!situations. (useadditionail pages ss necessary) f € , gf 3i 1
yField Copv 0 Final Notes.,_.,.-.�;'al
3° :..�tEJ
�$ ��� Lu f �� n ,° s �s�;�A /�� l<.�n a�� ��.� l�o�rt �: 1r ,s'd.�
.,•(%,-r�,,
�701 � 5 6>�" L� a ,�; W a f ore .f� v � " X a 5 A 0 �� 1 ��Q Gil v✓lJ � / i
3,f r ` a "1 P✓� �{�G C��l n �G �'j .mil ,ET L �t o �j 1 b I �C T �j �0 fi k v �t o+
/W
Reviewer/Inspector Name �,,� - D �''� v� _ ,,•,,, .;,
Reviewer/Inspector Signature: Date: '2 r
05103101 ' !/ U
Continued

Facility Number: - 5 Date of Inspeclim) 1 L %
7--
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes ❑ No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes ❑ No
28, is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes ❑ No
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ❑ No
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes ❑ No
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes ❑ No
32. Do the flush tanks lack a submerged fill pipe or a permanent/temporary cover? ❑ Yes ❑ No
Additional'Co'mmcnts an' or"'Drawings:
F,ty 19" 23 z%Lf— 3$c)y
#OM e-- - 2Cz/56V-2-4477
C"ell z T :7- 5/ —
I
05103101

v
Facility Number 3 D
Date of Visit: Time: 10 2-S
Not Operational OBelowThreshold
©Permitted. Q Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: _ A rS 1� �'' ��r "` County: VAO l �_
Owner Name: WI a rs A—, Phone No:
Mailing Address:
Facility Contact: jj Title:
Onsite Representative: S t: 979
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude 0 0" 0" Longitude 0 6 44
Discharges & $tream Impacts
1. Is any discharge observed from any part of the operation? )KYes ❑ No
Discharge originated at: ZrLaaoon ❑ 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 &
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
Structure 6
Freeboard (inches):
05103101 Continued

Facility Number: 31 - 50 7 Date of Inspection ! 3 0 Z
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion, ❑ Yes ❑ No
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan? El Yes ❑ No
(If any of questions 4-6 was answered yes, and the situation poses an .
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement? ❑ Yes ❑ No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes ❑ No
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings? ❑ Yes ❑ No
Waste Application
10. Are there any buffers that need maintenance/improvement? ❑ Yes ❑ No
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN ❑ Hydraulic Overload ❑ Yes ❑ No
12. Crop type
13. Do the receiving crops differ 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 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
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ Yes
❑ No
❑ No
❑ No
❑ No
❑ No
❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes 00No
❑ Yes ❑ No
❑ Yes ❑ No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
Comments (refer to"question#} Explain any YES answers antllor any recoutmentlAtions OfFiny: oihej", 0 men tS ,
Used rawings of facility to better explain�situations :(usc'addititlnal pages,iis'necess ry)
}. �. ❑Field Copy ❑ Final Notes
k t�t 1p
I. `TM;'S �eljoc,.rU� 1nS c4?oil &,/Ps do+1e ih eo/1J✓n G4,'oh w;4t, Ltr+d
+ des a a
4v^11'4 - Dot►-,% Setyee+o obseeve legk.'►\5 A ke. iO �
-1�tgfi 1�o►-� 'i r leAA _ taI•t,r Sq�P1ef �M P;Cfpv,c-f
peef� 444 Cerr C14 145pevi 4ild /',­ opn n eA e bj'j pond I be ih
G01114otG4 about-� vt��-F;no�.��s And e7eca<n r 4o be -f tke*7
Reviewer/Inspector Name w" 6 ,jam ' �S'K
Reviewer/Inspector Signature: Date:
05103101 Continued

11
I
Type of Visit S Compliance Inspection Q Operation Review 0 Lagoon Evaluation
Reason for Visit I}Routine O Comptaint Q Follow up Q Emergency Notification O Other ❑ Denied Access
Facility Number
Date of Visit: �Z Time: ;
rO 'i
Not Operational 0 Below Threshold
® Permitted 'M Certified 0 Conditionally Certified 0 Registered Date Last Operated or Above Threshold:
Farm Name: m 5 rf} r County:
Owner Name: A4116411 ,' Phone No:
Mulling Address:
Facilitv Contact: 'Title
Onsite Representative:
t
Certified Operator:
Location of Farm:
Phone No:
Integrator:
Operator Certification Number;
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse. Latitude a 1 11 Longitude ' 1 ••
Design:; =Current a `Design Current Design Cutrent ,
,,
a i 1 -f
.Swine y „ _6 ",Poultr Cattle'
Ca `aci - Po ulation Y Ca aci � Po elation ' Ca ara dPo� elation
El Wean to
❑ Layer Dairy
®Feeder to Finish AM Farrow
❑ t Non -Layer ;,t . ❑Non-Dai
❑ Other n 5 q +4
Vi'.- kDes>tgn�Capactty ,
eTtital:SSL'W,�"
s
4.
r s �Tumber,af Lagoons i ,ws Z t ara"' ❑Subsurface Drains Present Ga oon Area ❑ Spray Field Area
;
loldtng Ponds l SoUd Traps L" 1 El No Liquid Waste Mana ement Svstem t' z '
Feeder
❑Farrow to Wean
El Farrow to Feeder
El Farrow to Finish
El Gilt,
�c;:a ❑ Boars
0
Discharges g Stream Impacts
!. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑Other
a. If discharge is observed, was the conveyance man-made? .
b. if discharge is observed, did it reach Water of the 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 .0 eatme t
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I S
Freeboard (inches): .l r z l0
❑ Yes ®No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ Na
❑ Yes No
❑Yes No
❑ Yes ®No
Structure 6
5/03/01 Continued
Discharges g Stream Impacts
!. is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Sprav Field ❑Other
a. If discharge is observed, was the conveyance man-made? .
b. if discharge is observed, did it reach Water of the 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 .0 eatme t
4, is storage capacity (freeboard plus storm storage) less than adequate? ❑Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
Identifier: I S
Freeboard (inches): .l r z l0
❑ Yes ®No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ Na
❑ Yes No
❑Yes No
❑ Yes ®No
Structure 6
5/03/01 Continued

s
Facility Number: 3( ] Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage. etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(if any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
❑ Yes ZNo
❑ Yes S No
®Yes ❑No
8. Does any part of the waste management system other than waste structures require maintenance/improvement? ❑ Yes 1�9 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 [H No
11. Is there evidence of over application? y ❑ Excessive Pondin//g /❑ P`AN ❑ Hydraulic Overload ❑ Yes ® No
12. Crop typey 6P�rt�,, fNnelt�/hUifk l t1hy)!l Frn4i HP/
13. Do the receiving crops differ with those designated in the Certified Animal Waste Management Plan (CAWMP)? ❑ Yes C&No
14. a) Does the facility lack adequate acreage for land application? ❑ Yes ®No
b) Does the facility need a wettable acre determination? ❑ Yes fKjNo
c) This facility is pended for a wettable acre determination? ❑ Yes [4No
15. Does the receiving crop need improvement? ❑ Yes E,No
16. Is there a lack of adequate waste application equipment? ❑ Yes C&No
Reouired Records & Documents
17.
Fail to have Certificate of Coverage & General Permit or other Permit readily available?
❑ Yes
[ZNo
18.
Does the facility fail to have all components of the Certified Animal Waste Management Plan readily available?
(ie/ WUP, checklists, design, maps, etc.)
❑ Yes
No
19.
Does record keeping need improvement? (ie/ irrigation, freeboard, waste analysis & soil sample reports)
❑ Yes
XNo
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
VNo
22.
Fail to notify regional DWQ of emergency situations as required by General Permit?
(ie/ discharge, freeboard problems, over application) ❑ Yes f Z 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 ® No
25. Were any additional problems noted which cause noncompliance of the Certified AWMP? ❑ Yes W No
10 No violations or deficiencies were noted during this visit. You will receive no further correspondence about this visit.
*7 %jute✓ wits /egcA;n� ovt+4e,
Accords Siow +ta-Y Ad, 41mei
irtc6l LVAil4 Lmoon .* Zs 14,eI6
-t i,s I-AlooH W'46 KepGtrfl
Reviewer/Inspector Name
Reviewer/Inspector Signature..
❑ Field Covy ❑ Final Notes
b6rl0hr
DT -JPAG b"JL ;A5141
C6✓hL6✓
474 1ed�00rt. #l, r
h elog
etc w4hv level /ptv
;A
Lc�no ii ('S"01*
r'QA*01n
dp✓y `r,`54, (, Aem 45ka4,
X w45 41s6 ;.4rrAp4
4V 4,f
sit dt E ,tirohj-ft i kt
�146
re eh /-IvaSt,
Date: tZZS d2

;yam t_ 2'z
Facility lumber: 3f —50 bale of Inspection
dor Lima
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below
liquid level of lagoon or�torage 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 tA No
❑ Yes C&No
❑ Yes 5 No
❑ Yes 9 No
❑ Yes ® No
❑ Yes ® No
❑ Yes ® No
A�d#tionaf;Commentsiandlor�rawbtgs�'��•�"1'�?�'�.`�;'� _ `, " .7r` 'r�,�
r1WCiT' G60���Z�
pZ, 0on a5`�1 Y Ie�l 55 44e Sf�r um/pt,� loolr ACt
om MurkP✓ k6IM4y heed[ -t"0 6e ✓e/plGled ` v m4ya eX T�rS`
YA! ire m ends.
05103101

IType of Visit 10 Compliance Inspection O Operation Review O Lagoon Evaluation I
Reason for Visit A Routine 0 Complaint. O Follow up 0 Emergency Notification O Other 1 ❑ Denied Access
Facility Number Date of Visit:—a'�—CJ Time:
Q Not Operational 2 Below Threshold
` .permitted U Certified 0 Conditionally Certified [3 Registered Date Last Operated or #Above Threshold: .........................
FarmName:.........��............................................................ County: .... !--.l�R................................. .......................
OwnerName: ........................................................................................................................... Phone No:.................................................................................
FacilityContact: ............................................................................... Title:................................................................ Phone No:...................................................
Mailing Address: ....................................................................... ............................... ............... ......................... ..........................
............................................ ...... ........
Onsite Representative: .......................................... Integrator....Fr`...................................................
1 l
CertifiedOperator:................................................................................................................ Operator Certification Number:..........................................
Location of Farm:
❑ Swine ❑ Poultry ❑ Cattle ❑ Horse Latitude • 6 44 Longitude • �49
Design ; Current Design Current Design Current ,
Svrhue 'Cltry tin" Cattle
. Capacity Po elation
❑ Wean to Feeder ❑ Layer ❑ Dairy
eeder to Finish ❑Non -Layer ❑ Non -Dairy
❑ Farrow to Wean
❑ Farrow to Feeder ❑Other
13 Farrow to Finish Total De53gn'Capscity
❑ Gilts z'
❑ Boars Total SSLW
r
Ain"mbar' of Lagoons ❑ Subsurface Drains Present ❑ Lagoon Area I0 Spray Field Area
HoIdiag Ponds/ Soli&Traps:. ❑ No Liquid Waste Management System
Dischar es & Stream Imnact�S
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 gaUmin?
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? 0-Spillway
Structure I Structure 2 Structure 3 Structure 4
❑ Yes )4 No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes E(No
❑ Yes 9No
❑ Yes P1 No
Structure 5 Structure 6
Identifier: ...........................................................................................................
Freeboard (inches): 60 34,
5/00
Continued on back

lFacility dumber: 1 - ar] 1 Date of Inspection
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
6. Are there structures on -site which are not properly addressed and/or managed through a waste management or
closure plan?
(If any of questions 4-6 was answered yes, and the situation poses an
immediate public health or environmental threat, notify DWQ)
7. Do any of the structures need maintenance/improvement?
8. Does any part of the waste management system other than waste structures require maintenance/improvement?
9. Do any stuctures lack adequate, gauged markers with required maximum and minimum liquid level
elevation markings?
Waste Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of ver application? ❑ Excessive Ponding ❑ PAN Hydraulic Overload
12. Crop type C-_ W 15' 0--i �^ 5-W
13. Do the receiving crops differ 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 Iack 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?
Yi4i;aiiocls:or- iiglllcjeja�i" ire 00f - 0ttring ��js vas}t� Y00,ily �•ec lye ti fu1't i'.. .
• corres o deice: abbijf this visit. • .. • . • • • • • .
❑ Yes �blo
❑ Yes )4 No
XYes ❑ No
❑ Yes 9NO
Yes ❑ No
❑ Yes A No
9Yes Not
❑ Yes
ONo .
❑ Yes
No
:Q Yes
❑ No
❑ Yes
❑ No
❑ Yes XO No
❑ Yes
9No
❑ Yes W No
9Yes ❑ No
❑ Yes )�No
❑ Yes gr No,
❑ Yes J'No
❑ Yes No
❑ Yes No
❑ Yes D�No
❑ Yes ,KNO
Conpupaents (refer `to question #) ° Explain any YES answers and/or, any,reco'mmeadaons or any other` co'mitiai`ents,
Use'drawin of facility to:better explain srtuations: {use additional pages as necessary) �, ii= t, 1;' f �t r
r7) Ukrzi, 0.� �jm
Reviewer/Inspector Name e�
• a
Reviewer/Inspector Signature: '>�, r�� Date: 7—a_)_Gk 5/00

Facility Number: ?� Date of Inspection o1 cf(
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below 4Yes. ❑ 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 O No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes VrNo
roads, building structure, and/or public property)
29. Is the land application spray system intake not located near the liquid surface of the lagoon? ❑ Yes ONo
30. Were any major maintenance problems with the ventilation fan(s) noted? (i.e. broken fan belts, missing or
or broken fan blade(s), inoperable shutters, etc.) ❑ Yes P 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 PkNo
ppal,,�;qTMents. an or. DrA winGCk
e,
`�4
J
" Zl-\-
It, C �5
r
5/00

Facility Number Date of Inspection O
Time of Inspection V3 O 24 hr. (hh:mm)
APermitted 13 Certified S13 Conditionally Certified Cj Registered Not Operational Date Last Operated:
Farm Name: ff:� .✓.. .. ?!r` `7!. ................................... County: .._D..y��,�.`.:'�........................... .......................
OwnerName:........................................................................................................................... Phone No:....................................................:..................................
Facility Contact: .. Title ..... .............................. Phone No:...................................................
MailingAddress:. ............................................. .............. ............................................................. ......................... ..........................
........................Y .
LAU
Onsite Representative:.�...........?'......... Integrator:.....
CertifiedOperator: ................................................. . ............................. I— ........... I ................ Operator Certification Number:..........................................
Location of Farm:
................................................................................................................................................................................................................................................................
................... ........... ......... .. V
Latitude ' & i' Longitude ' & 6°
Design Current Design Current �zr" _ Design
Ca aat ,;IPo' ulatSon, .:Poultry Ca aci ,r.Po "ulatioit [ Castle ,' vl;l ,Ca''acit
..wine ....� ;n. � ...-::�...1.,.._..
❑ Wean to Feeder
Feederto Finish
`.: ❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
❑ Layer ❑ Dairy
❑ Non -Layer =' ❑ Non -Dairy
❑ Otherii
-A
.
Total Design Capacity
Total SSi'W i 1;i
A.
Number of°Lagoons., '` ❑
' Subsurface Drains Present ❑ Lagoon Area ❑Spray Field Area
,
Holding Ponds / Solid Traps ❑ No Liquid Waste Management System
Discharges & Stream Impacts
1. Is any discharge observed from any part of the operation?
Discharge originated at: ❑ Lagoon ❑ Spray Field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Water of the State? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (II` ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure 1 Structure 2 Structure 3 Structure 4 Structure 5
❑ Yes WNo
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes XNo
❑ Yes �No
❑ Yes XNo
Structure 6
Identifier: �-1
Freeboard(inches): ......................... G:^V........................................................................
................................................................................................................ ..
5. Are there any immediate'threats to the integrity of any of the structures observed? (ic/ trees, severe erosion, ❑ Yes )SrNo
seepage, etc.)
3/23/99 Continued on back

Facility Number: — 0 Date of inspection C
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 Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of over application? ❑ Excessive Ponding ❑ PAN
12. Crop type 1 L,7i_-A; C /UzJ S614
13. Do the receiving crops differ 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?
❑ Yes KNo
JxYes ❑ No
❑ Yes ONO
❑ Yes 0 No
❑ Yes NrNo
❑ Yes ONO
❑ Yes I�No
❑ Yes ONO
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes �0 No
❑ Yes 4No
❑ Yes O�No
❑ Yes a/ No
❑ Yes JU(No
❑ Yes I&No
❑ Yes )Q No
❑ Yes X No
❑ Yes IL_
No
❑ Yes X No
❑ Yes �J/No
0. K.6 A61h(ri00s'0- ci f cji nciej -*Oro pofed• during (bis'visit} • Y;oo s iii t&Oiye 06 fuefte
cor'res' 6fidence' ab' ' this visit:
Ei {" "'- jq 1,. .�".'k ilY I.,'i-. d- 4'YI �3. E'.
Comments (refer,;i6 questtoh #)i Explaiii'any YES answers and/ar any recommendations oriany otli'er comments , k ='1 �� H
I., 1 r �• E! _ S E 9 �i r'! f i+t�..Eale'
Use,drawings of+facility to:better explain situations (use addthonal pages as;necessary) ' _ j , E E,tr �'' u ,"'
n
CL
p
Reviewer/Inspector Name 1 Q.
Reviewer/Inspector Signature: Date: �— �d

Facility Number:13t Date of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes No
liquid level of lagoon or storage pond with no agitation?
27. Are there any dead animals not disposed of properly within 24 hours? ❑ Yes XNo
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 �`f 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 KNo
31. Do the animals feed storage bins fail to have appropriate cover? ❑ Yes b(No
32. Do the flush tanks lack a submerged fill pipe or a permancndtemporary cover? ❑ Yes A�No
Ndditionat.Comments'$n or' ra
., Wlltgs:
�r c

Division of Soil and Water Conservation Operation Review
0 Division of Soil and Water Conservatton Compliance Inspection F
Et
t r I
'toj t
i. t E
!P.
- a, 3 a- rtfllf .�, {'[Ei; t 'I .., E E',I Ei i 3 ,.
E Division of Water Quality '�ComphanceIspection l r, ;, f ,E 6 t " I €, ,n kkt s,
„
ek! EE
[ Other Agency OPerattoi eview
t,
= r
;: .. .
.
Routine O Complaint O Follow-up of DW
IFacility Number G I
Follow-un of DSWC review O Other
Date of Inspection TI
Time of Inspection 24 hr. (hh:mm)
Permitted [j Certified © Conditionally Certified © Registered 10 Not O erational Date Last Operated:
FarmName: ..... .1..".��5..... ,Vy.VA............................................................................... C,ounty:.......:.........I...�1.....................................................
OwnerName:..................................................................................................................... Phone No:.......................................................................................
FacilityContact:.............................................................................. Titl ........................... Phone No: .................................................. ... ...........
A6.
Mailing Address:(, 1 .. _tl `....................7Vx.... {.e• ••... ��.�.......... �.... 1
OnsiteRepresentative. ......... "1........................................................................ lutegrator.....%`...................................................
Certified Operator.................................................................................................................. Operator Certification Number:.........................................
Lycatirtn ofirgi t t f ► l f f
AL
.. y...r.... m.. J.... ..n w.x...:....a�.x....... ....... .............................r.............x.........m.................................... .............. -....... ................................................................
...(64..3................................................................................................................. .
Latitude ' & Longitude • ` 'C
Design Current` Design Current E Design Current
'Swine Capacity Po ulation Poultry, '' Capacity Pb ulation . Cattle Capacity Population''i
❑ Wean to Feeder
Feeder to Finish
❑ Farrow to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts,
❑ Boars
In Layer ❑ Dairy
E,
❑ Non -Layer ❑ Non -Dairy
❑ Other
Total Desi n Ca acit
g .,p y
5 � ,
Total'�SSLW
r
Number.of.Lag 'oons- y ;«V❑ Subsurface' ❑ Lagoon A ❑ Area Drains Present Area Spray Field ®`;.
Holditii Ponds / Solid Traps , ! ` ❑ No Liquid Waste Management System
Discharges & Stream Impacts .
I. Is any discharge observed from any part of the operation?
Discharge originated at: ElLagoon [ISpray Field ElOther
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. Discs discharge bypass a lagoon system'? (If ycs, notify DWQ)
2. Is there evidence of past discharge from any part of the operation?
3. Were there any adverse impacts or potential adverse impacts to the Waters of the State other than from a discharge?
Waste Collection & Treatment
4. Is storage capacity (freeboard plus storm storage) less than adequate? ❑ Spillway
Structure I Structure 2 Structure 3 Structure 4 Structure 5
Identifier:
Freeboard (inches): ..............
........... �Q............................!.g............. .................................... ................................... ...................................
5. Are there any immediate threats to the integrity of any of the structures observed? (ie/ trees, severe erosion,
seepage, etc.)
❑ Yes PI No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes ❑ No
❑ Yes No
❑ Yes I No
❑ Yes gNo
Structure 6
❑ Yes '0 No
Continued on back
3/23/99

li ity Number: 69 Date of Inspection
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 Application
10. Are there any buffers that need maintenance/improvement?
11. Is there evidence of 9ver application? , ❑ Excessive Ponding ❑ PAN
12. Crop type e_1W
13. Do the receiving crops differ 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?
(ic/ 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?
�q� •Vwl 000s;or• deficiencies •w•gre no(ed• duxirig �bis'visit. Y:oo will •teeciye rid further
�corres' ox d6c' e: abo' u this visit: ' ' ' '
❑ Yes XNo
9Yes 9 NoQ§&
❑ Yes A No
❑ Yes IM No
❑ Yes �d No
❑ Yes 0 No
❑ Yes KNo
❑ Yes M No
❑ Yes ?j No
Yes ❑ No
❑ Yes 'K No
❑ Yes Sd No
❑ Yes 0 No
❑ Yes KNo
❑ Yes F;2f No
❑ Yes No
❑ Yes No
❑ Yes W No
❑ Yes N'No
❑ Yes �) No
❑ Yes P No
Fuc
omm(refer'to question #) Explain anyYES°answers aud/or any;rec©rimendation's or any othermnt
comes se,drofawtngs facility, to better explain 'situations (use�;addtttonal' pages as:necessary) t i :€ -.` ; �'�' �;,(j3'� t�` `l E _� is �.t ; 1 �� E: ' .f• �i
9
Reviewer/Inspector Name
Reviewer/Inspector Signature: Date:
3l23/99

Ni ility Number: 31 —!� hate of Inspection
Odor Issues
26. Does the discharge pipe from the confinement building to the storage pond or lagoon fail to discharge at/or below ❑ Yes M 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 15�No
28. Is there any evidence of wind drift during land application? (i.e. residue on neighboring vegetation, asphalt, ❑ Yes KNo
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 KNo
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? O'Yes ❑ No
ltlona omrnents San Or rA1 qi7 8 f iU' E, a
• .. I. ., .g h' . - 3 1. 1
♦t
3/23/99

0 Division of Soil and Water Conservation 0 Other Agency
® Division of Water Quality
Routine O Com laint 0Follow-ulfofDNVQinspection O 1' ollow-u of DSWC review O Other
Date of lnspection 1!
Facility Number "I
Time of Inspection O 24 hr. (hh:mm)
13 Registered Wertified 1% Applied for Permit OtPermitted 10 Not Operational Date Last Operated:
Farm Name ......... X(J— 5....Sn-,w.....Vanlr.,S............................................................ County:...... .s� ��.i^..................................... .......................
Owner Name : ............ �►�l�t.i............. .....�lc i� ... ... PhoneNo- ��...S7a�.�.� �7.7...............
FacilityContact ..... :......•...•....., , : ..........�.�.4�...........:.. YS.�..................... Title: �.............. .......................... Phone No:
Mailing Address......4.5;5 .co., s. x. .........Q.:. ........... PAC� ..................................z
Onsite Representative:...... 1p S 1.1......... 6....................................... Integrator:........ lika .......................................................
Certified Operator:..................................................... Operator Certification umber,..........................
Location of Farm:
l 1C�...lAR�... ... ai Q....cs� ... s. ..f.`a ` ..t.�?;.5....�►ii t S......Gt? 5 ..Q f... ..� ............................... A
............. .. ..... ..
Latitude �•:0° �'
' ^ De .igni 4 ; `.CurrenFt
d Swtne .'} a Capacity Population
❑ Wean to Feeder
Feeder to Finish
3& ?7i
L
❑ Farrow. to Wean
❑ Farrow to Feeder
❑ Farrow to Finish
❑ Gilts
❑ Boars
Longitude 0'
Design Current _
Poultry Capacity Population Cattle
❑ Layer ❑ Dairy
❑ Nan -Layer '; ❑ Non-Dair,
❑ Other
Total Desi n Ca5 a&
.Total SSLW6
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Lagoon ❑ Spray Field 'A Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
maintenance/improvement?
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
Z. Did the facility fail to have a certifiedoperator in responsible charge?
7/25/97
❑ Yes ® No
19 Yes C1 No
�j Yes ❑ No
❑ Yes IM No
0.1
❑ Yes P9 No
❑ Yes ® No
❑ Yes ® No
Yes ❑ No
❑ Yes No
❑ Yes No
Continued on back

Facility Number: 3 -- �
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures (Lagoons,Ifold inu- Ponds, Flush Pits, etc.)
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Structure 1 Structure 2 Structure 3 Structure 4
Identifier: 1 L
Freeboard (fty............. ..,:..)............. ............. .Z a............
10. Is seepage observed from any of the structures'?
11. Is erosion, or any other threats to the integrity of any of the structures observed'?
Structure 5
12. Do any of the structures need maintenance/inprovement'?
(If any of questions 9-12 was answered yes, and the situation poses
an immediate publichealthor environmental threat, notify DWQ)
13. Do any of the structures lack adequate; minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application'?
(If in excess of WMP, or runoff entering waters of the State. notify DWQ) 15. Crop type ................(_Or.r ...............t lls��.........5.4.11.bCca.ts�....................... 17Mdr...........................................
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWM1')?
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?
a
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'?
❑ Yes
5FNo
❑ Yes
JZ No
Structure 6
5aYes
® No
❑ Yes
CO No
19 Yes
❑ No
❑ Yes
P No
❑ Yes
No
................................................
❑ Yes
M No
❑ Yes
0 No
0 No.violations or de'ficiencie's.were-noted'during this.visit.-.You.will receive no further
correspondence aboiit this.visit: .
❑ Yes .0 No
❑ Yes No
❑ Yes i No
❑ Yes j$ No
(D Yes ❑ No
❑ Yes 4 No
❑ Yes ® No
❑ Yes P No
Comments' ('refer to question #): ,.Explain any YES answers and/or any recommendations or any other comiments
Use drawings of facility to.better explain situations (use additional pages as necessaryAL
) y � r
vn-lr�k ��r+pa Or �i1 d 3eVVf f NO tlksc rlo_ `ke U T )� 5'r e
Z . Ido
.1 �+ .,}� c} �_\l s a�
s. Wk' a1 o, �i e s6dfd be se� vT + frke. Lt V_ttc5& a-, r.Lxf, cut passt'wo-
10. Ih �YOCe5 ; a 1 u(k'1[V) 14,yam a0,yV" 41— eeA IM1�pS �7 gA�lprt.
ry. �r•4� ?t?a.3 tv'CoO �.- C?4wej � tV0d•(J A-t % �acl>% �'`�c�d w�-1 -l.�.y �►ts�ede�J
Tret.s 4_womc Attl
s 1"0 r,��} b�� rG�oret� �o,� avke � �(4 WaA.
evWl(oc# o r �Cefi{e 5 (� s �tu✓(c) 6e— Up oia�CC�.
7125197
Reviewer/inspector Name
Reviewer/Inspector Signature: Date:

® Routine 0 Complaint 0 Follow-up of UWQ inspection 0 Follow-up of IISWC review 0 Other
Date of Inspection ��
Facility Number Time of inspection � 24 hr. (hh:mm)
Total Time (in fraction of hours
Farm Status: ❑ Registered ❑ Applied for Permit (ex:1.25 for 1 hr 15 min)) Spent on Review
IRCertified ❑ Permitted or Inspection includes travel andprocessing)
❑ Not Operational Date Last Operated:
Farm Name: .bra.,r x.-.L2 �....,�.r..l..i .. ...111.A...L.0
C,t � a 5 �'g.'....Zy `T 7 .
Land Owner Name:..��A.Q�rS..! E........Q..rs..�l............................................ .phone No:...(..' 1.9�....��..&........3S.(�.�.........................
FacilityConctact: .................................................................................. Title:................................................ Phone No:.........................................................
MailingAddress: ... %.S.S...... ( y. ...I�nel.s.th .........................................., ..,L .�. .P. S.c?.a.o..r.....�.i. L� ...........
Onsite Representative: It1...�ara .c.C.1`.�.....Pi.tr.:..]�.... Integrator:.....�/(.V..e �^ .S ....................
Certified Operator: .... L.! A.C.5.kRt..11 ..... ...........Y..t.................................. Operator Certification Number:......�....1. ..........
Location of Farm:
QjM :MU; t ...`.L ................ ,5.....�..t.GS......s........i rx....... 4
..... ... .. ........ ,... ...
..`�..�'.:��i.�.t�.......rr?i.�h. �.Pal.�.`.:i.3....�..to....��+.R�...�!.gs.�...�. K..�..�:....�rr.r::+�s.. ua.►z..i.�h.....�c.....►.a.�:�..�.....rd.�1.p..Y.:.�.... ly
Latitude Longitude '7 ? • 7 ` ®64
General
1. Are there any buffers that need maintenance/improvement?
2. Is any discharge observed from any part of the operation?
Discharge originated at; ❑ Lagoon ❑ Spray field ❑ Other
a. If discharge is observed, was the conveyance man-made?
b. If discharge is observed, did it reach Surface Water? (If yes, notify DWQ)
c. If discharge is observed, what is the estimated flow in gal/min?
d. Does discharge bypass a lagoon system? (If yes, notify DWQ)
3. Is there evidence of past discharge from any part of the operation?
4. Were there any adverse impacts to the waters of the State other than from a discharge?
5. Does any part of the waste management system (other than lagoons/holding ponds) require
4/30/97 maintenancelimprovement?
❑ Yes M No
❑ Yes 12 No
❑ Yes ® No
❑ Yes RNo
[:]Yes
® No
❑ Yes
!a No
❑ Yes
JR No
❑ Yes
&No
Continued
on back

Facility Number: .3.1 ....... —..�.Q...
6. Is facility not in compliance with any applicable setback criteria in effect at the time of design?
7. Did the facility fail to have a certified operator in responsible charge?
8. Are there lagoons or storage ponds on site which need to be properly closed?
Structures lagoons and/or Holding Pondsl
9. Is storage capacity (freeboard plus storm storage) less than adequate?
Freeboard (ft): Structure I Structure 2 Structure 3
.r �?...... ... ......... ..... ...........................
10. Is seepage observed from any of the structures?
Structure 4
11. Is erosion, or any other threats to the integrity of any of the structures observed?
12. Do any of the structures need maintenance/improvement?
(If any of questions 9-12 was answered yes, and the situation poses an
Immediate public health or environmental threat, notify DWQ)
13. Do any of the structures lack adequate minimum or maximum liquid level markers?
Waste Application
14. Is there physical evidence of over application?
(If in excess of WMP, or runoff entering waters of the State, notify DWQ)
❑ Yes No
❑ Yes No
❑ Yes M No
❑ Yes I.No
Structure 5 Structure 6
15. Crop type ...............................1N.}n R..A ........................ .ash., .4. ..ra.............�.�m a.�.i...c}..! 5..4..►r
16. Do the receiving crops differ with those designated in the Animal Waste Management Plan (AWMP)?
17, Does the facility have a lack of adequate acreage for land application?
18. Does the receiving crop need improvement?
19, Is there a lack of available waste application equipment?
20. Does facility require a follow-up visit by same agency?
21. Did Reviewer/Inspector fail to discuss review/inspection with on -site representative?
22. Does the facility fail to have a copy of the Animal Waste Management Plan readily available?
23. Were any additional problems noted which cause noncompliance of the Certified AWMP?
24. Does record keeping need improvement?
Comments (refer to question #) Explain`any YES answers and/or any recommendations or any,other comments
Use drawin �s,of facili. to better ex lain situations.. usekadiiI'tioriai `a es as necess
d e vv. ,P_ i r% 0-­0 v r-11. b
w a l r� r- t' s e_ S
Zq a 1C.e S c� rQ �-i .L v ✓• .- i .1 L �.,.t
1' u ..v� b Z 4 s•• i r r i cl a A Y 2
❑ Yes 19 No
[:]Yes ® No
❑ Yes KNo
❑ Yes ® No
❑ Yes EZNo
❑ Yes ® No
❑ Yes Q No
❑ Yes Ea No
❑ Yes 0,No
❑ Yes KNo
[--]Yes ®,No
❑ Yes IS No
❑ Yes 9 No
& Yes ❑ No
a- Y-e... s 4 a f--S a 1 a� d a m
C-t r +-e� P o �k k °-; e.L j_.
Reviewer/Inspector Name.
.-
Reviewer/Inspector Signature: Date:
cc: Division of Water Ouality. Water Ouality Section. Facility Assessor t Unit 4/'10/97

Site Requires Immediate Attend
DIVISION OF ENVIRONMENTAL MANAGEMENTity No.��
ANIMAL FEEDLOT OPERATIONS SITE VISITATION RECORD
DATE: 1995 f�� �~61 f —27 17
Time:' %� •� C� D
4—
Farm Name/Owner:
a--
Mailing Address: C611
County:
Integrator: Phone:
Ot Site Representative: Phone:
Physical Address/Location: =�
Type of Operation: Swine Poultry Cattle
Design Capacity: Number of Animals on Site: T�
DEM Certification Number: CE �C DEM Certification Number: ACNEW
Latitude- Longitude: " . Elevation: Feet
Circle Yes or No
Does the Animal Waste Lagoon have sufficient freeboard of 1 Foot + 25 year 24 hour storm event
(approximately 1 Foot + 7 inches) Yes or No Actual Freeboard: �Ft. Inches
Was any seepage observed from the lagoon(s)? Yes or 0 Was any erosion observed? Yes or No
Is adequate land availableEfosray? Se or No Is the cover crop adequate? 'e or No
Crop(s) being utilized:
Does the facility meet SCS minimum setback c teria? 200 Feet from Dwellings?&e or No
100 Feet from Wells? 0orNo
Is the animal waste stockpiled within 100 Feet of USGS Blue Line Stream? Yes or 1
Is animal waste land applied or spray irrigated within 25 Feet of a USGS Map Blue Line? Yes orGI
Is animal waste discharged into waters of the state by man-made ditch, flushing system; or other
similar man-made devices? Yes oo 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 Ora sL
Additional Comments:
f
Inspector Name Signature
cc: Facility Assessment Unit Use Attachments if Needed.